Implementation of minimum unit pricing for alcohol in Scotland and subsequent rates of hospital-admitted self-harm: controlled interrupted time series analysis

Article

Steeg, S., Webb, R.T., Das-Munshi, J., Dutta, R., Kapur, N., Marzano, L., Strelitz, J. and John, A. 2026. Implementation of minimum unit pricing for alcohol in Scotland and subsequent rates of hospital-admitted self-harm: controlled interrupted time series analysis . Journal of Public Health. https://doi.org/10.1093/pubmed/fdag058
TypeArticle
TitleImplementation of minimum unit pricing for alcohol in Scotland and subsequent rates of hospital-admitted self-harm: controlled interrupted time series analysis
AuthorsSteeg, S., Webb, R.T., Das-Munshi, J., Dutta, R., Kapur, N., Marzano, L., Strelitz, J. and John, A.
Abstract

Background
Harmful alcohol use is a major modifiable risk factor for self-harm. We aimed to examine associations between minimum unit pricing (MUP) for alcohol, introduced in Scotland in 2018, and rates of hospital-admitted self-harm.

Methods
Data were obtained from Public Health Scotland and English Hospital Episode Statistics. Interrupted time series (ITS) analysis compared pre-post intervention self-harm admission rates per 100,000 population, including controlled comparisons with England.

Results
The before-after slope reduction in Scotland corresponded to -5.6 (95% CI -7.5 to -3.7) admissions per quarter, per 100,000 population, over the intervention period. Using controlled ITS, a greater slope reduction was observed in Scotland relative to England: -3.5, CI -6.4 to -0.6. No differences in slope change were observed when examining only pre-pandemic study quarters. Findings were consistent with a possible postintervention rate reduction in the two most deprived population quintiles, while no between-nation slope difference was observed in the three least deprived quintiles.

Conclusions
Findings were consistent with possible postintervention reductions in hospital-admitted self-harm in Scotland compared to England, with reductions concentrated in more deprived populations. Population-level alcohol pricing policies may contribute to reducing self-harm frequency, although causal interpretation is limited by the observational, quasi-experimental study design and differing between-nation pre-intervention trajectories.

Keywordsalcohol; mental health; population-based and preventative services
Sustainable Development Goals3 Good health and well-being
Middlesex University ThemeHealth & Wellbeing
Research GroupCentre for Abuse, Trauma and Suicide Studies (CATS)
PublisherOxford University Press (OUP)
JournalJournal of Public Health
ISSN1741-3842
Electronic1741-3850
Publication dates
Online03 Aug 2026
Publication process dates
Submitted19 Mar 2026
Accepted07 Jul 2026
Deposited21 Jul 2026
Output statusPublished
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Open
Copyright Statement

Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the Faculty of Public Health.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Digital Object Identifier (DOI)https://doi.org/10.1093/pubmed/fdag058
Related Output
Is supplemented byhttps://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdag058/8749468#supplementary-data
LanguageEnglish
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Evaluation of long-term counselling at a community health service for women who are on a low income
Payne, N., Ciclitira, K., Starr, F., Marzano, L. and Brunswick, N. 2015. Evaluation of long-term counselling at a community health service for women who are on a low income. Counselling and Psychotherapy Research. 15 (2), pp. 79-87. https://doi.org/10.1080/14733145.2013.877513
The application of mHealth to mental health: opportunities and challenges
Marzano, L., Bardill, A., Fields, B., Herd, K., Veale, D., Grey, N. and Moran, P. 2015. The application of mHealth to mental health: opportunities and challenges. The Lancet Psychiatry. 2 (10), pp. 942-948. https://doi.org/10.1016/S2215-0366(15)00268-0
Hard-to-get-at data from difficult-to-access users
Fields, B., Bardill, A., Marzano, L. and Herd, K. 2015. Hard-to-get-at data from difficult-to-access users. Abascal, J., Barbosa, S., Fetter, M., Gross, T., Palanque, P. and Winckler, M. (ed.) 15th IFIP TC 13 International Conference on Human-Computer Interaction. Bamberg, Germany 14 - 18 Sep 2015 Springer. pp. 409-416 https://doi.org/10.1007/978-3-319-22723-8_32
Responding to repetitive, non-suicidal self-harm in an English male prison: staff experiences, reactions, and concerns
Marzano, L., Adler, J. and Ciclitira, K. 2015. Responding to repetitive, non-suicidal self-harm in an English male prison: staff experiences, reactions, and concerns. Legal and Criminological Psychology. 20 (2), pp. 241-254. https://doi.org/10.1111/lcrp.12025
Psychosocial characteristics and social networks of suicidal prisoners: towards a model of suicidal behaviour in detention
Rivlin, A., Hawton, K., Marzano, L. and Fazel, S. 2013. Psychosocial characteristics and social networks of suicidal prisoners: towards a model of suicidal behaviour in detention. PLoS ONE. 8 (7), pp. 1-11. https://doi.org/10.1371/journal.pone.0068944
A typology of male prisoners making near-lethal suicide attempts
Rivlin, A., Ferris, R., Marzano, L., Fazel, S. and Hawton, K. 2013. A typology of male prisoners making near-lethal suicide attempts. Crisis: The Journal of Crisis Intervention and Suicide Prevention. 34 (5), pp. 335-347. https://doi.org/10.1027/0227-5910/a000205
The suicidal process in male prisoners making near-lethal suicide attempts
Rivlin, A., Fazel, S., Marzano, L. and Hawton, K. 2013. The suicidal process in male prisoners making near-lethal suicide attempts. Psychology, Crime and Law. 19 (4), pp. 305-327. https://doi.org/10.1080/1068316X.2011.631540
Comfort and challenge: A thematic analysis of female clinicians’ experiences of supervision
Starr, F., Ciclitira, K., Marzano, L., Brunswick, N. and Costa, A. 2013. Comfort and challenge: A thematic analysis of female clinicians’ experiences of supervision. Psychology and Psychotherapy: Theory, Research and Practice. 86 (3), pp. 334-351. https://doi.org/10.1111/j.2044-8341.2012.02063.x
Impact on prisoners of participating in research interviews related to near-lethal suicide attempts
Rivlin, A., Marzano, L., Hawton, K. and Fazel, S. 2012. Impact on prisoners of participating in research interviews related to near-lethal suicide attempts. Journal of Affective Disorders. 136 (1-2), pp. 54-62. https://doi.org/10.1016/j.jad.2011.09.009
Studying survivors of near-lethal suicide attempts as a proxy for completed suicide in prisons
Rivlin, A., Fazel, S., Marzano, L. and Hawton, K. 2012. Studying survivors of near-lethal suicide attempts as a proxy for completed suicide in prisons. Forensic Science International. 220 (1), pp. 19-26. https://doi.org/10.1016/j.forsciint.2012.01.022
Women counsellors' experiences of personal therapy: A thematic analysis
Ciclitira, K., Starr, F., Marzano, L., Brunswick, N. and Costa, A. 2012. Women counsellors' experiences of personal therapy: A thematic analysis. Counselling and Psychotherapy Research. 12 (2), pp. 136-145. https://doi.org/10.1080/14733145.2011.645050
The impact of prison staff responses on self-harming behaviours: prisoners’ perspectives
Marzano, L., Ciclitira, K. and Adler, J. 2012. The impact of prison staff responses on self-harming behaviours: prisoners’ perspectives. British Journal of Clinical Psychology. 51 (1), pp. 4-18. https://doi.org/10.1111/j.2044-8260.2010.02007.x
Psychosocial influences on prisoner suicide: a case-control study of near-lethal self-harm in women prisoners
Marzano, L., Hawton, K., Rivlin, A. and Fazel, S. 2011. Psychosocial influences on prisoner suicide: a case-control study of near-lethal self-harm in women prisoners. Social Science & Medicine. 72 (6), pp. 874-883. https://doi.org/10.1016/j.socscimed.2010.12.028
Near-lethal self-harm in women prisoners: contributing factors and psychological processes
Marzano, L., Fazel, S., Rivlin, A. and Hawton, K. 2011. Near-lethal self-harm in women prisoners: contributing factors and psychological processes. The Journal of Forensic Psychiatry & Psychology. 22 (6), pp. 863-884. https://doi.org/10.1080/14789949.2011.617465
Self-harm in a men's prison: staff's and prisoners' perspectives.
Marzano, L. 2007. Self-harm in a men's prison: staff's and prisoners' perspectives. PhD thesis Middlesex University
Visuo-spatial ability and dyslexia: is there a male global advantage?
Brunswick, N., Martin, G. and Marzano, L. 2008. Visuo-spatial ability and dyslexia: is there a male global advantage? British Dyslexia Association International Conference, 2008 [Dyslexia: making links]. Harrogate, York 27 - 29 Mar 2008
Visuo-spatial ability, handedness and developmental dyslexia: just how sinister was Andy Warhol?
Brunswick, N., Martin, G. and Marzano, L. 2007. Visuo-spatial ability, handedness and developmental dyslexia: just how sinister was Andy Warhol? 25th European Workshop on Cognitive Neuropsychology. Bressanone, Italy 21 - 26 Jan 2007
To be or not to be … a psychologist: critical and feminist dilemmas.
Ciclitira, K., Capdevila, R., Marzano, L. and Adams, E. 2008. To be or not to be … a psychologist: critical and feminist dilemmas. 2008 BPS Annual Conference.. Dublin 04 Feb 2008
Counsellors’ experiences of working as volunteers at a women’s service.
Costa, A., Ciclitira, K. and Marzano, L. 2008. Counsellors’ experiences of working as volunteers at a women’s service. 2008 Psychology of Women Section 21st Anniversary Conference on 'Rights and Changes'.. Cumberland Lodge, The Great Park, Windsor.
The impact of personal psychotherapy and supervision on volunteer counsellors.
Ciclitira, K., Marzano, L., Starr, F., Brunswick, N., Costa, A. and Berger, S. 2009. The impact of personal psychotherapy and supervision on volunteer counsellors. 2009 BPS Annual Conference. Brighton, UK 01 - 03 Apr 2009
Afghan nationals in the UK: professional capacity and views on return
Sales, R., Blitz, B. and Marzano, L. 2002. Afghan nationals in the UK: professional capacity and views on return. Research commissioned by Refugee Action and the International Organization for Migration, London..
Self-harm in prisons: dominant models and (mis)understandings
Marzano, L. 2010. Self-harm in prisons: dominant models and (mis)understandings. in: Adler, J. and Gray, J. (ed.) Forensic psychology: concepts, debates and practice Willan. pp. 486-507
Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case-control study
Rivlin, A., Hawton, K., Marzano, L. and Fazel, S. 2010. Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case-control study. The British Journal of Psychiatry. 197 (4), pp. 313-319. https://doi.org/10.1192/bjp.bp.110.077883
Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case–control study
Marzano, L., Fazel, S., Rivlin, A. and Hawton, K. 2010. Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case–control study. The British Journal of Psychiatry. 197 (3), pp. 219-226. https://doi.org/10.1192/bjp.bp.109.075424
Visuospatial superiority in developmental dyslexia: myth or reality?
Brunswick, N., Martin, G. and Marzano, L. 2010. Visuospatial superiority in developmental dyslexia: myth or reality? Learning and Individual Differences. 20 (5), pp. 421-426. https://doi.org/10.1016/j.lindif.2010.04.007
Theoretical and ethical issues in conducting research at a women’s centre.
Ciclitira, K. and Marzano, L. 2004. Theoretical and ethical issues in conducting research at a women’s centre. Proceedings of the British Psychological Society. 12 (2).
Being a man: justice and care.
Capdevila, R., Ciclitira, K., Lazard, L. and Marzano, L. 2006. Being a man: justice and care. Psychology of Women Section Annual Conference 2005.. University of Huddersfield. The British Psychological Society.
Interviewing survivors of near-lethal self-harm: a novel approach for investigating suicide amongst prisoners
Marzano, L., Rivlin, A., Fazel, S. and Hawton, K. 2009. Interviewing survivors of near-lethal self-harm: a novel approach for investigating suicide amongst prisoners. Journal of Forensic and Legal Medicine. 16 (3), pp. 152-155. https://doi.org/10.1016/j.jflm.2008.08.011
Justice and care: theorising the 'new man' and the 'caring father.'
Marzano, L., Capdevila, R., Ciclitira, K. and Lazard, L. 2009. Justice and care: theorising the 'new man' and the 'caring father.'. Psychology of Women Secton Review. 11 (2), pp. 11-20.
Being young feminists: discussions and (dis)contents
Adams, E., Del Busso, L., Foster, N., Majumdar, A., Marzano, L. and Papadima, M. 2007. Being young feminists: discussions and (dis)contents. Feminism and Psychology. 17 (3), pp. 291-294. https://doi.org/10.1177/0959353507079081
I. Is my work 'feminist' enough? Tensions and dilemmas in researching male prisoners who self-harm
Marzano, L. 2007. I. Is my work 'feminist' enough? Tensions and dilemmas in researching male prisoners who self-harm. Feminism and Psychology. 17 (3), pp. 295-301. https://doi.org/10.1177/0959353507079082
Supporting staff working with prisoners who self-harm: a survey of support services for staff dealing with self-harm in prisons in England and Wales
Marzano, L. and Adler, J. 2007. Supporting staff working with prisoners who self-harm: a survey of support services for staff dealing with self-harm in prisons in England and Wales. International Journal of Prisoner Health. 3 (4), pp. 268-282. https://doi.org/10.1080/17449200701682501
Non voluntary return? The politics of refugee return to Afghanistan
Sales, R., Blitz, B. and Marzano, L. 2005. Non voluntary return? The politics of refugee return to Afghanistan. Political Studies. 53 (1), pp. 182-200. https://doi.org/10.1111/j.1467-9248.2005.00523.x
Theoretical and ethical issues in conducting research at a women’s health centre.
Ciclitira, K., Marzano, L., Brunswick, N., Starr, F. and Berger, S. 2004. Theoretical and ethical issues in conducting research at a women’s health centre. Psychology of Women Section Review. 6 (1), pp. 60-69.