Skip to main content Accessibility help
×
Home

Epidemiology and trends in non-fatal self-harm in three centres in England: 2000–2007

  • Helen Bergen (a1), Keith Hawton (a1), Keith Waters (a2), Jayne Cooper (a3) and Navneet Kapur (a3)...

Abstract

Background

Self-harm is a common reason for presentation to a general hospital, with a strong association with suicide. Trends in self-harm are an important indicator of community psychopathology, with resource implications for health services and relevance to suicide prevention policy. Previous reports in the UK have come largely from single centres.

Aims

To investigate trends in non-fatal self-harm in six general hospitals in three centres from the Multicentre Study of Self-harm in England, and to relate these to trends in suicide.

Method

Data on self-harm presentations to general hospital emergency departments in Oxford (one), Manchester (three) and Derby (two) were analysed over the 8-year period 1 January 2000 to 31 December 2007.

Results

Rates of self-harm declined significantly over 8 years for males in three centres (Oxford: −14%; Manchester: −25%; Derby: −18%) and females in two centres (Oxford: −2% (not significant); Manchester: −13%; Derby: −17%), in keeping with national trends in suicide. A decreasing proportion and number of episodes involved self-poisoning alone, and an increasing proportion and number involved other self-injury (e.g. hanging, jumping, traffic related). Episodes involving self-cutting alone showed a slight decrease in numbers over time. Trends in alcohol use at the time of self-harm and repetition within 1 year were stable.

Conclusions

There were decreasing rates of non-fatal self-harm over the study period that paralleled trends in suicide in England. This was reflected mainly in a decline in emergency department presentations for self-poisoning.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Epidemiology and trends in non-fatal self-harm in three centres in England: 2000–2007
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Epidemiology and trends in non-fatal self-harm in three centres in England: 2000–2007
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Epidemiology and trends in non-fatal self-harm in three centres in England: 2000–2007
      Available formats
      ×

Copyright

Corresponding author

Keith Hawton, Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK. Email: keith.hawton@psych.ox.ac.uk

Footnotes

Hide All

We acknowledge financial support from the Department of Health under the NHS R&D Programme (DH/DSH2008). The Department of Health had no role in study design, the collection, analysis and interpretation of data, the writing of the report, and the decision to submit the paper for publication. The views and opinions expressed herein do not necessarily reflect those of the Department of Health. K.H. is a National Institute for Health Research Senior Investigator.

Declaration of interest

None.

Footnotes

References

Hide All
1 Hawton, K, Bergen, H, Casey, D, Simkin, S, Palmer, B, Cooper, J, et al. Self-harm in England: a tale of three cities. Multicentre study of self-harm. Soc Psychiatry Psychiatr Epidemiol 2007; 42: 513–21.
2 Owens, D, Horrocks, J, House, A. Fatal and non-fatal repetition of self-harm. Systematic review. Br J Psychiatry 2002; 181: 193–9.
3 Cooper, J, Kapur, N, Webb, R, Lawlor, M, Guthrie, E, Mackway-Jones, K, et al. Suicide after deliberate self-harm: a 4-year cohort study. Am J Psychiatry 2005; 162: 297303.
4 Hawton, K, Harriss, L, Zahl, D. Deaths from all causes in a long-term follow-up study of 11,583 deliberate self harm patients. Psychol Med 2006; 36: 397405.
5 Department of Health. National Suicide Prevention Strategy for England. Department of Health, 2002.
6 National Mental Health Development Unit. National Suicide Prevention Strategy for England. Annual Report on Progress 2008. National Mental Health Development Unit, 2009 (http://www.nmhdu.org.uk/silo/files/national-suicide-prevention-strategy-for-england--annual-report-on-progress-2008.pdf).
7 Schmidtke, A, Bille-Brahe, U, De Leo, D, Kerkhof, AJFM. Suicidal Behaviour in Europe: Results from the WHO/EURO Multicentre Study on Suicidal Behaviour. Hogrefe & Huber, 2004.
8 Belgamwar, RB, Hodgson, RE, Waters, K. Trends and characteristics of deliberate self-harm hospital presentations in an English County. Int J Psychiatry Cli Pract 2006; 10: 5963.
9 Hawton, K, Harriss, L, Hall, S, Simkin, S, Bale, E, Bond, A. Deliberate self-harm in Oxford, 1990–2000: a time of change in patient characteristics. Psychol Med 2003; 33: 987–96.
10 O'Loughlin, S, Sherwood, J. A 20-year review of trends in deliberate self-harm in a British town, 1981–2000. Soc Psychiatry Psychiatr Epidemiol 2005; 40: 446–53.
11 Platt, S, Hawton, K, Kreitman, N, Fagg, J, Foster, J. Recent clinical and epidemiological trends in parasuicide in Edinburgh and Oxford: a tale of two cities. Psychol Med 1988; 18: 405–18.
12 Schmidtke, A, Bille-Brahe, U, De Leo, D, Kerkhof, A, Bjerke, T, Crepet, P, et al. Rates and trends of attempted suicide in Europe 1989–1992. In Attempted Suicide in Europe: Findings from the Multicentre Study on Parasuicide by the WHO Regional Office for Europe (eds Kerkhof, AJFM, Schmidtke, A, Bille-Brahe, U, De Leo, D, Lönnqvist, J): 209–29. DSWO Press, 1994.
13 Wilkinson, S, Taylor, G, Templeton, L, Mistral, W, Salter, E, Bennett, P. Admissions to hospital for deliberate self-harm in England 1995–2000: an analysis of Hospital Episode Statistics. J Public Health 2002; 24: 179–83.
14 Claassen, CA, Carmody, T, Bossarte, R, Trivedi, MH, Elliott, S, Currier, GW. Do geographic regions with higher suicide rates also have higher rates of nonfatal intentional self-harm? Suicide Life Threat Behav 2008; 38: 637–49.
15 Bergen, H, Hawton, K, Murphy, E, Cooper, J, Kapur, N, Stalker, C, et al. Trends in prescribing and self-poisoning in relation to UK regulatory authority warnings against use of SSRI antidepressants in under-18 year-olds. Br J Clin Pharmacol 2009; 68: 618–29.
16 Kapur, N, Murphy, E, Cooper, J, Bergen, H, Hawton, K, Simkin, S, et al. Psychosocial assessment following self-harm: results from the Multi-Centre Monitoring of Self-Harm Project. J Affect Disord 2008; 106: 285–93.
17 National Collaborating Centre for Mental Health. Self-Harm: the Short-Term Physical and Psychological Management and Secondary Prevention of Self-harm in Primary and Secondary Care. Clinical Guideline 16. British Psychological Society and Royal College of Psychiatrists, 2004.
18 Royal College of Psychiatrists. Assessment Following Self-harm in Adults. Council Report CR122. Royal College of Psychiatrists, 2004.
19 Office for National Statistics. Population Estimates for UK, England and Wales, Scotland and Northern Ireland – Current Datasets. ONS, 2008 (http://www.statistics.gov.uk/statbase/Product.asp?vlnk=15106).
20 The NHS Information Centre for health and social care. Mortality from Suicide and Injury Undetermined. The Clinical and Health Outcomes Knowledge Base, 2009 (http://www.nchod.nhs.uk/).
21 Communities and local government. Indices of Deprivation 2004. Communities and local government, 2009 (http://webarchive.nationalarchives.gov.uk/+/http://www.communities.gov.uk/archived/general-content/communities/indicesofdeprivation/216309/).
22 Hawton, K, Harriss, L, Hodder, K, Simkin, S, Gunnell, D. The influence of the economic and social environment on deliberate self-harm and suicide: an ecological and person-based study. Psychol Med 2001; 31: 827–36.
23 Hawton, K, Fagg, J, Simkin, S, Bale, E, Bond, A. Trends in deliberate self-harm in Oxford, 1985–1995. Implications for clinical services and the prevention of suicide. Br J Psychiatry 1997; 171: 556–60.
24 National Institute for Mental Health in England. Fourth Annual Report on Progress in Implementing the National Suicide Prevention Strategy for England, 2006. Department of Health, 2007 (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_074134).
25 Organisation for Economic Cooperation and Development. Country Statistical Profiles 2007: United Kingdom. OECD StatExtracts, 2010(http://stats.oecd.org/Index.aspx?DatasetCode=MEILABOUR).
26 Johnson, GM, Zastawny, S, Kulpa, A. E-message boards for those who self-injure: implications for e-health. Int J Ment Health Addict 2009; August 18 (Epub ahead of print).
27 Prasad, V, Owens, D. Using the internet as a source of self-help for people who self-harm. Psychiatr Bull 2001; 25: 222–5.
28 National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Annual Report July 2009. University of Manchester, 2009 (http://www.medicine.manchester.ac.uk/psychiatry/research/suicide/prevention/nci/inquiryannualreports/AnnualReportJuly2009.pdf).
29 Gunnell, D, Bennewith, O, Hawton, K, Simkin, S, Kapur, N. The epidemiology and prevention of suicide by hanging: a systematic review. Int J Epidemiol 2005; 34: 433–22.
30 Joseph Rountree Foundation. Drinking in the UK: An Exploration of Trends. Joseph Rountree Foundation, 2009 (http://www.jrf.org.uk/publications/drinking-in-the-uk).
31 The NHS Information Centre Lifestyles Statistics. Statistics on Alcohol, England 2009. NHS Information Centre for Health and Social Care, 2009.
32 Haw, C, Hawton, K, Casey, D, Bale, E, Shepherd, A. Alcohol dependence, excessive drinking and deliberate self-harm: trends and patterns in Oxford, 1989–2002. Soc Psychiatry Psychiatr Epidemiol 2005; 40: 964–71.
33 Bennewith, O, Peters, TJ, Hawton, K, House, A, Gunnell, D. Factors associated with the non-assessment of self-harm patients attending an Accident and Emergency Department: results of a national study. J Affect Disord 2005; 89: 91–7.
34 Bergen, H, Hawton, K, Waters, K, Cooper, J, Kapur, N. Psychosocial assessment and repetition of self-harm: the significance of single and multiple repeat episode analyses. J Affect Disord 2010; May 29 (Epub ahead of print).
35 Crawford, MJ, Wessely, S. Does initial management affect the rate of repetition of deliberate self-harm? Cohort study. BMJ 1999; 317: 985.
36 Bennewith, O, Gunnell, D, Peters, TJ, Hawton, K, House, A. Variations in the hospital management of self-harm in adults in England: observational study. BMJ 2004; 328: 1108–9.
37 Hawton, K, Harriss, L, Simkin, S, Bale, E, Bond, A. Social class and suicidal behaviour: the associations between social class and the characteristics of deliberate self-harm patients and the treatment they are offered. Soc Psychiatry Psychiatr Epidemiol 2001; 36: 437–43.
38 Johnston, A, Cooper, J, Webb, R, Kapur, N. Individual- and area-level predictors of self-harm repetition. Br J Psychiatry 2006; 189: 416–21.
Type Description Title
PDF
Supplementary materials

Bergen et al. supplementary material
Supplementary Table S1

 PDF (34 KB)
34 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Epidemiology and trends in non-fatal self-harm in three centres in England: 2000–2007

  • Helen Bergen (a1), Keith Hawton (a1), Keith Waters (a2), Jayne Cooper (a3) and Navneet Kapur (a3)...
Submit a response

eLetters

Our experience of Self Harm Trends.

Dr Mukesh Kripalani, Consultant Psychiatrist
24 January 2011

Dear Sir/Madam

We read with interest the article: Epidemiology and trends in non-fatal self-harm in three centres in England: 2000–2007, published in Dec 2010. We have a Liaison service running during the same above period and have collated our data in order to see whether it does match the trends as described in the paper.

The model of our service has been well described (1) with a dedicated self harm team and an integrated care pathway. Our area serves a vast population under the catchment area of James Cook University Hospital in Middlesbrough, ordinarily covering residents from the Middlesbrough, Redcar and Cleveland areas (Redcar population 139,132 and Middlesbrough, approximately 134,855 via the 2001 Census available at http://www.statistics.gov.uk/census2001/pyramids/pages/00ee.asp). The population we serve is among the most deprived in the country with 45% of people in the area living in the 20% most deprived areas of England and over 30% of children living in families receiving means tested benefits (England average 22.4% according to http://www.mrccs.nhs.uk/index.asp?categoryid=1&contentid=1593&parentid=1371)

In the 8 years between 2000 and 2007, we did not record a reduction in the number of episodes of self harm, in contrast to the 3 centres in the study above.

For males, our trend has increased gradually from 390 in the year 2000 to peak at 713 in 2006.

For females, our lowest figure was recorded in the year 2000 as 483 and peaked at 712 in 2005 and hovers around 650 since.

Regarding methods of self-harm, we broke down data in to “Self poisoning” only (79%) and “Self Cutting” only (16.5%) and our results startlingly mirror that of Manchester.

Suicide figures, (including suicide verdicts and undetermined injury) show fluctuating rates. Interestingly, despite a peak in self harm in 2005, the suicide numbers were lower (17) compared to 2006 (31). (See table below)

2000: 33, 2001: 32, 2002: 34, 2003: 32, 2004: 33, 2005: 17, 2006 31, 2007: 32

To summarise, we have yet to see a reduction in the overall rates of self harm as pictured in the article and nationally. Our suicide statistics also do not quite reflect a reduction. Our concern remains about the impending cuts to public services which have the potential to jeopardise our region further. Middlesbrough has been labelled ‘the worse place to live in the UK’.(http://www.dailymail.co.uk/news/article-1204127/Middlesbrough-really-worst-place-live.html).

Can our region expect a further worsening in the recent future? Do we have the capacity to manage a further increase in the people who self harm? Only time will tell.

References:1. Integrated care pathway for self-harm: our way forward. Emerg Med J 2010;27:544-546 http://emj.bmj.com/content/27/7/544.full

Acknowledgement: To the Liaison Psychiatry Team and Samantha Broadbent
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *