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. 2017 May;15(3):246-254.
doi: 10.1370/afm.2054.

Premature Death Among Primary Care Patients With a History of Self-Harm

Matthew J Carr  1 , Darren M Ashcroft  2 , Evangelos Kontopantelis  2 , David While  2 , Yvonne Awenat  2 , Jayne Cooper  2 , Carolyn Chew-Graham  2 , Nav Kapur  2 , Roger T Webb  2
Affiliations

Premature Death Among Primary Care Patients With a History of Self-Harm

Matthew J Carr et al. Ann Fam Med. 2017 May.

Abstract

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.

Keywords: general practice; mortality; practice-based research; primary care; self-harm; suicide.

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Figures

Figure 1
Figure 1
Hazard ratios for death due to various causes, stratified by individual follow-up year. Notes: Hazard ratios for self-harm cohort vs comparison cohort. Note that y-axis scales differ. Dark gray line indicates modeled 2-stage trend. Light gray line indicates unity (1).
Figure 1
Figure 1
Hazard ratios for death due to various causes, stratified by individual follow-up year. Notes: Hazard ratios for self-harm cohort vs comparison cohort. Note that y-axis scales differ. Dark gray line indicates modeled 2-stage trend. Light gray line indicates unity (1).
Figure 1
Figure 1
Hazard ratios for death due to various causes, stratified by individual follow-up year. Notes: Hazard ratios for self-harm cohort vs comparison cohort. Note that y-axis scales differ. Dark gray line indicates modeled 2-stage trend. Light gray line indicates unity (1).
Figure 1
Figure 1
Hazard ratios for death due to various causes, stratified by individual follow-up year. Notes: Hazard ratios for self-harm cohort vs comparison cohort. Note that y-axis scales differ. Dark gray line indicates modeled 2-stage trend. Light gray line indicates unity (1).
See this image and copyright information in PMC

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