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Objectives The objective of this study was to determine risk factors for those diagnosed with eating disorders who report self-harm and suicidality.Design and setting This study was a retrospective cohort study within a secondary mental health service, South London and Maudsley National Health Service Trust.Participants All diagnosed with an F50 diagnosis of eating disorder from January 2009 to September 2019 were included.Intervention and measures Electronic health records (EHRs) for these patients were extracted and two natural language processing tools were used to determine documentation of self-harm and suicidality in their clinical notes. These tools were validated manually for attribute agreement scores within this study.Results The attribute agreements for precision of positive mentions of self-harm were 0.96 and for suicidality were 0.80; this demonstrates a ‘near perfect’ and ‘strong’ agreement and highlights the reliability of the tools in identifying the EHRs reporting self-harm or suicidality. There were 7434 patients with EHRs available and diagnosed with eating disorders included in the study from the dates January 2007 to September 2019. Of these, 4591 (61.8%) had a mention of self-harm within their records and 4764 (64.0%) had a mention of suicidality; 3899 (52.4%) had mentions of both. Patients reporting either self-harm or suicidality were more likely to have a diagnosis of anorexia nervosa (AN) (self-harm, AN OR=3.44, 95% CI 1.05 to 11.3, p=0.04; suicidality, AN OR=8.20, 95% CI 2.17 to 30.1; p=0.002). They were also more likely to have a diagnosis of borderline personality disorder (p≤0.001), bipolar disorder (p<0.001) or substance misuse disorder (p<0.001).Conclusion A high percentage of patients (>60%) diagnosed with eating disorders report either self-harm or suicidal thoughts. Relative to other eating disorders, those diagnosed with AN were more likely to report either self-harm or suicidal thoughts. Psychiatric comorbidity, in particular borderline personality disorder and substance misuse, was also associated with an increase risk in self-harm and suicidality. Therefore, risk assessment among patients diagnosed with eating disorders is crucial.Data are available on reasonable request. Data are available on request due to privacy/ethical considerations.The data are made available under specific governance requirements: researchers need to have a contract with the South London and Maudsley NHS Trust, which can be applied for relevant research studies. Each research project is reviewed by a service-user led oversight committee of the National Institute of Health Research Biomedical Research Centre. On request, and after appropriate arrangements, the data and modelling employed in this study can be viewed within the secure system firewall.

Original publication




Journal article


BMJ Open

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