RT Journal Article
SR Electronic
T1 Premature Death Among Primary Care Patients With a History of Self-Harm
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 246
OP 254
DO 10.1370/afm.2054
VO 15
IS 3
A1 Matthew J. Carr
A1 Darren M. Ashcroft
A1 Evangelos Kontopantelis
A1 David While
A1 Yvonne Awenat
A1 Jayne Cooper
A1 Carolyn Chew-Graham
A1 Nav Kapur
A1 Roger T. Webb
YR 2017
UL http://www.annfammed.org/content/15/3/246.abstract
AB PURPOSE Self-harm is a public health problem that requires a better understanding of mortality risk. We undertook a study to examine premature mortality in a nationally representative cohort of primary care patients who had harmed themselves.METHODS During 2001–2013, a total of 385 general practices in England contributed data to the Clinical Practice Research Datalink with linkage to Office for National Statistics mortality records. We identified 30,017 persons aged 15 to 64 years with a recorded episode of self-harm. We estimated the relative risks of all-cause and cause-specific natural and unnatural mortality using a comparison cohort of 600,258 individuals matched on age, sex, and general practice.RESULTS We found an elevated risk of dying prematurely from any cause among the self-harm cohort, especially in the first year of follow-up (adjusted hazard ratio for that year, 3.6; 95% CI, 3.1–4.2). In particular, suicide risk was especially high during the first year (adjusted hazard ratio, 54.4; 95% CI, 34.3–86.3); although it declined sharply, it remained much higher than that in the comparison cohort. Large elevations of risk throughout the follow-up period were also observed for accidental, alcohol-related, and drug poisoning deaths. At 10 years of follow-up, cumulative incidence values were 6.5% (95% CI, 6.0%–7.1%) for all-cause mortality and 1.3% (95% CI, 1.2%–1.5%) for suicide.CONCLUSIONS Primary care patients who have harmed themselves are at greatly increased risk of dying prematurely by natural and unnatural causes, and especially within a year of a first episode. These individuals visit clinicians at a relatively high frequency, which presents a clear opportunity for preventive action. Primary care patients with myriad comorbidities, including self-harming behavior, mental disorder, addictions, and physical illnesses, will require concerted, multipronged, multidisciplinary collaborative care approaches.