The urban distribution of non-fatal deliberate self-harm

1. The incidence of non-fatal deliberate self-harm throughout the City of Bristol during 1972 and 1973 was assessed by means of a survey of patients presenting to Accident and Emergency Departments of hospitals in the area. Fatal or repeated acts of self-harm were not included in the survey. 2. The rates for females exceeded those for males at all ages, with peak incidence of 645 per 100,000 females (age group 15-29 years) and 334 per 100,000 males (age group 25-29 years). Ninety-three per cent had taken a drug overdose of some kind. 3. The problem was found in all electoral wards of tE CITY, THOUGH ITS DISTRIBUTION WAS MARKEDLY CENTRIPETAL, WITH A CENTRAL AREA HAVING MORBIDITY RATES UP TO 2-8 TIMES THAT FOR THE CITY AS A WHOLE. 4. The socio-economic correlates of deliberate self-harm were examined by reference both to a series of 368 patients interviewed soon after the event and to the pattern of its distribution throughout the city. A significant positive association was found with areas of overcrowding, lack of exclusive domestic amenities and high proportion of foreign born residents, but there was no correlation with the proportion of persons living alone nor with the type of accommodation. 5. The central high rate area was found to be heterogeneous in socio-economic terms, ranging from a student and young professionals' bed-sitter area to one with a high proportion of unskilled manual labourers and New Commonwealth immigrants. 6. The aetiological implications of the ecological findings for deliberate self-harm throughout the city are discussed.