The Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Can J Psychiatry. 2019 Nov;64(11):777-788. doi: 10.1177/0706743719856851. Epub 2019 Jun 24.
To estimate the rates of suicide and self-harm among recent immigrants and to determine which immigrant-specific risk factors are associated with these outcomes.
Population-based cohort study using linked health administrative data sets (2003 to 2017) in Ontario, Canada which included adults ≥18 years, living in Ontario ( = 9,055,079). The main exposure was immigrant status (long-term resident vs. recent immigrant). Immigrant-specific exposures included visa class and country of origin. Outcome measures were death by suicide or emergency department visit for self-harm. Cox proportional hazards estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).
We included 590,289 recent immigrants and 8,464,790 long-term residents. Suicide rates were lower among immigrants ( = 130 suicides, 3.3/100,000) than long-term residents ( = 6,354 suicides, 11.8/100,000) with aHR 0.3, 95% CI, 0.2 to 0.3. Male-female ratios in suicide rates were attenuated in immigrants. Refugees had 2.1 (95% CI, 1.3 to 3.6; rate 6.1/100,000) and 2.8 (95% CI, 2.5 to 3.2) times the likelihood of suicide and self-harm, respectively, compared with nonrefugee immigrants. Self-harm rate was lower among immigrants ( = 2,256 events, 4.4/10,000) than long-term residents ( = 68,039 events, 9.7/10,000 person-years; aHR 0.3; 95% CI, 0.3 to 0.3). Unlike long-term residents, where low income was associated with high suicide rates, income was not associated with suicide among immigrants and there was an attenuated income gradient for self-harm. Country of origin-specific analyses showed wide ranges in suicide rates (1.4 to 9.9/100,000) and self-harm (1.8 to 14.9/10,000).
Recent immigrants have lower rates of suicide and self-harm and different sociodemographic predictors compared with long-term residents. Analysis of contextual factors including immigrant class, origin, and destination should be considered for all immigrant suicide risk assessment.
评估近期移民的自杀和自残率，并确定哪些特定于移民的风险因素与这些结果相关。
采用加拿大安大略省基于人群的队列研究，使用了链接的健康管理数据集（2003 年至 2017 年），其中包括≥18 岁的成年人，居住在安大略省（=9055079）。主要暴露因素是移民身份（长期居民与近期移民）。移民特定的暴露因素包括签证类别和原籍国。结局指标为自杀死亡或因自残到急诊就诊。Cox 比例风险估计了调整后的危险比（aHR）和 95%置信区间（CI）。
我们纳入了 590289 名近期移民和 8464790 名长期居民。移民的自杀率较低（=130 例自杀，3.3/100000），低于长期居民（=6354 例自杀，11.8/100000），aHR 为 0.3，95%CI 为 0.2 至 0.3。移民中自杀率的男女比例有所降低。难民自杀和自残的可能性分别是非难民移民的 2.1 倍（95%CI，1.3 至 3.6；发生率 6.1/100000）和 2.8 倍（95%CI，2.5 至 3.2）。与长期居民相比，移民的自残率较低（=2256 例事件，4.4/10000），aHR 为 0.3；95%CI 为 0.3 至 0.3）。与长期居民不同，低收入与高自杀率相关，而收入与移民自杀无关，且自残的收入梯度减弱。原籍国特定分析显示自杀率（1.4 至 9.9/100000）和自残率（1.8 至 14.9/10000）差异很大。
与长期居民相比，近期移民的自杀和自残率较低，且具有不同的社会人口学预测因素。应考虑包括移民类别、原籍国和目的地在内的移民自杀风险评估的背景因素分析。
