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Validation of suicide and self‐harm records in the C linical P ractice R esearch D atalink
Author(s) -
Thomas Kyla H.,
Davies Neil,
Metcalfe Chris,
Windmeijer Frank,
Martin Richard M.,
Gunnell David
Publication year - 2013
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.12059
Subject(s) - harm , medicine , incidence (geometry) , injury prevention , suicide prevention , diagnosis code , poison control , medical emergency , psychology , environmental health , population , social psychology , mathematics , geometry
Aims The UK C linical P ractice R esearch D atalink ( CPRD ) is increasingly being used to investigate suicide‐related adverse drug reactions. No studies have comprehensively validated the recording of suicide and nonfatal self‐harm in the CPRD . We validated general practitioners' recording of these outcomes using linked O ffice for N ational S tatistics ( ONS ) mortality and Hospital Episode Statistics ( HES ) admission data. Methods We identified cases of suicide and self‐harm recorded using appropriate R ead codes in the CPRD between 1998 and 2010 in patients aged ≥15 years. Suicides were defined as patients with R ead codes for suicide recorded within 95 days of their death. I nternational C lassification of D iseases codes were used to identify suicides/hospital admissions for self‐harm in the linked ONS and HES data sets. We compared CPRD ‐derived cases/incidence of suicide and self‐harm with those identified from linked ONS mortality and HES data, national suicide incidence rates and published self‐harm incidence data. Results Only 26.1% ( n = 590) of the ‘true’ ( ONS ‐confirmed) suicides were identified using R ead codes. Furthermore, only 55.5% of R ead code‐identified suicides were confirmed as suicide by the ONS data. Of the HES ‐identified cases of self‐harm, 68.4% were identified in the CPRD using R ead codes. The CPRD self‐harm rates based on R ead codes had similar age and sex distributions to rates observed in self‐harm hospital registers, although rates were underestimated in all age groups. Conclusions The CPRD recording of suicide using R ead codes is unreliable, with significant inaccuracy (over‐ and under‐reporting). Future CPRD suicide studies should use linked ONS mortality data. The under‐reporting of self‐harm appears to be less marked.