Canadian Journal of Psychiatry
2019

Suicide and Self-Harm in Recent Immigrants in Ontario, Canada: A Population-Based Study [Suicide et Automutilation Chez Des Immigrants Récents en Ontario, Canada: Une Étude Dans la Population] (Article)

Saunders N.R.* , Chiu M. , Lebenbaum M. , Chen S. , Kurdyak P. , Guttmann A. , Vigod S.
  • a The Hospital for Sick Children, Toronto, ON, Canada, Department of Pediatrics, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, ON, Canada
  • b ICES, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, ON, Canada
  • c ICES, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, ON, Canada
  • d ICES, Toronto, ON, Canada
  • e ICES, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, ON, Canada, Centre for Addiction and Mental Health, Toronto, ON, Canada
  • f The Hospital for Sick Children, Toronto, ON, Canada, Department of Pediatrics, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, ON, Canada
  • g ICES, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, ON, Canada, Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada

Abstract

Objective: To estimate the rates of suicide and self-harm among recent immigrants and to determine which immigrant-specific risk factors are associated with these outcomes. Methods: Population-based cohort study using linked health administrative data sets (2003 to 2017) in Ontario, Canada which included adults ≥18 years, living in Ontario (N = 9,055,079). The main exposure was immigrant status (long-term resident vs. recent immigrant). Immigrant-specific exposures included visa class and country of origin. Outcome measures were death by suicide or emergency department visit for self-harm. Cox proportional hazards estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Results: We included 590,289 recent immigrants and 8,464,790 long-term residents. Suicide rates were lower among immigrants (n = 130 suicides, 3.3/100,000) than long-term residents (n = 6,354 suicides, 11.8/100,000) with aHR 0.3, 95% CI, 0.2 to 0.3. Male–female ratios in suicide rates were attenuated in immigrants. Refugees had 2.1 (95% CI, 1.3 to 3.6; rate 6.1/100,000) and 2.8 (95% CI, 2.5 to 3.2) times the likelihood of suicide and self-harm, respectively, compared with nonrefugee immigrants. Self-harm rate was lower among immigrants (n = 2,256 events, 4.4/10,000) than long-term residents (n = 68,039 events, 9.7/10,000 person-years; aHR 0.3; 95% CI, 0.3 to 0.3). Unlike long-term residents, where low income was associated with high suicide rates, income was not associated with suicide among immigrants and there was an attenuated income gradient for self-harm. Country of origin-specific analyses showed wide ranges in suicide rates (1.4 to 9.9/100,000) and self-harm (1.8 to 14.9/10,000). Conclusion: Recent immigrants have lower rates of suicide and self-harm and different sociodemographic predictors compared with long-term residents. Analysis of contextual factors including immigrant class, origin, and destination should be considered for all immigrant suicide risk assessment. © The Author(s) 2019.

Author Keywords

Self-harm Refugees immigrants Suicide

Index Keywords

[No Keywords available]
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85068265897&doi=10.1177%2f0706743719856851&partnerID=40&md5=d798f33b8e1671e287296208235d3222
DOI: 10.1177/0706743719856851
ISSN: 07067437
Original Language: English