Ethnic density and deliberate self harm; a small area study in south east London

Neeleman, J
Wilson-Jones, C
Wessely, S

¹Department of Social Psychiatry, University of Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands, ²Department of Psychological Medicine, Institute of Psychiatry, London

Accepted for publication 4 May 2000

Correspondence to: Dr Neeleman ([email protected])

We thank staff at the casualty departments for their kind cooperation.

Funding: this study was funded by the UK Medical Research Council.

Conflicts of interest: none.

Journal of Epidemiology & Community Health 55(2):p 85-90, February 1, 2001.

STUDY OBJECTIVE

Relative risks are frequently used to convey how strongly outcomes like mental illness and suicidal behaviour are associated with personal characteristics like ethnic background. This study examined whether RRs for deliberate self harm (DSH) in ethnic groups vary between small areas according to their ethnic mix.

DESIGN

Small area study of DSH rates in ethnic groups, by local ethnic density, using negative binomial regression.

SETTING

73 south London electoral wards, 1994–1997.

SUBJECTS

1643 people attending casualty after DSH.

MAIN RESULTS

African-Caribbean and Asian DSH rates, relative to the white population, varied between wards. A linear model indicated a decline by factors (relative rate ratios) 0.76 (95% confidence intervals (CI) 0.64 to 0.90) and 0.59 (95% CI 0.36 to 0.97) respectively per SD increase in the local size of these minority populations. However, for both groups, an inverted U shaped curve provided a better fit for the link between the relative DSH rate in these groups and their local population density.

CONCLUSIONS

The DSH rate of minority groups relative to the white group is low (suggesting protection) in some areas, and high (suggesting risk) elsewhere. This has implications for management of suicidal behaviour in ethnic groups but also for interpretation, and policy implementation, of research on risk for suicidal behaviour, and, probably, many other outcomes. Relative risks or rates are not stable indicators of association in psychiatric epidemiology.