TY  - JOUR
PY  - 2016//
TI  - Clinical management following self-harm in a UK-wide primary care cohort
JO  - Journal of affective disorders
A1  - Carr, Matthew J.
A1  - Ashcroft, Darren M.
A1  - Kontopantelis, Evangelos
A1  - While, David
A1  - Awenat, Yvonne
A1  - Cooper, Jayne
A1  - Chew-Graham, Carolyn
A1  - Kapur, Nav
A1  - Webb, Roger T.
SP  - 182
EP  - 188
VL  - 197
IS  - 
N2  - 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>
LA  - en
SN  - 0165-0327
UR  - http://dx.doi.org/10.1016/j.jad.2016.03.013
ID  - ref1
ER  -