Suicide deaths corresponded to "intentional self harm", codes X60 to X84, according to the ICD-10.
Although data coders in different hospitals are likely to vary in the proportion of cases of self harm coded as "intentional" and of "undetermined intent," in part because the level of intent is often difficult to determine, these two codes are usually combined in epidemiological studies of suicide to identify all cases of self inflicted injury.
Approximately two-thirds of hospital admissions for self-harm had a self-harm Read code recorded within 6 months of their admission.
14 Secondly, we elected not to use deliberate self harm E-codes because they are incompletely coded across sites in the Mental Health Research Network and in commercial plan databases generally.
Approximately 68.4% of patients had a self-harm Read code in the CPRD within 6 months of a relevant HES self-harm ICD code, indicating that around one-third of hospital-admitted cases of self-harm are not recorded by their GP using these Read codes on the CPRD.
34 Therefore, instead of deliberate self harm E-codes, we used poisoning by psychotropic agents (international classification of diseases, ninth revision, clinical modification (ICD-9) code 969), a more reliable proxy for population level suicide attempts.
We performed a sensitivity analysis for the CPRD-detected suicides using death dates within 30, 180 and 360 days of the suicide/self-harm Read code date.
12 14 15 We defined self-harm using codes that mentioned either 'self-harm' or 'self-poisoning'.
Also, many intentional self-harm Read codes were omitted from their algorithms; no clear rationale was provided for their omission.
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