Table 2.
Characteristics of studies on self harm in ethnic groups in the UK
| Author | Ethnicity definition | Population from sample is taken | Sample size | DSH or Suicide rating scale? | Data sources | Quality Rating |
| *Bagley 1972 | Defined by oppression. Black refers to those who lack economic power, and do not control their destinies. White as oppressors. |
South London A&E Department. 206 consecutive Admissions to casualty Followed up over 18 months |
25 Black (2 completed suicide, 23 recovered) Black included the following: Caribbean (48%), Indian and Pakistani (20%), African (16%) Cypriot (16%). 25 White in comparison group |
No | Hospital records | 2 |
| *Bhugra 2003 | South Asian (Indian sub-continent origin) or White | All adolescents presenting to local East London Hospital in 1 year period for DSH | 76 cases: 15 South Asian (12 women) 46 White (38 women) 6 Middle Eastern (4 women) 9 Black (9 women) |
No | Case notes and interviews | 1 |
| *Bhugra 2004 | South Asian: self ascribed origin: individuals whose parents, grandparents or themselves originate in Indian sub-continent | All adolescents presenting to hospital services in West London in a 1 year period for DSH | 76 cases: 15 South Asian (12 women) 46 White (38 women) 6 Middle Eastern (4 women) 9 Black (9 women) |
No DSH scale DACS (DSH Assessment by Clinicians Schedule) | Case notes and interviews | 2 |
| *Bhugra 1999a | Self-ascribed OPCS census categories & case notes. | Patient's aged 16–64 presenting with DSH to general, medical, accident or psychiatric services within local hospital in West London. | 434 patients presenting with suicidal behaviour. 90 Asian cases of attempted suicide |
No Numbers of people presenting with DSH or attempted suicide |
Hospital records, interview, GP records | 4 |
| *Bhugra et al 1999b | Self-ascribed OPCS census categories & case notes. | Patients aged 16–64 and resident in the areas for at least six months, presenting with DSH to general, medical, accident or psychiatric services in West London | Comparison of first 27 Asian women presenting with DSH with 27 matched controls (Asian women attending GP surgeries for other reasons) | Numbers of DSH or attempted suicide (DACS : DSH Assessment by Clinicians Schedule)) | Hospital records, interview | 4 |
| * Burke 1976a | Self assigned Place of birth known for 2695 cases Of 2075 with no place of birth, a 10% sample selected and case notes examined. 2.5% were of Asian origin |
Admissions following attempted suicide to Birmingham hospital during a four year period: 1969–1972 Under 65s admitted with poisoning |
68 admissions with Asian place of birth 16 cases: iatrogenic or accidental cases 52 deliberate self poisoning cases |
No. Admission to Birmingham hospitals following self poisoning used as entry criterion and definition for inclusion |
Case notes | 3 |
| *Burke 1976b | Self assigned Place of birth known for 2695 cases Of 2075 with no place of birth, a 10% sample selected and case notes examined. 2.5% were of Asian origin |
Admissions following attempted suicide to Birmingham hospital during a four year period: 1969–1972 Under 65s admitted with poisoning |
60 admissions with place of birth in West Indies | No | Case notes | 3 |
| * ≠ Burke 1980 | As Burke 1976 a, b-same samples | Attempted suicide (1969–1972) and admitted to Birmingham hospitals 100 patients followed up until Jan 1969-average follow up period of 5 years |
52 West Indian (3 had made 2 previous attempts) 48 Asian (three had made two attempts and one died at admission) |
No Classification based on attempted suicide and psychiatric history: 1. no psych history, 2. psych care at time of attempt 3. psych care before attempt 4 psych care following attempt |
Medical, psychiatric records from GP, hospital and coroner | 3 |
| *Biswas 1990 | Not given Asians selected on basis of Asian names | A & E presentations to Bradford Royal Infirmary, with self poisoning before or on 1st March 1987 | 72 (38 Asian, 34 White) adolescents aged < or = 17 yrs |
No "self-poisoning" from case notes |
Case notes | 1 |
| *± Dean et al 1976 | Place of birth: country comparisons of rates of Non-fatal self poisoning: but no comparison of ethnic groups. | All deaths registered as suicides between 1970–72 | 333 | Admissions for poisoning and adverse reactions in E, W & § Rep of Ireland Assumed all for DSH and not adverse reactions: assessed assumption on 80 admissions. Of 80, 82.5% confirmed to be DSH. |
Population census | 5 |
| *Goddard 1996 | Based upon 1991 census. GP notes for clarification on 22 of them: 14 white, 7 black, 1 other. Black Caribbean, Black African, Black Other, Indian, Pakistani, Bangladeshi, Chinese, Asian, Other White. Groups collapsed into white, black, and other Asian |
Total referrals to specialist centre at Maudsley Hospital Age > 10 First referral following DSH |
Total 100 White: 64 Black :28 Other 8 |
No Standardised Maudsley assessment sheet: summary of symptoms, diagnosis, treatment, emotional symptoms and antisocial behaviour |
Hospital records and OPCS | 2 |
| *Handy 1991 | Parent & children's place of birth Parents UK born = British Asian born = Asian |
Presenters to child guidance clinic, Walsgrave hospital Coventry | 50 Adolescents 25 Asian 25 White |
No Self poisoning on presentation |
Medical records | 1 |
| ± Hawton 2002 | None given White Asian Black Other |
Pupils in 41 schools in England: Oxfordshire, Northamptonshire, and Birmingham. 90% of pupils aged 15 and 16 | 6020 pupils White 2356 Asian 371 Black 68 Other 74 |
Question on self harm Asked for description of the act and consequences Classified by 3 independent ratings using agreed definitions |
Self report questionnaire | 6 |
| *Kingsbury 1994 | No definition Asian: Indian, Pakistani, Sri Lankan |
12–18 year old attendees at West Middlesex hospital A&E. following overdose, Feb 1987-April1998 | 50 Total 113 Asian, 37 Caucasian 13 lost due to premature discharge and failure to attend follow up OPA |
Pallis suicide intent scale | Hospital records, semi-structured interview questionnaire | 4 |
| *Lockhart 1987 | Ethnic origin: no definition Asian West Indian, Europid |
Adults admitted after self poisoning to inner London General hospital. Two time periods: from 1) Nov 1971 to Feb 1972. 2) Sept 1983-June1984 Adults over 15 |
1971/72 Europid = 80 Asian = 1 WI = 0 Other = 1 1983/84 Euro = 72 Asian = 6 WI = 7 Other = 1 |
No | Questionnaire completed for each patient | 0 |
| *McGibben 1992 | No definitions Denominators established from Asian names in electoral register and racial breakdown obtained from school data |
Admissions to Coventry hospitals for overdose aged < 16 between 1982–90 92% of admissions referred for opinion and therefore included in sample |
340 referrals for overdose 1982–90 295 admitted for DSH 222 girls 73 boys 45 Asian of which 37 were girls |
No. Deliberate self poisoning | Hospital records, population denominators from city of Coventry, 1981 census data, Coventry school pupil census | 0 |
| *McKenzie 1995 | White i.e. self or parents UK born, Afro-Caribbean =both parents born in Caribbean | Admissions for psychosis to 2 London psychiatric hospitals 1985/March 986 – Feb 1988 Oct 1988-August 1989 Recent (5 year) onset of psychosis Four year follow up |
191 in total, but follow up data on 166 (87%) available 53 Afro-Caribbean 60 White |
No WHO life chart HADS WHO disability assessment schedule PSE at baseline |
Interview | 7 |
| ≠ McKenzie 2003 | Observer defined OPCS 1991 and Gen Register for Scotland White = OPCS white with mother and father born in the UK Caribbean = OPCS Black-Caribbean or Black Other with mother or father born in Caribbean or UK |
People with psychosis in a case management trial 3 London 1 Manchester centre |
708 Baseline 203 Caribbean 234 White British Follow up attrition AC: 26 (13%) WB: 35 (15%) Drop outs: AC 20 & 25 WB |
No. WHO Life Chart: asked if attempted suicide and frequency Rated on patient report and all sources of information including case notes/relatives/managers |
Case notes, interview with family, client, case managers | 8 |
| *Merrill 1986 | Whites: born in England, Scotland & Wales South Asians: born in India. Pakistan, Bangladesh, UK (n = 52, 26.5%) & East Africa (5.26%) |
Admission to West Midlands Poisons unit for self poisoning with mediation or taking substances not fit for consumption 1 Jan 1979 to 31 Dec 1981 |
1171 975 White 196 Asians (59% Indian, Sikh) |
No | Admissions records. Coding sheet completed by admitting clinicians | 4 |
| *Merrill 1987 | Place of birth | Admission to West Midlands Poisons unit for self poisoning with mediation or taking substances not fit for consumption 1 Jan 1979 to 31 Dec 1981 |
975 White 130 West Indian (55 born in WI, 75 born in UK but WI parentage) | No | Admissions records. Coding sheet completed by admitting clinicians | 2 |
| *Merrill 1988 | Place of birth Irish Scottish English Indian/Pakistan West Indian |
A & E attendees at West Birmingham. DSH leading to admission to West Midlands poisons unit Birmingham 1st Jan 1979 to 31st Dec 1981 |
467 Asian: 36 West India: 16 Scottish: 17 English: 364 Irish: 34 |
No | Admissions records. Coding sheet completed by admitting clinicians | 3 |
| *Neeleman 1996 | Region of birth, ethnicity from OPCS 1991 census: White Black Caribbean Black African Other, Indian Pakistani Bangladeshi Chinese Asian Others |
A&E attendees at Kings College Hospital, for intentional overdose, over 6 month period in 1991: 237 patients attended DSH team assessed 48% (113/247) of all attenders. |
Total 105 Ethnic Group 83 White (78) 11 African Caribbean (4) 7 Asian (1) 4 African (2) |
No Attendance and psychiatric assessment were criteria |
Hospital records OPCS | 3 |
| *Neeleman 2001 | Observer assigned OPCS categories collapsed into: White African Caribbean Asian |
A & E attendees with DSH at two London Hospitals: King's College Hospital (KCH) and Lewisham Hospital (LH). |
Attenders: 2352 Analyses for 1643 attending own A&E. Unknown ethnic origin: 184 KCH LH 1341+1011 White: 720 + 608 AC : 212 + 71 Asian : 9 + 23 |
No Attendence for DSH, excluded accidents and uncertain cases |
Hospital records. 1991 census | 6 |
| *Sheth 1994 | None | Adult admitted to Yorkshire burns unit, March 1983 to March 1993, with suicidal burns injury | 234 admissions, 20 of which had suicidal burns injury, 17 of whom were women Of the women 14 (70%) were Asian |
No | Case notes | 1 |
| *Wright 1981 | Asian (from the Indian sub continent-majority Sikhs) West Indian Caucasian |
Admissions to Dudley Road Hospital 1976–79 | 2001 Total 1665 White 160 Caribbean 176 Asian |
No | Questionnaire on social, physical, psychiatric history. Filled in by doctors | 0 |
*Cross sectional studies, usually a case series using ethnic group comparisons, and associations between those with and without self harm.
≠ Prospective.
± Population based study using schools as sampling frame