Spatial patterning and correlates of self-harm in Manchester, England

Abstract

Aims To investigate the spatial distribution of self-harm incidence rates, their socioeconomic correlates and sex/age differences using data on self-harm presentations to emergency departments from The Manchester Self-Harm Project (2003–2013). Methods Smoothed standardised incidence ratios for index self-harm episodes (n = 14 771) and their associations with area-level socioeconomic factors across 258 small areas (median population size = 1470) in the City of Manchester municipality were estimated using Bayesian hierarchical models. Results Higher numbers and rates of self-harm were found in the north, east and far southern zones of the city, in contrast to below average rates in the city centre and the inner city zone to the south of the centre. Males and females aged 10–24, 25–44 and 45–64 years showed similar geographical patterning of self-harm. In contrast, there was no clear pattern in the group aged 65 years and older. Fully adjusted analyses showed a positive association of self-harm rates with the percentage of the unemployed population, households privately renting, population with limiting long-term illness and lone-parent households, and a negative association with the percentage of ethnicity other than White British and travel distance to the nearest hospital emergency department. The area-level characteristics investigated explained a large proportion (four-fifths) of the variability in area self-harm rates. Most associations were restricted to those aged under 65 years and some associations (e.g. with unemployment) were present only in the youngest age group. Conclusions The findings have implications for allocating prevention and intervention resources targeted at high-risk groups in high incidence areas. Targets for area-based interventions might include tackling the causes and consequences of joblessness, better treatment of long-term illness and consideration of the accessibility of health services.

Does neighbourhood identification buffer against the effects of socioeconomic disadvantage on self-harm?

“…The results regarding socioeconomic disadvantage are consistent with an established body of research demonstrating a relationship between disadvantage and poorer mental health, including increased self-harm (Cairns et al, 2017;Carr et al, 2016;Griffin et al, 2019;Hawton et al, 2001;Lin et al, 2020;Lodebo et al, 2017;O'Farrell et al, 2014). The effect sizes observed in the present study suggests that disadvantage has a substantive relationship with self-harm.…”

“…Parental socioeconomic position (based on income and education) was associated with child self-harm rates in Sweden (Lodebo et al, 2017). Studies in the UK and Ireland have further demonstrated that area-level disadvantage (including specific indicators such as unemployment) has a consistent and substantive association with self-harm rates (Carr et al, 2016;Griffin et al, 2019;Hawton et al, 2001;Lin et al, 2020;O'Farrell et al, 2014). These studies rely on rates of self-harm based on people presenting to health services, and so miss instances of self-harm that do not result in health service contact.…”

Factors Affecting Emergency Medical Utilization After Self-harm and Effectiveness of Community-Based Suicide Prevention Provisions in Preventing Self-harm: A Nationwide Registry-Based Study in Korea

“…The burden of adult responsibilities such as economic independence, employment, and family obligations are more apparent in young adults (Benson & Furstenberg Jr, 2006). A failure to fulfill these roles will result in feelings of economic failure and self-harm impulses (Lin, et al, 2020 ). The loss of young adults, who play a significant role in economic activities, is a tremendous loss for society.…”

Variation in rates of self-harm hospital admission and re-admission by ethnicity in London: a population cohort study

“…More recent studies in a 2015 systematic review [8] have suggested that self-harm rates may no longer be raised in South Asian women but two studies, one in Manchester, Derby and Oxford [9] and the other in London [10] have suggested they may be raised in young Black women. Conversely, recent area-level studies in South East London [11] and Manchester [12] have suggested that rates of selfharm may be lower in areas with higher non-White British populations.…”