Table 3.

Rates of Self Harm across Ethnic groups in the UK

Studies of Adults
	Units of Rates	Population of Interest	Statistics as reported in the paper									Summary of Main Findings
Bhugra et al 1999a	Attempted suicide Per 10 000 person years	Women		Women	Men							Young South Asian women are vulnerable to increased rates of DSH.
				Rate, 95%CI	Rate, 95%CI							Attempted suicide rates highest in South Asian women than other ethnic groups but highest in white men, maybe because inclusion of Irish in white category.
			South Asian	37.7, 29.02–47.1	13.9, 8.9–20.8							In men highest rate in Whites aged 16–24 and Black people aged 25–34.
			White	23.3, 19.7–27.4	24.6, 20.9–28.7
			Black	23.9, 13.9–38.7	11.3, 4.6–23.2
			Other	30.1, 17.6–48.2	8.7, 2.8–20.3
			Attempted suicide rates highest in South Asian women aged 16–24 (92.7/10000 person years), aged 25–34 (34.4) and also high in "other" ethnic women aged 16–24 (75.9 per 100000 person years) and aged 25–34 (41.1).
			White men also had high rates compared with other ethnic groups in 16–24 (30.2), 25–34 (28.1), 35–44 (30.1), as did black men in 25–34 age group (31.8).
Burke 1976a	Per 100 000 population	South Asian Adults	Age	Female Rate	Male Rate	Total Rate						Proportion of South Asians in self harm group was 60% of those expected considering population distributions
			15–24	213	74	123
			25–44	95	70	66
			45–64	32	0	9
				216	57	79
			Rate lower than native population (57/100,000, 126/100,000).									Women more common among 15–24 group and men more common at later ages
Burke 1976b	Per 100 000 persons years	West Indian Adults	Age	Female	Male	Total						Rates among Caribbean females aged 15–24 twice that of males same age.
			15–24	514	101	336
			25–44	84	66	74
			Total	180	56	113						Low risk of attempted suicide in Caribbean people
Dean et al 1976	Rates	Adults	Rates increasing in all countries, especially in 15–44 age groups, especially among women.									Country comparison of rates, England & Wales rate is greater than those of Scotland, Northern Ireland, or Republic of Ireland
			Rates among women in England and Wales are twice the rate for Scotland and Ireland, and four times the rate for Republic of Ireland.
Lockhart et al 1987	Risk expressed as % at two time points 1971 and 1984	Adults	1971: 93 patients admitted on 100 occasions from population of 92 720									An increase in admissions for among West Indians for self-poisoning.
			1983/84: 86 patients admitted on 94 occasions from 73 929
			Risk of admissions per week halved from 5.8 to 2.5
			Incidence rate halved from 326 to 178/100 000 persons a year
			Rise in WI admissions from 0 to 7%, p < 0.05, fall among South Asians: 1 to 7%. P = 0.13, fall of Europids, p < 0.01
			In 1971 and 1981, 6.4% of local population of WI origin
			In 1983/4: 7% of local population of WI origin
McKenzie et al 2003	OR: unadjusted and adjusted for age, gender, MADRS, education, Diagnosis, time since onset)	Adults		AC	WB	OR	OR (adjusted)					Lower prevalence of suicidal behaviour in Caribbean origin people with psychosis not present in under 35's.
			Attempted Suicide (AS)	14	29	0.52, 0.26 to 1.02	0.54, 0.26 to 1.13
			AS for < 35 yo	12(13%)	13 (18%)	0.7, 0.36 to 1.51	0.93, 0.37 to 2.32
			AS for > 35 yo	2(2.1%)	16 (11.4%)	0.17 (0.04–0.71)	0.19 (0.04 to 0.89)
			AS or Completed Suicide	17	33	0.56, 0.3 to 1.03	0.59, 0.3 to 1.14
			(age/gender adjusted = 0.49, 0.26 -0.92, p = 0.06)
			Caribbean origin patients aged > 35 5 times less likely to attempt suicide
			No difference in under 35's.
			Attempted & completed suicide combined Caribbean origin patients aged > 35 4 times less likely.
			Caribbean origin patients aged < 35 risk same as British whites
Merrill et al 1986	Rates of self poisoning per 100 000 per year	Adults			UK born	Asian born	p value					Rate for self-poisoning higher in Asian females than white females. Culture conflict important. Asian patients less likely to have previously self-poisoned, received psychiatric treatment or psychiatric diagnosis.
			Men	25–34	438	146	< 0.0005
				35–44	240	80	< 0.025
				> 44	98	28	< 0.05
				Overall	190	102	< 0.0005
			Women
				Overall	299	376	< 0.05
Merrill et al 1987	Rates of self poisoning/100 000 per year	Adult			West Indian	White British	p					Not very different from Asians, could be a reflection of service characteristics rather than ethnic group.
			Overall	Men	103	190	< 0.025
				Men 25–34	129	438	< 0.05
				Women > 45	30	133	< 0.05
			Rates for over 25s lower for men WI (men: p < 0.001; women: p < 0.005)
Merrill et al 1988	Rates per 100 000 per year	Adult	Men	Asians	West Indian	English	Irish	Scottish				Asian aribbean young females had greater rates than English females. Irish & Scottish of both sexes had higher rates than English.
			25–34 yo:	146*****	129	406	662	1199*				Power and denominator problems
			> 35	48**	57*	131	156	462*****
			< 16	113*****	98***	236	243	648*****
			Women
			25–34 yo:	501	257	447	853*	565****
			> 35	90	37	167	367*****	547****
			< 16	402	229*	341	456*	626*
			*p < 0.05, ** p < 0.01 ***p < 0.005 ****p < 0.001 *****p < 0.0005
Neeleman et al 1996	Referral Ratios	Adult	Unadjusted Referral Ratios (Ethnic groups generally younger) for all subjects									Indian female rates of Self Harm are 2.6 times the rate of white women
				Men	Women	All						UK born Indian females had 7.8 times rate of UK born white females. Unemployment associated with a 9-fold increase in referral rates in whites and 3-fold increase in minorities.
			Black Caribbean	0.56, 0.16–1.43	0.61, 0.24–1.26	0.61, 0.3–1.09
			South Asian	0.39, 0.01–2.17	1.68, 0.61–3.66	1.15,0.46–2.37
			Indian	0	2.6, 0.53–7.6
			All Ethnic groups	0.45, 0.17–0.98	0.78, 0.45–1.27	0.65, 0.41–0.99
			Unadjusted Referral Ratios (Ethnic groups generally younger) for UK born only
				Men	Women	All
			AC	0.19, 0.00–1.05	0.41, 0.08–1.20	0.32, 0.09–0.82
			AS	1.2, 0.03–6.68	3.53, 0.96–9.03	2.55, 0.83–5.95
			IN	0	7.76, 1.6–22.66
			Cross validation study: ethnicity assigned on basis of name, to check that referral to DSH may be biased by ethnic group rather than reflect attendance. Only possible for Indian names
			Attendance ratio Indian Men (indirect standardization): 1.92, 0.52–10.24; Indian women: 3.07, 1.4 to 5.8
Wright 1981	Annual increase in % admissions	Adult	Mean annual increase %		% born in country of origin for ethnic group							Self-poisoning is an inarticulate cry for help or even a cry of frustration.
					1976	1979
			Caucasian	9.5	100	100
			West Indian	31.5	69.6	48
			Asian	14.5	83.9	70.3
Studies of Adolescents
Hawton 2002	Prevalence	Adolescents	Males					Females				Lower risk among South Asian females not sustained in multivariate analyses
				No	% self harm	OR	95%CI	No	% self harm	OR	95%CI
			White	2536	3.3	1		2727	11.6	1
			Asian	371	2.7	0.82	0.42–1.58	254	6.7	0.55	0.33–0.91
			Black	68	0	-	-	89	6.7	0.55	0.24–1.27
			Other	74	6.8	2.14	0.84–5.85	72	13.9	1.23	0.62–2.42
McGibben et al 1992	Per 1000 persons a year	Adolescents	Overall rates: 2.33/1000/year									Excess admission for DSP in Asian and white girls
			Asians = 2.47/1000/year
			White = 2.31/1000/year
			Asian boys: 0..88/1000/year	White Boys 1.14/1000/year
			Asian girl: 4.06/1000/year	White Girls: 3.47/1000/year
			(NS)
			Religion: NS, but a trend for more Sikhs to be admitted: Sikh 3.17/1000/year, Muslim 1.76, Hindu 1.46
Bhugra et al 2003	Rates of DSH per 10 000	Adolescents		White	South Asian							Female Self Harm rates are greater than male rates for South Asians & Whites.
			Male aged 10–14:	7.3	9							Rates for South Asian and White women aged 14–15 do not differ much
			Male aged 14–15:	62	-							Self Harm rates greater in white females aged 10–14 compared with South Asian
			Female aged 10–14:	51	21
			Female aged 14–15:	158	127
			Female aged > 15:	44	-