Temporal variations in the distribution of self-harm episodes and methods across the Australian asylum seeker population: An observational study


Autoři: Kyli Hedrick aff001;  Gregory Armstrong aff003;  Guy Coffey aff001;  Rohan Borschmann aff005
Působiště autorů: Centre for Mental Health, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia aff001;  Community-Minded Psychological Services, Kingsville, Melbourne, Victoria, Australia aff002;  Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia aff003;  The Victorian Foundation for Survivors of Torture (Foundation House), Brunswick, Victoria, Australia aff004;  Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia aff005;  Centre for Adolescent Health, Murdoch Children’s Research Institute, Parkville, Victoria, Melbourne, Australia aff006;  Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom aff007;  Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia aff008
Vyšlo v časopise: Temporal variations in the distribution of self-harm episodes and methods across the Australian asylum seeker population: An observational study. PLoS Med 17(8): e32767. doi:10.1371/journal.pmed.1003235
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003235

Souhrn

Background

Temporal patterns in the frequency and characteristics of self-harm episodes across the Australian asylum seeker population may have implications for self-harm prevention and public health policy. The aim of this study was to examine how the distribution of self-harm episodes and method(s) of self-harm used across the Australian asylum seeker population vary according to the 24-hour cycle, day, and month, and to establish a basis for further research.

Methods and findings

We conducted an observational study of all 949 self-harm incidents reported across the Australian asylum seeker population (representing a monthly average of 28,992 adults) between 1 August 2014 and 31 July 2015, obtained by Freedom of Information (FOI) from the Department of Immigration. Time of self-harm, day, and month of occurrence were investigated across all five Australian asylum seeker populations (i.e., community-based arrangements, community detention, onshore immigration detention, offshore immigration detention [Nauru], and offshore immigration detention [Manus Island]). Significant variations in distributions over the 24-hour cycle were observed by processing arrangements. Compared with the average distribution across all other processing arrangements, self-harm more commonly occurred among community-based asylum seekers (36.3%) between 12:00 AM and 3:59 AM (p < 0.001), in asylum seekers on Manus Island (36.4%) between 4:00 PM and 7:59 PM (p = 0.02), and among asylum seekers in onshore detention (20.4%) between 8:00 PM and 11:59 PM (p < 0.001). Compared with the average distribution across all other methods, self-poisoning (by medication) (25%) was significantly more likely to occur between 12:00 AM and 3:59 AM (p = 0.009), and self-battery (42%) between 8:00 AM and 11:59 AM (p < 0.001). The highest and lowest monthly self-harm episode rates for the whole asylum seeker population were in August (2014) (5 episodes per 1,000 asylum seekers; 95% confidence interval [CI] 1–11) and in both January and February (2015) (2.1 episodes per 1,000 asylum seekers; 95% CI 0.6–7.2), respectively; however, the overlapping CIs indicate no statistically significant differences across the months. When examining monthly trends by processing arrangements, we observed that self-harm was significantly more likely to occur in August (2014) than other months of the year among asylum seekers in onshore detention (19%) (p < 0.001), in January (2015) on Manus Island (18%) (p = 0.002), and in October (2014) on Nauru (15%) (p < 0.001). The main study limitations were that we could not investigate certain characteristics associated with self-harm (e.g., gender, country of origin), as the Department of Immigration did not routinely collect such data. There was also the potential risk of making a type 1 error, given the exploratory nature of the comparisons we undertook; we minimised this by lowering our significance threshold from 0.05 to 0.01.

Conclusions

Self-harm in the Australian asylum seeker population was found to vary according to time of day and month of the year, by processing arrangements. A series of procedure-related and detention-related factors were observed to be associated with the temporal variations in self-harm. These findings should form the basis for further investigation into temporal variations in self-harm among asylum seekers, which may in turn lead to effective self-harm prevention strategies.

Klíčová slova:

Australia – Islands – Mental health and psychiatry – Observational studies – Post-traumatic stress disorder – Self harm – Suicide – Nauru


Zdroje

1. The United Nations High Commissioner for Refugees. Global Trends. Forced Displacement in 2017 [cited 2019 Sep 1]. Available from: https://www.unhcr.org/globaltrends2017/

2. The United Nations High Commissioner for Refugees. 2014–2019 Beyond Detention. A Global Strategy to Support Governments to End the Detention of Asylum Seekers and Refugees [cited 2020 Jan 2]. Available from: https://www.unhcr.org/53aa929f6

3. Phillips, J, Spinks, H. Immigration Detention in Australia [cited 2019 Sep 1]. Available from: http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/BN/2012-2013/Detention

4. Australian Human Rights Commission. Asylum seekers, Refugees and Human Rights. Snapshot report; 2017 [cited 2020 Jan 3]. Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/AHRC_Snapshot%20report_2nd%20edition_2017_WEB.pdf

5. Hedrick K, Armstrong G, Coffey G, Borschmann R. Self-harm in the Australian asylum seeker population: A national records-based study. SSM—Population Health. 2019;8:100452. doi: 10.1016/j.ssmph.2019.100452 31440577

6. Medecin Sans Frontieres. Indefinite Despair. The Tragic Mental Health Consequences of Offshore Processing on Nauru; 2018 [cited 2020 Jan 3]. Available from: https://www.msf.org.au/sites/default/files/attachments/indefinite_despair_4.pdf

7. Legal and Constitutional Affairs Reference Committee. Serious Allegations of Abuse, Self-harm and Neglect of Asylum Seekers in Relation to the Nauru Regional Processing Centre, and any Like Allegations in Relation to the Manus Regional Processing Centre; 2017 [cited 2020 Jul 7]. Available from: http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/NauruandManusRPCs/Report

8. Australian Human Rights Commission. Immigration Detention and Human Rights; 2014 [cited 2020 Jan 3]. Available from: https://www.humanrights.gov.au/our-work/asylum-seekers-and-refugees/projects/immigration-detention-and-human-rights

9. Refugee Council of Australia. With Empty Hands: How the Australian Government is Forcing People Seeking Asylum to Destitution; 2018 [cited 2019 Sep 1]. Available from: https://www.refugeecouncil.org.au/with-empty-hands-destitution/2/

10. von Werthern M, Robjant K, Chui Z, Schon R, Ottisova L, Mason C, et al. The impact of immigration detention on mental health: a systematic review. BMC Psychiatry. 2018;18(1):382. doi: 10.1186/s12888-018-1945-y 30522460

11. World Health Organisation. Practice Manual for Establishing and Maintaining Surveillance Systems for Suicide Attempts and Self-harm; 2016 [cited 2020 Jan 3]. Available from: https://www.who.int/mental_health/suicide-prevention/attempts_surveillance_systems/en/

12. Hedrick K, Armstrong G, Borschmann R. Self-harm among asylum seekers in Australian immigration detention. The Lancet Public Health. 2019. doi: 10.1016/S2468-2667(19)30221-X

13. Commonwealth Consolidated Acts. Freedom of Information Act (Cth) (Austl) [cited 2020 Jan 3]. Available from: http://www.austlii.edu.au/au/legis/cth/consol_act/foia1982222/

14. Department of Immigration and Border Protection. Freedom of Information Disclosure Log [cited 2020 Jan 3]. Available from: https://www.homeaffairs.gov.au/access-and-accountability/freedom-of-information/disclosure-logs

15. Commonwealth Immigration Ombudsman. Final Report. Suicide and Self-harm in the Immigration Detention Network; 2013 [cited 2019 Dec 3]. Available from: http://www.ombudsman.gov.au/__data/assets/pdf_file/0022/30298/December-2013-Suicide-and-self-harm-in-the-Immigration-Detention-Network.pdf

16. Australian Border Deaths Database. Australian Border Deaths Database [cited 2020 Jan 30]. Available from: https://www.monash.edu/arts/border-crossing-observatory/research-agenda/australian-border-deaths-database

17. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276–82.

18. Department of Home Affairs (previously DIBP). Statistics; 2015 [cited 2020 Jan 3]. Available from: https://www.homeaffairs.gov.au/research-and-statistics/statistics/visa-statistics/live

19. Bryman A. Social Research Methods. 5th ed. Oxford: Oxford University Press; 2016.

20. Bergen H, & Hawton K. Variations in time of hospital presentation for deliberate self-harm and their implications for clinical services. Journal of Affective Disorders. 2007;98:227–37. doi: 10.1016/j.jad.2006.08.007 16978707

21. Blenkiron P, House A, Milnes D. The timing of acts of deliberate self-harm: is there any relation with suicidal intent, mental disorder or psychiatric management? Journal of Psychosomatic Research. 2000;49(1):3–6. doi: 10.1016/s0022-3999(99)00100-2 11053597

22. Irish Prison Service. Self-harm in Irish Prisons 2017. First Report from the Self-harm Assessment and Data Analysis (SADA) Project [cited 2019 Dec 3]. Available from: https://www.nsrf.ie/wp-content/uploads/2018/10/Prison-self-harm-annual-report-2017-final-draft-with-PIMS-10-Sept-2018.2-3.pdf

23. Hedrick K. Getting out of (self-) harm's way: A study of factors associated with Australian immigration detention. Journal of Forensic and Legal Medicine. 2017;49:89–93. doi: 10.1016/j.jflm.2017.05.014 28601787

24. Australian National Audit Office (ANAO). The Auditor-General ANAO Report No. 32 (2016–17) Performance Audit. Offshore Processing Centres in Nauru and Papua New Guinea-Contract Management of Garrison Support and Welfare Services [cited 2020 Jul 7]. Available from: https://www.anao.gov.au/sites/g/files/net3241/f/ANAO_Report_2016-2017_32.pdf

25. Amnesty International. This is Still Breaking People. Update on Human Rights Violations at Australia’s Asylum Seeker Processing Centre on Manus Island, Papua New Guinea; 2014 [cited 2020 Jul 7]. Available from: https://www.amnesty.org.au/wp-content/uploads/2016/09/This_is_still_breaking_people_update_from_Manus_Island.pdf

26. Hedrick K, Armstrong G, Coffey G, Borschmann R. Self-harm among asylum seekers in Australian onshore immigration detention: how incidence rates vary by held detention type. BMC Public Health. 2020;20(1):592. doi: 10.1186/s12889-020-08717-2 32354370

27. Essex R, Govintharajah P. Mental health of children and adolescents in Australian alternate places of detention. Journal of Paediatrics and Child Health. 2017(53):525–8.

28. Coffey GJ, Kaplan I, Sampson RC, Tucci MM. The meaning and mental health consequences of long-term immigration detention for people seeking asylum. Social Science & Medicine. 2010;70:2070–9.

29. Australian Human Rights Commission. The Forgotten Children: National Inquiry into Children in Immigration Detention; 2014 [cited 2019 Sep 1]. Available from: https://www.humanrights.gov.au/our-work/asylum-seekers-and-refugees/publications/forgotten-children-national-inquiry-children

30. Buckley NA, Whyte IM, Dawson AH. There are days… and moons; Self-poisoning is not lunacy. Medical Journal of Australia. 1993;159(11–12):786–9. 8264469

31. Migration and Maritime Powers Legislation Amendment (Resolving the Asylum Legacy Caseload) Bill 2014 [cited 2019 Dec 5]. Available from: https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/Bills_Search_Results/Result?bId=r5346&utm

32. Steel Z, Silove D, Brooks R, Momartin S, Alzuhairi B, Susljik I. Impact of immigration detention and temporary protection on the mental health of refugees. British Journal of Psychiatry. 2006;188(1):58–64.

33. Asylum Seeker Resource Centre. Factsheet. Temporary Protection Visas; 2014 [cited 2020 Jan 3]. Available from: https://www.asrc.org.au/wp-content/uploads/2013/07/Coalition-Policies-May-2014.pdf

34. New Matilda. Self-harm, Protests Escalate on Nauru after Morrison Video Played to Asylum Seekers. New Matilda. 2014 Sep 29 [cited 2020 July 7]. Available from: https://newmatilda.com/2014/09/29/self-harm-protests-escalate-nauru-after-morrison-video-played-asylum-seekers/

35. Department of Foreign Affairs and Trade. Memorandum of Understanding Between the Government of the Kingdom of Cambodia and the Government of Australia, Relating to the Settlement of Refugees in Cambodia; 2014 [cited 2020 Jul 7]. Available from: https://www.dfat.gov.au/sites/default/files/cambodia-australia-mou-and-operational-guidelines.pdf

36. Kaldor Centre. In Focus. Resettlement of Refugees from Nauru to Cambodia [cited 2020 Jan 3]. Available from: https://www.kaldorcentre.unsw.edu.au/news/focus-resettlement-refugees-nauru-cambodia

37. Dingle S. Reports of Self-harm by Asylum Seekers on Nauru on Hearing Cambodia Resettlement Plan. ABC PM. 2014 Sep 26 [cited 2020 Jul 7]. Available from: http://www.abc.net.au/pm/content/2014/s4095666.htm

38. Australian Lawyer’s Alliance (ALA). Untold Damage. Workplace Health and Safety in Immigration Detention Under the Work, Health and Safety Act (2011) (Cth); 2016 [cited 2019 Sep 1]. Available from: https://www.lawyersalliance.com.au/documents/item/583

39. Moss P. Review into Recent Allegations Relating to the Conditions and Circumstances at the Regional Processing Centre in Nauru; 2015 [cited 2020 Jul 7]. Available from: https://www.documentcloud.org/documents/1689988-moss-report-review-conditions-circumstances-nauru.html

40. Ministry of Foreign Affairs and Immigration Officer of the Minister. PNG Takes Action on Refugees. Press release. 2014 Nov 4 [cited 2020 Jan 3]. Available from: http://www.immigration.gov.pg/images/documents/Media%20Release%20-%20PNG%20Takes%20Action%20on%20Refugees.pdf

41. Davidson H, Doherty B. More than 100 Manus Asylum Seekers Go on Strike. Guardian Australia. 2015 Jan 13 [cited 2020 Jul 7] Available from: https://www.theguardian.com/australia-news/2015/jan/13/more-than-100-manus-island-asylum-seekers-hunger-strike

42. Evershed N, Doherty B. Manus Island Detention Centre Protests Timeline. Guardian Australia. 2015 Jan 19 [cited 2020 Jan 3] Available from: https://www.theguardian.com/australia-news/2015/jan/19/manus-island-detention-centre-protests-timeline

43. Klonsky ED. The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review. 2007;27(2):226–39. doi: 10.1016/j.cpr.2006.08.002 17014942

44. Green JP, Eagar K. The health of people in Australian immigration detention centres. Medical Journal of Australia. 2010;192(2):65–70. 20078404

45. World Health Organisation [WHO]. Preventing Suicide: A Global Imperative; 2014 [cited 2020 Jan 3]. Available from: https://www.who.int/mental_health/suicide-prevention/world_report_2014/en/


Článek vyšel v časopise

PLOS Medicine


2020 Číslo 8

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

VIRTUÁLNÍ ČEKÁRNA ČR Jste praktický lékař nebo pediatr? Zapojte se! Jste praktik nebo pediatr? Zapojte se!

×