Appleby, L

Bebbington, PE

Brugha, T

Cooper, C

Gunnell, D

Hassiotis, A

Howard, LM

Jenkins, R

McManus, S

Weich, S

English

UCL Discovery

   Correspondence: Psychological Medicine.  Sally McManus,1 David Gunnell,2 Claudia Cooper,3 4 Paul E Bebbington,3 Louise M Howard,5 Traolach Brugha,6 Rachel Jenkins, 7 Angela Hassiotis, 3 Scott Weich, 8 Louis Appleby 9  1 National Centre for Social Research, 35 Northampton Square, London EC1V 0AX, UK; City, University of London, UK 2 Population Health Sciences, University of Bristol; National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol UK  3 Division of Psychiatry, University College London 4 Camden and Islington NHS Foundation Trust, UK 5 IoPPN, Section of Women’s Mental Health, Kings College London, UK 6 Department of Health Sciences, University of Leicester, UK  7 Health Services and Population Research Department, IoPPN, Kings College London, UK 8 School of Health and Related Research, University of Sheffield, UK 9 Division of Psychology and Mental Health, University of Manchester, UK   Title: Recognising a changing epidemiology   To the Editor  We welcome Richard Liu’s analysis of the 2007 Adult Psychiatric Morbidity Survey (APMS), which provides important insights, but question his claim to present the first epidemiological study of non-suicidal self-injury (termed self-harm or non-suicidal self-harm in the UK). The survey is, in fact, the second in a series on this topic carried out in England in 2000, 2007 (McManus et al., 2009), and 2014 (McManus et al, 2016), recently summarised in a Lancet Psychiatry paper (McManus et al., 2019).  In neither the title, the abstract, nor the introduction does Liu mention that the data he used were collected in 2007, fourteen years ago. He therefore misses important changes in the epidemiology of self-harm that have occurred since then, including shifts in the prevalence, methods, and characteristics of those who engage in self-harm.  Our primary analyses of the same dataset, alongside the surveys in the APMS series carried out earlier (2000) and more recently (2014), reveal that the prevalence of non-suicidal self-harm in England increased steeply from 3·8% in 2007 to 6·4% in 2014. While the rise was evident across age groups and in both sexes, it was particularly pronounced in young women. Liu’s discussion of the lack of difference in rates by sex does not reflect the current situation: non-suicidal self-harm is now more common in women than in men.   Since 2007 both the methods of self-harm and reported motivations have also changed. Cutting has come to account for a higher proportion of female cases, and people have become more likely to report self-harm as being a coping mechanism. In addition, the more recent 2014 survey included improved methods of enquiry, establishing a history of self-harm in the past year as well as over the lifetime, enabling a more accurate estimate of the proportion who were not in contact with services.  Liu’s article does deal with several other issues of interest and value. However, we would welcome a correction from the author that alerts readers to the distinct and well-documented changes seen in the epidemiology of self-harm in the general population since these data were collected.     Conflict of interest No authors report conflicts of interest.  References Liu RT. The epidemiology of non-suicidal self-injury: lifetime prevalence, sociodemographic and clinical correlates, and treatment use in a nationally representative sample of adults in England. Psychological medicine. 2021 May 7:1-9.  McManus S, Meltzer H, Brugha T, Bebbington PE, Jenkins R. Adult psychiatric morbidity in England: Results of a household survey. Health and Social Care Information Centre; 2009.  McManus S, Hassiotis A, Jenkins R, Dennis M, Aznar C, Appleby L, Bebbington P, Brugha T. Suicidal thoughts, suicide attempts and self-harm. Mental Health and Wellbeing in England: Adult Psychiatric Morbidity Survey 2014. 2016.  McManus S, Gunnell D, Cooper C, Bebbington PE, Howard LM, Brugha T, Jenkins R, Hassiotis A, Weich S, Appleby L. Prevalence of non-suicidal self-harm and service contact in England, 2000–14: repeated cross-sectional surveys of the general population. The Lancet Psychiatry. 2019 Jul 1;6(7):573-81.   

Non-suicidal self-harm: an evolving epidemiology

https://discovery.ucl.ac.uk/id/eprint/10131853/1/Bebbington_McManus%20PsychMed%20Letter%20-%20comment%20on%20Liu%20-NSSI%20Epidemiology%20-2021_FINAL.pdf

Non-suicidal self-harm: an evolving epidemiology

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