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Table 2 Characteristics of studies on self harm in ethnic groups in the UK

From: Rates, risk factors & methods of self harm among minority ethnic groups in the UK: a systematic review

Author

Ethnicity definition

Population from sample is taken

Sample size

DSH or Suicide rating scale?

Data sources

Quality Rating

*Bagley 1972

Defined by oppression.

Black refers to those who lack economic power, and do not control their destinies.

White as oppressors.

South London A&E Department.

206 consecutive Admissions to casualty

Followed up over 18 months

25 Black (2 completed suicide, 23 recovered)

Black included the following: Caribbean (48%), Indian and Pakistani (20%), African (16%) Cypriot (16%).

25 White in comparison group

No

Hospital records

2

*Bhugra 2003

South Asian (Indian sub-continent origin) or White

All adolescents presenting to local East London Hospital in 1 year period for DSH

76 cases:

15 South Asian (12 women)

46 White (38 women)

6 Middle Eastern (4 women)

9 Black (9 women)

No

Case notes and interviews

1

*Bhugra 2004

South Asian: self ascribed origin: individuals whose parents, grandparents or themselves originate in Indian sub-continent

All adolescents presenting to hospital services in West London in a 1 year period for DSH

76 cases:

15 South Asian (12 women)

46 White (38 women)

6 Middle Eastern (4 women)

9 Black (9 women)

No DSH scale DACS (DSH Assessment by Clinicians Schedule)

Case notes and interviews

2

*Bhugra 1999a

Self-ascribed OPCS census categories & case notes.

Patient's aged 16–64 presenting with DSH to general, medical, accident or psychiatric services within local hospital in West London.

434 patients presenting with suicidal behaviour.

90 Asian cases of attempted suicide

No

Numbers of people presenting with DSH or attempted suicide

Hospital records, interview, GP records

4

*Bhugra et al 1999b

Self-ascribed OPCS census categories & case notes.

Patients aged 16–64 and resident in the areas for at least six months, presenting with DSH to general, medical, accident or psychiatric services in West London

Comparison of first 27 Asian women presenting with DSH with 27 matched controls (Asian women attending GP surgeries for other reasons)

Numbers of DSH or attempted suicide (DACS : DSH Assessment by Clinicians Schedule))

Hospital records, interview

4

* Burke 1976a

Self assigned Place of birth known for 2695 cases

Of 2075 with no place of birth, a 10% sample selected and case notes examined. 2.5% were of Asian origin

Admissions following attempted suicide to Birmingham hospital during a four year period: 1969–1972

Under 65s admitted with poisoning

68 admissions with Asian place of birth

16 cases: iatrogenic or accidental cases

52 deliberate self poisoning cases

No.

Admission to Birmingham hospitals following self poisoning used as entry criterion and definition for inclusion

Case notes

3

*Burke 1976b

Self assigned Place of birth known for 2695 cases

Of 2075 with no place of birth, a 10% sample selected and case notes examined. 2.5% were of Asian origin

Admissions following attempted suicide to Birmingham hospital during a four year period: 1969–1972

Under 65s admitted with poisoning

60 admissions with place of birth in West Indies

No

Case notes

3

* ≠ Burke 1980

As Burke 1976 a, b-same samples

Attempted suicide (1969–1972) and admitted to Birmingham hospitals

100 patients followed up until Jan 1969-average follow up period of 5 years

52 West Indian (3 had made 2 previous attempts)

48 Asian (three had made two attempts and one died at admission)

No

Classification based on attempted suicide and psychiatric history:

1. no psych history,

2. psych care at time of attempt

3. psych care before attempt

4 psych care following attempt

Medical, psychiatric records from GP, hospital and coroner

3

*Biswas 1990

Not given Asians selected on basis of Asian names

A & E presentations to Bradford Royal Infirmary, with self poisoning before or on 1st March 1987

72 (38 Asian, 34 White) adolescents

aged < or = 17 yrs

No

"self-poisoning" from case notes

Case notes

1

*± Dean et al 1976

Place of birth: country comparisons of rates of Non-fatal self poisoning: but no comparison of ethnic groups.

All deaths registered as suicides between 1970–72

333

Admissions for poisoning and adverse reactions in E, W & § Rep of Ireland

Assumed all for DSH and not adverse reactions: assessed assumption on 80 admissions. Of 80, 82.5% confirmed to be DSH.

Population census

5

*Goddard 1996

Based upon 1991 census. GP notes for clarification on 22 of them: 14 white, 7 black, 1 other.

Black Caribbean, Black African, Black Other, Indian, Pakistani, Bangladeshi, Chinese, Asian, Other White.

Groups collapsed into white, black, and other Asian

Total referrals to specialist centre at Maudsley Hospital

Age > 10 First referral following DSH

Total 100

White: 64

Black :28

Other 8

No

Standardised Maudsley assessment sheet: summary of symptoms, diagnosis, treatment, emotional symptoms and antisocial behaviour

Hospital records and OPCS

2

*Handy 1991

Parent & children's place of birth

Parents UK born = British

Asian born = Asian

Presenters to child guidance clinic, Walsgrave hospital Coventry

50 Adolescents

25 Asian

25 White

No

Self poisoning on presentation

Medical records

1

± Hawton 2002

None given

White

Asian

Black

Other

Pupils in 41 schools in England: Oxfordshire, Northamptonshire, and Birmingham. 90% of pupils aged 15 and 16

6020 pupils

White 2356

Asian 371

Black 68

Other 74

Question on self harm Asked for description of the act and consequences

Classified by 3 independent ratings using agreed definitions

Self report questionnaire

6

*Kingsbury 1994

No definition

Asian: Indian, Pakistani, Sri Lankan

12–18 year old attendees at West Middlesex hospital A&E. following overdose, Feb 1987-April1998

50 Total

113 Asian, 37 Caucasian

13 lost due to premature discharge and failure to attend follow up OPA

Pallis suicide intent scale

Hospital records, semi-structured interview questionnaire

4

*Lockhart 1987

Ethnic origin: no definition

Asian West Indian, Europid

Adults admitted after self poisoning to inner London General hospital. Two time periods:

from 1) Nov 1971 to Feb 1972. 2) Sept 1983-June1984

Adults over 15

1971/72

Europid = 80

Asian = 1

WI = 0

Other = 1

1983/84

Euro = 72

Asian = 6

WI = 7

Other = 1

No

Questionnaire completed for each patient

0

*McGibben 1992

No definitions

Denominators established from Asian names in electoral register and racial breakdown obtained from school data

Admissions to Coventry hospitals for overdose aged < 16 between 1982–90

92% of admissions referred for opinion and therefore included in sample

340 referrals for overdose 1982–90

295 admitted for DSH

222 girls

73 boys

45 Asian of which 37 were girls

No. Deliberate self poisoning

Hospital records, population denominators from city of Coventry, 1981 census data, Coventry school pupil census

0

*McKenzie 1995

White i.e. self or parents UK born, Afro-Caribbean =both parents born in Caribbean

Admissions for psychosis to 2 London psychiatric hospitals 1985/March 986 – Feb 1988 Oct 1988-August 1989

Recent (5 year) onset of psychosis

Four year follow up

191 in total, but follow up data on 166 (87%) available

53 Afro-Caribbean 60 White

No

WHO life chart

HADS

WHO disability assessment schedule

PSE at baseline

Interview

7

≠ McKenzie 2003

Observer defined OPCS 1991 and Gen Register for Scotland

White = OPCS white with mother and father born in the UK

Caribbean = OPCS Black-Caribbean or Black Other with mother or father born in Caribbean or UK

People with psychosis in a case management trial

3 London 1 Manchester centre

708

Baseline

203 Caribbean

234 White British

Follow up attrition

AC: 26 (13%)

WB: 35 (15%)

Drop outs: AC 20 & 25 WB

No.

WHO Life Chart: asked if attempted suicide and frequency

Rated on patient report and all sources of information including case notes/relatives/managers

Case notes, interview with family, client, case managers

8

*Merrill 1986

Whites: born in England, Scotland & Wales

South Asians: born in India. Pakistan, Bangladesh, UK (n = 52, 26.5%) & East Africa (5.26%)

Admission to West Midlands Poisons unit for self poisoning with mediation or taking substances not fit for consumption

1 Jan 1979 to 31 Dec 1981

1171

975 White 196 Asians (59% Indian, Sikh)

No

Admissions records. Coding sheet completed by admitting clinicians

4

*Merrill 1987

Place of birth

Admission to West Midlands Poisons unit for self poisoning with mediation or taking substances not fit for consumption

1 Jan 1979 to 31 Dec 1981

975 White 130 West Indian (55 born in WI, 75 born in UK but WI parentage)

No

Admissions records. Coding sheet completed by admitting clinicians

2

*Merrill 1988

Place of birth

Irish

Scottish

English Indian/Pakistan

West Indian

A & E attendees at West Birmingham. DSH leading to admission to West Midlands poisons unit Birmingham

1st Jan 1979 to 31st Dec 1981

467

Asian: 36

West India: 16

Scottish: 17

English: 364

Irish: 34

No

Admissions records. Coding sheet completed by admitting clinicians

3

*Neeleman 1996

Region of birth, ethnicity from OPCS 1991 census: White Black Caribbean

Black African

Other, Indian Pakistani

Bangladeshi

Chinese

Asian Others

A&E attendees at Kings College Hospital, for intentional overdose, over 6 month period in 1991:

237 patients attended

DSH team assessed 48% (113/247) of all attenders.

Total 105

Ethnic Group

83 White (78)

11 African Caribbean (4)

7 Asian (1)

4 African (2)

No

Attendance and psychiatric assessment were criteria

Hospital records OPCS

3

*Neeleman 2001

Observer assigned OPCS categories collapsed into:

White

African Caribbean

Asian

A & E attendees with DSH at two London

Hospitals: King's College Hospital (KCH) and Lewisham Hospital (LH).

Attenders: 2352

Analyses for 1643 attending own A&E. Unknown ethnic origin: 184

KCH LH

1341+1011

White: 720 + 608

AC : 212 + 71

Asian : 9 + 23

No

Attendence for DSH, excluded accidents and uncertain cases

Hospital records. 1991 census

6

*Sheth 1994

None

Adult admitted to Yorkshire burns unit, March 1983 to March 1993, with suicidal burns injury

234 admissions, 20 of which had suicidal burns injury, 17 of whom were women

Of the women 14 (70%) were Asian

No

Case notes

1

*Wright 1981

Asian (from the Indian sub continent-majority Sikhs)

West Indian

Caucasian

Admissions to Dudley Road Hospital 1976–79

2001 Total

1665 White

160 Caribbean

176 Asian

No

Questionnaire on social, physical, psychiatric history. Filled in by doctors

0

  1. *Cross sectional studies, usually a case series using ethnic group comparisons, and associations between those with and without self harm.
  2. ≠ Prospective.
  3. ± Population based study using schools as sampling frame