Temporal variations in the distribution of self-harm episodes and methods across the Australian asylum seeker population: An observational study
Autoři:
Kyli Hedrick aff001; Gregory Armstrong aff003; Guy Coffey aff001; Rohan Borschmann aff005
Působiště autorů:
Centre for Mental Health, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia
aff001; Community-Minded Psychological Services, Kingsville, Melbourne, Victoria, Australia
aff002; Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
aff003; The Victorian Foundation for Survivors of Torture (Foundation House), Brunswick, Victoria, Australia
aff004; Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia
aff005; Centre for Adolescent Health, Murdoch Children’s Research Institute, Parkville, Victoria, Melbourne, Australia
aff006; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
aff007; Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
aff008
Vyšlo v časopise:
Temporal variations in the distribution of self-harm episodes and methods across the Australian asylum seeker population: An observational study. PLoS Med 17(8): e32767. doi:10.1371/journal.pmed.1003235
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pmed.1003235
Souhrn
Background
Temporal patterns in the frequency and characteristics of self-harm episodes across the Australian asylum seeker population may have implications for self-harm prevention and public health policy. The aim of this study was to examine how the distribution of self-harm episodes and method(s) of self-harm used across the Australian asylum seeker population vary according to the 24-hour cycle, day, and month, and to establish a basis for further research.
Methods and findings
We conducted an observational study of all 949 self-harm incidents reported across the Australian asylum seeker population (representing a monthly average of 28,992 adults) between 1 August 2014 and 31 July 2015, obtained by Freedom of Information (FOI) from the Department of Immigration. Time of self-harm, day, and month of occurrence were investigated across all five Australian asylum seeker populations (i.e., community-based arrangements, community detention, onshore immigration detention, offshore immigration detention [Nauru], and offshore immigration detention [Manus Island]). Significant variations in distributions over the 24-hour cycle were observed by processing arrangements. Compared with the average distribution across all other processing arrangements, self-harm more commonly occurred among community-based asylum seekers (36.3%) between 12:00 AM and 3:59 AM (p < 0.001), in asylum seekers on Manus Island (36.4%) between 4:00 PM and 7:59 PM (p = 0.02), and among asylum seekers in onshore detention (20.4%) between 8:00 PM and 11:59 PM (p < 0.001). Compared with the average distribution across all other methods, self-poisoning (by medication) (25%) was significantly more likely to occur between 12:00 AM and 3:59 AM (p = 0.009), and self-battery (42%) between 8:00 AM and 11:59 AM (p < 0.001). The highest and lowest monthly self-harm episode rates for the whole asylum seeker population were in August (2014) (5 episodes per 1,000 asylum seekers; 95% confidence interval [CI] 1–11) and in both January and February (2015) (2.1 episodes per 1,000 asylum seekers; 95% CI 0.6–7.2), respectively; however, the overlapping CIs indicate no statistically significant differences across the months. When examining monthly trends by processing arrangements, we observed that self-harm was significantly more likely to occur in August (2014) than other months of the year among asylum seekers in onshore detention (19%) (p < 0.001), in January (2015) on Manus Island (18%) (p = 0.002), and in October (2014) on Nauru (15%) (p < 0.001). The main study limitations were that we could not investigate certain characteristics associated with self-harm (e.g., gender, country of origin), as the Department of Immigration did not routinely collect such data. There was also the potential risk of making a type 1 error, given the exploratory nature of the comparisons we undertook; we minimised this by lowering our significance threshold from 0.05 to 0.01.
Conclusions
Self-harm in the Australian asylum seeker population was found to vary according to time of day and month of the year, by processing arrangements. A series of procedure-related and detention-related factors were observed to be associated with the temporal variations in self-harm. These findings should form the basis for further investigation into temporal variations in self-harm among asylum seekers, which may in turn lead to effective self-harm prevention strategies.
Klíčová slova:
Australia – Islands – Mental health and psychiatry – Observational studies – Post-traumatic stress disorder – Self harm – Suicide – Nauru
Zdroje
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