@article{ref1,
title="Clinical management following self-harm in a UK-wide primary care cohort",
journal="Journal of affective disorders",
year="2016",
author="Carr, Matthew J. and Ashcroft, Darren M. and Kontopantelis, Evangelos and While, David and Awenat, Yvonne and Cooper, Jayne and Chew-Graham, Carolyn and Kapur, Nav and Webb, Roger T.",
volume="197",
number="",
pages="182-188",
abstract="BACKGROUND: Little is known about the clinical management of patients in primary care following self-harm. <br><br>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. <br><br>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. <br><br>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.<br><br>Copyright © 2016 Elsevier B.V. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0165-0327",
doi="10.1016/j.jad.2016.03.013",
url="http://dx.doi.org/10.1016/j.jad.2016.03.013"
}