The epidemiology of self-harm in a UK-wide primary care patient cohort, 2001-2013.

Matthew J Carr,Nav Kapur,Roger T Webb,Yvonne Awenat,Evangelos Kontopantelis,Carolyn Chew-Graham,Darren M Ashcroft,Jayne Cooper

doi:10.1186/s12888-016-0753-5

Abstract

BackgroundMost of the research conducted on people who harm themselves has been undertaken in secondary healthcare settings. Little is known about the frequency of self-harm in primary care patient populations. This is the first study to describe the epidemiology of self-harm presentations to primary care using broadly representative national data from across the United Kingdom (UK).MethodsUsing the Clinical Practice Research Datalink (CPRD), we calculated directly standardised rates of incidence and annual presentation during 2001–2013. Rates were compared by gender and age and across the nations of the UK, and also by degree of socioeconomic deprivation measured ecologically at general practice level.ResultsWe found significantly elevated rates in females vs. males for incidence (rate ratio - RR, 1.45, 95 % confidence interval - CI, 1.42-1.47) and for annual presentation (RR 1.56, CI 1.54–1.58). An increasing trend over time in incidence was apparent for males (P < 0.001) but not females (P = 0.08), and both genders exhibited rising temporal trends in presentation rates (P < 0.001). We observed a decreasing gradient of risk with increasing age and markedly elevated risk for females in the youngest age group (aged 15–24 years vs. all other females: RR 3.75, CI 3.67–3.83). Increasing presentation rates over time were observed for males across all age bands (P < 0.001). We found higher rates when comparing Northern Ireland, Scotland, and Wales with England, and increasing rates of presentation over time for all four nations. We also observed higher rates with increasing levels of deprivation - most vs. least deprived male patients: RR 2.17, CI 2.10–2.25.ConclusionsIncorporating data from primary care yields a more comprehensive quantification of the health burden of self-harm. These novel findings may be useful in informing public health programmes and the targeting of high-risk groups toward the ultimate goal of lowering risk of self-harm repetition and premature death in this population.

Highlights

Most of the research conducted on people who harm themselves has been undertaken in secondary healthcare settings
Evidence from secondary care suggests that a significant gender difference exists, with males being at higher suicide risk but with females having a greater incidence of nonfatal self-harm [6, 7]
Formal comparisons produced the following female versus male rate ratios: 1.45 (CI: 1.42–1.47) for incident episodes, and 1.56 (CI 1.54–1.58) for all presentations to general practice (Table 1)

Summary

Introduction

Most of the research conducted on people who harm themselves has been undertaken in secondary healthcare settings. Little is known about the frequency of self-harm in primary care patient populations. Evidence from secondary care suggests that a significant gender difference exists, with males being at higher suicide risk but with females having a greater incidence of nonfatal self-harm [6, 7]. We anticipated that these findings would be replicated in a primary care cohort, and that we would observe varying patterns by age, with higher risk expected for the younger age groups [6]. In this paper we describe patterns of self-harm risk using directly standardised estimates of incidence and annual presentation rates at general practice

Methods

Results

Discussion

Conclusion