Self-harm presentation across healthcare settings by sex in young people: an e-cohort study using routinely collected linked healthcare data in Wales, UK

Abstract

BackgroundThis study used individual-level linked data across general practice, emergency departments (EDs), outpatients and hospital admissions to examine contacts across settings and time by sex for self-harm in individuals aged 10–24 years old in Wales, UK.MethodsA whole population-based e-cohort study of routinely collected healthcare data was conducted. Rates of self-harm across settings over time by sex were examined. Individuals were categorised based on the service(s) to which they presented.ResultsA total of 937 697 individuals aged 10–24 years contributed 5 369 794 person years of data from 1 January 2003 to 30 September 2015. Self-harm incidence was highest in primary care but remained stable over time (incident rate ratio (IRR)=1.0; 95% CI 0.9 to 1.1). Incidence of ED attendance increased over time (IRR=1.3; 95% CI 1.2 to 1.5) as did hospital admissions (IRR=1.4; 95% CI 1.1 to 1.6). Incidence in the 15–19 years age group was the highest across all settings. The largest increases were seen in the youngest age group. There were increases in ED attendances for both sexes; however, females are more likely than males to be admitted following this. This was most evident in individuals 10–15 years old, where 76% of females were admitted compared with just 49% of males. The majority of associated outpatient appointments were under a mental health specialty.ConclusionsThis is the first study to compare self-harm in people aged 10–24 years across primary care, EDs and hospital settings in the UK. The high rates of self-harm in primary care and for young men in EDs highlight these as important settings for intervention.

Temporal trends in annual incidence rates for psychiatric disorders and self-harm among children and adolescents in the UK, 2003–2018

“…Girls aged 13-16 had the highest incidence, but rates increased at a faster rate in in the 10-12 group. Evidence from England & Wales report increases of a similar magnitude among adolescent girls aged 13-16 [14] and 10-14 [15] only, whereas we observed increases in both sexes and all age groups.…”

“…These studies also indicate a stable trend in incidence over time. Investigation of the incidence of self-harm, a behaviour that is strongly linked to poor mental health, has demonstrated an increase among adolescents in the UK [ 14 , 15 ] in recent years.…”

Patient safety and suicide prevention in mental health services: time for a new paradigm?

“…Methods of self-harm may also change and escalate to more lethal means (Witt, Daly, Arensman, Pirkis, & Lubman, 2019). Several large epidemiological studies based on UK primary care cohorts (Carr et al, 2016;Morgan et al, 2017); multicentre monitoring projects of self-harm (Geulayov et al, 2018); national UK wide surveys (McManus et al, 2019) and national data linkage studies in Wales (Marchant et al, 2019) indicate that rates of self-harm particularly in young people may be increasing. Internationally, similar rising rates of self-harm have been found in Australia (Perera et al, 2018), the United States (Westers, 2019), and Ireland .…”

Public Involvement & Engagement in the work of a data safe haven:

“…The 'Be Heard to Be Seen' project funded by Medical Research Council is an arts-led participatory approach to understanding 'big data' in mental health and use of images by young people. The aim of this project is to bring together researchers from across disciplines of arts, data science and medicine with young people to explore the issues around the generation and use of 'big data', including health records [30,31].…”