Journal
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY
Volume 76, Issue 1, Pages 145-157Publisher
WILEY-BLACKWELL
DOI: 10.1111/bcp.12059
Keywords
Clinical Practice Research Datalink; General Practice Research Database; nonfatal self-harm; suicide; validation
Categories
Funding
- National Institute for Health Research
- UK Medicines and Healthcare products Regulatory Agency (MHRA)
- Medicines and Healthcare products Regulatory Agency [SDS 33437]
- Medical Research Council
- Medical Research Council Centre for Causal Analysis in Translational Epidemiology
- National Institutes of Health Research (NIHR) [DRF-2010-03-138] Funding Source: National Institutes of Health Research (NIHR)
- Economic and Social Research Council [ES/H005331/1] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0512-10068, DRF-2010-03-138] Funding Source: researchfish
- ESRC [ES/H005331/1] Funding Source: UKRI
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Aims The UK Clinical Practice Research Datalink (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 Office for National Statistics (ONS) mortality and Hospital Episode Statistics (HES) admission data. Methods We identified cases of suicide and self-harm recorded using appropriate Read codes in the CPRD between 1998 and 2010 in patients aged 15 years. Suicides were defined as patients with Read codes for suicide recorded within 95 days of their death. International Classification of Diseases 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 Read codes. Furthermore, only 55.5% of Read 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 Read codes. The CPRD self-harm rates based on Read 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 Read 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.
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