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Social Psychiatry and Psychiatric Epidemiology
Published in: Social Psychiatry and Psychiatric Epidemiology 1/2019

Open Access 01-01-2019 | Original Paper

Spatial patterning of self-harm rates within urban areas

Authors: Catherine Polling, Ioannis Bakolis, Matthew Hotopf, Stephani L. Hatch

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 1/2019

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Abstract

Purpose

Urban areas are usually found to have higher rates of self-harm, with deprivation the strongest predictor at area-level. We use a disease mapping approach to examine how self-harm is patterned within an urban area and its associations with deprivation, urbanness and ethnicity.

Methods

Data from clinical records on individuals admitted for self-harm for 725 small areas in South East London were included. Bayesian hierarchical models explored the spatio-temporal patterns of self-harm admission rates and potential associations with proximity to city centre, population density, percentage greenspace and non-white ethnic-minority populations. All models were adjusted for area-level deprivation, social fragmentation and hospital of admission.

Results

There were 8327 first admissions for self-harm during the study period. Self-harm admission rates varied fourfold across the study area, with lower rates close to the city centre [adjusted standardised admission ratio, closest versus furthest quartile 0.71(95% CrI 0.54–0.96)]. Deprivation was associated with self-harm but partially masked rather than explained the spatial pattern, which strengthened after adjustment. After adjustment for deprivation, hospital of admission and social fragmentation, greenspace, population density and ethnicity were not associated with self-harm rates.

Conclusion

Proximity to the city centre was associated with lower rates of self-harm, but the usual operationalisations of urbanness, population density and greenspace, were not. Deprivation did not explain the spatial patterning, nor did ethnicity. While nationally self-harm rates are higher in urban and deprived areas, this cannot be extrapolated to mean that within cities the inner-city is the highest risk area nor that risk will be principally patterned according to deprivation.
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Metadata
Title
Spatial patterning of self-harm rates within urban areas
Authors
Catherine Polling
Ioannis Bakolis
Matthew Hotopf
Stephani L. Hatch
Publication date
01-01-2019
Publisher
Springer Berlin Heidelberg
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 1/2019
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-018-1601-3

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