ORIGINAL PAPER Jayne Cooper Æ Nusrat Husain Æ Roger Webb Æ Waquas Waheed Æ Navneet Kapur Æ Else Guthrie Louis Appleby Self-harm in the UK Differences between South Asians and Whites in rates, characteristics, provision of service and repetition Accepted: 15 June 2006 / Published online: 12 July 2006 j Abstract Background Rates of self-harm appear high in South Asian young women in the United Kingdom (UK) although previous studies were mostly small. Data on treatment and outcomes for South Asians are lacking. This study compared rates of self-harm, socio-demographic and clinical char- acteristics, provision of services and risk of repeti- tion by ethnicity. Method A prospective cohort of adult self-harm attendees (n = 7185), aged 15 and over presenting to four emergency departments in the cities of Manchester and Salford, UK over a 4- year period. Results The study included 299 South Asians. South Asian women aged 16–24 years were more likely to self-harm than Whites of the same age group (1010.9 vs. 754 per 100,000). Across all age groups the rates of self-harm were lower in South Asian men compared to White men and to South Asian women. South Asian women were significantly more likely to report relationship problems within the family than White women (32% vs. 19%, P = <0.001). South Asians were less likely than Whites to report depressive symptoms and to be offered specialist mental health services (Rate ra- tio = 0.75), and more likely to be referred back to the GP (Rate ratio = 1.83). South Asians were less likely to attend with a repeat episode (Rate ra- tio = 0.56). Conclusions Young South Asian women are at high risk of self-harm, but their clinical risk appears to be lower in terms of the accepted con- textual factors contributing to risk. Potentially useful service provision may include an interpersonal problem solving approach although to be effective, interventions would need to be acceptable to South Asian women and culturally appropriate. j Key words deliberate self-harm – ethnicity – epidemiology – health services research Introduction Self-harm is a major public health problem in the United Kingdom (UK), with more than 170,000 hos- pital attendances per annum [1]. Reported rates are second only to Finland in a multi-centre European study of self-harm [2]. Previous studies have sug- gested that rates of self-harm in young South Asian women in the UK are higher than in the White pop- ulation [3, 4]. Reasons for the disproportionately high rates of self-harm in young South Asian women are unclear. Comparatively high rates of depression have been found in Punjabi primary care attenders in the UK, particularly women [5, 6]. Similarly in a UK wide population based study, EMPIRIC [7], higher rates of depression were found in Pakistani and Indian wo- men. As with other immigrant groups, South Asian SPPE 99 The project and subsequent scientific papers based on aggregated data was ratified by the relevant LRECs. J. Cooper (&) Æ N. Kapur Æ L. Appleby Centre for Suicide Prevention, Division of Psychiatry 7th Floor Williamson Building University of Manchester, Oxford Road Manchester M13 9PL, UK Tel.: +44-161/275-0718 E-Mail: jayne.cooper@manchester.ac.uk N. Husain Æ E. Guthrie Manchester Royal Infirmary Manchester, UK R. Webb Centre for Women’s Mental Health Research Division of Psychiatry, University of Manchester Manchester, UK W. Waheed The Lantem Centre Preston, UK Soc Psychiatry Psychiatr Epidemiol (2006) 41:782–788 DOI 10.1007/s00127-006-0099-2