Intentional self-harm in culturally and linguistically diverse communities: A study of hospital admissions in Victoria, Australia

Abstract

Purpose: To examine the rates and profiles of intentional self-harm hospital admissions among people from culturally and linguistically diverse and non-culturally and linguistically diverse backgrounds. Methods: A retrospective analysis of 29,213 hospital admissions for self-harm among people aged 15 years or older in Victoria, Australia, was conducted using data from the Victorian Admitted Episodes Dataset between 2014/2015 and 2018/2019. The Victorian Admitted Episodes Dataset records all hospital admissions in public and private hospitals in Victoria (population 6.5 million). Population-based incidence of self-harm, logistic regression and percentages (95% confidence intervals) were calculated to compare between culturally and linguistically diverse groups by birthplaces and the non-culturally and linguistically diverse groups of self-harm admissions. Results: When grouped together culturally and linguistically diverse individuals had lower rates of (hospital-treated) self-harm compared with the non-culturally and linguistically diverse individuals. However, some culturally and linguistically diverse groups such as those originating from Sudan and Iran had higher rates than non-culturally and linguistically diverse groups. Among self-harm hospitalised patients, those in the culturally and linguistically diverse group (vs non-culturally and linguistically diverse group) were more likely to be older, Metropolitan Victorian residents, from the lowest socioeconomic status, and being ever or currently married. Self-harm admissions by persons born in Southern and Eastern Europe were the oldest of all groups; in all other groups number of admissions tended to decrease as age increased whereas in this group the number of admissions increased as age increased. Conclusion: There was considerable heterogeneity in rates of hospital-treated self-harm in culturally and linguistically diverse communities, with some countries of origin (e.g. Sudan, Iran) having significantly higher rates. Some of this variation may be due to factors relating to the mode of entry into Australia (refugee vs planned migration), and future research needs to examine this possibility and others, to better plan for support needs in the culturally and linguistically diverse communities most affected by self-harm. Combining all culturally and linguistically diverse people into one group may obscure important differences in self-harm. Different self-harm prevention strategies are likely to be needed for different culturally and linguistically diverse populations.

Repeat self-harm and mental health service use after self-harm in Culturally and Linguistically Diverse communities: Insights from a data linkage study in Victoria, Australia

“…However, CALD people, especially those from Southern and Central Asia, made less use of hospital services due to self-harm readmissions and repeat ED presentations (among those who had at least one hospital revisit with self-harm). The findings of this study and other work suggest a complex interplay between cultural background and health-related outcomes of self-harm (Borrill et al, 2011;Cooper et al, 2006;Pham et al, 2023).…”

“…The overall incidence of self-harm and health service use observed here and elsewhere (Pham et al, 2023) may underestimate the true extent of the problem. People who engaged in self-harm may be less likely to seek help from services following self-harm, especially those from CALD backgrounds.…”

“…First, due to the unavailability of the Mental Health Community Support Services dataset within the time frame, we did not examine non-clinical mental health service contacts as an outcome of self-harm. Second, there are also well-known limitations in using country of birth only to define CALD backgrounds as discussed elsewhere (Pham et al, 2023). As most Indigenous peoples in Victoria were born in Australia or English-speaking countries, they were mostly included in the non-CALD population (which is based on country of birth).…”

“…While combining all CALD people into a CALD group is common in current practice and policy, studies have shown that this group is highly heterogeneous and should not be grouped into one group in self-harm research (Pham et al, 2023; Troya et al, 2022). This study conducted two separate analyses of (1) CALD as one group and (2) CALD groups divided by ROBs to have more specific results.…”

Suicide and mortality following self-harm in Culturally and Linguistically Diverse communities in Victoria, Australia: insights from a data linkage study

“…Age group, sex, marital status, remoteness (Accessibility and Remoteness Index of Australia—ARIA+), and socioeconomic status (Socio-Economic Indexes for Areas—SEIFA) were extracted from VAED. The ARIA+ ( 25 ) and SEIFA were defined based on the residential addresses of patients as described elsewhere ( 18 , 26 ). SEIFA was defined based on the Index of Relative Socio-Economic Advantage and Disadvantage, with state deciles based on statistical local areas.…”