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Janca E, Keen C, Willoughby M, Borschmann R, Sutherland G, Kwon S, Kinner SA. Sex differences in suicide, suicidal ideation, and self-harm after release from incarceration: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:355-371. [PMID: 36462041 PMCID: PMC9971066 DOI: 10.1007/s00127-022-02390-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 11/14/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE People released from incarceration are at increased risk of suicide compared to the general population. We aimed to synthesise evidence on the incidence of and sex differences in suicide, suicidal ideation, and self-harm after release from incarceration. METHODS We searched MEDLINE, EMBASE, PsycINFO, Web of Science and PubMed between 1 January 1970 and 14 October 2021 for suicide, suicidal ideation, and self-harm after release from incarceration (PROSPERO registration: CRD42020208885). We calculated pooled crude mortality rates (CMRs) and standardised mortality ratios (SMRs) for suicide, overall and by sex, using random-effects models. We calculated a pooled incidence rate ratio (IRR) comparing rates of suicide by sex. RESULTS Twenty-nine studies were included. The pooled suicide CMR per 100,000 person years was 114.5 (95%CI 97.0, 132.0, I2 = 99.2%) for non-sex stratified samples, 139.5 (95% CI 91.3, 187.8, I2 = 88.6%) for women, and 121.8 (95% CI 82.4, 161.2, I2 = 99.1%) for men. The suicide SMR was 7.4 (95% CI 5.4, 9.4, I2 = 98.3%) for non-sex stratified samples, 14.9 for women (95% CI 6.7, 23.1, I2 = 88.3%), and 4.6 for men (95% CI 1.3, 7.8, I2 = 98.8%). The pooled suicide IRR comparing women to men was 1.1 (95% CI 0.9, 1.4, I2 = 82.2%). No studies reporting self-harm or suicidal ideation after incarceration reported sex differences. CONCLUSION People released from incarceration are greater than seven times more likely to die by suicide than the general population. The rate of suicide is higher after release than during incarceration, with the elevation in suicide risk (compared with the general population) three times higher for women than for men. Greater effort to prevent suicide after incarceration, particularly among women, is urgently needed.
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Affiliation(s)
- Emilia Janca
- Curtin School of Population Health, Curtin University, 410 Koorliny Way, Bentley, WA, 6102, Australia. .,Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
| | - Claire Keen
- Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC 3053 Australia
| | - Melissa Willoughby
- Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC 3053 Australia ,Centre for Adolescent Health, Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, VIC 3052 Australia
| | - Rohan Borschmann
- Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC 3053 Australia ,Centre for Adolescent Health, Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, VIC 3052 Australia ,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK ,Melbourne School of Psychological Sciences, The University of Melbourne, Grattan Street, Parkville, VIC Australia
| | - Georgina Sutherland
- Disability and Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC 3053 Australia
| | - Sohee Kwon
- Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC 3053 Australia
| | - Stuart A. Kinner
- Curtin School of Population Health, Curtin University, 410 Koorliny Way, Bentley, WA 6102 Australia ,Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC 3053 Australia ,Centre for Adolescent Health, Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, VIC 3052 Australia ,Mater Research Institute-UQ, University of Queensland, Mater Hospital, Raymond Terrace, South Brisbane, QLD 4101 Australia ,Griffith Criminology Institute, Griffith University, 176 Messines Ridge Road, Mount Gravatt, QLD 4122 Australia ,School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004 Australia
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Hedrick K, Borschmann R. Prevalence, methods and characteristics of self-harm among asylum seekers in Australia: protocol for a systematic review. BMJ Open 2022; 12:e060234. [PMID: 35264371 PMCID: PMC8915378 DOI: 10.1136/bmjopen-2021-060234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Kyli Hedrick
- Discipline of Psychology, School of Health and Biomedical Sciences, College of Science, Technology, Engineering, and Mathematics, RMIT University, Melbourne, Victoria, Australia
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rohan Borschmann
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, UK
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