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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.