title: Rates of self-harm presenting to general hospitals: a comparison of data from the Multicentre Study of Self-Harm in England and Hospital Episode Statistics.
abstract: OBJECTIVE
  Rates of hospital presentation for self-harm in England were compared using different national and local data sources.
  
  
  METHODS
  The study was descriptive and compared bespoke data collection methods for recording self-harm presentations to hospital with routinely collected hospital data.
  
  
  METHODS
  Local area data on self-harm from the 3 centres of the Multicentre Study of Self-harm in England (Oxford, Manchester and Derby) were used along with national and local routinely collected data on self-harm admissions and emergency department attendances from Hospital Episode Statistics (HES).
  
  
  METHODS
  Rate ratios were calculated to compare rates of self-harm generated using different data sources nationally and locally (between 2010 and 2012) and rates of hospital presentations for self-harm were plotted over time (between 2003 and 2012), based on different data sources.
  
  
  RESULTS
  The total number of self-harm episodes between 2010 and 2012 was 13,547 based on Multicentre Study data, 9600 based on HES emergency department data and 8096 based on HES admission data. Nationally, routine HES data underestimated overall rates of self-harm by approximately 60% compared with rates based on Multicentre Study data (rate ratio for HES emergency department data, 0.41 (95% CI 0.35 to 0.49); rate ratio for HES admission data, 0.42 (95% CI 0.36 to 0.49)). Direct local area comparisons confirmed an overall underascertainment in the HES data, although the difference varied between centres. There was a general increase in self-harm over time according to HES data which contrasted with a fall and then a rise in the Multicentre Study data.
  
  
  CONCLUSIONS
  There was a consistent underestimation of presentations for self-harm recorded by HES emergency department data, and fluctuations in year-on-year figures. HES admission data appeared more reliable but missed non-admitted episodes. Routinely collected data may miss important trends in self-harm and cannot be used in isolation as the basis for a robust national indicator of self-harm.
authors.affiliation: Centre for Mental Health and Safety, The University of Manchester, Manchester, UK.
authors.forename: Caroline
authors.identifier: http://orcid.org/0000-0003-4735-6728
authors.initials: C
authors.lastname: Clements
authors.affiliation: Centre for Mental Health and Safety, The University of Manchester, Manchester, UK.
authors.forename: Pauline
authors.initials: P
authors.lastname: Turnbull
authors.affiliation: Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
authors.affiliation: Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK.
authors.forename: Galit
authors.initials: G
authors.lastname: Geulayov
authors.affiliation: Derbyshire Healthcare NHS Foundation Trust, Royal Derby Hospital, Derby, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Waters
authors.affiliation: Derbyshire Healthcare NHS Foundation Trust, Royal Derby Hospital, Derby, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ness
authors.affiliation: School of Psychology, University of Nottingham, Nottingham, UK.
authors.forename: Ellen
authors.initials: E
authors.lastname: Townsend
authors.affiliation: Northern and Yorkshire Knowledge and Intelligence Team, Chief Knowledge Office, Public Health England, UK.
authors.forename: Kazem
authors.initials: K
authors.lastname: Khundakar
authors.affiliation: Centre for Mental Health and Safety, The University of Manchester, Manchester, UK Manchester Mental Health and Social Care Trust, Manchester, UK.
authors.forename: Nav
authors.initials: N
authors.lastname: Kapur
mesh_terms: D000328:Adult; D003625:Data Collection / Q000379:methods; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D055815:Young Adult
keywords: EPIDEMIOLOGY; PSYCHIATRY