Multicentre Study of Self-harm in England
In England and Wales there are at least 200,000 general hospital presentations for self-harm (intentional self-poisoning or self-injury) per year. Self-harm occurs in relation to a wide range of personal problems, emotional turmoil and psychiatric disorders. It carries a significant risk of subsequent suicide and has major impacts on family members and friends. It also places pressure on busy emergency departments, wards and clinicians, as well as having major financial costs for the NHS.
The aim of this programme of research is to conduct a series of related studies on the epidemiology, causes, clinical management, outcome and prevention of self-harm. Through a multicentre collaboration the research provides representative and reliable data on self-harm in England. It contributes to the National Suicide Prevention Strategy for England (2002, 2012) and prevention and service initiative, including NICE guidance on self-harm (National Collaborating Centre for Mental Health 2004, 2011).
The research is a collaboration between the University of Oxford (Principal Investigator Professor Keith Hawton), the University of Manchester (Lead, Professor Nav Kapur), and Derbyshire Healthcare NHS Foundation Trust (Lead, Mr Keith Waters). Data for the study are collected in these three centres in five general hospitals, one in Oxford, three in Manchester and one in Derby. Over 10 collaborating researchers are part of the research group. The project also has input from service users.
The programme of research includes 4 broad areas:
- Epidemiology and trends in self-harm.
- Clinical management of self-harm.
- Outcome of self-harm, including repetition and mortality.
- Pharmaco-epidemiology, including drug toxicology and impacts of changes in prescribing legislation and trends.
We do not provide a treatment service or advice for those in crisis. If you are in crisis or feeling suicidal we urge you to seek help from your general practitioner, through a telephone helpline service such as Samaritans (UK telephone number 116 123), or by discussing your problems with a friend or colleague. Befrienders Worldwide offers a comprehensive directory of crisis helplines worldwide. We are also not able to discuss individual cases.
Economic recessions are known to be associated with increases in suicides. There is little information, however, about whether recessions affect non-fatal self-harm. A recent study investigates the impact of the last recession on rates of self-harm in England and problems faced by patients who self-harm.
In a study based on analysis of data from the Multicentre study of Self-harm in England for 2001-2010 researchers from Oxford, Manchester and Derby (the three centres involved in the multicentre study) have shown that rates of self-harm increased in both genders in Derby and in males in Manchester in 2008-2010, but not in either gender in Oxford.
These results were largely in keeping with changes in local general population unemployment. More patients who self-harm were unemployed in 2008-10 compared to before the recession. The proportion of patients in receipt of sickness or disability allowances decreased. More patients of both genders had employment and financial problems in 2008-2010 and more females also had housing problems. These changes in the problems patients were experiencing at the time of self-harm were also largely found in employed individuals who self-harmed.
These findings have implications for policy makers, clinicians and researchers. Policy makers should recognise that maintenance of social welfare and work programmes at times of recession are likely to be important in reducing the impact of the consequences of recessions. Clinicians, especially those working in primary care and in self-harm services, should try to identify individuals and families at risk due to the local effects of economic downturn and ask about actual or threatened change of employment status and of disability or sickness allowances.
Provision of advice on welfare benefits may be helpful. Researchers investigating the impacts of economic downturns on suicidal behaviour need to look beyond just associations between unemployment and rates of the behaviour, including investigating the problems people face and the impact of changes in welfare and other benefits.
By: Keith Hawton, Helen Bergen, Galit Geulayov, Keith Waters, Jennifer Ness, Jayne Cooper, Navneet Kapur Journal of Affective Disorders, 19, 132-138
Trends in Self-harm, 2000-2013
For an overview of trends in self-harm in England see the summary of findings from the Multicentre Study of Self-harm in England from 2000 to 2012 (released August 2015):
Download a copy of the Overview of Trends in Self-harm, 2000-2013
The following are the specific investigations within the areas of research;
Epidemiology and trends in self-harm
- Rates and trends in self-harm and socio-demographic and clinical characteristics of self-harm patients:
- children and adolescents
- older people
- Rates and trends in self-harm in ethnic groups including Black (Caribbean and African), South Asian (Indian, Pakistani, Bangladeshi and Sri Lankan), Chinese and White groups
- Alcohol and drug misuse and self-harm
- Characteristics of frequent repeaters of self-harm
- Impact of the recession on self-harm
Clinical management of self-harm
- Determinants of type of hospital management following self-harm, and the relationship between management and outcome
- Validation and refinement of a clinical screening tool to identify risk of repetition of self-harm or suicide following a self-harm episode
- Relationship between psychosocial assessment following self-harm and subsequent repetition of self-harm, in both the short-term and longer term
Outcome of self-harm, including repetition and mortality
- Risk of suicide following self-harm in gender and age subgroups, and changes over time
- Risk factors for suicide
- Risk of death from non-suicidal causes
- Mortality following self-harm in
- children and adolescents
- older people,
- people who misuse alcohol and drugs,
- people in current psychiatric contact
- different ethnic groups
- Change in use of different methods of self-harm between episodes and relationship to outcome
Pharmaco-epidemiology, including drug toxicology and impacts of changes in prescribing legislation and trends.
- Impact on self-harm of MHRA decision to withdraw co-proxamol
- Comparison of size of overdoses of paracetamol in England and Ireland in relation to differing pack sizes
- Relationship between use of specific antidepressants in self-poisoning and prescribing rates
- Relative toxicity (lethality) of individual antidepressants
- Trends in self-poisoning with SSRI antidepressants over time and in relation to MHRA warnings
- Relative toxicity of individual drugs used for self-harm and suicide
- Professor Keith Hawton (Oxford)
- Professor Nav Kapur (Manchester)
- Mr Keith Waters (Derby)
- Dr Galit Geulayov (Project Coordinator)
- Ms Deborah Casey (Database Manager)
- Ms Elizabeth Bale (Research Assistant)
- Mr John Ryall (Research Clerk)
- Ms Fiona Brand (Research Nurse)
- Ms Caroline Clements (Research Assistant)
- Ms Harriet Bickley (Research Assistant)
- Mr Iain Donaldson (Research Secretary)
- Ms Victoria Matthews (Clerical Assistant)
- Ms Jennifer Ness (Research Project Manager)
- Ms Muzamal Rehman (Research Assistant)
- Professor Ellen Townsend (University of Nottingham)
- Dr Anne Ferrey
- Ms Louise Harriss
- Dr Camilla Haw
- Dr Kate Saunders
- Dr Roger Webb
- Dr Kevin Mackway-Jones
- Dr Damien Longson
- Dr Elspeth Guthrie
- Prof Louis Appleby
- Dr David Owens (University of Leeds)
- Dr Ella Arensman (National Suicide Research Foundation, Cork)
- Dr Paul Corcoran (National Suicide Research Foundation, Cork)