Clinical management following self-harm in a UK-wide primary care cohort

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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 BV
  • Journal: Journal of Affective Disorders, volume 197, pages 182-188 (issn: 0165-0327, eissn: 1573-2517)
  • Related identifiers: pmc: PMC4870375, doi: 10.1016/j.jad.2016.03.013
  • Subject: Clinical Psychology | NICE, National Institute for Health and Clinical Excellence | Medication | UK, United Kingdom | CI, Confidence Interval | SSRI, Selective Serotonin Reuptake Inhibitor | Diagnoses | GP, General Practitioner | Psychiatry and Mental health | NHS, National Health Service | Referrals | CPRD, Clinical Practice Research Datalink | LSOA, Lower-Layer Super Output Area | YLL, Years of Life Lost | Primary care | FHSA, Family Health Services Authority | Self-harm | Research Paper | MHRA, Medicines and Healthcare products Regulatory Agency | IMD, Index of Multiple Deprivation | R1

Background\ud Little is known about the clinical management of patients in primary care following self-harm.\ud \ud Methods\ud 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.\ud \ud Results\ud 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.\ud \ud Conclusions\ud 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.
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