Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care

Abstract

Objectives To examine temporal trends in sex and age specific incidence of self harm in children and adolescents, clinical management patterns, and risk of cause specific mortality following an index self harm episode at a young age. Design Population based cohort study. Setting UK Clinical Practice Research Datalink—electronic health records from 674 general practices, with practice level deprivation measured ecologically using the index of multiple deprivation. Patients from eligible English practices were linked to hospital episode statistics (HES) and Office for National Statistics (ONS) mortality records. Participants For the descriptive analytical phases we examined data pertaining to 16 912 patients aged 10-19 who harmed themselves during 2001-14. For analysis of cause specific mortality following self harm, 8638 patients eligible for HES and ONS linkage were matched by age, sex, and general practice with up to 20 unaffected children and adolescents (n=170 274). Main outcome measures In the first phase, temporal trends in sex and age specific annual incidence were examined. In the second phase, clinical management was assessed according to the likelihood of referral to mental health services and psychotropic drug prescribing. In the third phase, relative risks of all cause mortality, unnatural death (including suicide and accidental death), and fatal acute alcohol or drug poisoning were estimated as hazard ratios derived from stratified Cox proportional hazards models for the self harm cohort versus the matched unaffected comparison cohort. Results The annual incidence of self harm was observed to increase in girls (37.4 per 10 000) compared with boys (12.3 per 10 000), and a sharp 68% increase occurred among girls aged 13-16, from 45.9 per 10 000 in 2011 to 77.0 per 10 000 in 2014. Referrals within 12 months of the index self harm episode were 23% less likely for young patients registered at the most socially deprived practices, even though incidences were considerably higher in these localities. Children and adolescents who harmed themselves were approximately nine times more likely to die unnaturally during follow-up, with especially noticeable increases in risks of suicide (deprivation adjusted hazard ratio 17.5, 95% confidence interval 7.6 to 40.5) and fatal acute alcohol or drug poisoning (34.3, 10.2 to 115.7). Conclusions Gaining a better understanding of the mechanisms responsible for the recent apparent increase in the incidence of self harm among early-mid teenage girls, and coordinated initiatives to tackle health inequalities in the provision of services to distressed children and adolescents, represent urgent priorities for multiple public agencies.

Supporting emotional well‐being in schools in the context of austerity: An ecologically informed humanistic perspective

“…What is important to acknowledge however is that staff had the perception that things were worsening and observed their working roles changing. As there is substantial evidence that large numbers of young people encounter great struggles during adolescence (Green, McGinnity, Meltzer, Ford, & Goodman, ; Kim‐Cohen et al ., ; Morgan et al ., ), and given the therapeutic turn within British Culture (Hanley, Noble, & Toor, ), it does not seem far‐fetched to assert that schools are having to be increasingly responsive to young people's emotional well‐being. Given the international trends and political expectations referred to at the outset of this paper (e.g., Department of Health, ), alongside research reflecting that emotional labour of this kind has become ‘part and parcel’ of the work of teachers (Kidger et al ., ), such sentiments would be in keeping even if the difficulties individuals encounter have not increased in volume.…”

Self-harm scar revision

“…They can often be covered with long sleeves, but this is incompatible with a wide variety of occupations ranging from the catering industry to nursing and medicine with its necessary ‘bare below the elbow’ culture. Self-harm has become increasingly recognised and discussed12 and the scars resulting from it are easily recognised. Patients with self-harm scars often try to keep them covered at all times, which restricts their choice of clothing and activity 13.…”

Emergency department nurse's attitudes towards patients who self‐harm: A meta‐analysis

“…Self-harm can present as a behaviour in its own right or co-exist with mental health illnesses, for example, mood disorders, eating disorders, and borderline personality disorder (NHS 2014). The corresponding rate in boys of the same age was 12.3 per 10 000 (Morgan et al 2017). Indeed, in a recent UK-based population cohort study using data from several data collection methods including electronic health records from 674 general practices, hospital episode statistics (HES) and Office for National Statistics (ONS) mortality records found that between 2001 and 2014, the incidence of self-harm increased markedly in girls aged 10-19 years old to 37.4 per 10 000, an increase in incidence rate of 68%.…”