Variation in rates of self-harm hospital admission and re-admission by ethnicity in London: a population cohort study

Abstract

Purpose To compare sex-specific rates of hospital admission and repeat admission following self-harm between ethnic groups in London and test whether differences persist after adjustment for socio-economic deprivation. Methods A population-based cohort of all individuals aged over 11 admitted to a general hospital for physical health treatment following self-harm between 2008 and 2018, using administrative Hospital Episode Statistics for all people living in Greater London. Results There were 59,510 individuals admitted to the hospital following self-harm in the 10 year study period, ethnicity data were available for 94% of individuals. The highest rates of self-harm admission and readmission were found in the White Irish group. Rates of admission and readmission were lower in Black and Asian people compared to White people for both sexes at all ages and in all more specific Black and Asian ethnic groups compared to White British. These differences increased with adjustment for socio-economic deprivation. People of Mixed ethnicity had higher rates of readmission. Rates were highest in the 25–49 age group for Black and Mixed ethnicity men, but in under-25 s for all other groups. There were substantial differences in rates within the broader ethnic categories, especially for the Black and White groups. Conclusion In contrast to earlier UK studies, self-harm rates were not higher in Black or South Asian women, with lower self-harm admission rates seen in almost all ethnic minority groups. Differences in rates by ethnicity were not explained by socio-economic deprivation. Aggregating ethnicity into broad categories masks important differences in self-harm rates between groups.

A systematic review and meta‐ethnography to explore people's experiences of psychotherapy for self‐harm

“…The paucity of reporting and inclusion of diverse ethnicities within the included studies is a further limitation, where most papers ( n = 6) did not identify an ethnicity and with the large majority of identified ethnicities being white. Whilst white populations have been found to have the highest rates of hospital admissions for self‐harm (Polling et al, 2021), community surveys identify lower rates of professional support seeking and misclassification of self‐harming behaviours due to uncommon presentations of self‐harm within minority populations (Crawford et al, 2005; Rockett et al, 2010). It is therefore imperative to include those from diverse genders and ethnicities in future research to ensure that appropriate considerations are made that fulfil the needs of a wider population.…”

Self-harm in children and adolescents by ethnic group: an observational cohort study from the Multicentre Study of Self-Harm in England

“…17 The lower risk of 12-month repeat self-harm in minority ethnic groups was consistent with findings from minority ethnic adults. 7,16 Those with a history of self-harm were twice as likely to repeat self-harm, 7 and higher levels of deprivation were associated with an increase in repeat self-harm in the fully-adjusted Cox regression model. Children and adolescents from socioeconomically deprived areas were less likely to receive follow-up care than were those from less deprived areas, and subsequently can have poorer outcomes.…”

“…14,15 Different ethnic and cultural identities, practices, beliefs, and senses of belonging might influence the meaning of self-harm and attitudes towards seeking help. 15,16 Additionally, levels of social support and sense of community might vary between different cultural groups, as could stigma around seeking help from services and its effect on social status. 17 Previous work on ethnicity and self-harm has largely been limited to adults and is dated.…”

Examining readmission factors in psychiatric emergency care for individuals with personality disorders: A 6-year retrospective study.

“…Based on published findings, it was hypothesized that the risk for readmission would be higher for women and young adults compared to men and middle-aged adults (Clements et al, 2006; Gunnell et al, 2008; Polling et al, 2021; Tulloch et al, 2016). Considering PD categories as per ICD, it was hypothesized that anxious-avoidant, dependent, and anankastic categories would be associated with more readmission than the impulsive, histrionic, and dissocial ones, while schizoid and paranoid with less readmissions (Fok et al, 2019).…”