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 |
---|---|---|---|---|
E21..00 | Personality disorders | res69: person_disorder | Read | diagnostic |
E21..11 | Neurotic personality disorder | res69: person_disorder | Read | diagnostic |
E210.00 | Paranoid personality disorder | res69: person_disorder | Read | diagnostic |
E211.00 | Affective personality disorder | res69: person_disorder | Read | diagnostic |
E211000 | Unspecified affective personality disorder | res69: person_disorder | Read | diagnostic |
E211100 | hypomanic personality disorder | res69: person_disorder | Read | diagnostic |
E211200 | depressive personality disorder | res69: person_disorder | Read | diagnostic |
E211300 | cyclothymic personality disorder | res69: person_disorder | Read | diagnostic |
E211z00 | Affective personality disorder NOS | res69: person_disorder | Read | diagnostic |
E212.00 | schizoid personality disorder | res69: person_disorder | Read | diagnostic |
E212000 | unspecified schizoid personality disorder | res69: person_disorder | Read | diagnostic |
E212z00 | schizoid personality disorder nos | res69: person_disorder | Read | diagnostic |
E213.00 | Explosive personality disorder | res69: person_disorder | Read | diagnostic |
E214.00 | Compulsive personality disorders | res69: person_disorder | Read | diagnostic |
E214.11 | Anancastic personality | res69: person_disorder | Read | diagnostic |
E214000 | Anankastic personality | res69: person_disorder | Read | diagnostic |
E214z00 | Compulsive personality disorder NOS | res69: person_disorder | Read | diagnostic |
E215.00 | Histrionic personality disorders | res69: person_disorder | Read | diagnostic |
E215.11 | Hysterical personality disorders | res69: person_disorder | Read | diagnostic |
E215000 | Unspecified histrionic personality disorder | res69: person_disorder | Read | diagnostic |
E215z00 | Histrionic personality disorder NOS | res69: person_disorder | Read | diagnostic |
E216.00 | Inadequate personality disorder | res69: person_disorder | Read | diagnostic |
E217.00 | Antisocial or sociopathic personality disorder | res69: person_disorder | Read | diagnostic |
E21y.00 | Other personality disorders | res69: person_disorder | Read | diagnostic |
E21y000 | Narcissistic personality disorder | res69: person_disorder | Read | diagnostic |
E21y100 | Avoidant personality disorder | res69: person_disorder | Read | diagnostic |
E21y200 | Borderline personality disorder | res69: person_disorder | Read | diagnostic |
E21y300 | Passive-aggressive personality disorder | res69: person_disorder | Read | diagnostic |
E21y400 | Eccentric personality disorder | res69: person_disorder | Read | diagnostic |
E21y500 | Immature personality disorder | res69: person_disorder | Read | diagnostic |
E21y600 | Masochistic personality disorder | res69: person_disorder | Read | diagnostic |
E21y700 | Psychoneurotic personality disorder | res69: person_disorder | Read | diagnostic |
E21yz00 | Other personality disorder NOS | res69: person_disorder | Read | diagnostic |
E21z.00 | Personality disorder NOS | res69: person_disorder | Read | diagnostic |
E21z.11 | Psychopathic personality | res69: person_disorder | Read | diagnostic |
Eu06000 | [X]Organic personality disorder | res69: person_disorder | Read | diagnostic |
Eu06011 | [X]Organic pseudopsychopathic personality | res69: person_disorder | Read | diagnostic |
Eu21.17 | [x]pseudopsychopathic schizophrenia | res69: person_disorder | Read | diagnostic |
Eu21.18 | [x]schizotypal personality disorder | res69: person_disorder | Read | diagnostic |
Eu34011 | [X]Affective personality disorder | res69: person_disorder | Read | diagnostic |
Eu34112 | [x]depressive personality disorder | res69: person_disorder | Read | diagnostic |
Eu60.00 | [X]Specific personality disorders | res69: person_disorder | Read | diagnostic |
Eu60000 | [X]Paranoid personality disorder | res69: person_disorder | Read | diagnostic |
Eu60013 | [X]Querulant personality disorder | res69: person_disorder | Read | diagnostic |
Eu60014 | [X]Sensitive paranoid personality disorder | res69: person_disorder | Read | diagnostic |
Eu60100 | [x]schizoid personality disorder | res69: person_disorder | Read | diagnostic |
Eu60200 | [X]Dissocial personality disorder | res69: person_disorder | Read | diagnostic |
Eu60211 | [X]Amoral personality disorder | res69: person_disorder | Read | diagnostic |
Eu60212 | [X]Antisocial personality disorder | res69: person_disorder | Read | diagnostic |
Eu60213 | [X]Asocial personality disorder | res69: person_disorder | Read | diagnostic |
Eu60214 | [X]Psychopathic personality disorder | res69: person_disorder | Read | diagnostic |
Eu60215 | [X]Sociopathic personality disorder | res69: person_disorder | Read | diagnostic |
Eu60300 | [X]Emotionally unstable personality disorder | res69: person_disorder | Read | diagnostic |
Eu60311 | [X]Aggressive personality disorder | res69: person_disorder | Read | diagnostic |
Eu60312 | [X]Borderline personality disorder | res69: person_disorder | Read | diagnostic |
Eu60313 | [X]Explosive personality disorder | res69: person_disorder | Read | diagnostic |
Eu60400 | [X]Histrionic personality disorder | res69: person_disorder | Read | diagnostic |
Eu60411 | [X]Hysterical personality disorder | res69: person_disorder | Read | diagnostic |
Eu60412 | [X]Psychoinfantile personality disorder | res69: person_disorder | Read | diagnostic |
Eu60500 | [X]Anankastic personality disorder | res69: person_disorder | Read | diagnostic |
Eu60511 | [X]Compulsive personality disorder | res69: person_disorder | Read | diagnostic |
Eu60512 | [X]Obsessional personality disorder | res69: person_disorder | Read | diagnostic |
Eu60513 | [X]Obsessive-compulsive personality disorder | res69: person_disorder | Read | diagnostic |
Eu60600 | [x]anxious [avoidant] personality disorder | res69: person_disorder | Read | diagnostic |
Eu60700 | [X]Dependent personality disorder | res69: person_disorder | Read | diagnostic |
Eu60711 | [X]Asthenic personality disorder | res69: person_disorder | Read | diagnostic |
Eu60712 | [X]Inadequate personality disorder | res69: person_disorder | Read | diagnostic |
Eu60713 | [X]Passive personality disorder | res69: person_disorder | Read | diagnostic |
Eu60714 | [X]Self defeating personality disorder | res69: person_disorder | Read | diagnostic |
Eu60800 | [X]Addictive personality | res69: person_disorder | Read | diagnostic |
Eu60y00 | [X]Other specific personality disorders | res69: person_disorder | Read | diagnostic |
Eu60y11 | [X]Eccentric personality disorder | res69: person_disorder | Read | diagnostic |
Eu60y12 | [X]Haltlose type personality disorder | res69: person_disorder | Read | diagnostic |
Eu60y13 | [X]Immature personality disorder | res69: person_disorder | Read | diagnostic |
Eu60y14 | [X]Narcissistic personality disorder | res69: person_disorder | Read | diagnostic |
Eu60y16 | [X]Psychoneurotic personality disorder | res69: person_disorder | Read | diagnostic |
Eu60z00 | [X]Personality disorder; unspecified | res69: person_disorder | Read | diagnostic |
Eu60z11 | [X]Character neurosis NOS | res69: person_disorder | Read | diagnostic |
Eu60z12 | [X]Pathological personality NOS | res69: person_disorder | Read | diagnostic |
Eu61.00 | [X]Mixed and other personality disorders | res69: person_disorder | Read | diagnostic |
Eu84511 | [x]autistic psychopathy | res69: person_disorder | Read | diagnostic |
Code | Description | Entity type | Coding System (ICD-10 Read) | Category |
---|---|---|---|---|
F60 | Specific personality disorders | res69: person_disorder | ICD-10 | diagnostic |
F61 | Mixed and other personality disorders | res69: person_disorder | ICD-10 | diagnostic |
To Export Phenotype Details:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH889/version/1857/detail/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH889/version/1857/detail/?format=json |
R Package |
|
To Export Phenotype Code List:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH889/version/1857/export/codes/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH889/version/1857/export/codes/?format=json |
CSV | site_root/phenotypes/PH889/version/1857/export/codes/ |
R Package |
|
Version ID |
Name | Owner | Publish date | |
---|---|---|---|---|
1857 | Personality Disorder | ieuan.scanlon | 2022-04-04 | currently shown |
Export - export all codes into a csv file/JSON/XML for the current phenotype version.
Print - Print page.