title: Self-harm amongst people of Chinese origin versus White people living in England: a cohort study.
abstract: BACKGROUND
  There has been little previous research on self-harm among people of Chinese origin living in the UK, although this population has grown substantially in recent years and China is now the largest source of international students at UK universities.
  
  
  METHODS
  We conducted a prospective cohort study using self-harm presentation data (1997-2011) collected from three hospitals in the City of Manchester, which has the largest Chinese population across all UK Local Authorities. Rate ratios between the Chinese and White groups were calculated using Poisson regression models. Chi-square tests (or Fisher's exact tests), logistic regression, and log-binomial regression were used to examine differences in characteristics and clinical management between groups.
  
  
  RESULTS
  Ethnicity was known in the study cohort for 23,297 (87%) amongst 26,894 individuals aged 15 years and above. A total number of 97/23,297 (0.4%) people of Chinese ethnic origin presented with self-harm over the study period and 20,419 (88%) were White people. Incidence of self-harm in the Chinese group (aged 16-64 years) was less than one fifth of that found in White people (0.6 versus 3.2 per 1000 person-years; rate ratio 0.18, 95% confidence interval 0.13-0.24), and was particularly low amongst men of Chinese origin. Individuals of Chinese origin who presented with self-harm were younger, more likely to be female and students, and more likely to self-injure and describe relationship problems as a precipitant than White people. They were less likely to have clinical risk factors such as drug/alcohol misuse and receiving psychiatric treatment, and were rated to have lower risk of self-harm repetition by treating clinicians.
  
  
  CONCLUSIONS
  Future research needs to investigate whether the low incidence of self-harm presenting to hospitals amongst people of Chinese origin truly reflects a lower frequency of self-harm, or alternatively is due to markedly different post-episode help-seeking behaviours or student overrepresentation in this ethnic group. Relevant healthcare professionals need to be aware of the risk characteristics of people of Chinese origin who self-harm.
authors.affiliation: Institute of Health Policy and Management, and Department of Public Health, College of Public Health, National Taiwan University, No 17, Xuzhou Road, Taipei, 10055, Taiwan. shusen.chang@gmail.com.|The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 5 Sassoon Road, Pokfulam, Hong Kong, SAR, China. shusen.chang@gmail.com.
authors.forename: Shu-Sen
authors.initials: SS
authors.lastname: Chang
authors.affiliation: Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford road, Manchester, M13 9PL, UK. Sarah.Steeg@manchester.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Steeg
authors.affiliation: Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford road, Manchester, M13 9PL, UK. nav.kapur@manchester.ac.uk.
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
authors.affiliation: Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford road, Manchester, M13 9PL, UK. roger.webb@manchester.ac.uk.
authors.forename: Roger T
authors.initials: RT
authors.lastname: Webb
authors.affiliation: The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 5 Sassoon Road, Pokfulam, Hong Kong, SAR, China. sfpyip@hku.hk.
authors.forename: Paul S F
authors.initials: PS
authors.lastname: Yip
authors.affiliation: Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford road, Manchester, M13 9PL, UK. Jayne.B.Cooper@manchester.ac.uk.
authors.forename: Jayne
authors.initials: J
authors.lastname: Cooper
mesh_terms: D000293:Adolescent; D000328:Adult; D044466:Asian People / Q000523:psychology / Q000706:statistics & numerical data; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005008:Ethnopsychology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000208:ethnology* / Q000628:therapy; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data; D014495:Universities; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data