Self-Harm Primary care

The attached lists represent the codes used in papers (Thomas et. al. 2014; Marchant et. al. 2020) and reviewed by a clinician in the study team (Prof Ann John). These can be combined and used as one list to replicate the methodology used in the aforementioned papers.

When going forward with Snomed coding the way these codes are used is to be amended to more accurately identify self-harm adding in the following age-based criteria.

Self-harm is defined as non-fatal intentional self-poisoning or self-injury, regardless of motivation or intention. We included all forms of intentional self-harm in those 10 years of age and older, from non-suicidal self-injury through to suicide attempts, with the exception of intentional alcohol poisoning or overdose. We also included the events of undetermined intent for hanging, strangulation and suffocation; rifle shotgun and larger firearm discharges; other and unspecified firearm discharges; falling, and jumping from a high place in those 15 years of age and older as they are likely unidentified self-harm. When intent is not explicitly recorded (neither ‘intentional’ nor ‘undetermined’), we include events of overdose of drug, biological substance or medicament (without further substance specification), and poisoning and overdose of antidepressants (commonly implicated in suicide) also for those 15 years of age and older, as they are also likely unidentified self-harm events. A small number of codes do not distinguish between non-fatal and fatal self-harm descriptors and include both. We have included these for completion sake. Fatal events could be removed if linkage occurs to mortality records.

Events of poisoning and overdose with analgesics, although commonly implicated in suicidal behaviours as well, were not included as they are often accidental. The list of codes is based on validated, published and comparable lists (Thomas et. al. 2014; Marchant et. al. 2020) and reviewed by a clinician in the study team (Prof Ann John).