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

Farooq, Bushra; Clements, Caroline; Hawton, Keith; Ness, Jennifer; Patel, Anita; Kelly, Samantha; Townsend, Ellen; Appleby, Louis; Kapur, Nav

Abstract

Background: Studies report an increasing incidence of self-harm in children and adolescents, but the extent to which this is seen in different ethnic groups is unclear. We aimed to investigate rates of emergency department presentations for self-harm in children and adolescents by ethnicity, as well as to examine their demographic characteristics, clinical characteristics, and outcomes. Methods: In this observational cohort study, we used data on hospital emergency department presentations for self-harm in children and adolescents aged 10–19 years between 2000 and 2016 from the Multicentre Study of Self-harm in England. This study collects data from five general hospitals in Manchester, Oxford, and Derby in the UK, and defines self-harm as any act of intentional self-injury or self-poisoning, regardless of intent. All children and adolescents aged 10–19 years for whom ethnicity data were available were included. Mortality follow-up was available through linkage with mortality records from the Office for National Statistics. Rates of self-harm over time, demographic and clinical characteristics, and self-harm methods were investigated by ethnic group. Risk of repeat self-harm and mortality following an initial presentation for self-harm was compared by ethnic group using Kaplan-Meier curves and Cox proportional hazards models. Findings: Of 14 894 individuals who presented at hospitals with self-harm, 11 906 had data for ethnicity, of whom 10 211 (85·8%) were White, 344 (2·9%) were Black, 619 (5·2%) were South Asian, and 732 (6·1%) were other non-White. Rates of self-harm were highest in White children and adolescents but increased between 2009 and 2016 in all ethnicities. Mean annual rates of self-harm per 100 000 population were 574 for White, 225 for Black, 260 for South Asian, and 344 for other non-White groups. Increases in rates of self-harm between 2009 and 2016 appeared slightly greater in Black groups (incidence rate ratio 1·07 [95% CI 1·03–1·11]), South Asian groups (1·05 [1·01–1·09]), and other non-White groups (1·11 [1·06–1·16]) than in White groups (1·02 [1·00–1·03]). Children and adolescents from a minority ethnic background were more likely to live in areas of high deprivation and were less likely to receive a specialist psychosocial assessment than were White children and adolescents. Children and adolescents from minority ethnic groups were also less likely to repeat self-harm. However, there were no differences in suicide mortality by ethnic group, although the numbers were small. Interpretation: Minority ethnic children and adolescents accounted for an increased proportion of self-harm presentations to hospital over time compared with White ethnic groups. The minority ethnic groups also tended to be more socioeconomically disadvantaged and were less likely to receive a psychosocial assessment. Socioeconomic disparities need to be addressed, and equitable access to culturally sensitive comprehensive psychosocial assessments must be ensured. Funding: UK Department of Health and Social Care.

Citation

Farooq, B., Clements, C., Hawton, K., Ness, J., Patel, A., Kelly, S., …Kapur, N. (2021). Self-harm in children and adolescents by ethnic group: an observational cohort study from the Multicentre Study of Self-Harm in England. Lancet Child and Adolescent Health, 5(11), 782-791. https://doi.org/10.1016/S2352-4642%2821%2900239-X

• Journal Article Type: Article
• Acceptance Date: Jul 30, 2021
• Online Publication Date: Sep 20, 2021
• Publication Date: Nov 1, 2021
• Deposit Date: Aug 5, 2021
• Publicly Available Date: Mar 21, 2022
• Journal: Lancet Child and Adolescent Health
• Electronic ISSN: 2352-4642
• Peer Reviewed: Peer Reviewed
• Volume: 5
• Issue: 11
• Pages: 782-791
• DOI: https://doi.org/10.1016/S2352-4642%2821%2900239-X
• Public URL: https://nottingham-repository.worktribe.com/output/5955372
• Publisher URL: https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00239-X/fulltext
• Related Public URLs: https://www.sciencedirect.com/science/article/abs/pii/S235246422100239X