Article Text

Download PDFPDF

Self-harm presentation across healthcare settings by sex in young people: an e-cohort study using routinely collected linked healthcare data in Wales, UK
  1. Amanda Marchant1,
  2. Samantha Turner1,
  3. Lloyd Balbuena2,
  4. Evyn Peters2,
  5. Dave Williams3,
  6. Keith Lloyd1,
  7. Ronan Lyons1,
  8. Ann John1
  1. 1 Swansea University Medical School, Swansea University, Swansea, UK
  2. 2 Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  3. 3 Child and Adolescent Psychiatry, Aneurin Bevan Health Board, Newport, UK
  1. Correspondence to Professor Ann John, Swansea University Medical School, Swansea University, Swansea SA2 8PP, UK; a.john{at}


Background This study used individual-level linked data across general practice, emergency departments (EDs), outpatients and hospital admissions to examine contacts across settings and time by sex for self-harm in individuals aged 10–24 years old in Wales, UK.

Methods A whole population-based e-cohort study of routinely collected healthcare data was conducted. Rates of self-harm across settings over time by sex were examined. Individuals were categorised based on the service(s) to which they presented.

Results A total of 937 697 individuals aged 10–24 years contributed 5 369 794 person years of data from 1 January 2003 to 30 September 2015. Self-harm incidence was highest in primary care but remained stable over time (incident rate ratio (IRR)=1.0; 95% CI 0.9 to 1.1). Incidence of ED attendance increased over time (IRR=1.3; 95% CI 1.2 to 1.5) as did hospital admissions (IRR=1.4; 95% CI 1.1 to 1.6). Incidence in the 15–19 years age group was the highest across all settings. The largest increases were seen in the youngest age group. There were increases in ED attendances for both sexes; however, females are more likely than males to be admitted following this. This was most evident in individuals 10–15 years old, where 76% of females were admitted compared with just 49% of males. The majority of associated outpatient appointments were under a mental health specialty.

Conclusions This is the first study to compare self-harm in people aged 10–24 years across primary care, EDs and hospital settings in the UK. The high rates of self-harm in primary care and for young men in EDs highlight these as important settings for intervention.

  • Child Psychiatry
  • Accident & Emergency
  • Adolescent Health
  • Epidemiology
  • Health Service

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

View Full Text

Statistics from


  • Contributors AJ and AM conceived the study. All authors contributed to study design Analysis was conducted by AM and AJ. AM and AJ drafted the manuscript. All authors commented on the manuscript and agreed on the final version.

  • Funding This work was funded by MQ Mental Health Research Charity through the Adolescent Mental Health Data Platform (ADP) (Grant Reference MQBF/3 ADP) and the MRC Pathfinder (MC_PC_17211). The ADP and the authors would like to acknowledge the data providers who supplied the data sets enabling this research study. The views expressed are entirely those of the authors and should not be assumed to be the same as those of ADP or MQ Mental Health Research Charity. This work was supported by Health Data Research UK, which receives its funding from HDR UK (NIWA1) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF), and the Wellcome Trust.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Approval was granted by the Information Governance Review Panel (IGRP; approval number 0281). The IGRP oversees study approvals in line with permissions already granted to the analysis of data in the SAIL databank. Data are electronic and anonymised.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Atoms
    Nick Brown