Background

Studies report an increasing incidence of self-harm in children and adolescents, but the extent to which this is seen in different ethnic groups is unclear. We aimed to investigate rates of emergency department presentations for self-harm in children and adolescents by ethnicity, as well as to examine their demographic characteristics, clinical characteristics, and outcomes.

Methods

In this observational cohort study, we used data on hospital emergency department presentations for self-harm in children and adolescents aged 10–19 years between 2000 and 2016 from the Multicentre Study of Self-harm in England. This study collects data from five general hospitals in Manchester, Oxford, and Derby in the UK, and defines self-harm as any act of intentional self-injury or self-poisoning, regardless of intent. All children and adolescents aged 10–19 years for whom ethnicity data were available were included. Mortality follow-up was available through linkage with mortality records from the Office for National Statistics. Rates of self-harm over time, demographic and clinical characteristics, and self-harm methods were investigated by ethnic group. Risk of repeat self-harm and mortality following an initial presentation for self-harm was compared by ethnic group using Kaplan-Meier curves and Cox proportional hazards models.

Findings

Of 14 894 individuals who presented at hospitals with self-harm, 11 906 had data for ethnicity, of whom 10 211 (85·8%) were White, 344 (2·9%) were Black, 619 (5·2%) were South Asian, and 732 (6·1%) were other non-White. Rates of self-harm were highest in White children and adolescents but increased between 2009 and 2016 in all ethnicities. Mean annual rates of self-harm per 100 000 population were 574 for White, 225 for Black, 260 for South Asian, and 344 for other non-White groups. Increases in rates of self-harm between 2009 and 2016 appeared slightly greater in Black groups (incidence rate ratio 1·07 [95% CI 1·03–1·11]), South Asian groups (1·05 [1·01–1·09]), and other non-White groups (1·11 [1·06–1·16]) than in White groups (1·02 [1·00–1·03]). Children and adolescents from a minority ethnic background were more likely to live in areas of high deprivation and were less likely to receive a specialist psychosocial assessment than were White children and adolescents. Children and adolescents from minority ethnic groups were also less likely to repeat self-harm. However, there were no differences in suicide mortality by ethnic group, although the numbers were small.

Interpretation

Minority ethnic children and adolescents accounted for an increased proportion of self-harm presentations to hospital over time compared with White ethnic groups. The minority ethnic groups also tended to be more socioeconomically disadvantaged and were less likely to receive a psychosocial assessment. Socioeconomic disparities need to be addressed, and equitable access to culturally sensitive comprehensive psychosocial assessments must be ensured.

Funding

UK Department of Health and Social Care.

中文翻译：

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不同种族儿童和青少年的自我伤害：一项来自英国多中心自我伤害研究的观察性队列研究

背景

研究报告称，儿童和青少年的自残发生率在增加，但不同种族群体的自残程度尚不清楚。我们的目的是按种族调查儿童和青少年因自残而在急诊科就诊的比率，并检查他们的人口统计学特征、临床特征和结果。

方法

在这项观察性队列研究中，我们使用了英格兰多中心自伤研究中 2000 年至 2016 年间 10-19 岁儿童和青少年自伤的医院急诊科报告数据。这项研究收集了英国曼彻斯特、牛津和德比的五家综合医院的数据，并将自残定义为任何故意的自伤或自毒行为，无论其意图如何。所有可获得种族数据的 10-19 岁儿童和青少年都包括在内。通过与国家统计局的死亡率记录相关联，可以进行死亡率跟踪。随时间推移的自我伤害率、人口统计学和临床​​特征以及自我伤害方法按族群进行了调查。

发现

在 14 894 名因自残而到医院就诊的人中，11 906 人有种族数据，其中 10 211 人（85·8%）为白人，344 人（2·9%）为黑人，619 人（5·2%）是南亚人，732 (6·1%) 是其他非白人。自残率在白人儿童和青少年中最高，但在 2009 年至 2016 年期间所有种族都有所上升。每 100 000 人的年平均自残率分别为白人 574 人、黑人 225 人、南亚人 260 人和其他非白人群体 344 人。2009 年至 2016 年间自残率的增加在黑人群体（发生率比率 1·07 [95% CI 1·03–1·11]）、南亚群体（1·05 [1·01– 1·09]), 和其他非白人群体 (1·11 [1·06–1·16]) 而不是白人群体 (1·02 [1·00–1·03])。与白人儿童和青少年相比，来自少数民族背景的儿童和青少年更有可能生活在高度贫困地区，并且不太可能接受专业心理社会评估。来自少数民族的儿童和青少年也不太可能重复自残。然而，尽管人数很少，但种族群体的自杀死亡率没有差异。

解释

随着时间的推移，与白人族群相比，少数族裔儿童和青少年在向医院报告自我伤害的比例有所增加。少数族裔群体在社会经济上也往往处于更不利的地位，并且不太可能接受社会心理评估。需要解决社会经济差异，必须确保公平获得对文化敏感的综合社会心理评估。

资金

英国卫生和社会保健部。