BMJ Open
Volume 7, Issue 9, 2017

Suicide and self-harm trends in recent immigrant youth in Ontario, 1996-2012: A population-based longitudinal cohort study (Article) (Open Access)

Saunders N.R.* , Lebenbaum M. , Stukel T.A. , Lu H. , Urquia M.L. , Kurdyak P. , Guttmann A.
  • a Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Canada, Department of Pediatrics, University of Toronto, Toronto, Canada, Institute for Clinical Evaluative Sciences, Toronto, Canada, Child Health Evaluative Sciences, Sickkids Research Institute, Toronto, Canada
  • b Institute for Clinical Evaluative Sciences, Toronto, Canada
  • c Institute for Clinical Evaluative Sciences, Toronto, Canada, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
  • d Institute for Clinical Evaluative Sciences, Toronto, Canada
  • e Institute for Clinical Evaluative Sciences, Toronto, Canada, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada, Manitoba Centre for Health Policy, Department of Community Health Services, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
  • f Institute for Clinical Evaluative Sciences, Toronto, Canada, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Centre for Addiction and Mental Health, Toronto, Canada
  • g Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Canada, Department of Pediatrics, University of Toronto, Toronto, Canada, Institute for Clinical Evaluative Sciences, Toronto, Canada, Child Health Evaluative Sciences, Sickkids Research Institute, Toronto, Canada, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

Abstract

Objective To describe the trends in suicide and emergency department (ED) visits for self-harm in youth by immigration status and immigrant characteristics. Design Population-based longitudinal cohort study from 1996 to 2012 using linked health and administrative datasets. Setting Ontario, Canada. Participants Youth 10 to 24 years, living in Ontario, Canada. Exposure The main exposure was immigrant status (recent immigrant (RI) versus long-term residents (LTR)). Secondary exposures included region of birth, duration or residence, and refugee status. Main outcome measure Trends over time in suicide and ED self-harm were modelled within consecutive 3-year time periods. Rate ratios were estimated using Poisson regression models. Results 2.5 to 2.9 million individuals were included per cohort period. LTR suicide rates ranged from 7.4 to 9.4/100 000 male person-years versus 2.2-3.4/100 000 females. RI's suicide rates were 2.7-7.2/100,000 male versus 1.9-2.7/100 000 female person-years. Suicide rates were lower among RI compared with LTR (adjusted relative rate (aRR)=0.70, 95% CI=0.57 to 0.85) with different mechanisms of suicide. No significant time trend in suicide rates was observed (p=0.40). ED self-harm rates for LTR and RI were highest in females (2.6-3.4/1000 LTR females versus 1.1-1.5/1000 males, 1.2-1.8/1000 RI females versus 0.4-0.6/1000 males). RI had lower rates of self-harm compared with LTR (aRR=0.60, 95% CI=0.56 to 0.65). Stratum-specific rates showed a steeper decline per period in RI compared with LTR (RI: aRR=0.85, 95% CI=0.81 to 0.89; LTR: aRR=0.91, 95% CI=0.90 to 0.93). Observed trends were not universal across region of origin and by refugee status. Interpretation Suicide rates have been stable and ED self-harm rates are declining over time among RI youth. These trends by important subgroups should continue to be monitored to allow for early identification of subpopulations of immigrant youth in need of targeted and culturally appropriate public health interventions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Author Keywords

intentional injury Death Mental health Immigration Refugee

Index Keywords

immigrant longitudinal study refugee population based case control study mental health human immigration Refugees Longitudinal Studies suicide attempt trends statistics and numerical data Cohort Studies controlled study Suicide, Attempted Self-Injurious Behavior emergency ward disease duration Young Adult Humans migrant psychology Adolescent male Emigrants and Immigrants female risk factor Risk Factors environmental exposure automutilation Article Ontario major clinical study adult migration hospital emergency service cohort analysis Emergency Service, Hospital Emigration and Immigration ICD-10 case control study Suicide Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85029108587&doi=10.1136%2fbmjopen-2016-014863&partnerID=40&md5=21517edfc08aac06334dc523abae2a0a
DOI: 10.1136/bmjopen-2016-014863
ISSN: 20446055
Cited by: 4
Original Language: English