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MHS Referrals

Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft

Type
Disease or Syndrome
ID
PH883
Version ID
1845
Data Sources
Valid event data range
01/01/2001 - 31/12/2014
Sex
Female, Male
Agreement Date
2018-10-15
Coding system
Read codes v2
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

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.

Publications

  • 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.

Clinical Code List

Rows: 41
Code Description Entity type Category Coding System (Read)
64R7.11 Child refer- clinical psychol. res69: MHS referrals diagnostic Read
8H23.00 Admit psychiatric emergency res69: MHS referrals diagnostic Read
8H23000 Emerg psychiatric admiss MHA res69: MHS referrals diagnostic Read
8H2L.00 Admit psychogeriatric emergency res69: MHS referrals diagnostic Read
8H2T.00 Emergency voluntary psychiatric admission Mental Health Act res69: MHS referrals diagnostic Read
8H38.00 Non-urgent psychiatric admisn. res69: MHS referrals diagnostic Read
8H3Q.00 Non-urgent psychogeriatric admission res69: MHS referrals diagnostic Read
8H49.00 Psychiatric referral res69: MHS referrals diagnostic Read
8H4D.00 Referral to psychogeriatrician res69: MHS referrals diagnostic Read
8H4P.00 Referral to child psychiatrist res69: MHS referrals diagnostic Read
8H4f.00 Referral to learning disabilities psychiatrist res69: MHS referrals diagnostic Read
8H7T.00 Refer to psychologist res69: MHS referrals diagnostic Read
8HHR.00 Referral to child and adolescent psychiatry service res69: MHS referrals diagnostic Read
8HHT.00 Referral to psychotherapist res69: MHS referrals diagnostic Read
8HHn.00 Referral to non NHS mental health community service res69: MHS referrals diagnostic Read
8HHo.00 Referral to older age communiy mental health team res69: MHS referrals diagnostic Read
8HHs.00 Referral to psychosis early intervention service res69: MHS referrals diagnostic Read
8HHu.00 Referral to primary care mental health gateway worker res69: MHS referrals diagnostic Read
8HHv.00 Referral to primary care mental health graduate worker res69: MHS referrals diagnostic Read
8HJ3.00 Psychiatric self-referral res69: MHS referrals diagnostic Read
8HVO.00 Private referral to psychiatrist res69: MHS referrals diagnostic Read
8HVS.00 Private referral to psychogeriatrician res69: MHS referrals diagnostic Read
8HVi.00 Private referral to psychologist res69: MHS referrals diagnostic Read
8Hc..00 Referral to mental health team res69: MHS referrals diagnostic Read
8Hc0.00 Referral to community mental health team res69: MHS referrals diagnostic Read
8Hc2.00 Referral to primary care mental health team res69: MHS referrals diagnostic Read
8HlB.00 Urgent referral to psychiatrist res69: MHS referrals diagnostic Read
8HlD.00 Referral to forensic psychiatrist res69: MHS referrals diagnostic Read
ZL5B.00 Referral to psychiatrist res69: MHS referrals diagnostic Read
ZL5B100 Referral to child and adolescent psychiatrist res69: MHS referrals diagnostic Read
ZL5B111 Referral to child psychiatrist res69: MHS referrals diagnostic Read
ZL5B200 Referral to forensic psychiatrist res69: MHS referrals diagnostic Read
ZL5B300 Referral to liaison psychiatrist res69: MHS referrals diagnostic Read
ZL5B400 Referral to rehabilitation psychiatrist res69: MHS referrals diagnostic Read
ZL5B500 Referral to psychiatrist for mental handicap res69: MHS referrals diagnostic Read
ZL62A00 Referral to nurse behavioural therapist res69: MHS referrals diagnostic Read
ZL62B00 Referral to nurse psychotherapist res69: MHS referrals diagnostic Read
ZL62E00 Referral to psychiatric nurse res69: MHS referrals diagnostic Read
ZL77.00 Referral to psychotherapist res69: MHS referrals diagnostic Read
ZL78.00 Referral to psychologist res69: MHS referrals diagnostic Read
ZL78.11 Refer to psychologist res69: MHS referrals diagnostic Read

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH883/version/1845/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH883/version/1845/detail/?format=json
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get details of phenotype

details = get_phenotype_detail_by_version('PH883', '1845', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH883/version/1845/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH883/version/1845/export/codes/?format=json
CSV site_root/phenotypes/PH883/version/1845/export/codes/
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get codelists of phenotype

codelists = get_phenotype_code_list('PH883', '1845', api_client=client)

Version History

Version
ID
Name Owner Publish date
1845 MHS Referrals ieuan.scanlon 2022-04-04 currently shown

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