TY - JOUR T1 - Reducing risk following self-harm: the need for careful prescribing JF - British Journal of General Practice JO - Br J Gen Pract SP - 224 LP - 225 DO - 10.3399/bjgp19X702317 VL - 69 IS - 682 AU - Carolyn Anne Chew-Graham AU - Catharine Morgan AU - Roger T Webb AU - Angela Emery AU - Matthew J Carr AU - Evangelos Kontopantelis AU - Alison R Yung AU - Darren M Ashcroft Y1 - 2019/05/01 UR - http://bjgp.org/content/69/682/224.abstract N2 - Self-harm is the strongest risk factor for suicide.1,2 Globally, suicide is the second most common cause of death among 10– to 24-year-olds after road traffic incidents.3 Recent evidence indicates that the incidence of self-harm may be increasing among adolescents.4 Older people who self-harm have an increased suicidal intent,5 and, although repetition rates are low compared with middle-aged adults, self-harm is more often fatal in older adults.6Tyrell et al 7 identify antidepressants and analgesics as common drugs used by young people for self-poisoning. Overdose as a form of self-harm may be with prescription-only or sales-restricted drugs, often in combination with alcohol.8 Depression is also a key risk factor for suicide.9 Older adults with previously diagnosed comorbid mental and physical health conditions have an increased risk of self-harm.6,10Recent evidence also suggests that the Inverse Care Law,11 whereby quantity or quality of healthcare service provision is inversely associated with the level of healthcare need, operates in the clinical management of self-harm in all age groups. Thus, self-harm incidence is elevated across the life-course in practice populations in deprived areas.4,10,12 Among children and adolescents,4 and adults of working age,13 the incidence of self-harm is highest and the likelihood of referral to specialist services following self-harm is lowest in … ER -