Data_Sheet_1_Suicide among those who use mental health services: Suicide risk factors as evidenced from contact-based characteristics in Victoria.docx

ObjectiveThe majority of suicide decedents have had contact with health services in the months before their death. Contacts for mental health services present potential suicide prevention opportunities. This study aims to compare contact-based characteristics among suicide decedents and living controls in the year subsequent to clinical mental health contact with the public health system in Victoria, Australia.MethodsA population-based nested case-control study of those who had mental health-related hospital and community contacts with the public health system was conducted. Cases (suicide decedents) were age and gender-matched to living controls (suicide non-decedents). These records were linked to records of suicides that occurred in the 12 months following the health service contact, between January 1, 2011, and December 31, 2016. Victorian residents aged 10 years and above were selected at the time of contact (483,933 clients). In the study population, conditional logistic regression models were used to assess the relationship between contact-based characteristics and suicide. Socio-demographics and mental health-related hospital and community contact data was retrieved from the Victorian Admitted Episodes Dataset, the Victorian Emergency Minimum Dataset and the Public Clinical Mental Health database and suicide data from the Victorian Suicide Register.ResultsDuring a six-year period, 1,091 suicide decedents had at least one mental health contact with the public health system in the 12 months preceding the suicide. Overall, controls used more mental health services than cases; however, cases used more mental health services near the event. The relationship between the type of service and suicide differed by service type: hospital admissions and emergency department presentations had a significant positive association with suicide with an OR of 2.09 (95% CI 1.82–2.40) and OR of 1.13 (95% CI 1.05–1.22), and the effect size increased as the event approached, whereas community contacts had a significant negative association with an OR of 0.93 (95% CI 0.92–0.94), this negative association diminished in magnitude as the event approached (OR∼1).ConclusionSuicide decedents had less contact with mental health services than non-decedents; however, evidence suggests suicide decedents reach out to mental health services proximal to suicide. An increase in mental health service contact by an individual could be an indication of suicide risk and therefore an opportunity for intervention. Further, community level contact should be further explored as a possible prevention mechanism considering the majority of suicide decedents do not access the public clinical mental health services.</p

Data_Sheet_2_Suicide among those who use mental health services: Suicide risk factors as evidenced from contact-based characteristics in Victoria.docx

ObjectiveThe majority of suicide decedents have had contact with health services in the months before their death. Contacts for mental health services present potential suicide prevention opportunities. This study aims to compare contact-based characteristics among suicide decedents and living controls in the year subsequent to clinical mental health contact with the public health system in Victoria, Australia.MethodsA population-based nested case-control study of those who had mental health-related hospital and community contacts with the public health system was conducted. Cases (suicide decedents) were age and gender-matched to living controls (suicide non-decedents). These records were linked to records of suicides that occurred in the 12 months following the health service contact, between January 1, 2011, and December 31, 2016. Victorian residents aged 10 years and above were selected at the time of contact (483,933 clients). In the study population, conditional logistic regression models were used to assess the relationship between contact-based characteristics and suicide. Socio-demographics and mental health-related hospital and community contact data was retrieved from the Victorian Admitted Episodes Dataset, the Victorian Emergency Minimum Dataset and the Public Clinical Mental Health database and suicide data from the Victorian Suicide Register.ResultsDuring a six-year period, 1,091 suicide decedents had at least one mental health contact with the public health system in the 12 months preceding the suicide. Overall, controls used more mental health services than cases; however, cases used more mental health services near the event. The relationship between the type of service and suicide differed by service type: hospital admissions and emergency department presentations had a significant positive association with suicide with an OR of 2.09 (95% CI 1.82–2.40) and OR of 1.13 (95% CI 1.05–1.22), and the effect size increased as the event approached, whereas community contacts had a significant negative association with an OR of 0.93 (95% CI 0.92–0.94), this negative association diminished in magnitude as the event approached (OR∼1).ConclusionSuicide decedents had less contact with mental health services than non-decedents; however, evidence suggests suicide decedents reach out to mental health services proximal to suicide. An increase in mental health service contact by an individual could be an indication of suicide risk and therefore an opportunity for intervention. Further, community level contact should be further explored as a possible prevention mechanism considering the majority of suicide decedents do not access the public clinical mental health services.</p

Additional file 1: Table S1. of The relationship between working conditions and self-rated health among medical doctors: evidence from seven waves of the Medicine In Australia Balancing Employment and Life (Mabel) survey

Psychosocial job stressors and self-rated health, female doctors, random and fixed effect regression models using a continuous outcome measure, adjusted for all variables, MABEL, 2001 to 2008. Table S2. Psychosocial job stressors and self-rated health, male doctors, random and fixed effect regression models using a continuous outcome measure, adjusted for all variables, MABEL, 2001 to 2008. Fixed-effect regression model. (DOCX 108 kb

Deaths in young people after contact with the youth justice system: A retrospective data linkage study

Introduction: Young people who have contact with the youth justice system are distinguished by a high prevalence of complex, co-occurring health problems, including known risk factors for preventable mortality. However, almost nothing is known about health outcomes for these young people after separation from the youth justice system. Objectives and Approach: We aimed to examine the incidence, timing, causes and risk factors for death in justice-involved young people. We linked youth justice records in Queensland, Australia 1993-2016 (N=48,963) with adult correctional records and the National Death Index. We split the cohort into three subgroups: those who had ever been in detention (n=7,643), those supervised in the community but never detained (n=12,953), and those charged with an offence but never convicted (n=28,367). We calculated all-cause and cause-specific crude mortality rates (CMRs), and indirectly standardised mortality ratios (SMRs). We used Cox regression to identify static and time-varying risk factors for death. Results: During a median of 13.6 years of follow-up there were 1,452 deaths (3.0%). The all-cause CMR was 2.2 (95%CI 2.1-2.3) per 1000 person-years, and the all-cause SMR was 3.1 (95%CI 3.0-3.3). The leading external causes of death were suicide (32% of all deaths), transport accidents (16%), accidental drug-related causes (13%), and violence (3%). In adjusted analyses, independent risk factors for all-cause mortality included being male (HR=1.4, 95%CI 1.2-1.6) and older (>=15 vs. vs. charge only; HR=1.6, 95%CI 1.2-2.0) and subsequent incarceration as an adult (HR=1.8, 95%CI 1.4-2.4). Conclusion/Implications: Young people who have contact with the youth justice system are at markedly increased risk of preventable death, after separation from that system. Efforts to improve long-term health outcomes for justice-involved youth have the potential to reduce preventable deaths in these highly vulnerable young people