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Self-harm in Oxford, England: epidemiological and clinical trends, 1996–2010

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Abstract

Background

Self-harm is a major healthcare problem and changes in its prevalence and characteristics can have important implications for clinical services, treatment and prevention.

Methods

We analysed data on all self-harm presentations to the general hospital in Oxford between 1996 and 2010 using the Oxford Monitoring System for Self-harm. We investigated trends in prevalence, methods and repetition of self-harm, and receipt of psychosocial assessment. For patients receiving a psychosocial assessment, we investigated trends in alcohol use and misuse, prior psychiatric treatment and self-harm, problems, and suicidal intent.

Results

Rates of self-harm rose in both genders between 1996 and 2002/2003, after which they declined. There was evidence of a possible cohort effect, whereby higher rates in younger males in earlier years transferred over time to older age groups. Self-cutting, hanging and jumping became more common. Paracetamol was involved in 44.9 % of all self-poisoning episodes. Overdoses of antidepressants (particularly selective serotonin reuptake inhibitors) increased, as did those of mood stabilisers, non-opiate analgesics excluding paracetamol (e.g. non-steroidal anti-inflammatory drugs), and non-ingestible poisons. Alcohol use in relation to self-harm and alcohol-related problems became more common, as did history of prior psychiatric treatment and, especially, of self-harm, and employment problems from 2008. Despite national guidance, the proportion of patients undergoing psychosocial assessment declined.

Conclusions

Major changes in the extent and nature of self-harm occurred over the study period, some suggestive of increased psychopathology and others reflecting prescribing practices and changes in drinking patterns. The findings emphasise the need for psychosocial assessment following self-harm, to identify treatment needs and reduce repetition.

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Acknowledgments

We thank all members of the general hospital self-harm service (Barnes Unit) for assistance with data collection, especially Karen Lascelles, and John Ryall for helping with data entry. We acknowledge financial support from the Department of Health including the Policy Research Programme. KH is a National Institute for Health Research Senior Investigator. The Department of Health had no role in study design, the collection, analysis and interpretation of data, the writing of the manuscript, and the decision to submit the paper for publication. The views and opinions expressed do not necessarily reflect those of the Department of Health or the National Institute for Health Research.

Conflict of interest

The authors have no conflicts of interest.

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Authors and Affiliations

  1. Centre for Suicide Research, University of Oxford, Oxford, UK

    Keith Hawton, Camilla Haw, Deborah Casey, Liz Bale, Fiona Brand & Dorothy Rutherford

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  1. Keith Hawton
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  2. Camilla Haw
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  3. Deborah Casey
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  4. Liz Bale
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  5. Fiona Brand
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  6. Dorothy Rutherford
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Correspondence to Keith Hawton.

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Hawton, K., Haw, C., Casey, D. et al. Self-harm in Oxford, England: epidemiological and clinical trends, 1996–2010. Soc Psychiatry Psychiatr Epidemiol 50, 695–704 (2015). https://doi.org/10.1007/s00127-014-0990-1

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  • DOI: https://doi.org/10.1007/s00127-014-0990-1

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