Nonsuicidal Self-Harm Increased Significantly Between 2000 and 2014 in England

The prevalence of nonsuicidal self-harm (NSSH) increased in England, particularly in young women and girls, while subsequent medical or psychological service contact remained low, according to a study published in The Lancet Psychiatry.¹

The lifelong consequences of NSSH can be serious and include an increased frequency of suicide, particularly if NSSH is adopted as a coping mechanism. Evidence from studies has suggested an increase in NSSH in various populations.

In a secondary analysis of data from the 2000, 2007, and 2014 Adult Psychiatric Morbidity Surveys, author Sally McManus, MSc, of the National Centre for Social Research, London, United Kingdom, and colleagues used weighted data and controlled for complex survey design to evaluate temporal trends in lifetime prevalence and methods of and motivations for NSSH and consequent service contact.

Researchers analyzed data for 7243 people in 2000, 6477 in 2007, and 6477 in 2014. Subjects were between the ages of 16 and 74 years. The lifetime prevalence of NSSH rose from 2.4% in 2000 to 3.8% in 2007 and to 6.4% in 2014. NSSH was more prevalent in the youngest age groups and least prevalent in the oldest age groups in the 3 time periods analyzed. Whereas prevalence was similar in male and female participants in 2000 and 2007, it was significantly higher in women and girls (7.9%) than in men and boys (5.0%) in 2014. Among girls and women age 16 to 24 years, the prevalence increased from 6.5% in 2000 to 19.7% in 2014. The majority of this increase occurred in 2007. However, prevalence increased in both sexes and across all age groups. In all 3 time periods, no significant differences were noted for NSSH among different ethnic groups.

The proportion of those engaging in NSSH and reporting no subsequent medical or psychological service contact increased from 51.2% in 2000 to 51.8% in 2007 and to 59.4% in 2014. Women and girls were twice as likely to have medical or psychological service contact than men and boys.

The number of people using NSSH to relieve unpleasant feelings of anger, tension, anxiety, or depression tripled between 2000 and 2014. Researchers noted that this could have serious long-term public health consequences, with the potential for NSSH becoming normalized among youth.

In a commentary, Rohan Borschmann, PhD, and Stuart A. Kinner, PhD, of the Justice Health Unit, Center for Health Equity, Carlton, Victoria, Australia, noted that NSSH is a marker for other risk behaviors, including mental health problems, substance use, and antisocial behavior. ² They also remarked that the study was limited by the absence of data from individuals living in institutional settings and a lack of robust analysis by ethnic group. Ultimately, they concluded for the scaling up of evidence-based population-level targeted preventive responses to meet the challenge of increasing NSSH.

References

1. McManus S, Gunnell D, Cooper C, et al. Prevalence of non-suicidal self-harm and service contact in England, 2000-14: repeated cross-sectional surveys of the general population. Lancet Psychiatry. 2019;6(7):573-581.

2. Borschmann R, Kinner SA. Responding to the rising prevalence of self-harm. Lancet Psychiatry. 2019;6(7):548-549.