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Using natural language processing to extract self-harm and suicidality data from a clinical sample of patients with eating disorders: A retrospective cohort study

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Charlotte Cliffe, Aida Seyedsalehi, Katerina Vardavoulia, André Bittar, Sumithra Velupillai, Hitesh Shetty, Ulrike Schmidt, Rina Dutta

Original languageEnglish
Article numbere053808
JournalBMJ Open
Issue number12
Published31 Dec 2021

Bibliographical note

Funding Information: Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.RD was funded by a Clinician Scientist Fellowship (research project e-HOST-IT) from the Health Foundation in partnership with the Academy of Medical Sciences. This work was supported by the the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Funding Information: This study is a retrospective cohort study using data obtained from South London and Maudsley National Health Service Foundation trust (SLaM). This is a mental health service serving an estimated population of 2 million residents of southeast London. Patients come from the London boroughs of Croydon, Southwark, Lambeth, Lewisham, Bromley, Bexley and Greenwich. SLaM has had fully electronic records since 2006 and the National Institute for Health Research funded Biomedical Research Centre supports the infrastructure for rendering its anonymised records available for research. We analysed the data as ‘event notes’ in the EHRs, irrespective whether they were created during an inpatient stay, during follow-up or a telephone appointment. Publisher Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

King's Authors


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.

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