Chew-Graham, CA, Carr, MJ, Ashcroft, DM, Kontopantelis, E, While, D, Awenat, Y, Cooper, J, Kapur, N and Webb, RT (2016) Clinical management following self-harm in a UK-wide primary care cohort. Journal of Affective Disorders, 197. pp. 182-188. ISSN 1573-2517

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Abstract

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 6318 (15.2%, 14.9-15.6) were referred to mental health services; 4105 (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.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at http://dx.doi.org/10.1016/j.jad.2016.03.013 Please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Self-harm, Primary care, Diagnoses, Referrals, Medication
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 09 Mar 2016 11:49
Last Modified: 08 Jun 2018 08:15
URI: http://eprints.keele.ac.uk/id/eprint/1552

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