Self-harm: boys are less likely to be admitted to hospital
Self-harm is one of the most important risk factors for suicide. Although rare in young people, suicide is still the leading cause of death in males and females aged 10-19 years in England and Wales. And with evidence of a rise in rates of suicide among 15-19 year olds in the UK since 2010, it’s important to understand how young people seek help for self-harm and what happens when they do.
Most studies looking at where young people who self-harm go for help have only looked at hospital and GP records. While we know that many young people who self-harm won’t contact healthcare services, we wanted to capture the full spectrum of those who do. So for our study we looked at data from GP clinics, emergency departments and outpatient clinics, as well as hospital admissions for the years 2003 to 2015 in Wales, UK. Our study included 937,697 young people aged 10-24, of whom 15,739 sought help for self-harm.
Girls more likely to be admitted
More young people saw their GP about self-harm than in any other service – one in four young people went to primary care only. This has barely changed since 2003. But the number of young people attending emergency departments and subsequently being admitted to hospital after an episode of self-harm has increased.
One of our most interesting findings was that after going to an emergency department to report self-harm, girls and young women are more likely to be admitted to hospital than boys and young men of the same age. This difference was the same even for 10-15 year olds, despite guidelines advising that those under 16 years old should be admitted to hospital overnight.
Based on our data we can’t say exactly why this is happening. It could be down to the method used – girls and young women are more likely to take an overdose and so be admitted for drug monitoring than people who have self-injured in other ways, such as cutting themselves.
The sex difference could also be related to boys and young men being more likely to refuse to be admitted. While it’s difficult to pin down the exact reason, the fact that girls and young women contacting services with self-harm outnumber boys and young men in every healthcare setting except the emergency department makes our emergency departments an important place to provide help.
There is a current focus on initiatives to get more boys and young men to seek help, but we also need to consider if we manage them differently to girls. There may be attitudes we need to change in society. We still need to encourage boys to seek help early, potentially in settings other than emergency departments, which may not be best suited to their needs when in acute distress. But we also need to change how we respond and manage them when they do seek help.
Rates of self-harm were highest among 15-19 year olds across all healthcare services. We know from surveys of the general public that rates of self-harm in this age group are higher, so it’s not a huge surprise.
Increase in young girls self-harming
The largest increases in self-harm were seen among 10-14 year olds, particularly girls. Again it’s difficult to say exactly why this is the case, but it is probably due to several factors such as parents being more aware of self-harm and it’s possible causes, making it more likely that they will seek help for their children. So the rise in reported rates of self-harm may ironically be a good thing because it suggests more people are asking for help and getting the support they need.
But the increase could also reflect a genuine rise in self-harm in this age group. There is survey data in older teenagers that shows this is the case particularly in older girls and young women.
Young people from the most deprived areas of Wales were most at risk, with rates of self-harm more than double those in young people living in more affluent areas.
Providing the right ongoing support to young people who contact health services is a good start, but many young people who self-harm don’t seek this sort of help and our study does not include them. But it highlights a group of young people where we can offer help in the places they seek it – particularly for hard to reach groups, such as boys and young people from deprived areas.
Ann John receives funding from MQ, MRC and HCRW. She is a Trustee of the Mental Health Foundation
Amanda Marchant receives funding from Health and Care Research Wales and the Medical Research Council