title: The epidemiology of self-harm in a UK-wide primary care patient cohort, 2001-2013.
abstract: BACKGROUND
  Most of the research conducted on people who harm themselves has been undertaken in secondary healthcare settings. Little is known about the frequency of self-harm in primary care patient populations. This is the first study to describe the epidemiology of self-harm presentations to primary care using broadly representative national data from across the United Kingdom (UK).
  
  
  METHODS
  Using the Clinical Practice Research Datalink (CPRD), we calculated directly standardised rates of incidence and annual presentation during 2001-2013. Rates were compared by gender and age and across the nations of the UK, and also by degree of socioeconomic deprivation measured ecologically at general practice level.
  
  
  RESULTS
  We found significantly elevated rates in females vs. males for incidence (rate ratio - RR, 1.45, 95 % confidence interval - CI, 1.42-1.47) and for annual presentation (RR 1.56, CI 1.54-1.58). An increasing trend over time in incidence was apparent for males (P < 0.001) but not females (P = 0.08), and both genders exhibited rising temporal trends in presentation rates (P < 0.001). We observed a decreasing gradient of risk with increasing age and markedly elevated risk for females in the youngest age group (aged 15-24 years vs. all other females: RR 3.75, CI 3.67-3.83). Increasing presentation rates over time were observed for males across all age bands (P < 0.001). We found higher rates when comparing Northern Ireland, Scotland, and Wales with England, and increasing rates of presentation over time for all four nations. We also observed higher rates with increasing levels of deprivation - most vs. least deprived male patients: RR 2.17, CI 2.10-2.25.
  
  
  CONCLUSIONS
  Incorporating data from primary care yields a more comprehensive quantification of the health burden of self-harm. These novel findings may be useful in informing public health programmes and the targeting of high-risk groups toward the ultimate goal of lowering risk of self-harm repetition and premature death in this population.
authors.affiliation: Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, M13 9PL, UK. matthew.carr@manchester.ac.uk.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Carr
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, UK.|NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester, UK.
authors.forename: Darren M
authors.initials: DM
authors.lastname: Ashcroft
authors.affiliation: Centre for Health Informatics, Institute of Population Health, University of Manchester, UK, Manchester, UK.|NIHR School for Primary Care Research, University of Manchester, Manchester, UK.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kontopantelis
authors.affiliation: School of Psychological Sciences, University of Manchester, Manchester, UK.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Awenat
authors.affiliation: Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, M13 9PL, UK.
authors.forename: Jayne
authors.initials: J
authors.lastname: Cooper
authors.affiliation: Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK.|Manchester Mental Health and Social Care Trust, Manchester, UK.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
authors.affiliation: Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, M13 9PL, UK.
authors.forename: Nav
authors.initials: N
authors.lastname: Kapur
authors.affiliation: Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, M13 9PL, UK.
authors.forename: Roger T
authors.initials: RT
authors.lastname: Webb
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D017678:Sex Distribution; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult