Background:
Self-harm is a major risk factor for suicide, with older adults (older than 65 years) having reportedly greater suicidal intent than any other age group. With the aging population rising and paucity of research focus in this age group, the extent of the problem of self-harm needs to be established. In a primary care cohort of older adults we aimed to investigate the incidence of self-harm, subsequent clinical management, prevalence of mental and physical diagnoses, and unnatural-cause mortality risk, including suicide.
Methods:
The UK Clinical Practice Research Datalink contains anonymised patient records from general practice that routinely capture clinical information pertaining to both primary and secondary care services. We identified 4124 adults aged 65 years and older with a self-harm episode ascertained from Read codes recorded during 2001–14. We calculated standardised incidence and in 2854 adults with at least 12 months follow-up examined the frequency of psychiatric referrals and prescription of psychotropic medication after self-harm. We estimated prevalence of mental and physical illness diagnoses before and after self-harm and, using Cox regression in a matched cohort, we examined cause-specific mortality risks.
Findings:
Overall incidence of self-harm in older adults aged 65 years and older was 4·1 per 10 000 person-years with stable gender-specific rates observed over the 13-year period. After self-harm, 335 (11·7%) of 2854 adults were referred to mental health services, 1692 (59·3%) were prescribed an antidepressant, and 336 (11·8%) were prescribed a tricyclic antidepressant (TCA). Having a diagnosed previous mental illness was twice as prevalent in the self-harm cohort as in the comparison cohort (prevalence ratio 2·10 [95% CI 2·03–2·17]) and with a previous physical health condition prevalence was 20% higher in the self-harm cohort compared to the comparison cohort (1·20 [1·17–1·23]). Adults from the self-harm cohort (n=2454) died from unnatural causes an estimated 20 times more frequently than the comparison cohort (n=48 921) during the first year. A markedly elevated risk of suicide (hazard ratio 145·4 [95% CI 53·9–392·3]) was observed in the self-harm cohort.
Interpretation:
Within primary care, we have identified a group of older adults at high risk from unnatural death, particularly within the first year of self-harm. We have highlighted a high frequency of prescription of TCAs, known to be potentially fatally toxic in overdose. We emphasise the need for early intervention, careful alternative prescribing, and increased support when older adults consult after an episode of self-harm and with other health conditions.
Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft, Self-harm in a primary care cohort of older people incidence, clinical management, and risk of suicide and other causes of death. Psychiatry, 5, 2018.
Code | Description | Entity type | Coding System (ICD-10 Read) | Category |
---|---|---|---|---|
1434.00 | H/O: diabetes mellitus | res69: diabetes | Read | diagnostic |
66A5.00 | Diabetic on insulin | res69: diabetes | Read | diagnostic |
66AI.00 | Diabetic - good control | res69: diabetes | Read | diagnostic |
66AJ.00 | Diabetic - poor control | res69: diabetes | Read | diagnostic |
66AJ.11 | Unstable diabetes | res69: diabetes | Read | diagnostic |
66AJz00 | Diabetic - poor control NOS | res69: diabetes | Read | diagnostic |
66AK.00 | Diabetic - cooperative patient | res69: diabetes | Read | diagnostic |
66AS.00 | Diabetic annual review | res69: diabetes | Read | diagnostic |
66AV.00 | Diabetic on insulin and oral treatment | res69: diabetes | Read | diagnostic |
8A13.00 | Diabetic stabilisation | res69: diabetes | Read | diagnostic |
8BL2.00 | Patient on maximal tolerated therapy for diabetes | res69: diabetes | Read | diagnostic |
8H2J.00 | Admit diabetic emergency | res69: diabetes | Read | diagnostic |
C10..00 | Diabetes mellitus | res69: diabetes | Read | diagnostic |
C100.00 | Diabetes mellitus with no mention of complication | res69: diabetes | Read | diagnostic |
C100000 | Diabetes mellitus, juvenile type, no mention of complication | res69: diabetes | Read | diagnostic |
C100011 | Insulin dependent diabetes mellitus | res69: diabetes | Read | diagnostic |
C100100 | Diabetes mellitus, adult onset, no mention of complication | res69: diabetes | Read | diagnostic |
C100111 | Maturity onset diabetes | res69: diabetes | Read | diagnostic |
C100112 | Non-insulin dependent diabetes mellitus | res69: diabetes | Read | diagnostic |
C100z00 | Diabetes mellitus NOS with no mention of complication | res69: diabetes | Read | diagnostic |
C101.00 | Diabetes mellitus with ketoacidosis | res69: diabetes | Read | diagnostic |
C101000 | Diabetes mellitus, juvenile type, with ketoacidosis | res69: diabetes | Read | diagnostic |
C101100 | Diabetes mellitus, adult onset, with ketoacidosis | res69: diabetes | Read | diagnostic |
C101y00 | Other specified diabetes mellitus with ketoacidosis | res69: diabetes | Read | diagnostic |
C101z00 | Diabetes mellitus NOS with ketoacidosis | res69: diabetes | Read | diagnostic |
C102.00 | Diabetes mellitus with hyperosmolar coma | res69: diabetes | Read | diagnostic |
C102000 | Diabetes mellitus, juvenile type, with hyperosmolar coma | res69: diabetes | Read | diagnostic |
C102100 | Diabetes mellitus, adult onset, with hyperosmolar coma | res69: diabetes | Read | diagnostic |
C102z00 | Diabetes mellitus NOS with hyperosmolar coma | res69: diabetes | Read | diagnostic |
C103.00 | Diabetes mellitus with ketoacidotic coma | res69: diabetes | Read | diagnostic |
C103000 | Diabetes mellitus, juvenile type, with ketoacidotic coma | res69: diabetes | Read | diagnostic |
C103y00 | Other specified diabetes mellitus with coma | res69: diabetes | Read | diagnostic |
C103z00 | Diabetes mellitus NOS with ketoacidotic coma | res69: diabetes | Read | diagnostic |
C107.00 | Diabetes mellitus with peripheral circulatory disorder | res69: diabetes | Read | diagnostic |
C107.11 | Diabetes mellitus with gangrene | res69: diabetes | Read | diagnostic |
C107000 | Diabetes mellitus, juvenile +peripheral circulatory disorder | res69: diabetes | Read | diagnostic |
C107100 | Diabetes mellitus, adult, + peripheral circulatory disorder | res69: diabetes | Read | diagnostic |
C107200 | Diabetes mellitus, adult with gangrene | res69: diabetes | Read | diagnostic |
C107300 | IDDM with peripheral circulatory disorder | res69: diabetes | Read | diagnostic |
C107400 | NIDDM with peripheral circulatory disorder | res69: diabetes | Read | diagnostic |
C107z00 | Diabetes mellitus NOS with peripheral circulatory disorder | res69: diabetes | Read | diagnostic |
C108.00 | Insulin dependent diabetes mellitus | res69: diabetes | Read | diagnostic |
C108.11 | IDDM-Insulin dependent diabetes mellitus | res69: diabetes | Read | diagnostic |
C108.12 | Type 1 diabetes mellitus | res69: diabetes | Read | diagnostic |
C108.13 | Type I diabetes mellitus | res69: diabetes | Read | diagnostic |
C108400 | Unstable insulin dependent diabetes mellitus | res69: diabetes | Read | diagnostic |
C108411 | Unstable type I diabetes mellitus | res69: diabetes | Read | diagnostic |
C108500 | Insulin dependent diabetes mellitus with ulcer | res69: diabetes | Read | diagnostic |
C108511 | Type I diabetes mellitus with ulcer | res69: diabetes | Read | diagnostic |
C108600 | Insulin dependent diabetes mellitus with gangrene | res69: diabetes | Read | diagnostic |
C108800 | Insulin dependent diabetes mellitus - poor control | res69: diabetes | Read | diagnostic |
C108811 | Type I diabetes mellitus - poor control | res69: diabetes | Read | diagnostic |
C108812 | Type 1 diabetes mellitus - poor control | res69: diabetes | Read | diagnostic |
C108911 | Type I diabetes mellitus maturity onset | res69: diabetes | Read | diagnostic |
C108E00 | Insulin dependent diabetes mellitus with hypoglycaemic coma | res69: diabetes | Read | diagnostic |
C108E11 | Type I diabetes mellitus with hypoglycaemic coma | res69: diabetes | Read | diagnostic |
C108E12 | Type 1 diabetes mellitus with hypoglycaemic coma | res69: diabetes | Read | diagnostic |
C108G00 | Insulin dependent diab mell with peripheral angiopathy | res69: diabetes | Read | diagnostic |
C109.00 | Non-insulin dependent diabetes mellitus | res69: diabetes | Read | diagnostic |
C109.11 | NIDDM - Non-insulin dependent diabetes mellitus | res69: diabetes | Read | diagnostic |
C109.12 | Type 2 diabetes mellitus | res69: diabetes | Read | diagnostic |
C109.13 | Type II diabetes mellitus | res69: diabetes | Read | diagnostic |
C109300 | Non-insulin-dependent diabetes mellitus with multiple comps | res69: diabetes | Read | diagnostic |
C109400 | Non-insulin dependent diabetes mellitus with ulcer | res69: diabetes | Read | diagnostic |
C109411 | Type II diabetes mellitus with ulcer | res69: diabetes | Read | diagnostic |
C109412 | Type 2 diabetes mellitus with ulcer | res69: diabetes | Read | diagnostic |
C109500 | Non-insulin dependent diabetes mellitus with gangrene | res69: diabetes | Read | diagnostic |
C109511 | Type II diabetes mellitus with gangrene | res69: diabetes | Read | diagnostic |
C109700 | Non-insulin dependent diabetes mellitus - poor control | res69: diabetes | Read | diagnostic |
C109711 | Type II diabetes mellitus - poor control | res69: diabetes | Read | diagnostic |
C109712 | Type 2 diabetes mellitus - poor control | res69: diabetes | Read | diagnostic |
C109900 | Non-insulin-dependent diabetes mellitus without complication | res69: diabetes | Read | diagnostic |
C109D00 | Non-insulin dependent diabetes mellitus with hypoglyca coma | res69: diabetes | Read | diagnostic |
C109D11 | Type II diabetes mellitus with hypoglycaemic coma | res69: diabetes | Read | diagnostic |
C109D12 | Type 2 diabetes mellitus with hypoglycaemic coma | res69: diabetes | Read | diagnostic |
C109F11 | Type II diabetes mellitus with peripheral angiopathy | res69: diabetes | Read | diagnostic |
C109F12 | Type 2 diabetes mellitus with peripheral angiopathy | res69: diabetes | Read | diagnostic |
C109G00 | Non-insulin dependent diabetes mellitus with arthropathy | res69: diabetes | Read | diagnostic |
C109G11 | Type II diabetes mellitus with arthropathy | res69: diabetes | Read | diagnostic |
C109G12 | Type 2 diabetes mellitus with arthropathy | res69: diabetes | Read | diagnostic |
C109J00 | Insulin treated Type 2 diabetes mellitus | res69: diabetes | Read | diagnostic |
C109J11 | Insulin treated non-insulin dependent diabetes mellitus | res69: diabetes | Read | diagnostic |
C109J12 | Insulin treated Type II diabetes mellitus | res69: diabetes | Read | diagnostic |
C109K00 | Hyperosmolar non-ketotic state in type 2 diabetes mellitus | res69: diabetes | Read | diagnostic |
C10A.00 | Malnutrition-related diabetes mellitus | res69: diabetes | Read | diagnostic |
C10A000 | Malnutrition-related diabetes mellitus with coma | res69: diabetes | Read | diagnostic |
C10A100 | Malnutrition-related diabetes mellitus with ketoacidosis | res69: diabetes | Read | diagnostic |
C10B000 | Steroid induced diabetes mellitus without complication | res69: diabetes | Read | diagnostic |
C10D.00 | Diabetes mellitus autosomal dominant type 2 | res69: diabetes | Read | diagnostic |
C10D.11 | Maturity onset diabetes in youth type 2 | res69: diabetes | Read | diagnostic |
C10E.00 | Type 1 diabetes mellitus | res69: diabetes | Read | diagnostic |
C10E.11 | Type I diabetes mellitus | res69: diabetes | Read | diagnostic |
C10E.12 | Insulin dependent diabetes mellitus | res69: diabetes | Read | diagnostic |
C10E400 | Unstable type 1 diabetes mellitus | res69: diabetes | Read | diagnostic |
C10E412 | Unstable insulin dependent diabetes mellitus | res69: diabetes | Read | diagnostic |
C10E500 | Type 1 diabetes mellitus with ulcer | res69: diabetes | Read | diagnostic |
C10E600 | Type 1 diabetes mellitus with gangrene | res69: diabetes | Read | diagnostic |
C10E800 | Type 1 diabetes mellitus - poor control | res69: diabetes | Read | diagnostic |
C10E812 | Insulin dependent diabetes mellitus - poor control | res69: diabetes | Read | diagnostic |
C10E900 | Type 1 diabetes mellitus maturity onset | res69: diabetes | Read | diagnostic |
C10EA00 | Type 1 diabetes mellitus without complication | res69: diabetes | Read | diagnostic |
C10EE00 | Type 1 diabetes mellitus with hypoglycaemic coma | res69: diabetes | Read | diagnostic |
C10EG00 | Type 1 diabetes mellitus with peripheral angiopathy | res69: diabetes | Read | diagnostic |
C10EK00 | Type 1 diabetes mellitus with persistent proteinuria | res69: diabetes | Read | diagnostic |
C10EL00 | Type 1 diabetes mellitus with persistent microalbuminuria | res69: diabetes | Read | diagnostic |
C10EM00 | Type 1 diabetes mellitus with ketoacidosis | res69: diabetes | Read | diagnostic |
C10EM11 | Type I diabetes mellitus with ketoacidosis | res69: diabetes | Read | diagnostic |
C10EN00 | Type 1 diabetes mellitus with ketoacidotic coma | res69: diabetes | Read | diagnostic |
C10EN11 | Type I diabetes mellitus with ketoacidotic coma | res69: diabetes | Read | diagnostic |
C10F.00 | Type 2 diabetes mellitus | res69: diabetes | Read | diagnostic |
C10F.11 | Type II diabetes mellitus | res69: diabetes | Read | diagnostic |
C10F400 | Type 2 diabetes mellitus with ulcer | res69: diabetes | Read | diagnostic |
C10F500 | Type 2 diabetes mellitus with gangrene | res69: diabetes | Read | diagnostic |
C10F700 | Type 2 diabetes mellitus - poor control | res69: diabetes | Read | diagnostic |
C10F711 | Type II diabetes mellitus - poor control | res69: diabetes | Read | diagnostic |
C10F900 | Type 2 diabetes mellitus without complication | res69: diabetes | Read | diagnostic |
C10FD00 | Type 2 diabetes mellitus with hypoglycaemic coma | res69: diabetes | Read | diagnostic |
C10FF00 | Type 2 diabetes mellitus with peripheral angiopathy | res69: diabetes | Read | diagnostic |
C10FG00 | Type 2 diabetes mellitus with arthropathy | res69: diabetes | Read | diagnostic |
C10FJ00 | Insulin treated Type 2 diabetes mellitus | res69: diabetes | Read | diagnostic |
C10FJ11 | Insulin treated Type II diabetes mellitus | res69: diabetes | Read | diagnostic |
C10FL00 | Type 2 diabetes mellitus with persistent proteinuria | res69: diabetes | Read | diagnostic |
C10FL11 | Type II diabetes mellitus with persistent proteinuria | res69: diabetes | Read | diagnostic |
C10FM00 | Type 2 diabetes mellitus with persistent microalbuminuria | res69: diabetes | Read | diagnostic |
C10FN00 | Type 2 diabetes mellitus with ketoacidosis | res69: diabetes | Read | diagnostic |
C10FP00 | Type 2 diabetes mellitus with ketoacidotic coma | res69: diabetes | Read | diagnostic |
C10G.00 | Secondary pancreatic diabetes mellitus | res69: diabetes | Read | diagnostic |
C10H.00 | Diabetes mellitus induced by non-steroid drugs | res69: diabetes | Read | diagnostic |
C10M.00 | Lipoatrophic diabetes mellitus | res69: diabetes | Read | diagnostic |
C10N.00 | Secondary diabetes mellitus | res69: diabetes | Read | diagnostic |
C10y.00 | Diabetes mellitus with other specified manifestation | res69: diabetes | Read | diagnostic |
C10y100 | Diabetes mellitus, adult, + other specified manifestation | res69: diabetes | Read | diagnostic |
C10yy00 | Other specified diabetes mellitus with other spec comps | res69: diabetes | Read | diagnostic |
C10yz00 | Diabetes mellitus NOS with other specified manifestation | res69: diabetes | Read | diagnostic |
C10z.00 | Diabetes mellitus with unspecified complication | res69: diabetes | Read | diagnostic |
C10z100 | Diabetes mellitus, adult onset, + unspecified complication | res69: diabetes | Read | diagnostic |
C10zy00 | Other specified diabetes mellitus with unspecified comps | res69: diabetes | Read | diagnostic |
C10zz00 | Diabetes mellitus NOS with unspecified complication | res69: diabetes | Read | diagnostic |
Cyu2.00 | [X]Diabetes mellitus | res69: diabetes | Read | diagnostic |
Cyu2000 | [X]Other specified diabetes mellitus | res69: diabetes | Read | diagnostic |
G73y000 | Diabetic peripheral angiopathy | res69: diabetes | Read | diagnostic |
L180500 | Pre-existing diabetes mellitus, insulin-dependent | res69: diabetes | Read | diagnostic |
L180600 | Pre-existing diabetes mellitus, non-insulin-dependent | res69: diabetes | Read | diagnostic |
L180X00 | Pre-existing diabetes mellitus, unspecified | res69: diabetes | Read | diagnostic |
Code | Description | Entity type | Coding System (ICD-10 Read) | Category |
---|---|---|---|---|
E10.0 | Insulin-dependent diabetes mellitus with coma | res69: diabetes | ICD-10 | diagnostic |
E10.1 | Insulin-dependent diabetes mellitus with ketoacidosis | res69: diabetes | ICD-10 | diagnostic |
E10.9 | Insulin-dependent diabetes mellitus without complications | res69: diabetes | ICD-10 | diagnostic |
E11.0 | Non-insulin-dependent diabetes mellitus with coma | res69: diabetes | ICD-10 | diagnostic |
E11.1 | Non-insulin-dependent diabetes mellitus with ketoacidosis | res69: diabetes | ICD-10 | diagnostic |
E11.9 | Non-insulin-dependent diabetes mellitus with coma | res69: diabetes | ICD-10 | diagnostic |
To Export Phenotype Details:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH880/version/1839/detail/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH880/version/1839/detail/?format=json |
R Package |
|
To Export Phenotype Code List:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH880/version/1839/export/codes/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH880/version/1839/export/codes/?format=json |
CSV | site_root/phenotypes/PH880/version/1839/export/codes/ |
R Package |
|
Version ID |
Name | Owner | Publish date | |
---|---|---|---|---|
1839 | Diabetes | ieuan.scanlon | 2022-04-04 | currently shown |
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