Prevalence, methods and characteristics of self-harm among asylum seekers in Australia: Protocol for a systematic review

Introduction Asylum seekers are at increased risk of self-harm compared with the general population, and the experience of detention may further exacerbate this risk. Despite this, evidence regarding the prevalence, methods and characteristics of self-harm among asylum seekers in Australia (including those detained in onshore and offshore immigration detention) has not been synthesised. Such information is necessary to inform evidence-based prevention initiatives, and effective clinical and governmental responses to self-harm. This review will synthesise findings from the literature regarding the prevalence, methods and characteristics of self-harm among asylum seekers in both detained and community-based settings in Australia. Methods and analysis We searched key electronic health, psychology and medical databases (PsycINFO, Scopus, PubMed and MEDLINE) for studies published in English between 1 January 1992 and 31 December 2021. Our primary outcome is self-harm among asylum seekers held in onshore and/or offshore immigration detention, community detention and/or in community-based arrangements in Australia. We will include all study designs (except single case studies) that examine the prevalence of self-harm in asylum seekers. Studies published between 1992 - the commencement of Australia's policy of mandatory immigration detention - and 2021 will be included. We will not apply any age restrictions. The Methodological Standard for Epidemiological Research scale will be used to assess the quality of included studies. If there are sufficient studies, and homogeneity between them, we will conduct meta-analyses to calculate pooled estimates of self-harm rates and compare relevant subgroups. If studies report insufficient data, or there is substantial heterogeneity, findings will be provided in narrative form. Ethics and dissemination This review is exempt from ethics approval as it will synthesise findings from published studies with pre-existing ethics approval. Our findings will be disseminated through a peer-reviewed journal article and conference presentations. PROSPERO registration number CRD42020203444

Contact with mental health services after medically verified self-harm: A prospective data linkage study

Introduction High rates of self-harm resulting in acute health service contact have been observed in adults released from prison. Contact with health services due to self-harm is a key intervention opportunity to prevent deleterious health outcomes. Little is known about subsequent mental health service contact after discharge from acute health services. Objectives and Approach We aimed to describe mental health service contact after discharge from acute health service contacts following self-harm in a representative sample of adults released from prison. Ambulance, emergency department (ED), hospital inpatient and ambulatory mental health service records were probabilistically linked to pre-release interview data. Self-harm events after release were identified from ICD codes and coded from case notes in ambulance, ED, and hospital records. We calculated the time between discharge from ambulance, ED, or hospital after self-harm and subsequent contact with mental health services. Factors predicting the likelihood of mental health service contact were examined using multivariate logistic regression. Results Of 1307 adults released from prison, 108 (8.3%) experienced 218 self-harm events resulting in acute health service use in the community. Of these presentations, 0%, 59%, and 50% of discharges from ambulance attendances, ED and hospital, respectively, had subsequent contact with a specialist mental health service within 7 days of that acute service contact. Mental health service contact within 7 days of acute service contact was positively associated with being female (adjusted odds ratio [AOR]: 3.27; 95%CI: 1.26-8.47) and being identified by prison staff as at risk for self-harm (AOR: 3.34; 95%CI: 1.29-8.62), and was negatively associated with dual diagnosis (AOR: 0.19: 95%CI: 0.06-0.61), substance use disorder only (AOR: 0.13; 95%CI: 0.04-0.48) and physical health functioning (AOR: 0.96; 95\%CI: 0.92-0.99). Conclusion/Implications Almost half of adults with a recent history of incarceration discharged from acute health service after self-harm did not receive timely specialist mental health care. Improved integration of acute health services and ambulatory mental health services could improve outcomes for adults who present with self-harm

The Mortality After Release from Incarceration Consortium (MARIC) study: Strengths of international data linkage

Introduction Adults released from incarceration experience complex physical and mental health problems, and are at markedly increased risk of preventable death. Despite this, not enough is known about the granular epidemiology of mortality in this population to inform development of targeted, evidence-based responses. Objectives and Approach We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration from 12 countries representing 30 cohorts of adults with a history of incarceration. The combined sample size is 1,210,168, with 58,840 deaths recorded over 8,261,743 person-years of follow-up time. In this protocol paper, using a two-step, individual participant data meta-analysis (IPDM-A) methodology involving 22 MARIC cohorts, we calculated 1) a crude mortality rate (CMR; with 95% confidence intervals) for each individual cohort over the first 84 days (12 weeks) following release; and 2) a combined, meta-analysed CMR for the same period. Results Of 1,704,208 individual releases, we observed 4,018 deaths over the first 84 days. The overall CMR over the first 84 days after release was 1610.97 deaths per 100,000 person-years (95% CI: 1263.4 - 1958.5). The rate was highest on the day of release (5768.0; 95% CI: 3296.5 - 8239.4), which was significantly higher than on days 4-84. Conclusion/Implications Adults released from incarceration were at an acutely increased risk of death on the day of release, and this risk remained elevated for at least the first 12 weeks. The MARIC study will provide decisive and empirical evidence to guide clinicians and policy makers in reducing mortality in this marginalize

Increased risk of death following release from incarceration: an individual participant data meta-analysis of 1,314,568 adults in eight countries.

Objectives People released from incarceration are at increased risk of death from diverse causes. We aimed to calculate the incidence of all-cause and cause-specific death after release from incarceration and identify individual-level risk factors for death. Approach We conducted a series of individual participant data meta-analyses using data from >1.3 million adults released from incarceration in eight countries from 1980-2018. We used random effects meta-analysis to estimate the pooled all-cause and cause-specific crude mortality rates (CMRs), with 95% confidence intervals (CI) for the entire follow-up period, and for specific time periods after release from incarceration, overall and stratified by age, sex, and region. Results We included 1,395,318 people, 10,164,341 person-years of follow-up time, and 72,920 deaths in our analyses. The overall pooled CMR was 727 (95%CI: 623-840) per 100,000 person-years, with no difference between males and females. The risk of death was highest during the first week following release (all-cause CMR: 1,612, 95%CI: 1048-2,287, I2=91.5%), and the three most common causes of death across the entire follow-up period were 1) alcohol and other drug poisoning (CMR=144, 95%CI: 99-197); 2) cardiovascular disease (CMR: 102, 95%CI: 85-121); and 3) cancer and other neoplasms (CMR=74, 95%CI: 85-121). Leading causes of death varied across time periods following release from incarceration. Conclusion Our findings indicate the need for routine monitoring of mortality following release from incarceration. The distribution of cause of death varies over time, such that clinical decision-making needs to be informed by the proximity to release from incarceration. The elevated risk of death in first 7 days following release highlights the urgent need for coordinated transitional care – including substance use and mental health treatment – and injury prevention initiatives

Self-harm following release from incarceration: Patterns and measurement issues

Introduction Despite an elevated prevalence of self-harm in the incarcerated adult population, little is known about patterns of self-harm following release from prison. Objectives and Approach Baseline self-report interviews with 1315 adults immediately prior to release from prison in Queensland, Australia, combined with interrogation of linked health data from >3750 post-release emergency department presentations, >2000 ambulance attendances, and corrections data during periods of re-incarceration. Results Approximately 5% of all contacts with medical emergency services following release from prison resulted from self-harm. These were associated with being Indigenous, having a lifetime history of a mental disorder and having been identified by prison staff as being at risk of self-harm. Agreement between self-reported self-harm and medically-verified episodes of self-harm was poor. Conclusion/Implications Emergency services contacts resulting from self-harm following release from prison are common and represent an opportunity for tertiary intervention for self-harm. Our findings suggest that a self-reported history of self-harm should not be considered a reliable indicator of prior self-harm, or of future self-harm risk, in incarcerated adults

The influence of personality disorder on the future mental health and social adjustment of young adults:a population-based cohort study

BackgroundExisting knowledge about the consequences of personality disorders (PD) is substantially derived from the study of clinical populations. This paper reports findings from a large, population-based, longitudinal study of the long-term mental health and social consequences of PD.MethodsCommunity-based, longitudinal study of a stratified random sample of 1635 non-treatment seeking young adults recruited from Victoria, Australia. Presence and severity of PD was assessed at age 24 years, using a semi-structured, informant-based interview (the Standardised Assessment of Personality). Psychosocial outcomes were assessed at age 35 years.OutcomesAt age 24 years, 28% (n=458) of the sample had either personality difficulties or PD. The severity of PD was associated with absence of a degree or vocational qualification, the presence of common mental disorders and cigarette smoking. At age 35 years, PD severity was independently associated with not being in a relationship (adjusted odds ratio (aOR) for the effect of complex and severe PD vs. no PD or personality difficulty: 2.05, 95% CI: 1·21-3·45), increased odds of an anxiety disorder (aOR: 2·27, 95% CI: 1·20-4·28) and major depression (aOR: 2·23, 95% CI: 1·24-4·01).InterpretationThe presence of PD predicts the occurrence of later anxiety and depression, as well as the absence of long-term relationships, effects that are not attributable to pre-existing common mental disorder. The study provides strong support for including PD in global studies of the burden of mental disorders.FundingThe research was supported by grants from Australia’s National Health and Medical Research Council (NH&MRC) and Victoria’s Operational Infrastructure Support Program