Self-Injury in Children and Adolescents by Ethnicity: An Observational Cohort Study from the England Multicenter Self-Injury Study

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Background

Studies report an increasing incidence of self-harm in children and adolescents, but the extent to which this is observed in different ethnic groups is unclear. Our objective was to study the rates of emergency department referrals for self-harm among children and adolescents by ethnicity, as well as to examine their demographic characteristics, clinical characteristics and outcomes.

Methods

In this observational cohort study, we used data on hospital emergency department referrals for self-injury in children and adolescents aged 10 to 19 years between 2000 and 2016 from the Multi-Center Self-Injury Study in England. This study collects data from five general hospitals in Manchester, Oxford and Derby in the UK, and defines self-injury as any act of intentional self-injury or self-poisoning, regardless of intention. All children and adolescents aged 10-19 years for whom data on ethnicity were available were included. Mortality tracking was available by linkage to Office for National Statistics mortality records. Self-injury rates over time, demographic and clinical characteristics, and self-injury methods were studied by ethnic group. The risk of repeated self-injury and mortality following a first presentation of self-injury was compared by ethnic group using Kaplan-Meier curves and Cox proportional hazards models.

Results

Of 14,894 people who presented to hospitals for self-harm, 11,906 had data on ethnicity, of which 10,211 (85.8%) were white, 344 (2.9%) were black, 619 (5.2%) were South Asian and 732 (6.1%) were other non-whites. Self-harm rates were highest among white children and adolescents, but increased between 2009 and 2016 across all ethnicities. The average annual rates of self-harm per 100,000 population were 574 for whites, 225 for blacks, 260 for South Asians, and 344 for other non-white groups. Increases in self-injury rates between 2009 and 2016 appeared to be slightly higher in black groups (incidence rate ratio of 1.07 [95% CI 1·03–1·11]), South Asian groups (1.05 [1·01–1·09]) and other non-white groups (1 11 [1·06–1·16]) than in white groups (1 02 [1·00–1·03]). Children and adolescents from an ethnic minority were more likely to live in severely disadvantaged areas and were less likely to receive specialized psychosocial assessment than white children and adolescents. Children and adolescents from ethnic minority groups were also less likely to self-harm. However, there were no differences in suicide mortality by ethnic group, although the numbers were small.

Interpretation

Children and adolescents from ethnic minorities accounted for an increased proportion of hospital self-harm presentations over time compared to white ethnic groups. Ethnic minority groups also tended to be more socio-economically disadvantaged and were less likely to receive a psychosocial assessment. Socioeconomic disparities must be addressed and equitable access to comprehensive and culturally appropriate psychosocial assessments must be ensured.

Funding

UK Department of Health and Welfare.


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