title: Ethnic density and deliberate self harm; a small area study in south east London.
abstract: OBJECTIVE
  Relative risks are frequently used to convey how strongly outcomes like mental illness and suicidal behaviour are associated with personal characteristics like ethnic background. This study examined whether RRs for deliberate self harm (DSH) in ethnic groups vary between small areas according to their ethnic mix.
  
  
  METHODS
  Small area study of DSH rates in ethnic groups, by local ethnic density, using negative binomial regression.
  
  
  METHODS
  73 south London electoral wards, 1994-1997.
  
  
  METHODS
  1643 people attending casualty after DSH.
  
  
  RESULTS
  African-Caribbean and Asian DSH rates, relative to the white population, varied between wards. A linear model indicated a decline by factors (relative rate ratios) 0.76 (95% confidence intervals (CI) 0.64 to 0.90) and 0.59 (95% CI 0.36 to 0.97) respectively per SD increase in the local size of these minority populations. However, for both groups, an inverted U shaped curve provided a better fit for the link between the relative DSH rate in these groups and their local population density.
  
  
  CONCLUSIONS
  The DSH rate of minority groups relative to the white group is low (suggesting protection) in some areas, and high (suggesting risk) elsewhere. This has implications for management of suicidal behaviour in ethnic groups but also for interpretation, and policy implementation, of research on risk for suicidal behaviour, and, probably, many other outcomes. Relative risks or rates are not stable indicators of association in psychiatric epidemiology.
authors.affiliation: Department of Social Psychiatry, University of Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands. j.neeleman@med.rug.nl
authors.forename: J
authors.initials: J
authors.lastname: Neeleman
authors.forename: C
authors.initials: C
authors.lastname: Wilson-Jones
authors.forename: S
authors.initials: S
authors.lastname: Wessely
mesh_terms: D000328:Adult; D001208:Asia / Q000208:ethnology; D003710:Demography; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000208:ethnology*; D017062:Small-Area Analysis; D013405:Suicide / Q000208:ethnology*; D014900:West Indies / Q000208:ethnology