Remember Me
Or use your Academic/Social account:


Or use your Academic/Social account:


You have just completed your registration at OpenAire.

Before you can login to the site, you will need to activate your account. An e-mail will be sent to you with the proper instructions.


Please note that this site is currently undergoing Beta testing.
Any new content you create is not guaranteed to be present to the final version of the site upon release.

Thank you for your patience,
OpenAire Dev Team.

Close This Message


Verify Password:
Verify E-mail:
*All Fields Are Required.
Please Verify You Are Human:
fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Carr, Matthew J.; Ashcroft, Darren M.; Kontopantelis, Evangelos; While, David; Awenat, Yvonne; Cooper, Jayne; Chew-Graham, Carolyn; Kapur, Nav; Webb, Roger T. (2016)
Publisher: Elsevier/North-Holland Biomedical Press
Journal: Journal of Affective Disorders
Languages: English
Types: Article
Subjects: Clinical Psychology, NICE, National Institute for Health and Clinical Excellence, Medication, UK, United Kingdom, CI, Confidence Interval, Diagnoses, SSRI, Selective Serotonin Reuptake Inhibitor, GP, General Practitioner, Psychiatry and Mental health, NHS, National Health Service, Referrals, CPRD, Clinical Practice Research Datalink, LSOA, Lower-Layer Super Output Area, Primary care, YLL, Years of Life Lost, FHSA, Family Health Services Authority, Self-harm, Research Paper, MHRA, Medicines and Healthcare products Regulatory Agency, IMD, Index of Multiple Deprivation, R1
Background: Little is known about the clinical management of patients in primary care following self-harm.
Methods: A descriptive cohort study using data from 684 UK general practices that contributed to the Clinical Practice Research Datalink (CPRD) during 2001-2013. We identified 49,970 patients with a self-harm episode, 41,500 of whom had one complete year of follow-up.
Results: Among those with complete follow-up, 26,065 (62.8%, 62.3-63.3) were prescribed psychotropic medication and 6,318 (15.2%, 14.9-15.6) were referred to mental health services; 4,105 (9.9%, CI 9.6-10.2) were medicated without an antecedent psychiatric diagnosis or referral, and 4,506 (10.9%, CI 10.6-11.2) had a diagnosis but were not subsequently medicated or referred. Patients registered at practices in the most deprived localities were 27.1% (CI 21.5-32.2) less likely to be referred than those in the least deprived. Despite a specifically flagged NICE ‘Do not do’ recommendation in 2011 against prescribing tricyclic antidepressants following self-harm because of their potentially lethal toxicity in overdose, 8.8% (CI 7.8-9.8) of individuals were issued a prescription in the subsequent year. The percentage prescribed Citalopram, an SSRI antidepressant with higher toxicity in overdose, fell sharply during 2012/2013 in the aftermath of a Medicines and Healthcare products Regulatory Agency (MHRA) safety alert issued in 2011.
Conclusions: A relatively small percentage of these vulnerable patients are referred to mental health services, and reduced likelihood of referral in more deprived localities reflects a marked health inequality. National clinical guidelines have not yet been effective in reducing rates of tricyclic antidepressant prescribing for this high-risk group.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • Bergen, H., Hawton, K., Webb, R., Cooper, J., Steeg, S., Haigh, M., Ness, J., Waters, K., Kapur, N., 2014. Alcohol-related mortality following self-harm: a multicentre cohort study. J. R. Soc. Med. Open. 5, 1-11.
    • Bergen, H., Murphy, E., Cooper, J., Kapur, N., Stalker, C., Waters, K., Hawton, K. 2010. A comparative study of non-fatal self-poisoning with antidepressants relative to prescribing in three centres in England. J. Affect. Disord. 123, 95-101.
    • Carr, M.J., Ashcroft, D.M., Kontopantelis, E., Awenat, Y., Cooper, J., Chew-Graham, C., Kapur, N., Webb, R.T., 2015. The epidemiology of self-harm in the UK primary care patient population, 2001-2013. [Accepted for publication in BMC Psychiatry].
    • Chew-Graham, C.A., Mullin, S., May, C.R., Hedley, S., Cole, H. 2002. Managing depression in primary care: another example of the inverse care law? Fam. Pract. 19, 632-7.
    • Chisholm, J. 1990. The Read clinical classification. BMJ 300(6732), 1092.
    • Cooper, J., Kapur, N., Webb, R., Lawlor, M., Guthrie, E., Mackway-Jones, K., Appleby, L., 2007. Suicide after deliberate self-harm: a 4-year cohort study. Am. J. Psychiatry 162, 297-303.
    • De Leo, D., Padoani, W., Scocco, P., Lie, D., Bille-Brahe, U., Arensman, E., Hjelmeland, H., Crepet, P., Haring, C., Hawton, K., Lonnqvist, J., Michel, K., Pommereau, X., Querejeta, I., Phillipe, J., Salander-Renberg, E., Schmidtke, A., Fricke, S., Weinacker, B., Tamesvary, B., Wasserman, D., Faria, S., 2001. Attempted and completed suicide in older subjects: results from the WHO/EURO Multicentre Study of Suicidal Behaviour. In. J. Geriatr. Psychiatry 16, 300-10.
    • Finkelstein, Y., Macdonald, E.M., Hollands, S., Hutson, J.R., Sivilotti, M.L.A., Mamdani, M.M., Koren, G., Juurlink, D.N., 2015a. Long-term outcomes following self-poisoning in adolescents: a population-based cohort study. Lancet Psychiatry 2, 532-9.
    • Finkelstein, Y., Macdonald, E.M., Hollands, S., Sivilotti, M.L.A., Hutson, J.R., Mamdani, M.M., Koren, G., Juurlink, D.N., 2015b. Risk of suicide following deliberate selfpoisoning. JAMA Psychiatry 72, 570-5.
    • FirstDataBank. 2014. MULTILEX. http://www.fdbhealth.co.uk/solutions/multilex/
    • Flanagan, R.J., 2008. Fatal toxicity of drugs used in psychiatry. Hum Psychopharmacol 23(Suppl.1), 43-51.
    • García Rodríguez, L.A., Pérez Gutthann, S., 1998. Use of the UK General Practice Research Database for pharmacoepidemiology. Br. J. Clin. Pharmacol. 45, 419-25.
    • Gunnell, D., Bennewith, O., Peters, T.J., Stocks, N., Sharp, D.J., 2002. Do patients who selfharm consult their general practitioner soon after hospital discharge? A cohort study. Soc. Psychiatry Psychiatr. Epidemiol. 37, 599-602.
    • Gunnell, D., Saperia, J., Ashby, D., 2005. Selective serotonin reuptake inhibitors (SSRIs) and suicide in adults: meta-analysis of drug company data from placebo controlled, randomised controlled trials submitted to the MHRA's safety review. BMJ 330, 385.
    • Hawton, K., Bergen, H., Casey, D., Simkin, S., Palmer, B., Cooper, J., Kapur, N., Horrocks, J.., House, A., Lilley, R., Noble, R., Owens, D., 2007. Self-harm in England: a tale of three cities. Multicentre study of self-harm. Soc. Psychiatry Psychiatr. Epidemiol. 42, 513- 21.
    • Hawton, K., Bergen, H., Simkin, S., Cooper, J., Waters, K., Gunnell, D., Kapur, N., 2010. Toxicity of antidepressants: rates of suicide relative to prescribing and non-fatal overdose. Br. J. Psychiatry 196, 354-8.
    • Hawton, K., Blackstock, E., 1977. Deliberate self-poisoning: implications for psychotropic drug prescribing in general practice. J. R. Coll. Gen. Pract. 27, 560-3.
    • Hawton, K., Blackstock, E., 1976. General practice aspects of self-poisoning and self-injury. Psychol. Med. 6, 571-5.
    • Hawton, K., Harriss, L., 2008. Deliberate self-harm by under 15-year-olds: characteristics, trends and outcome. J. Child Psychol. Psychiatry 49, 441-8.
    • Hawton, K., Saunders, K., Topiwala, A., Camilla, H., 2013. Psychiatric disorders in patients presenting to hospital following self-harm: a systematic review. J. Affect. Disord. 151, 821-30.
    • Health and Social Care Information Centre (HSCIC), 2015. NHS UK Read Codes Clinical Terms Version 3. https://isd.hscic.gov.uk/trud3/user/guest/group/0/pack/9 Herrett, E., Gallagher, A.M., Bhaskaran, K., Forbes, H., Mathur, R., van Staa, T., Smeeth, L., 2015. Data resource profile: Clinical Practice Research Datalink (CPRD). Int. J. Epidemiol. 44, 827-36.
    • Kapur, N., Cooper, J., King-Hele, S., Webb, R., Lawlor, M., Rodway, C., Appleby, L., 2006. The repetition of suicidal behavior: a multicenter cohort study. J. Clin. Psychiatry 67, 1599-1609.
    • Khan, N.F., Harrison, S.E., Rose, P.W., 2010. Validity of diagnostic coding within the General Practice Research Database: a systematic review. Br. J. Gen. Pract. 60, e128-36.
    • Koopman, P.A., 1984. Confidence intervals for the ratio of two binomial proportions. Biometrics 40, 513-7.
    • Lebret, S., Perret-Vaille, E., Mulliez, A., Gerbaud, L., Jalenques, I., 2006. Elderly suicide attempters: characteristics and outcome. Int. J. Geriatr. Psychiatry 21, 1052-9.
    • Mercer, S.W., Watt, G., 2007. The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland. Ann. Fam. Med. 5, 503-10.
    • Moller, C.I., Tait, R.J., Byrne, D.G., 2013. Self-harm, substance misuse and psychological distress in the Australian general population. Addiction 108, 211-20.
    • Springate, D.A., Kontopantelis, E., Ashcroft, D.M., Olier, I., Parisi, R., Chamapiwa, E., Reeves, D., 2014. ClinicalCodes: an online clinical codes repository to improve the validity and reproducibility of research using electronic medical records. PLoS ONE 9, e99825.
  • Inferred research data

    The results below are discovered through our pilot algorithms. Let us know how we are doing!

    Title Trust
  • No similar publications.