Our aim is to determine whether people with rheumatological conditions are more likely than other patients to harm themselves intentionally (self-harm). We hope such knowledge will be beneficial by;
- providing new information to general practitioners to support the prompt identification of at-risk patients
- reducing the number of patients who cause themselves harm
In the UK, the number of men and women who see their GP about self-harm has been increasing over the last decade. As such, finding ways to prevent self-harm needs to be a priority for healthcare systems. One approach to reducing self-harm is to target groups that are high-risk; For example, previous research has shown patients with long-term health problems, such as high blood pressure, are more likely to harm themselves. However, we do not know whether this is also the case for patients with rheumatological conditions, who experience many of the same problems as those people who do hurt themselves intentionally (for example; depression, chronic pain). As it remains unclear whether these patients are more likely to harm themselves, then further examination into any relationship between the presence of rheumatological conditions and subsequent self-harm is warranted.
Every year in UK primary care, there are 12.3 and 17.9 incident cases of self-harm per 10,000 male and female patients respectively. As such, primary care presents an opportunity to address self-harm and intervene in potential cases, with one recommended approach being to target groups who are at high-risk of self-harming. Patients with rheumatological conditions (Musculoskeletal rheumatological: osteoarthritis (OA), osteoporosis (OP) or fibromyalgia or Inflammatory rheumatological: rheumatoid arthritis (RA) or ankylosing spondylitis (AS)), who are often managed in primary care, are exposed to several known risk factors for self-harm (such as chronic pain, depression, anxiety) and are therefore potential at-risk groups.
Our research will examine whether patients with rheumatological conditions are more likely to self-harm than other comparable groups of patients. We will undertake a matched retrospective cohort study using data from the CPRD. Our primary outcomes of interest will be the prevalence and incidence of self-harm Read codes (CPRD). Cox proportional hazards models will be used to compare risk of self-harm in patients with rheumatological conditions compared to controls. Understanding the role each rheumatological condition has on self-harm could highlight vulnerable patients for clinicians to focus on or where new interventions may be necessary.
Aim 1: Cases with a rheumatological condition will be examined for subsequent self-harm codes. Self-harm will be based on the National Institute for Health and Clinical Excellence (NICE) guidelines (CG16) definition of self-harm and Read code list used in previous research (2) (Appendix 1). Specific characteristics within these rheumatological conditions will be reported (deprivation, anxiety, depression etc) and adjusted for when comparing to controls without a self-harm code.
Aim 2: In the cohort of those with a rheumatological condition and self-harm, we will determine the role of several different patient characteristics on the risk of self-harming. These will include age, gender, level of deprivation and geographical area.
James Prior - Chief Investigator - Keele University
Alyshah Abdul Sultan - Collaborator - AstraZeneca Ltd - UK Headquarters
Athula Sumathipala - Collaborator - Keele University
Carolyn Chew-Graham - Collaborator - Keele University
Christian Mallen - Collaborator - Keele University
Rebecca Whittle - Collaborator - Keele University
Tom Shepherd - Collaborator - Keele University
Zoe Paskins - Collaborator - Keele University
Practice Level Index of Multiple Deprivation