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Non-suicidal self-harm rate increases in England, treatment lacking

Although the prevalence of non-suicidal self-harm increased from about 2% to 6% between 2000 and 2014 in the general population in England, there was no evidence of increasing treatment service contact, according to a study published in The Lancet Psychiatry.

“The number of studies of non-suicidal self-harm (NSSH) or non-suicidal self-injury has grown worldwide since 2000, leading to improved recognition and informed prevention programs,” Sally McManus, MSc, of the National Centre for Social Research in London, and colleagues wrote. “Whether the prevalence or nature of NSSH is changing is unclear, because studies of temporal trends are rare and their findings inconsistent.”

To better determine the temporal trends in the prevalence of NSSH in England, researchers analyzed data from participants in the 2000 (n = 7,243), 2007 (n = 6,444) and 2014 (n = 6,477) Adult Psychiatric Morbidity Surveys of the general population (aged 16 to 74 years).

Using weighted data and controlling for complex survey design, they produced temporal trends in lifetime prevalence, motivations for non-suicidal self-harm and subsequent service contact.

For later service contact, participants were asked whether they had received medical attention for deliberately harming themselves and whether they had ever gone to a psychiatrist, psychologist or counsellor because they had harmed themselves. McManus and colleagues grouped participants as having medical contact only, psychological contact only, both or neither.

Over the 14-year period, the prevalence of self-reported lifetime non-suicidal self-harm rose from 2.4% (95% CI, 2–2.8) in 2000 to 6.4% (95% CI, 5.8–7.2) in 2014, according to the study. Although the researchers found the prevalence increased for men and women as well as across age groups, the most notable increases were observed in females aged 16 to 24 years (6.5%; 95% CI, 4.2–10 in 2000 to 19.7% 95% CI, 15.7–24.5 in 2014).

In addition, participants who reported non-suicidal self-harm to alleviate unpleasant feelings of anger, tension, anxiety or depression rose from 1.4% (95% CI, 1–2) to 4% (95% CI, 3.2–5) in males and from 2.1% (95% CI, 1.6–2.7) to 6.8% (95% CI, 6–7.8) in females over the 14-year period.

McManus and colleagues found that nearly 60% (95% CI,54.7–63.9) of participants who reported non-suicidal self-harm had no subsequent medical or psychological service contact in 2014. This proportion increased from those who reported receiving no later service contact after non-suicidal self-harm in 2000 (51.2%; 95% CI, 42.2–60) and in 2007 (51.8%; 95% CI, 47.3–56.4).

Female participants who had engaged in non-suicidal self-harm were about twice as likely as male participants to have medical or psychological service contact (unadjusted OR = 1·99; 95% CI, 1.22–3.25), the results showed. In addition, younger participants aged 16 to 34 years were less likely to have contact with health services than older participants.

“An increase in the prevalence of using self-harm to cope with emotional stress could have serious long-term public health implications. There is a risk that self-harm will become normalized for young people,” the researchers wrote. “Young people need health and educational services to be available, and health and other professionals need to discuss self-harm with young people and encourage them to find safer ways of coping.”

More study is needed for effective interventions to reduce non-suicidal self-harm in young people, Rohan Borschmann, PhD, DPsych, and Stuart A Kinner, PhD, from the University of Melbourne, Australia, wrote in a related editorial.

“Unless evidence-based, population-level, and targeted preventive responses are scaled up proportionately to the increase in NSSH, and access to low-threshold mental health services for young people engaging in NSSH is improved, the burden of untreated NSSH will continue to rise,” they wrote. – by Savannah Demko

Disclosure: The authors and editorial authors report no relevant financial disclosures.