Postpartum self-inflicted injury, suicide, assault and homicide in relation to immigrant status in Ontario: a retrospective population-based cohort study.

Journal

CMAJ open
ISSN: 2291-0026
Titre abrégé: CMAJ Open
Pays: Canada
ID NLM: 101620603

Informations de publication

Date de publication:
Historique:
entrez: 14 4 2019
pubmed: 14 4 2019
medline: 14 4 2019
Statut: epublish

Résumé

Intentional injury, including suicide and assault, is a leading cause of maternal morbidity and mortality. We aimed to determine whether immigrant and nonimmigrant women differ in their 1-year risk of intentional injury after birth. This population-based retrospective cohort study used administrative data from Ontario from 2002 to 2012. Risk of self-inflicted injury (self-harm or suicide), and injury inflicted by others (assault or homicide), were each analyzed within 1 year after delivery of a live-born infant for immigrant and nonimmigrant mothers. Relative risks (RRs) were adjusted for maternal age, parity, income, resource utilization and psychiatric history. The study included 327 279 immigrant and 942 502 nonimmigrant mothers. Risk of self-inflicted injury was similar among immigrants and nonimmigrants (adjusted RR 0.91, 95% confidence interval [CI] 0.78-1.04), with no variation by duration of residence or refugee status. Immigrants were at lower risk than nonimmigrants for injury inflicted by others (adjusted RR 0.57, 95% CI 0.51-0.64); that risk was higher among refugees than among nonrefugee immigrants (adjusted RR 1.79, 95% CI 1.33-2.41), and it was higher among long-term (adjusted RR 2.27, 95% CI 1.76-2.91) and medium-term (adjusted RR 1.58, 95% CI 1.19-2.11) immigrants than among recent immigrants. Variability by country of origin was observed for both injury types. Immigrant mothers have a reported risk for self-inflicted injury after birth similar to that of their Canadian-born counterparts. The extent to which selective underreporting of intentional injury in immigrant women might explain our findings is a key consideration for future research.

Sections du résumé

BACKGROUND BACKGROUND
Intentional injury, including suicide and assault, is a leading cause of maternal morbidity and mortality. We aimed to determine whether immigrant and nonimmigrant women differ in their 1-year risk of intentional injury after birth.
METHODS METHODS
This population-based retrospective cohort study used administrative data from Ontario from 2002 to 2012. Risk of self-inflicted injury (self-harm or suicide), and injury inflicted by others (assault or homicide), were each analyzed within 1 year after delivery of a live-born infant for immigrant and nonimmigrant mothers. Relative risks (RRs) were adjusted for maternal age, parity, income, resource utilization and psychiatric history.
RESULTS RESULTS
The study included 327 279 immigrant and 942 502 nonimmigrant mothers. Risk of self-inflicted injury was similar among immigrants and nonimmigrants (adjusted RR 0.91, 95% confidence interval [CI] 0.78-1.04), with no variation by duration of residence or refugee status. Immigrants were at lower risk than nonimmigrants for injury inflicted by others (adjusted RR 0.57, 95% CI 0.51-0.64); that risk was higher among refugees than among nonrefugee immigrants (adjusted RR 1.79, 95% CI 1.33-2.41), and it was higher among long-term (adjusted RR 2.27, 95% CI 1.76-2.91) and medium-term (adjusted RR 1.58, 95% CI 1.19-2.11) immigrants than among recent immigrants. Variability by country of origin was observed for both injury types.
INTERPRETATION CONCLUSIONS
Immigrant mothers have a reported risk for self-inflicted injury after birth similar to that of their Canadian-born counterparts. The extent to which selective underreporting of intentional injury in immigrant women might explain our findings is a key consideration for future research.

Identifiants

DOI: 10.9778/cmajo.20180178 PMID: 30979727 PMC: PMC6461543
pubmed: 30979727
pii: 7/2/E227
doi: 10.9778/cmajo.20180178
pmc: PMC6461543
doi:

Types de publication

Journal Article

Langues

eng

Pagination

E227-E235

Informations de copyright

Copyright 2019, Joule Inc. or its licensors.

Déclaration de conflit d'intérêts

Competing interests: Sophie Grigoriadis reports royalties from Psychotherapy Essentials To Go, UpToDate and the Compendium of Therapeutic Choices outside the submitted work and personal fees from Allergan, Eli Lilly, Sage and Pfizer outside the submitted work. No other competing interests were declared.

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Auteurs

Simone N Vigod (SN)

Women's College Hospital and Research Institute (Vigod, Arora); ICES (Vigod, Urquia, Fung); Department of Psychiatry (Vigod, Grigoriadis, Ray), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Urquia), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Dennis, Ray), St. Michael's Hospital; Faculty of Nursing (Dennis), University of Toronto; Department of Psychiatry (Grigoriadis), Sunnybrook Health Sciences Centre; Department of Medicine (Ray), University of Toronto, Toronto, Ont. simone.vigod@wchospital.ca.

Serena Arora (S)

Women's College Hospital and Research Institute (Vigod, Arora); ICES (Vigod, Urquia, Fung); Department of Psychiatry (Vigod, Grigoriadis, Ray), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Urquia), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Dennis, Ray), St. Michael's Hospital; Faculty of Nursing (Dennis), University of Toronto; Department of Psychiatry (Grigoriadis), Sunnybrook Health Sciences Centre; Department of Medicine (Ray), University of Toronto, Toronto, Ont.

Marcelo L Urquia (ML)

Women's College Hospital and Research Institute (Vigod, Arora); ICES (Vigod, Urquia, Fung); Department of Psychiatry (Vigod, Grigoriadis, Ray), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Urquia), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Dennis, Ray), St. Michael's Hospital; Faculty of Nursing (Dennis), University of Toronto; Department of Psychiatry (Grigoriadis), Sunnybrook Health Sciences Centre; Department of Medicine (Ray), University of Toronto, Toronto, Ont.

Cindy-Lee Dennis (CL)

Women's College Hospital and Research Institute (Vigod, Arora); ICES (Vigod, Urquia, Fung); Department of Psychiatry (Vigod, Grigoriadis, Ray), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Urquia), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Dennis, Ray), St. Michael's Hospital; Faculty of Nursing (Dennis), University of Toronto; Department of Psychiatry (Grigoriadis), Sunnybrook Health Sciences Centre; Department of Medicine (Ray), University of Toronto, Toronto, Ont.

Kinwah Fung (K)

Women's College Hospital and Research Institute (Vigod, Arora); ICES (Vigod, Urquia, Fung); Department of Psychiatry (Vigod, Grigoriadis, Ray), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Urquia), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Dennis, Ray), St. Michael's Hospital; Faculty of Nursing (Dennis), University of Toronto; Department of Psychiatry (Grigoriadis), Sunnybrook Health Sciences Centre; Department of Medicine (Ray), University of Toronto, Toronto, Ont.

Sophie Grigoriadis (S)

Women's College Hospital and Research Institute (Vigod, Arora); ICES (Vigod, Urquia, Fung); Department of Psychiatry (Vigod, Grigoriadis, Ray), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Urquia), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Dennis, Ray), St. Michael's Hospital; Faculty of Nursing (Dennis), University of Toronto; Department of Psychiatry (Grigoriadis), Sunnybrook Health Sciences Centre; Department of Medicine (Ray), University of Toronto, Toronto, Ont.

Joel G Ray (JG)

Women's College Hospital and Research Institute (Vigod, Arora); ICES (Vigod, Urquia, Fung); Department of Psychiatry (Vigod, Grigoriadis, Ray), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Urquia), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Dennis, Ray), St. Michael's Hospital; Faculty of Nursing (Dennis), University of Toronto; Department of Psychiatry (Grigoriadis), Sunnybrook Health Sciences Centre; Department of Medicine (Ray), University of Toronto, Toronto, Ont.

Classifications MeSH