Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care

作者：Catharine Morgan, Roger T. Webb, Matthew Carr, Evangelos Kontopantelis, Jonathan Green, Carolyn Chew‐Graham, Navneet Kapur, Darren M. Ashcroft · 发表于：BMJ · 年份：2017 · DOI：10.1136/bmj.j4351 · 被引用次数：366 · 研究领域：Suicide and Self-Harm Studies、Child and Adolescent Health、Child and Adolescent Psychosocial and Emotional Development

Objectives To examine temporal trends in sex and age specific incidence of self harm in children and adolescents, clinical management patterns, and risk of cause specific mortality following an index self harm episode at a young age. Design Population based cohort study. Setting UK Clinical Practice Research Datalink—electronic health records from 674 general practices, with practice level deprivation measured ecologically using the index of multiple deprivation. Patients from eligible English practices were linked to hospital episode statistics (HES) and Office for National Statistics (ONS) mortality records. Participants For the descriptive analytical phases we examined data pertaining to 16 912 patients aged 10-19 who harmed themselves during 2001-14. For analysis of cause specific mortality following self harm, 8638 patients eligible for HES and ONS linkage were matched by age, sex, and general practice with up to 20 unaffected children and adolescents (n=170 274). Main outcome measures In the first phase, temporal trends in sex and age specific annual incidence were examined. In the second phase, clinical management was assessed according to the likelihood of referral to mental health services and psychotropic drug prescribing. In the third phase, relative risks of all cause mortality, unnatural death (including suicide and accidental death), and fatal acute alcohol or drug poisoning were estimated as hazard ratios derived from stratified Cox proportional hazards models ...