title: Epidemiology and trends in non-fatal self-harm in three centres in England, 2000-2012: findings from the Multicentre Study of Self-harm in England.
abstract: OBJECTIVE
  Self-harm is a major health problem in many countries, with potential adverse outcomes including suicide and other causes of premature death. It is important to monitor national trends in this behaviour. We examined trends in non-fatal self-harm and its management in England during the 13-year period, 2000-2012.
  
  
  METHODS
  This observational study was undertaken in the three centres of the Multicentre Study of Self-harm in England. Information on all episodes of self-harm by individuals aged 15 years and over presenting to five general hospitals in three cities (Oxford, Manchester and Derby) was collected through face-to-face assessment or scrutiny of emergency department electronic databases. We used negative binomial regression models to assess trends in rates of self-harm and logistic regression models for binary outcomes (eg, assessed vs non-assessed patients).
  
  
  METHODS
  During 2000-2012, there were 84,378 self-harm episodes (58.6% by females), involving 47,048 persons.
  
  
  RESULTS
  Rates of self-harm declined in females (incidence rate ratio (IRR) 0.98; 95% CI 0.97 to 0.99, p<0.0001). In males, rates of self-harm declined until 2008 (IRR 0.96; 95% CI 0.95 to 0.98, p<0.0001) and then increased (IRR 1.05; 95% CI 1.02 to 1.09, p=0.002). Rates of self-harm were strongly correlated with suicide rates in England in males (r=0.82, p=0.0006) and females (r=0.74, p=0.004). Over 75% of self-harm episodes were due to self-poisoning, mainly with analgesics (45.7%), antidepressants (24.7%) and benzodiazepines (13.8%). A substantial increase in self-injury occurred in the latter part of the study period. This was especially marked for self-cutting/stabbing and hanging/asphyxiation. Psychosocial assessment by specialist mental health staff occurred in 53.2% of episodes.
  
  
  CONCLUSIONS
  Trends in rates of self-harm and suicide may be closely related; therefore, self-harm can be a useful mental health indicator. Despite national guidance, many patients still do not receive psychosocial assessment, especially those who self-injure.
authors.affiliation: Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
authors.forename: Galit
authors.initials: G
authors.lastname: Geulayov
authors.affiliation: Centre for Suicide Prevention, University of Manchester, Manchester, UK Manchester Mental Health and Social Care Trust, Manchester, UK.
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
authors.affiliation: Centre for Suicide Prevention, University of Manchester, Manchester, UK.
authors.forename: Pauline
authors.initials: P
authors.lastname: Turnbull
authors.affiliation: Centre for Suicide Prevention, 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 Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Waters
authors.affiliation: Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ness
authors.affiliation: Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK.
authors.forename: Ellen
authors.initials: E
authors.lastname: Townsend
authors.affiliation: Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK Oxford Health NHS Foundation Trust, Oxford, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D003625:Data Collection; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D011634:Public Health; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013406:Suicide, Attempted / Q000706:statistics & numerical data / Q000639:trends*
keywords: EPIDEMIOLOGY; PUBLIC HEALTH