Rates of self-harm presenting to general hospitals: a comparison of data from the Multicentre Study of Self-Harm in England and Hospital Episode Statistics

Abstract

ObjectiveRates of hospital presentation for self-harm in England were compared using different national and local data sources.DesignThe study was descriptive and compared bespoke data collection methods for recording self-harm presentations to hospital with routinely collected hospital data.SettingLocal area data on self-harm from the 3 centres of the Multicentre Study of Self-harm in England (Oxford, Manchester and Derby) were used along with national and local routinely collected data on self-harm admissions and emergency department attendances from Hospital Episode Statistics (HES).Primary outcomeRate ratios were calculated to compare rates of self-harm generated using different data sources nationally and locally (between 2010 and 2012) and rates of hospital presentations for self-harm were plotted over time (between 2003 and 2012), based on different data sources.ResultsThe total number of self-harm episodes between 2010 and 2012 was 13 547 based on Multicentre Study data, 9600 based on HES emergency department data and 8096 based on HES admission data. Nationally, routine HES data underestimated overall rates of self-harm by approximately 60% compared with rates based on Multicentre Study data (rate ratio for HES emergency department data, 0.41 (95% CI 0.35 to 0.49); rate ratio for HES admission data, 0.42 (95% CI 0.36 to 0.49)). Direct local area comparisons confirmed an overall underascertainment in the HES data, although the difference varied between centres. There was a general increase in self-harm over time according to HES data which contrasted with a fall and then a rise in the Multicentre Study data.ConclusionsThere was a consistent underestimation of presentations for self-harm recorded by HES emergency department data, and fluctuations in year-on-year figures. HES admission data appeared more reliable but missed non-admitted episodes. Routinely collected data may miss important trends in self-harm and cannot be used in isolation as the basis for a robust national indicator of self-harm.

Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care

“…We found a noticeable increase in recorded self harm episodes among girls in their doi: 10.1136/bmj.j4351 | BMJ 2017;359:j4351 | the bmj early-mid teens, and at younger ages than previously reported. The recent sharp increase seems to be specific to [13][14][15][16] year old girls. This marked apparent increase prompts the urgent need to identify the causes of this phenomenon.…”

“…Having stratified on age band, index of multiple deprivation, and region of residence, we then applied stratum specific rates to calculate directly standardised incidence rates. Age was categorised as pre-teenager (10)(11)(12), early teenager (13)(14)(15)(16), and late teenager (17)(18)(19) year bands, and the index of multiple deprivation was placed into fifths based on general practice location.…”

Characteristics of Attempted Suicide Patients Presenting to a Greek Emergency Department

“…In England, there be over 200.000 presentations for self-harm to emergency departments annually and trends in rates of attempted suicide appeared to have a steady increase since 2008 [8,9]. These visits accounted for 0.4% and 4,7% of the total ED visits in USA and Japan, respectively [10,11].…”

Health outcomes associated with emergency department visits by adolescents for self-harm: a propensity-matched cohort study

“…This study used administrative data and is subject to weaknesses of such data, including the lack of validation of many specific mental health or other clinical codes. 18,[33][34][35][36][37][38] In Appendix 1, we argue it is likely that ICD-10 codes Note: CI = confidence interval, ED = emergency department, HR = hazard ratio, *Time-to-event analyses were Cox regressions of the time to the outcome regressed on whether the adolescent had a self-harm emergency department visit (self-harm column), whether the adolescent had a mental health code associated with the index emergency department visit or any other medical service in the last year (history of mental health conditions column), and the interaction between those markers (self-harm × mental health history column). In the cell with "≤ 5," the actual count and percentage were suppressed to prevent reidentification of patients.…”