Self-harm rates amongst individuals from ethnic minority backgrounds: A global systematic review

Purpose The evidence on ethnic variation in self-harm risk is growing. This systematic review is the first to synthesise the global epidemiological evidence on absolute and relative rates of self-harm in individuals from ethnic minority backgrounds (including migrant and Indigenous populations). Methods We identified empirical evidence through database searches (Medline, Embase, and PsycINFO published between 01/01/2000-19/12/2023). Studies were included if they reported absolute and/or relative rates of non-fatal self-harm in general population samples from ethnic minority groups. Lifetime self-harm was excluded. Due to limitations in the available data by country, we present a narrative synthesis and forest plots of the rates only. Synthesis was further stratified by sex, migration status, and self-harm method (where possible). Quality assessment was conducted using modified Newcastle Ottawa Scales. PROSPERO: CRD42021248646. Results We included 36 studies from 14 countries. Seven (19%) were of reasonable quality. Most were conducted in North America (15/36; 42%) and/or in high-income countries (33/36; 92%). Self-harm risk was elevated amongst certain Indigenous and migrant groups, though there was not always statistical evidence of elevated rates compared to the majority population. High heterogeneity was present. Conclusion The available evidence was of low quality and heterogeneous, indicating a need for improved reporting of self-harm by ethnicity and nuanced understanding of intersecting factors such as place of birth and migratory status. Appropriate surveillance, particularly in South America and Africa, is required to better understand international variations in self-harm prevalence for ethnic minority groups and inform population health suicide prevention.