Social Psychiatry and Psychiatric Epidemiology

, Volume 41, Issue 10, pp 782–788 | Cite as

Self-harm in the UK

Differences between South Asians and Whites in rates, characteristics, provision of service and repetition
  • Jayne CooperEmail author
  • Nusrat Husain
  • Roger Webb
  • Waquas Waheed
  • Navneet Kapur
  • Else Guthrie
  • Louis Appleby



Rates of self-harm appear high in South Asian young women in the United Kingdom (UK) although previous studies were mostly small. Data on treatment and outcomes for South Asians are lacking. This study compared rates of self-harm, socio-demographic and clinical characteristics, provision of services and risk of repetition by ethnicity.


A prospective cohort of adult self-harm attendees (n = 7185), aged 15 and over presenting to four emergency departments in the cities of Manchester and Salford, UK over a 4-year period.


The study included 299 South Asians. South Asian women aged 16–24 years were more likely to self-harm than Whites of the same age group (1010.9 vs. 754 per 100,000). Across all age groups the rates of self-harm were lower in South Asian men compared to White men and to South Asian women. South Asian women were significantly more likely to report relationship problems within the family than White women (32% vs. 19%, P = <0.001). South Asians were less likely than Whites to report depressive symptoms and to be offered specialist mental health services (Rate ratio = 0.75), and more likely to be referred back to the GP (Rate ratio = 1.83). South Asians were less likely to attend with a repeat episode (Rate ratio = 0.56).


Young South Asian women are at high risk of self-harm, but their clinical risk appears to be lower in terms of the accepted contextual factors contributing to risk. Potentially useful service provision may include an interpersonal problem solving approach although to be effective, interventions would need to be acceptable to South Asian women and culturally appropriate.

Key words

deliberate self-harm ethnicity epidemiology health services research 



The authors thank the staff from the MASSH project, in particular Amy Johnston, for data collation and the clinicians at the participating hospitals for completing the assessment form. The project was funded by Manchester Health Authority, South Manchester University Hospitals NHS Trust, Manchester Healthcare NHS Trust, North Manchester Healthcare NHS Trust and the Mental Health Services of Salford NHS Trust.


  1. 1.
    Kapur N, House A, Creed F, Feldman E, Guthrie E (1998) Management of deliberate self-poisoning in adults in four teaching hospitals: descriptive study. BMJ 316:831–832PubMedGoogle Scholar
  2. 2.
    Schmidke A, Bille-Brahe U, De Leo D, Kerkhof A, Bjerke T, Crepet PD, Haring C, Hawton K, Lönnqvist J, Michel K, Pommereau X, Querejeta I, Phillipe I, Salander-Renberg E, Temesvary B, Wasserman D, Fricke S, Weinacker B, Sampaio-Faria JG (1996) Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989–1992. Results of the WHO/EURO multicentre study on deliberate self-harm. Acta Psychiatr Scand 93:327–338Google Scholar
  3. 3.
    Merrill J, Owens J (1986) Ethnic differences in self poisoning—a comparison of Asian and white groups. Br J Psychiatry 148:708–712PubMedGoogle Scholar
  4. 4.
    Bhugra D, Desai M, Baldwin D (1999) Attempted suicide in West London 1. Rates across ethnic communities. Psychol Med 29:1125–1130PubMedCrossRefGoogle Scholar
  5. 5.
    Husain N, Creed F, Tomenson B (1997) Adverse social circumstances and depression in UK persons of Pakistani origin. Br J Psychiatry 171:434–433PubMedGoogle Scholar
  6. 6.
    Bhui K, Bhugra D, Goldberg D, Sauer J, Tylee A (2004) Assessing the prevalence of depression in Punjabi and English primary care attenders: the role of culture, physical illness and somatic symptoms. Trans Psychiatry 41(3):307–322CrossRefGoogle Scholar
  7. 7.
    Weich S, Nazroo J, Sproston K, McManus S, Blanchard M, Erens B, Karlsen S, King M, Lloyd K, Stansfeld S, Tyrer P (2004) Common mental disorders and ethnicity in England: the EMPIRIC. Psychol Med 34(8):1543–1551PubMedCrossRefGoogle Scholar
  8. 8.
    Beiser M, Johnson PJ, Turner RJ (1993) Unemployment, underemployment and depressive affect among Southeast Asian refugees. Psychol Med 23(3):731–743PubMedCrossRefGoogle Scholar
  9. 9.
    Hussain F, Cochrane R (2004) Depression in South Asian women living in the UK: a review of the literature with implications for service provision. Trans Psychiatry 41(2):253–270CrossRefGoogle Scholar
  10. 10.
    Fazil Q, Cochrane R (1998) The cultural dimension in a causal model of depression. Fourteenth International Congress of Cross Cultural Psychology, Bellingham, WAGoogle Scholar
  11. 11.
    Chew-Graham C, Bashir C, Chancellor K, Burman E, Batslee J (2002) South Asian women, psychological distress and self-harm: lessons for primary care trusts. Health Social Care Commun 10(5):339–347CrossRefGoogle Scholar
  12. 12.
    Bhugra D, Baldwin D, Desai M, Jacob KS (1999) Attempted suicide in West London. 11. Intergroup comparisons. Psychol Med 29:1131–1139PubMedCrossRefGoogle Scholar
  13. 13.
    Owens D, Horrocks J, House A (2002) Fatal and non-fatal repetition of self-harm: systematic review. Br J Psychiatry 181:193–199PubMedCrossRefGoogle Scholar
  14. 14.
    Cooper J, Kapur N, Webb R, Guthrie E, Lawlor M, Macway-Jones K, Appleby L (2004) Suicide following deliberate self-harm: a 4 year cohort study. Am J Psych 162:297–303CrossRefGoogle Scholar
  15. 15.
    Bennewith O, Gunnell D, Peters TJ, Hawton K, House A (2004) Variations in the hospital management of self-harm in adults in England: observational study. Br Med J 328:1108–1109CrossRefGoogle Scholar
  16. 16.
    National Institute for Mental Health in England (2003) Inside outside: improving mental health services for black and minority ethnic communities in England. Department of Health Google Scholar
  17. 17.
    National Statistics (2001) United Kingdom national census, 2001.
  18. 18.
    Davies HT, Crombie IK, Tavakoli M (1998) When can odds ratios mislead? BMJ 316:989–991PubMedGoogle Scholar
  19. 19.
    McNutt LA, Wu C, Xue X (2003) Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol 157:940–943PubMedCrossRefGoogle Scholar
  20. 20.
    Altman DG, Deeks JJ, Sackett DL (1998) Odds ratios should be avoided when events are common [letter]. BMJ 317:1318PubMedGoogle Scholar
  21. 21.
    Khan MM, Reza H (1998) Gender differences in nonfatal suicidal behavior in Pakistan: significance of sociocultural factors. Suicide Life Threat Behav Sring 28(1):62–68Google Scholar
  22. 22.
    Nazroo JY (1997) The health of Britain’s ethnic minorities: findings from a national survey. Policy Studies Institute, LondonGoogle Scholar
  23. 23.
    Cochrane R, Bal SS (1989) Mental hospital admission rates of immigrants to England: a comparison of 1971 and 1981. Soc Psychiatry Psychiatr Epidemiol 24:2–11PubMedCrossRefGoogle Scholar
  24. 24.
    Khan MM, Islam S, Kundi AK (1996) Parasuicide in Pakistan: experience at a university hospital. Acta Psychiatr Scand 93(4):264–267PubMedGoogle Scholar
  25. 25.
    Nazroo JY (1998) Rethinking the relationship between ethnicity and mental health: the British fourth national survey of ethnic minorities. Soc Psychiatry Psychiatr Epidemiol 33:145–148PubMedCrossRefGoogle Scholar
  26. 26.
    Beliappa J (1991) Illness or distress: alternative models of mental health. Confederation of Indian Organisations, UKGoogle Scholar
  27. 27.
    Newham Asian Women’s Project, Newham Inner-city Multifund (1998) Growing up Young, Asian and Female in Britain: a report on self-harm and suicide. Newham, East LondonGoogle Scholar
  28. 28.
    Dein S, Sembhi S (2001) The use of traditional healing in South Asian psychiatric patients in the UK: interactions between professional and folk psychiatries. Transcult Psychiatry 38(2):243–257Google Scholar
  29. 29.
    Senior PA, Bhopal R (1994) Ethnicity as a variable in epidemiological research. BMJ 309:327–330PubMedGoogle Scholar
  30. 30.
    Neeleman J, Mak V, Wessely S (1997). Suicide by age, ethnic group, coroners’ verdicts and country of birth: a three year survey in inner London. Br J Psychiatry 171:463–467PubMedCrossRefGoogle Scholar
  31. 31.
    Salkovskis PM, Atha C, Storer D (1990) Cognitive-behavioural problem solving in the treatment of patients who repeatedly attempt suicide. A controlled trial. Br J Psychiatry 157:871–876PubMedGoogle Scholar
  32. 32.
    Hawton K, Arensman E, Townsend E, Bremner S, Feldman E, Goldney R, Gunnell D, Hazell P, van Heeringen K, House A, Owens D, Sakinofsky I, Traskman-Bendz L (1998) Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition. BMJ 317(7156):441–447PubMedGoogle Scholar
  33. 33.
    Guthrie E, Kapur N, Mackway-Jones K, Chew-Graham C, Moorey J, Mendel E, Marino-Francis F, Sanderson S, Turpin C, Boddy G, Tomenson B (2001) Randomised controlled trial of brief psychological intervention after deliberate poisoning. BMJ 323(7305):135–138PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff Verlag Darmstadt 2006

Authors and Affiliations

  • Jayne Cooper
    • 1
    Email author
  • Nusrat Husain
    • 2
  • Roger Webb
    • 3
  • Waquas Waheed
    • 4
  • Navneet Kapur
    • 1
  • Else Guthrie
    • 2
  • Louis Appleby
    • 1
  1. 1.Centre for Suicide Prevention, Division of Psychiatry, 7th Floor Williamson BuildingUniversity of ManchesterManchesterUK
  2. 2.Manchester Royal InfirmaryManchesterUK
  3. 3.Centre for Women’s Mental Health Research, Division of PsychiatryUniversity of ManchesterManchesterUK
  4. 4.The Lantem CentrePrestonUK

Personalised recommendations