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Prevalence of non-suicidal self-harm and service contact in England, 2000-14: repeated cross-sectional surveys of the general population
Open accessAbstract
BACKGROUND: The number of people presenting to hospital emergency departments after self-harming has increased in England. However, most people who self-harm do not present to hospitals, so whether this rise reflects an increase in the prevalence of self-harm in the community is unknown. Also unknown is whether the prevalence of non-suicidal self-harm (NSSH) or suicidal self-harm, or both, has increased. We aimed to establish temporal trends in the prevalence of NSSH in England. METHODS: We analysed data from participants in the 2000 (n=7243), 2007 (n=6444), and 2014 (n=6477) Adult Psychiatric Morbidity Surveys of the general population, selecting those aged 16-74 years and living in England. We used weighted data and controlled for complex survey design. We generated temporal trends in lifetime prevalence and methods of, and motivations for, NSSH, and consequent service contact. We used multiple variable logistic regression analyses to investigate factors associated with service contact. FINDINGS: The prevalence of self-reported lifetime NSSH increased from 2·4% (95% CI 2·0-2·8) in 2000, to 6·4% (5·8-7·2) in 2014. Increases in prevalence were noted in both sexes and across age groups-most notably in women and girls aged 16-24 years, in whom prevalence increased from 6·5% (4·2-10·0) in 2000, to 19·7% (15·7-24·5) in 2014. The proportion of the population reporting NSSH to relieve unpleasant feelings of anger, tension, anxiety, or depression increased from 1·4% (95% CI 1·0-2·0) to 4·0% (3·2-5·0) in men and boys, and from 2·1% (1·6-2·7) to 6·8% (6·0-7·8) in women and girls, between 2000 and 2014. In 2014, 59·4% (95% CI 54·7-63·9) of participants who had engaged in NSSH reported no consequent medical or psychological service contact, compared with 51·2% (42·2-60·0) in 2000 and 51·8% (47·3-56·4) in 2007. Male participants and those aged 16-34 years were less likely to have contact with health services than were female participants and older people. INTERPRETATION: The prevalence of NSSH has increased in England, but resultant service contact remains low. In 2014, about one in five female 16-24-year-olds reported NSSH. There are potential lifelong implications of NSSH, such as an increased frequency of suicide, especially if the behaviours are adopted as a long-term coping strategy. Self-harm needs to be discussed with young people without normalising it. Young people should be offered help by primary care, educational, and other services to find safer ways to deal with emotional stress. FUNDING: NHS Digital, English Department of Health and Social Care, and the National Institute for Health Research.
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“despite self-harm being a common and high-burden issue in the general population (McManus et al., 2019).”
From Prospective Longitudinal Associations Between Adverse Childhood Experiences and Adult Mental Health Outcomes: Systematic Review and Meta-Analysis (2026) · cites this paper as McManus et al., 2019
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“These increases appear to have been accompanied by other signals of deteriorating mental health among young people (McManus et al., 2014; McManus et al., 2019; Twenge et al., 2019).”
From Social media use, economic recession and income inequality in relation to trends in youth suicide in high-income countries: a time trends analysis (2020) · cites this paper as McManus et al., 2019
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“For example, the prevalence of common mental disorders and self-harm in the United Kingdom (UK) rose between 2000-2014, particularly among 16-24 year old females (McManus et al., 2014; McManus et al., 2019).”
From Social media use, economic recession and income inequality in relation to trends in youth suicide in high-income countries: a time trends analysis (2020) · cites this paper as McManus et al., 2019
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Metadata
- Authors
- McManus, S., Gunnell, D., Cooper, C., Bebbington, P. E., Howard, L. M., Brugha, T., Jenkins, R., Hassiotis, A., Weich, S., & Appleby, L.
- Affiliations
- NatCen Social Research (GB)
- University Hospitals Bristol NHS Foundation Trust (GB)
- University College London (GB)
- King's College London (GB)
- University of Leicester (GB)
- University of Sheffield (GB)
- University of Manchester (GB)
- Corresponding author
- McManus, Sally
- ORCID
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2019-07
- Volume
- 6
- Issue
- 7
- Pages
- 573-581
- ISSN
- 2215-0366 (ISSN-L)
- PMC
- PMC7646286
- OpenAlex
- W2948102438
- Cited by
- 415
- References
- 29
- Citations by year
- 2026: 28 · 2025: 61 · 2024: 47 · 2023: 68 · 2022: 64 · 2021: 91 · 2020: 44 · 2019: 12
- FWCI
- 61.61
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- Bristol Research (University of Bristol) (publishedVersion, cc-by)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- City Research Online (City University London) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Leicester Research Archive (University of Leicester) (submittedVersion, other-oa)
- Funders
- University Hospitals Bristol NHS Foundation Trust
- South London and Maudsley NHS Foundation Trust
- National Institute for Health Research (PHPEHF50/27, 023/0167)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- non-suicidal self-injury, prevalence trends, temporal trends, service contact, mental health service utilization, self-harm methods, suicidal self-harm, young women, gender differences, England, Adult Psychiatric Morbidity Survey, general population, mental health services funding, mental health professionals
- MeSH terms
- Adolescent, Adult, Aged, Cross-Sectional Studies, Emergency Service, Hospital, England, Female, Humans, Male, Middle Aged, Risk Factors, Prevalence, Self-Injurious Behavior, Age Distribution, Sex Distribution, Young Adult
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