Suicide and self-harm trends in recent immigrant youth in Ontario, 1996-2012: a population-based longitudinal cohort study

Natasha Ruth Saunders, Michael Lebenbaum, Therese A Stukel, Hong Lu, Marcelo L Urquia, Paul Kurdyak, Astrid Guttmann, Natasha Ruth Saunders, Michael Lebenbaum, Therese A Stukel, Hong Lu, Marcelo L Urquia, Paul Kurdyak, Astrid Guttmann

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.

Keywords: death; immigration; intentional injury; mental health; refugee.

Conflict of interest statement

Competing interests: None declared.

© 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.

Figures

Figure 1
Figure 1
Trends in suicide by immigrant status and sex.
Figure 2
Figure 2
Mechanism of suicide and self-harm by immigrant status.
Figure 3
Figure 3
Trends in emergency department self-harm by immigrant status and sex.

References

    1. World Health Organization. Suicide fact sheet. Secondary Suicide fact sheet. 2016. .
    1. The Mental Health of Children and Youth in Ontario: A Baseline Scorecard. MHASEF Research Team. Toronto: Institute for Clinical Evaluative Sciences, 2015.
    1. Bridge JA, Asti L, Horowitz LM, et al. . Suicide Trends Among Elementary School-Aged Children in the United States From 1993 to 2012. JAMA Pediatr 2015;169:673–7.10.1001/jamapediatrics.2015.0465
    1. Fontanella CA, Hiance-Steelesmith DL, Phillips GS, et al. . Widening rural-urban disparities in youth suicides, United States, 1996-2010. JAMA Pediatr 2015;169:466–73.10.1001/jamapediatrics.2014.3561
    1. Skegg K. Self-harm. Lancet 2005;366:1471–83.10.1016/S0140-6736(05)67600-3
    1. World Health Organization. Suicide rates, age-standardized by country. 2015.
    1. Statistics Canada. Ten leading causes of death, by sex and geography, 2009 - Ontario. 2015.
    1. Voracek M, Loibl LM. Consistency of immigrant and country-of-birth suicide rates: a meta-analysis. Acta Psychiatr Scand 2008;118:259–71.10.1111/j.1600-0447.2008.01238.x
    1. Burvill PW. Migrant suicide rates in Australia and in country of birth. Psychol Med 1998;28:201–8.10.1017/S0033291797005850
    1. Statistics Canada. Immigration and Ethnocultural Diversity in Canada. 2013.
    1. Citizenship and Immigration Canada. Facts and figures 2013. Immigration overview –permanent and temporary residents. 2013.
    1. Skinner R, McFaull S. Suicide among children and adolescents in Canada: trends and sex differences, 1980-2008. CMAJ 2012;184:1029–34.10.1503/cmaj.111867
    1. Rhodes AE, Bethell J, Carlisle C, et al. . Time trends in suicide-related behaviours in girls and boys. Can J Psychiatry 2014;59:152–9.10.1177/070674371405900307
    1. Chiu M, Lebenbaum M, Lam K, et al. . Describing the linkages of the immigration, refugees and citizenship Canada permanent resident data and vital statistics death registry to Ontario’s administrative health database. BMC Med Inform Decis Mak 2016;16:135.10.1186/s12911-016-0375-3
    1. The World Bank Regions. . 2015
    1. Bergen H, Hawton K, Waters K, et al. . Epidemiology and trends in non-fatal self-harm in three centres in England: 2000-2007. Br J Psychiatry 2010;197:493–8.10.1192/bjp.bp.110.077651
    1. Biddle L, Brock A, Brookes ST, et al. . Suicide rates in young men in England and Wales in the 21st century: time trend study. BMJ 2008;336:539–42.10.1136/bmj.39475.603935.25
    1. Fond G, Llorca PM, Boucekine M, et al. . Disparities in suicide mortality trends between United States of America and 25 European countries: retrospective analysis of WHO mortality database. Sci Rep 2016;6:20256.10.1038/srep20256
    1. Statistics Canada. Suicide. 2016.
    1. Ide N, Kõlves K, Cassaniti M, et al. . Suicide of first-generation immigrants in Australia, 1974-2006. Soc Psychiatry Psychiatr Epidemiol 2012;47:1917–27.10.1007/s00127-012-0499-4
    1. Hawton K, Haw C, Casey D, et al. . Self-harm in Oxford, England: epidemiological and clinical trends, 1996-2010. Soc Psychiatry Psychiatr Epidemiol 2015;50:695–704.10.1007/s00127-014-0990-1
    1. Carr MJ, Ashcroft DM, Kontopantelis E, et al. . The epidemiology of self-harm in a UK-wide primary care patient cohort, 2001-2013. BMC Psychiatry 2016;16:53.10.1186/s12888-016-0753-5
    1. Government of Ontario. Open minds, healthy minds: Ontario's Comprehensive MentalHealth and Addictions Strategy. 2011.
    1. Hansson E, Tuck A, Lurie S, et al. . Improving mental health services for immigrant, refugee,ethno-cultural and racialized groups: Issues and options for service improvement. Mental Health Commission of Canada, 2010.
    1. Sisask M, Varnik A, Kolves K, et al. . Is religiosity a protective factor against attempted suicide: a cross-cultural case-control study. Arch Suicide Res 2010;14:44–55.10.1080/13811110903479052
    1. Bertolote J, Fleischmann A. A global perspective in the epidemiology of suicide. Suicidologi 2002;7:6–8.
    1. Geulayov G, Kapur N, Turnbull P, et al. . Epidemiology and trends in non-fatal self-harm in three centres in England, 2000-2012: findings from the Multicentre Study of Self-harm in England. BMJ Open 2016;6:e01053810.1136/bmjopen-2015-010538
    1. Malenfant EC. Suicide in Canada's immigrant population. Health Rep 2004;15:9–17.
    1. Sorenson SB, Shen H. Youth suicide trends in California: an examination of immigrant and ethnic group risk. Suicide Life Threat Behav 1996;26:143–54.
    1. Newbold KB. Health care use and the Canadian immigrant population. Int J Health Serv 2009;39:545–65.10.2190/HS.39.3.g
    1. El-Sayed AM, Tracy M, Scarborough P, et al. . Suicide among Arab-Americans. PLoS One 2011;6:e1470410.1371/journal.pone.0014704
    1. Anglemyer A, Horvath T, Rutherford G. The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis. Ann Intern Med 2014;160:101–10.10.7326/M13-1301
    1. Canadian Association for Suicide Prevention. Secondary Canadian Association for Suicide Prevention. .

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