Skip to main content

Ethnic differences in self-harm, rates, characteristics and service provision: three-city cohort study

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

Studies of self-harm in Black and minority ethnic (BME) groups have been restricted to single geographical areas, with few studies of Black people.


To calculate age- and gender-specific rates of self-harm by ethnic group in three cities and compare characteristics and outcomes.


A population-based self-harm cohort presenting to five emergency departments in three English cities during 2001 to 2006.


A total of 20 574 individuals (16–64 years) presented with self-harm; ethnicity data were available for 75%. Rates of self-harm were highest in young Black females (16–34 years) in all three cities. Risk of self-harm in young South Asian people varied between cities. Black and minority ethnic groups were less likely to receive a psychiatric assessment and to re-present with self-harm.


Despite the increased risk of self-harm in young Black females fewer receive psychiatric care. Our findings have implications for assessment and appropriate management for some BME groups following self-harm.

Corresponding author
Jayne Cooper, Centre for Suicide Prevention, University of Manchester, Community Based Medicine, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK. Email:
Hide All

Declaration of interest

N.K. is Chair of the NICE Guidelines Development Group for the new self-harm guidelines.

Hide All
1 McKenzie, K, Serfaty, M, Crawford, M. Suicide in ethnic minority groups. Br J Psychiatry 2003; 183: 100–1.
2 Garlow, S, Purselle, D, Heninger, M. Ethnic differences in patterns of suicide across the life cycle. Am J Psychiatry 2005; 162: 319–23.
3 McKenzie, K, Bhui, K, Nanchahal, K, Blizard, B. Suicide rates in people of South Asian origin in England and Wales: 1993–2003. Br J Psychiatry 2008; 193: 406–9.
4 Bhui, K, McKenzie, K. Rates and risk factors by ethnic group for suicides within a year of contact with mental health services in England and Wales. Psychiatr Serv 2008; 59: 414–20.
5 Soni Raleigh, V. Suicide patterns and trends in people of Indian Subcontinent and Caribbean origin in England and Wales. Ethn Health 1996; 1: 5563.
6 Cooper, J, Husain, N, Webb, R, Waheed, W, Kapur, N, Guthrie, E, et al. Self-harm in the UK: differences between South Asians and Whites in rates, characteristics, provision of service and repetition. Soc Psychiatry Psychiatr Epidemiol 2006; 41: 782–8
7 Neeleman, J, Jones, P, van Os, J, Murray, RM. Parasuicide in Camberwell: ethnic differences. Soc Psychiatry Psychiatr Epidemiol 1996; 31: 284–7.
8 Neeleman, J, Wessley, S. Ethnic minority suicide: a small area geographical study in south London. Psychol Med 1999; 29: 429–36.
9 Neeleman, J, Wilson-Jones, C, Wessely, S. Ethnic density and deliberate self harm; a small area study in south east London. J Epidemiol Community Health 2001; 55: 8590
10 Claassen, D, Ascoli, M, Berhe, T, Priebe, S. Research on mental disorders and their care in immigrant populations: a review of publications from Germany, Italy and the UK. Euro Psychiatry 2005; 20: 540–9.
11 Bhui, K, McKenzie, K, Rasul, F. Rates, risk factors & methods of self harm among minority ethnic groups in the UK: a systematic review. BMC Public Health 2007; 7: 336.
12 Bhui, K, McKenzie, K. Final Report: Suicide Prevention for BME Groups in England. Report from the BME Suicide Prevention Project. Centre for Health Improvement and Minority Ethnic Services (CHIMES), 2006.
13 Department for Communities and Local Government. Index of Multiple Deprivation. Department for Communities and Local Government, 2007 (
14 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.
15 Waters, K, Stalker, C. MHLT (Derby) 2007 Annual Report of Both Reported Self Harm and Mental Health Presentation, Presenting to the Derby Acute Hospitals. Derbyshire Mental Health Services Trust, 2008.
16 Hawton, K, Catalan, J. Attempted Suicide: A Practical Guide to its Nature and Management. Oxford University Press, 1987.
17 Bhugra, D, Desai, M, Baldwin, DS. Attempted suicide in west London, I. Rates across ethnic communities. Psychol Med 1999; 29, 1125–30.
18 National Statistics. United Kingdom National Census, 2001. Office for National Statistics, 2001 (
19 Merrill, J, Owens, J. Ethnic differences in self poisoning. A comparison of West Indian and White groups. Br J Psychiatry 1987; 150: 765–8.
20 Stronks, K, Kunst, AE. The complex interrelationship between ethnic and socio-economic inequalities in health. J Public Health; 31: 324–5.
21 Garlow, S, Rosenberg, , Moore, JD, Haas, A, Koestner, B, Hendin, H, et al. Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention College Screening Project at Emory University. Depress Anxiety 2007; 25: 482–8.
22 Verger, P, Combes, JB, Kovess-Masfety, V, Choquet, M, Guagliardo, V, Rouillon, F, et al. Psychological distress in first year university students: socioeconomic and academic stressors, mastery and social support in young males and females. Soc Psychiatry Psychiatr Epidemiol 2009; 44: 643–50.
23 Karlsen, S, Nazroo, J. The relationship between racism, social class and physical and mental health among different ethnic groups in England. Ethn Health 2004; 9: S467.
24 Kirkbride, JB, Barker, D, Cowden, F, Stamps, R, Yang, M, Jones, PB, et al. Psychoses, ethnicity and socio-economic status. Br J Psychiatry 2008; 193: 1824.
25 Sharpley, MS, Hutchinson, G, Murray, RM, McKenzie, K. Understanding the excess of psychosis among the African–Caribbean population in England: review of current hypotheses. Br J Psychiatry 2001; 178: s608.
26 Crawford, M, Nur, U, McKenzie, K, Tyrer, P. Suicidal ideation and suicide attempts among ethnic minority groups in England: results of a national household survey. Psychol Med 2005; 35: 1369–77.
27 Garland, A, Lau, A, Yeh, M, McCabe, K, Hough, R, Lansverk, J. Racial and ethnic differences in utilization of mental health services among high-risk youths. Am J Psychiatry 2005; 162: 1336–43.
28 Ahmed, K, Mohan, R, Bhugra, D. Self-harm in South Asian women: a literature review informed approach to assessment and formulation. Am J Psychother 2007; 61; 7181.
29 Edge, D, Rogers, A. Dealing with it: Black Caribbean women's response to adversity and psychological distress associated with pregnancy, childbirth, and early motherhood. Soc Sci Med 2005; 61: 1525.
30 Edge, D. Ethnicity, psychosocial risk, and perinatal depression – a comparative study among inner-city females in the United Kingdom. J Psychosom Res 2007; 63: 291–5.
31 Kapur, N, Cooper, J, King-Hele, S, Webb, R, Lawlor, M, Rodway, C, et al. The repetition of suicidal behavior: a multicenter cohort study. J Clin Psychiatry 2006; 67: 1599–609.
32 Commission for Healthcare Audit and Inspection. Variations in the Experiences of Patients using the NHS Services in England. Analysis of the Healthcare Commission's 2004/2005 Surveys of Patients. Commission for Healthcare Audit and Inspection, 2006.
33 Raleigh, VS, Irons, R, Hawe, E, Scobie, S, Cook, A, Reeves, R, et al. Ethnic variations in the experiences of mental health service users in England. Results of a national patient survey programme. Br J of Psychiatry 2007; 191: 304–12.
34 Taylor, TL, Hawton, K, Fortune, S, Kapur, N. Attitudes towards clinical services among people who self-harm: systematic review. Br J of Psychiatry 2009; 194: 104–10.
35 Merrill, J, Owens, J. Ethnic differences in self poisoning: a comparison of Asian and White groups. Br J Psychiatry 1986; 148: 708–12.
36 Platt, L, Simpson, L, Akinwale, B. Stability and change in ethnic groups in England and Wales. Popul Trends 2005; 121: 3546.
37 National Institute for Mental Health in England. Inside Outside: Improving Mental Health Services for Black and Minority Ethnic Communities in England. Department of Health, 2003.
38 Department of Health. Delivering Race Equality in Mental Health Care: A Summary. TSO (The Stationery Office), 2005.
39 Bhugra, D, Arya, P. Ethnic density, cultural congruity and mental illness in migrants. Int Rev Psychiatry 2005; 17: 133–7.
40 Bhui, K. The new science of cultural epidemiology to tackle ethnic health inequalities. J Public Health 2009; 31: 322–3.
41 Bhui, K, Warfa, N, Edonya, P, McKenzie, K, Bhugra, D. Cultural competence in mental health care: a review of model evaluations. BMC Health Serv Res 2007; 7: 15.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
Type Description Title
Supplementary materials

Cooper et al. supplementary material
Supplementary Table S1-S2

 PDF (45 KB)
45 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 20 *
Loading metrics...

Abstract views

Total abstract views: 100 *
Loading metrics...

* Views captured on Cambridge Core between 3rd January 2018 - 21st March 2018. This data will be updated every 24 hours.

Ethnic differences in self-harm, rates, characteristics and service provision: three-city cohort study

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


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *