Variation by ethnic group in premature mortality risk following self-harm: a multicentre cohort study in England.

Pauline Turnbull,Ellen Townsend,Keith Hawton,Helen Bergen,Caroline Clements,Roger Webb,Nav Kapur,Jayne Cooper,Jennifer Ness,Keith Waters

doi:10.1186/s12888-015-0637-0

Abstract

BackgroundIncidence and risk factors for self-harm vary according to ethnicity. People who self-harm have been shown to have increased risk of premature death, but little is known about mortality following self-harm in ethnic minority groups.MethodsA prospective cohort study of self-harm presentations to three English cities (Derby, Manchester, Oxford) between 2000 and 2010. We linked to a national mortality dataset to investigate premature death in South Asian and Black people in comparison with White people to the end of 2012.ResultsEthnicity was known for 72 % of the 28,512 study cohort members: 88 % were White, 5 % were South Asian, and 3 % were Black. After adjusting for age, gender and area-level socioeconomic deprivation, the risk of all-cause mortality was lower in South Asian (hazard ratio [HR] 0.51, 95 % confidence interval [CI] 0.42 – 0.62) and Black people (HR 0.46, 95 % CI 0.39 – 0.55) versus White people. Suicide risk was significantly lower in Black people (HR 0.43, 95 % CI 0.19 – 0.97) than in White people. Prevalence of risk factors for premature death, such as previous self-harm, psychiatric treatment or concurrent alcohol misuse, was lower in South Asian and Black people than in White people.ConclusionsThe risk of death following self-harm is lower in South Asian and Black people than White people in the UK, and they also have lower prevalence of risk factors for premature death. Awareness of both protective and risk factors might help to inform clinical decisions following assessment.

Highlights

Incidence and risk factors for self-harm vary according to ethnicity
Ethnicity was known for 20,652/28,512 (72 %) of the individuals presenting to the study emergency departments (EDs) following a selfharm episode between 2000 and 2010
18,255 (88 %) people were White, and the remainder were from an ethnic minority, including 1068 (5 %) South Asian and 637 (3 %) Black people

Summary

Introduction

Incidence and risk factors for self-harm vary according to ethnicity. People who self-harm have been shown to have increased risk of premature death, but little is known about mortality following self-harm in ethnic minority groups. People who self-harm are at increased risk of further suicidal behaviour including suicide [1,2,3]. An investigation of suicide and other unnatural death following self-harm identified additional risk factors: being aged older than 35 years, Little is known about mortality following self-harm among ethnic minority groups in the UK. There is evidence that self-harm repetition is lower amongst South Asian and Black people than White people, incidence in the younger female ethnic minority groups appears to be at least equivalent to the White population [6,7,8]. Of South Asian and Black people who self-harm, those who repeat have similar social and clinical characteristics to White patients who repeat self-harm [9]

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