Table 3 Rates of Self Harm across Ethnic groups in the UK

Bhugra et al 1999a

Attempted suicide Per 10 000 person years

Women

Women

Men

Young South Asian women are vulnerable to increased rates of DSH.

Rate, 95%CI

Rate, 95%CI

Attempted suicide rates highest in South Asian women than other ethnic groups but highest in white men, maybe because inclusion of Irish in white category.

South Asian

37.7, 29.02–47.1

13.9, 8.9–20.8

In men highest rate in Whites aged 16–24 and Black people aged 25–34.

White

23.3, 19.7–27.4

24.6, 20.9–28.7

Black

23.9, 13.9–38.7

11.3, 4.6–23.2

Other

30.1, 17.6–48.2

8.7, 2.8–20.3

Attempted suicide rates highest in South Asian women aged 16–24 (92.7/10000 person years), aged 25–34 (34.4) and also high in "other" ethnic women aged 16–24 (75.9 per 100000 person years) and aged 25–34 (41.1).

White men also had high rates compared with other ethnic groups in 16–24 (30.2), 25–34 (28.1), 35–44 (30.1), as did black men in 25–34 age group (31.8).

Burke 1976a

Per 100 000 population

South Asian Adults

Age

Female Rate

Male Rate

Total Rate

Proportion of South Asians in self harm group was 60% of those expected considering population distributions

15–24

213

74

123

25–44

95

70

66

45–64

32

0

9

216

57

79

Rate lower than native population (57/100,000, 126/100,000).

Women more common among 15–24 group and men more common at later ages

Burke 1976b

Per 100 000 persons years

West Indian Adults

Age

Female

Male

Total

Rates among Caribbean females aged 15–24 twice that of males same age.

15–24

514

101

336

25–44

84

66

74

Total

180

56

113

Low risk of attempted suicide in Caribbean people

Dean et al 1976

Rates

Adults

Rates increasing in all countries, especially in 15–44 age groups, especially among women.

Country comparison of rates, England & Wales rate is greater than those of Scotland, Northern Ireland, or Republic of Ireland

Rates among women in England and Wales are twice the rate for Scotland and Ireland, and four times the rate for Republic of Ireland.

Lockhart et al 1987

Risk expressed as % at two time points 1971 and 1984

Adults

1971: 93 patients admitted on 100 occasions from population of 92 720

An increase in admissions for among West Indians for self-poisoning.

1983/84: 86 patients admitted on 94 occasions from 73 929

Risk of admissions per week halved from 5.8 to 2.5

Incidence rate halved from 326 to 178/100 000 persons a year

Rise in WI admissions from 0 to 7%, p < 0.05, fall among South Asians: 1 to 7%. P = 0.13, fall of Europids, p < 0.01

In 1971 and 1981, 6.4% of local population of WI origin

In 1983/4: 7% of local population of WI origin

McKenzie et al 2003

OR: unadjusted and adjusted for age, gender, MADRS, education, Diagnosis, time since onset)

Adults

AC

WB

OR

OR (adjusted)

Lower prevalence of suicidal behaviour in Caribbean origin people with psychosis not present in under 35's.

Attempted Suicide (AS)

14

29

0.52, 0.26 to 1.02

0.54, 0.26 to 1.13

AS for < 35 yo

12(13%)

13 (18%)

0.7, 0.36 to 1.51

0.93, 0.37 to 2.32

AS for > 35 yo

2(2.1%)

16 (11.4%)

0.17 (0.04–0.71)

0.19 (0.04 to 0.89)

AS or Completed Suicide

17

33

0.56, 0.3 to 1.03

0.59, 0.3 to 1.14

(age/gender adjusted = 0.49, 0.26 -0.92, p = 0.06)

Caribbean origin patients aged > 35 5 times less likely to attempt suicide

No difference in under 35's.

Attempted & completed suicide combined Caribbean origin patients aged > 35 4 times less likely.

Caribbean origin patients aged < 35 risk same as British whites

Merrill et al 1986

Rates of self poisoning per 100 000 per year

Adults

UK born

Asian born

p value

Rate for self-poisoning higher in Asian females than white females. Culture conflict important. Asian patients less likely to have previously self-poisoned, received psychiatric treatment or psychiatric diagnosis.

Men

25–34

438

146

< 0.0005

35–44

240

80

< 0.025

> 44

98

28

< 0.05

Overall

190

102

< 0.0005

Women

Overall

299

376

< 0.05

Merrill et al 1987

Rates of self poisoning/100 000 per year

Adult

West Indian

White British

p

Not very different from Asians, could be a reflection of service characteristics rather than ethnic group.

Overall

Men

103

190

< 0.025

Men 25–34

129

438

< 0.05

Women > 45

30

133

< 0.05

Rates for over 25s lower for men WI (men: p < 0.001; women: p < 0.005)

Merrill et al 1988

Rates per 100 000 per year

Adult

Men

Asians

West Indian

English

Irish

Scottish

Asian aribbean young females had greater rates than English females. Irish & Scottish of both sexes had higher rates than English.

25–34 yo:

146*****

129

406

662

1199*

Power and denominator problems

> 35

48**

57*

131

156

462*****

< 16

113*****

98***

236

243

648*****

Women

25–34 yo:

501

257

447

853*

565****

> 35

90

37

167

367*****

547****

< 16

402

229*

341

456*

626*

*p < 0.05, ** p < 0.01 ***p < 0.005 ****p < 0.001 *****p < 0.0005

Neeleman et al 1996

Referral Ratios

Adult

Unadjusted Referral Ratios (Ethnic groups generally younger) for all subjects

Indian female rates of Self Harm are 2.6 times the rate of white women

Men

Women

All

UK born Indian females had 7.8 times rate of UK born white females. Unemployment associated with a 9-fold increase in referral rates in whites and 3-fold increase in minorities.

Black Caribbean

0.56, 0.16–1.43

0.61, 0.24–1.26

0.61, 0.3–1.09

South Asian

0.39, 0.01–2.17

1.68, 0.61–3.66

1.15,0.46–2.37

Indian

0

2.6, 0.53–7.6

All Ethnic groups

0.45, 0.17–0.98

0.78, 0.45–1.27

0.65, 0.41–0.99

Unadjusted Referral Ratios (Ethnic groups generally younger) for UK born only

Men

Women

All

AC

0.19, 0.00–1.05

0.41, 0.08–1.20

0.32, 0.09–0.82

AS

1.2, 0.03–6.68

3.53, 0.96–9.03

2.55, 0.83–5.95

IN

0

7.76, 1.6–22.66

Cross validation study: ethnicity assigned on basis of name, to check that referral to DSH may be biased by ethnic group rather than reflect attendance. Only possible for Indian names

Attendance ratio Indian Men (indirect standardization): 1.92, 0.52–10.24; Indian women: 3.07, 1.4 to 5.8

Wright 1981

Annual increase in % admissions

Adult

Mean annual increase %

% born in country of origin for ethnic group

Self-poisoning is an inarticulate cry for help or even a cry of frustration.

1976

1979

Caucasian

9.5

100

100

West Indian

31.5

69.6

48

Asian

14.5

83.9

70.3

Studies of Adolescents

Hawton 2002

Prevalence

Adolescents

Males

Females

Lower risk among South Asian females not sustained in multivariate analyses

No

% self harm

OR

95%CI

No

% self harm

OR

95%CI

White

2536

3.3

1

2727

11.6

1

Asian

371

2.7

0.82

0.42–1.58

254

6.7

0.55

0.33–0.91

Black

68

0

-

-

89

6.7

0.55

0.24–1.27

Other

74

6.8

2.14

0.84–5.85

72

13.9

1.23

0.62–2.42

McGibben et al 1992

Per 1000 persons a year

Adolescents

Overall rates: 2.33/1000/year

Excess admission for DSP in Asian and white girls

Asians = 2.47/1000/year

White = 2.31/1000/year

Asian boys: 0..88/1000/year

White Boys 1.14/1000/year

Asian girl: 4.06/1000/year

White Girls: 3.47/1000/year

(NS)

Religion: NS, but a trend for more Sikhs to be admitted: Sikh 3.17/1000/year, Muslim 1.76, Hindu 1.46

Bhugra et al 2003

Rates of DSH per 10 000

Adolescents

White

South Asian

Female Self Harm rates are greater than male rates for South Asians & Whites.

Male aged 10–14:

7.3

9

Rates for South Asian and White women aged 14–15 do not differ much

Male aged 14–15:

62

-

Self Harm rates greater in white females aged 10–14 compared with South Asian

Female aged 10–14:

51

21

Female aged 14–15:

158

127

Female aged > 15:

44

-