Abstract
PurposeUrban areas are usually found to have higher rates of self-harm, with deprivation the strongest predictor at area-level. We use a disease mapping approach to examine how self-harm is patterned within an urban area and its associations with deprivation, urbanness and ethnicity.MethodsData from clinical records on individuals admitted for self-harm for 725 small areas in South East London were included. Bayesian hierarchical models explored the spatio-temporal patterns of self-harm admission rates and potential associations with proximity to city centre, population density, percentage greenspace and non-white ethnic-minority populations. All models were adjusted for area-level deprivation, social fragmentation and hospital of admission.ResultsThere were 8327 first admissions for self-harm during the study period. Self-harm admission rates varied fourfold across the study area, with lower rates close to the city centre [adjusted standardised admission ratio, closest versus furthest quartile 0.71(95% CrI 0.54–0.96)]. Deprivation was associated with self-harm but partially masked rather than explained the spatial pattern, which strengthened after adjustment. After adjustment for deprivation, hospital of admission and social fragmentation, greenspace, population density and ethnicity were not associated with self-harm rates.ConclusionProximity to the city centre was associated with lower rates of self-harm, but the usual operationalisations of urbanness, population density and greenspace, were not. Deprivation did not explain the spatial patterning, nor did ethnicity. While nationally self-harm rates are higher in urban and deprived areas, this cannot be extrapolated to mean that within cities the inner-city is the highest risk area nor that risk will be principally patterned according to deprivation.
Highlights
Self-harm, through both self-poisoning and self-injury [1], represents a significant public health challenge in the UK, with evidence from administrative [2] and survey data [3] in England suggesting rates may have been rising since 2008
Over the 9.25-year period studied, there were 8327 first admissions to hospital for self-harm by individuals living within the study area
We have shown that rates of admission for self-harm are highly spatially patterned at small area-level within an urban study area
Summary
Self-harm, through both self-poisoning and self-injury [1], represents a significant public health challenge in the UK, with evidence from administrative [2] and survey data [3] in England suggesting rates may have been rising since 2008. Managing self-harm has a large impact on health services with over 100,000 general hospital inpatient admissions [4] in England each year. Self-harm requiring medical attention represents mental distress and usually disorder [5], damage to physical health [1] and is the strongest single risk factor for future suicide [6]. Rates of self-harm vary substantially between areas and communities [7]. Ecological studies of self-harm have attempted to do this by looking at small area-level associations with rates of self-harm [7].
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