title: Risk factors associated with repetition of self-harm in black and minority ethnic (BME) groups: a multi-centre cohort study.
abstract: BACKGROUND
  Little information is available to inform clinical assessments on risk of self-harm repetition in ethnic minority groups.
  
  
  METHODS
  In a prospective cohort study, using data collected from six hospitals in England for self-harm presentations occurring between 2000 and 2007, we investigated risk factors for repeat self-harm in South Asian and Black people in comparison to Whites.
  
  
  RESULTS
  During the study period, 751 South Asian, 468 Black and 15,705 White people presented with self-harm in the study centres. Repeat self-harm occurred in 4379 individuals, which included 229 suicides (with eight of these fatalities being in the ethnic minority groups). The risk ratios for repetition in the South Asian and Black groups compared to the White group were 0.6, 95% CI 0.5-0.7 and 0.7, 95% CI 0.5-0.8, respectively. Risk factors for repetition were similar across all three groups, although excess risk versus Whites was seen in Black people presenting with mental health symptoms, and South Asian people reporting alcohol use and not having a partner. Additional modelling of repeat self-harm count data showed that alcohol misuse was especially strongly linked with multiple repetitions in both BME groups.
  
  
  CONCLUSIONS
  Ethnicity was not recorded in a third of cases which may introduce selection bias. Differences may exist due to cultural diversity within the broad ethnic groups.
  
  
  CONCLUSIONS
  Known social and psychological features that infer risk were present in South Asian and Black people who repeated self-harm. Clinical assessment in these ethnic groups should ensure recognition and treatment of mental illness and alcohol misuse.
authors.affiliation: Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK. jayne.cooper@manchester.ac.uk
authors.forename: Jayne
authors.initials: J
authors.lastname: Cooper
authors.forename: Sarah
authors.initials: S
authors.lastname: Steeg
authors.forename: Roger
authors.initials: R
authors.lastname: Webb
authors.forename: Suzanne L K
authors.initials: SL
authors.lastname: Stewart
authors.forename: Eve
authors.initials: E
authors.lastname: Applegate
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
authors.forename: Helen
authors.initials: H
authors.lastname: Bergen
authors.forename: Keith
authors.initials: K
authors.lastname: Waters
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
mesh_terms: D044466:Asian People / Q000523:psychology* / Q000706:statistics & numerical data; D044383:Black People / Q000523:psychology* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000208:ethnology / Q000628:therapy; D008913:Minority Groups / Q000523:psychology* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000208:ethnology* / Q000523:psychology; D012959:Socioeconomic Factors; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data