Ethnic differences in self-harm, rates, characteristics and service provision: three-city cohort study

Abstract

Variation in rates of suicide in Black and minority ethnic (BME) groups have been reported in different countries.1,2 Rates of suicide 3,4 and self-harm 5-7 may be lower in BME groups than White groups overall, but this finding may obscure differences in age-and gender-specific groups. Also, rates of suicide and self-harm within ethnic minority groups may fluctuate according to area, with a decline in relative risk of suicide and self-harm where there is a larger density of minority populations. 8,9 Previous research on BME groups in the UK has generally been conducted in single geographical areas, 10 and self-harm studies have been limited by small sample size, with few studies of people of African-Caribbean origin.11 A report on suicide prevention for BME groups in England calls for better information on rates and risk factors for suicide or behaviours that increase the likelihood of suicide. 12 We have conducted a study of self-harm in different minority ethnic groups using a multicentre database of self-harm in three geographical areas in England. Our objectives were to compare ethnic groups (that is, White, South Asian and Black African-Caribbean) with regard to: age-and gender-specific rates of self-harm in different cities; sociodemographic and clinical characteristics; clinical management following self-harm; and risk of repetition of self-harm. Method Study design and data collectionWe conducted a prospective, multicentre cohort study, identifying all episodes of self-harm presenting to emergency departments in general hospitals in Manchester (three hospitals), Derby (two hospitals) and Oxford (one hospital). The study hospitals were chosen on a pragmatic basis -the centres included were those that had established monitoring systems. The cities of Manchester, Derby and Oxford have different profiles (Table 1), with ethnic groups forming a greater proportion of the general population in Manchester. According to the UK government's Index of Multiple Deprivation, where 353 local authority areas in England were scored on a number of indicators (covering a range of economic, social and health issues) into a single deprivation score, 13 Manchester was ranked fourth (worst), Derby sixty-ninth and Oxford one hundred and fifty-fifth.Data were collected using established monitoring systems in the three centres, described in full elsewhere.14,15 Self-harm attendances were identified via detailed examination of computerised emergency department records and defined consistently across all three centres as intentional self-poisoning or self-injury, irrespective of motivation and degree of suicidal intent.16 Most participants received a psychosocial assessment from emergency department staff and/or mental health specialists. For assessed participants, clinicians recorded a wide range of sociodemographic and clinical information using research assessment forms. For participants who were not assessed (for example, because they refused or took early discharge), basic information was collected by research clerks from medi...

Disparate patterns of hospitalisation reflect unmet needs and persistent ethnic inequalities in mental health care: the Scottish health and ethnicity linkage study

“…Previous data show that South Asian women are less likely to report depressive symptoms (Cooper et al 2006), or have a psychiatric history when presenting with parasuicide , and less likely to receive specialist and follow up care compared to White counterparts (Bhui et al 2003;Cooper et al 2010). Our data add to this work and show apparent heterogeneity in mood (affective) disorders in South Asians with a higher risk in Pakistanis, particularly men, compared to Indians.…”

Emergency Department Visits for Self-Inflicted Injuries in Adolescents

“…21 The lack of agreement in findings on SII risk across studies may be influenced by variances in the socioeconomic profiles experienced by a specific racial/ethnic group residing in one area versus another. 20 Only 4.9% of adolescents in our cohort with an SII had a diagnosis code for a mental health disorder. These findings differ from 2 other studies that reported .50% of ED visits for SII carrying a diagnosis for a mental health disorder.…”

“…14,15 We found that risk of SII was lower in African American adolescents than in white adolescents, which differs from previous research. Cooper et al found that rates of self-harm in patients presenting to EDs in 3 English cities were highest in young black females, 20 whereas Ting et al found that blacks in the United States had higher population rates of ED visits for attempted suicide and SII compared with whites. 4 Our finding that Asian adolescents were more likely to visit the ED for an SII is unique in the United States, although a study in England found that South Asian females were more likely to visit EDs for SII.…”

Outpatient Dialectical Behavior Therapy for Adolescents Engaged in Deliberate Self-Harm: Conceptual and Methodological Considerations

“…For instance, being female (Gratz et al, 2012; Hawton & Harriss, 2007) and between the ages of 15–18 years old (Sourander et al, 2006) have been found to increase the risk of DSH. Some studies have also documented racial/ethnic variation in self-harm most often showing higher prevalence rates among Caucasians (Cooper et al, 2010; Gratz et al, 2012) as well as higher prevalence rates of self-harm and suicidality in youth from more socio-economically disadvantaged backgrounds (Gratz et al, 2012; King & Merchant, 2008). …”