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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Little is known about the clinical management of patients in primary care following self-harm.

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.

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.

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 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

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