Socioeconomic deprivation and the clinical management of self-harm: a small area analysis

PURPOSE: Socioeconomic deprivation is associated with increased rates of self-harm but its association with levels of clinical care has not previously been explored. The aim of the current study was to investigate socioeconomic differences in the clinical management of people who self-harm. METHODS: Cross-sectional analysis of 3607 people presenting to a large inner-city hospital following self-harm. RESULTS: People living in the least deprived quintile were more likely to receive a psychosocial assessment (most vs. least deprived: 63.51 vs. 70.14%). This effect persisted in our fully adjusted model (OR 1.45, CI 1.15–1.82, p = 0.002). Mediation analysis suggested this association was in large part explained by higher rates of self-discharge in people presenting from areas of higher deprivation. CONCLUSIONS: Compared to those from more deprived areas, people from less deprived areas are more likely to receive a psychosocial assessment when presenting to hospital following self-harm. The occurrence of higher rates of self-discharge from emergency departments among those from more deprived areas may explain the association. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00127-017-1438-1) contains supplementary material, which is available to authorized users.