LAUSR

A UK population-based cohort study linked a clinical practice database to national mortality statistics to analyse longitudinal trends in child and adolescent self-harm. The study identified 16 912 youth aged 10–19 years who harmed themselves from 2011 to 2014. Overall annual incidence rates in girls were over three times higher than in boys (0.37 vs. 0.12%). The incidence in girls aged 13–16 years increased from 0.46 to 0.77% between 2011 and 2014. The epidemiology illustrated the ‘inverse care law’: children from deprived areas were most likely to harm themselves but least likely to be referred to mental health services. Children and adolescents who harmed themselves were more likely than their peers to commit suicide (hazard ratio 17.5, 95% confidence interval 7.6–40.5) or to die from poisoning due to alcohol of drugs (hazard ratio 34.3, 95% confidence interval 10.2–115.7). The data are not available for Australia, but the same message is likely to apply regarding the need for early appropriate referral to mental health services.