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 |
---|---|---|---|---|
14D1.00 | H/O: nephritis | res69: renal_disease | Read | diagnostic |
1Z10.00 | Chronic kidney disease stage 1 | res69: renal_disease | Read | diagnostic |
1Z11.00 | Chronic kidney disease stage 2 | res69: renal_disease | Read | diagnostic |
1Z12.00 | Chronic kidney disease stage 3 | res69: renal_disease | Read | diagnostic |
1Z13.00 | Chronic kidney disease stage 4 | res69: renal_disease | Read | diagnostic |
1Z14.00 | Chronic kidney disease stage 5 | res69: renal_disease | Read | diagnostic |
K0...00 | Nephritis, nephrosis and nephrotic syndrome | res69: renal_disease | Read | diagnostic |
K001.00 | Acute nephritis with lesions of necrotising glomerulitis | res69: renal_disease | Read | diagnostic |
K012.00 | Nephrotic syndrome+membranoproliferative glomerulonephritis | res69: renal_disease | Read | diagnostic |
K019.00 | Nephrotic syn,diffuse mesangiocapillary glomerulonephritis | res69: renal_disease | Read | diagnostic |
K02..00 | Chronic glomerulonephritis | res69: renal_disease | Read | diagnostic |
K02..11 | Nephritis - chronic | res69: renal_disease | Read | diagnostic |
K02..12 | Nephropathy - chronic | res69: renal_disease | Read | diagnostic |
K021.00 | Chronic membranous glomerulonephritis | res69: renal_disease | Read | diagnostic |
K022.00 | Chronic membranoproliferative glomerulonephritis | res69: renal_disease | Read | diagnostic |
K023.00 | Chronic rapidly progressive glomerulonephritis | res69: renal_disease | Read | diagnostic |
K02y000 | Chronic glomerulonephritis + diseases EC | res69: renal_disease | Read | diagnostic |
K02y200 | Chronic focal glomerulonephritis | res69: renal_disease | Read | diagnostic |
K02y300 | Chronic diffuse glomerulonephritis | res69: renal_disease | Read | diagnostic |
K02yz00 | Other chronic glomerulonephritis NOS | res69: renal_disease | Read | diagnostic |
K02z.00 | Chronic glomerulonephritis NOS | res69: renal_disease | Read | diagnostic |
K03..00 | Nephritis and nephropathy unspecified | res69: renal_disease | Read | diagnostic |
K03..11 | Nephritis and nephropathy unspecified | res69: renal_disease | Read | diagnostic |
K032.00 | Membranoproliferative nephritis unspecified | res69: renal_disease | Read | diagnostic |
K032000 | Focal membranoproliferative glomerulonephritis | res69: renal_disease | Read | diagnostic |
K032y00 | Nephritis unsp+OS membranoprolif glomerulonephritis lesion | res69: renal_disease | Read | diagnostic |
K032y13 | Mesangioproliferative glomerulonephritis NEC | res69: renal_disease | Read | diagnostic |
K032y14 | Mesangiocapillary glomerulonephritis NEC | res69: renal_disease | Read | diagnostic |
K032z00 | Nephritis unsp+membranoprolif glomerulonephritis lesion NOS | res69: renal_disease | Read | diagnostic |
K034.00 | Renal cortical necrosis unspecified | res69: renal_disease | Read | diagnostic |
K035.00 | Renal medullary necrosis unspecified | res69: renal_disease | Read | diagnostic |
K041.00 | Acute renal cortical necrosis | res69: renal_disease | Read | diagnostic |
K042.00 | Acute renal medullary necrosis | res69: renal_disease | Read | diagnostic |
K04y.00 | Other acute renal failure | res69: renal_disease | Read | diagnostic |
K04z.00 | Acute renal failure NOS | res69: renal_disease | Read | diagnostic |
K05..00 | Chronic renal failure | res69: renal_disease | Read | diagnostic |
K050.00 | End stage renal failure | res69: renal_disease | Read | diagnostic |
K06..00 | Renal failure unspecified | res69: renal_disease | Read | diagnostic |
K060.11 | Impaired renal function | res69: renal_disease | Read | diagnostic |
K080.00 | Renal osteodystrophy | res69: renal_disease | Read | diagnostic |
K080000 | Phosphate-losing tubular disorders | res69: renal_disease | Read | diagnostic |
K080100 | Renal dwarfism | res69: renal_disease | Read | diagnostic |
K080200 | Renal infantilism | res69: renal_disease | Read | diagnostic |
K080300 | Renal rickets | res69: renal_disease | Read | diagnostic |
K080z00 | Renal osteodystrophy NOS | res69: renal_disease | Read | diagnostic |
K081.00 | Nephrogenic diabetes insipidus | res69: renal_disease | Read | diagnostic |
K08y000 | Hypokalaemic nephropathy | res69: renal_disease | Read | diagnostic |
K08yz00 | Other impaired renal function disorder NOS | res69: renal_disease | Read | diagnostic |
K08z.00 | Impaired renal function disorder NOS | res69: renal_disease | Read | diagnostic |
K0A3200 | Chron nephritic syndrom difuse membranous glomerulonephritis | res69: renal_disease | Read | diagnostic |
K0A3300 | Chron neph syn difus mesangial prolifrtiv glomerulonephritis | res69: renal_disease | Read | diagnostic |
K0A3500 | Chronic neph syn difus mesangiocapillary glomerulonephritis | res69: renal_disease | Read | diagnostic |
K0A3700 | Chronic nephritic syn diffuse crescentic glomerulonephritis | res69: renal_disease | Read | diagnostic |
K0A5500 | [X]Heredtry nephrpthy NEC difus mesangiocapilry glomneph | res69: renal_disease | Read | diagnostic |
K100000 | Chronic pyelonephritis without medullary necrosis | res69: renal_disease | Read | diagnostic |
K100100 | Chronic pyelonephritis with medullary necrosis | res69: renal_disease | Read | diagnostic |
K101000 | Acute pyelonephritis without medullary necrosis | res69: renal_disease | Read | diagnostic |
Kyu2.00 | [X]Renal failure | res69: renal_disease | Read | diagnostic |
Kyu2000 | [X]Other acute renal failure | res69: renal_disease | Read | diagnostic |
Kyu2100 | [X]Other chronic renal failure | res69: renal_disease | Read | diagnostic |
Code | Description | Entity type | Coding System (ICD-10 Read) | Category |
---|---|---|---|---|
I12 | Hypertensive renal disease | res69: renal_disease | ICD-10 | diagnostic |
I13 | Hypertensive heart and renal disease | res69: renal_disease | ICD-10 | diagnostic |
N00 | Acute nephritic syndrome | res69: renal_disease | ICD-10 | diagnostic |
N01 | Rapidly progressive nephritic syndrome | res69: renal_disease | ICD-10 | diagnostic |
N02 | Recurrent and persistent haematuria | res69: renal_disease | ICD-10 | diagnostic |
N03 | Chronic nephritic syndrome | res69: renal_disease | ICD-10 | diagnostic |
N04 | Nephrotic syndrome | res69: renal_disease | ICD-10 | diagnostic |
N05 | Unspecified nephritic syndrome | res69: renal_disease | ICD-10 | diagnostic |
N07 | Herediatry nephropathy, not elsewhere classified | res69: renal_disease | ICD-10 | diagnostic |
N11 | Chronic tubulo-interstitial nephritis | res69: renal_disease | ICD-10 | diagnostic |
N14 | Drug- and heavy-metal-induced tubulo-interstitial and tubular conditions | res69: renal_disease | ICD-10 | diagnostic |
N17-N19 | Renal failure | res69: renal_disease | ICD-10 | diagnostic |
Q61 | Cystic kidney disease | res69: renal_disease | ICD-10 | diagnostic |
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Version ID |
Name | Owner | Publish date | |
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1859 | Renal Disease | ieuan.scanlon | 2022-04-04 | currently shown |
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