A Systematic Review of Interventions Addressing the Primary Prevention of Violence Against Women With Disability.

Women with disability experience significantly more violence and abuse than their nondisabled peers. Efforts to implement, evaluate, and scale-up strategies to prevent violence against women are rapidly expanding, but we know less about "what works" to prevent violence against women with disability. While secondary and tertiary prevention aim to identify violence early and prevent further occurrence, this review focuses on primary prevention. In the disability services sector, primary prevention is sometimes referred to as safeguarding and covers a range of activities that aim to address the underlying determinants of violence to prevent it from happening in the first place. The aim of this review is to identify and synthesize research on evaluated interventions addressing the primary prevention of violence against women with disability and explore evidence about their quality and effectiveness. A systematic search across the bibliographic databases of Medline, CINAHL, Embase, and PsychInfo for peer-reviewed literature published in English on or after January 1, 2010, yielded 483 papers of potential interest. Twelve studies met the inclusion criteria and were considered for review. Data were extracted and the quality of the studies was assessed using the Quality Assessment Tool for Quantitative Studies. Most studies reported outcomes from pre- and post-test research designs and received a weak rating of quality. Although interventions targeting awareness, knowledge, and skill development showed evidence of effectiveness, there is a distinct lack of program development that draws on known risk factors for violence such as the intersection of ableism and gender inequality.

Effects of an Aboriginal and Torres Strait Islander Mental Health First Aid training programme for non-suicidal self-injury on stigmatising attitudes, confidence in ability to assist, and intended and actual assisting actions: an uncontrolled trial with precourse and postcourse measurement and 6-month follow-up.

OBJECTIVES: Non-suicidal self-injury (NSSI) is a complex issue affecting Aboriginal and/or Torres Strait Islander Peoples in Australia. We evaluated the effects of an Aboriginal and Torres Strait Islander Mental Health First Aid (AMHFA) training course on assisting an Aboriginal and/or Torres Strait Islander person engaging in NSSI, including the effects on stigmatising attitudes, confidence in ability to assist, and intended and actual assisting actions. DESIGN: Uncontrolled trial with precourse and postcourse measurement (n=49) and 6-month follow-up (n=17). SETTING: Participants attended courses that were run in Queensland and Victorian communities and through one national organisation. PARTICIPANTS: Participants were 49 adults who worked directly with Aboriginal and/or Torres Strait Islander Peoples. INTERVENTION: The 5-hour 'Talking About Non-Suicidal Self-Injury' course was delivered by accredited AMHFA instructors and teaches people how to support an Aboriginal and/or Torres Strait Islander person who is engaging in NSSI. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome measures were stigmatising attitudes, confidence in ability to assist, and intended and actual actions to assist a person engaging in NSSI. RESULTS: Improvements were observed in stigmatising attitudes, with significant changes from precourse in both the 'weak-not-sick' (postcourse p<0.0623; follow-up p=0.0058) and 'dangerous/unpredictable' (postcourse p<0.0001; follow-up p=0.0036) subscales. Participants' confidence in ability to assist increased significantly both postcourse (p<0.0001) and at follow-up (p<0.0001). Despite a high level of endorsement for the nine recommended assisting actions at precourse, significant improvements (p<0.05) were observed in endorsement for six and four of the assisting actions postcourse and at follow-up, respectively. Course content was rated as being somewhat (3.4%), mostly (13.8%) or very (82.7%) culturally appropriate by participants who identified as Aboriginal and/or Torres Strait Islander. CONCLUSIONS: The results of this uncontrolled trial were encouraging, suggesting that the Talking About Non-Suicidal Self-Injury course was able to improve participants' attitudes, confidence and intended assisting actions.

Sex differences in suicide, suicidal ideation, and self-harm after release from incarceration: a systematic review and meta-analysis.

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.

Associations between workers' compensation and self-harm: A retrospective case-series study of hospital admissions data.

Background: While workers' compensation schemes aim to assist and support injured workers, there is some evidence that the process of pursuing a compensation claim may be extremely stressful for workers. This research aimed to compare hospital admissions for self-harm among workers' compensation claimants and non-claimants. Methods: A retrospective case-series design, this study used hospital admissions data for 42,567 patients (2011-2018) to estimate rates of hospital admission for intentional self-harm and 'self-harm and probable self-harm' (due to intentional self-harm, poisoning, or undetermined intent) and compare these between workers' compensation claimants and non-claimants. Rates were stratified by gender and calculated for each age group. Findings: For males, there was no observable difference between claimants and non-claimants for admission due to intentional self-harm. For female claimants, the incidence rate for admission for intentional self-harm was higher than non-claimants (rate ratio (RR) 2.4, 95%CI 1.8-3.2, risk difference (RD) 47.7 per 100,000 person-years). For the combined category of 'self-harm and probable self-harm', the incidence rate was elevated in both male (RR 5.8, 95%CI 5.0-6.6, RD 167.7 per 100,000 person-years) and female workers' compensation claimants (RR 3.4, 95%CI 2.8-4.2, RD 114.8 per 100,000 person-years) relative to non-claimants. Interpretation: Female workers' compensation claimants appear to have elevated rates of admission for intentional self-harm and 'self-harm and probable self-harm' compared to non-claimants. Male claimants appear to have increased rates of hospital admission for 'self-harm and probable self-harm'. This suggests that the process of pursuing workers' compensation may be associated with increased risk of self-harm, and highlights a need for further research. Funding: Suicide Prevention Australia Innovation Grant.

Association between maternal adversity, DNA methylation, and cardiovascular health of offspring: a longitudinal analysis of the ALSPAC cohort study.

OBJECTIVES: Maternal adversity during pregnancy has been shown to be associated with some health outcomes in the offspring. This study investigated the association of maternal adversity during pregnancy and DNA methylation with offspring cardiovascular (CV) health. DESIGN: Longitudinal observational cohort study SETTING: All pregnant residents in county Avon (∼0.9 million), UK, were eligible to participate if their estimated delivery date was between 1 April 1991 and 31 December 1992. PARTICIPANTS: Mother-offspring pairs enrolled in the Avon Longitudinal Study of Parents and Children cohort at seven (n=7431) and 17 years of age (n=3143). PRIMARY AND SECONDARY OUTCOME MEASURES: Offspring CV health primary measures were heart rate (HR), blood pressure (BP) and secondary measures were pulse-wave velocity and carotid intima-media thickness. RESULTS: Overall, there was no association between maternal adversity scores (number or perceived impact) and primary CV measures (Perceived impact; HR: 0.999-fold change 95% CI 0.998 to 1.001; systolic BP (SBP): 1.000-fold change 95% CI 0.999 to 1.001; diastolic BP: 1.000-fold change 95% CI 0.999 to 1.002). Some small offspring sex effects were observed and there was also a small association between methylation of some CpG sites and offspring BP measures. CONCLUSIONS: We found little evidence to support the overall association of maternal adversity during pregnancy and DNA methylation with offspring CV measures. Offspring sex-specific and age-specific associations require further investigation.

Why we need population data on gender norms, and why this is important for population health.

Gender norms are essential barometers of gender equality; inequitable gender norms are indicative of core inequalities in society that undermine the health of many groups. Fundamentally embedded in the gender system, prescriptive and restrictive gender norms have been shown to have deleterious effects on the health of women, men, girls and boys, as well as gender and sexual minorities. Gender norms are mutable, and there is potential to target and transform harmful and inequitable gender norms to drive gender equality. Gender-transformative approaches are needed, but a necessary first step is to identify and benchmark restrictive and inequitable gender norms, monitor change and progress, and highlight areas where interventions can be targeted for greatest effect. Efforts to do this are currently stymied by a lack of fit-for-purpose data. Routinely collected, population representative data on gender norms is urgently needed. This is vital to supporting and progressing gender equality and will contribute substantially to lifting population health.

Understanding the Context of Suicides by Older Men Compared With Younger Old Men and Women.

Background: The rate of suicide among men aged 85 years or older is the highest of any age or gender group in many countries, but little is known about their pathways to suicide. Aims: This study aimed to determine the context of suicide by men aged 85 years or older. Method: Data were extracted from the Victorian Suicide Register regarding suicide deaths between 2009 and 2015. Chi-squared test or Fisher's exact test was used to compare old men (65-84 years old) and older men (85 years or more), and old women and old men (both 65 years or more). Results: The context of suicide by older men differed significantly from that of old men, as did that of old men compared with old women, on variables related to suicidal behavior and intention, mental illness, mental health treatment, and life stressors. Limitations: The study is limited by the small numbers of deaths by suicide in this age group in Victoria. Conclusion: The context of suicide by older and old men is different from that of old men and old women, respectively. More research is needed to understand the pathways to suicide by older men.

Outcomes of Victorian Prevention and Recovery Care Services: A matched pairs comparison.

OBJECTIVE: In Victoria, Prevention and Recovery Care Services have been established to provide a partial alternative to inpatient admissions through short-term residential mental health care in the community. This study set out to determine whether Prevention and Recovery Care Services are achieving their objectives in relation to reducing service use and costs, fostering least restrictive care and leading to positive clinical outcomes. METHODS: We matched 621 consumers whose index admission in 2014 was to a Prevention and Recovery Care ('PARCS consumers') with 621 similar consumers whose index admission in the same year was to an acute inpatient unit and who had no Prevention and Recovery Care stays for the study period ('inpatient-only consumers'). We used routinely collected data to compare them on a range of outcomes. RESULTS: Prevention and Recovery Care Services consumers made less subsequent use of acute inpatient services and, on balance, incurred costs that were similar to or lower than inpatient-only consumers. They were also less likely to spend time on an involuntary treatment order following their index admission. Prevention and Recovery Care Services consumers also experienced positive clinical outcomes over the course of their index admission, but the magnitude of this improvement was not as great as for inpatient-only consumers. This type of clinical improvement is important for Prevention and Recovery Care Services, but they may place greater emphasis on personal recovery as an outcome. CONCLUSION: Prevention and Recovery Care Services can provide an alternative, less restrictive care option for eligible consumers who might otherwise be admitted to an acute inpatient unit and do so at no greater cost.

Age and gender differences in the reciprocal relationship between social connectedness and mental health.

PURPOSE: To examine (i) reciprocal longitudinal associations between social connectedness and mental health, and (ii) how these associations vary by age and gender. METHODS: Three waves of nationally representative data were drawn from the HILDA survey (n = 11,523; 46% men). The five-item Mental Health Inventory (MHI-5) assessed symptoms of depression and anxiety. The Australian Community Participation Questionnaire provided measures of informal social connectedness, civic engagement and political participation. Multivariable adjusted cross-lagged panel regression models with random intercepts estimated bidirectional within-person associations between mental health and each of the three types of social connectedness. Multi-group analyses were used to quantify differences between men and women, and between three broad age groups (ages: 15-30; 31-50; 51+). RESULTS: Reliable cross-lagged associations between prior informal social connections and future mental health were only evident among adults aged 50 years and older (B = 0.101, 95% CI 0.04, 0.16). Overall, there was no significant association between prior civic engagement and improvements in mental health (p = 0.213) though there was weak evidence of an association for men (B = 0.051, 95% CI 0.01, 0.09). Similarly, there was no significant association in the overall sample between political participation and improvements for mental health (p = 0.337), though there was weak evidence that political participation was associated with a decline in mental health for women (B = - 0.045, CI - 0.09, 0.00) and those aged 31-50 (B = - 0.057, CI - 0.10, - 0.01). Conversely, prior mental health was associated with future informal social connectedness, civic engagement, and political participation. CONCLUSION: Interventions promoting social connectedness to improve community mental health need to account for age- and gender-specific patterns, and recognise that poor mental health is a barrier to social participation.

Talking about suicide: An uncontrolled trial of the effects of an Aboriginal and Torres Strait Islander mental health first aid program on knowledge, attitudes and intended and actual assisting actions.

OBJECTIVE: Suicide is a leading cause of death among Aboriginal and Torres Strait Islander people. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is at risk of suicide. We developed culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islander people experiencing suicidal thoughts or behaviour and used this as the basis for a 5-hour suicide gatekeeper training course called Talking About Suicide. This paper describes the outcomes for participants in an uncontrolled trial of this training course. METHODS: We undertook an uncontrolled trial of the Talking About Suicide course, delivered by Aboriginal and Torres Strait Islander Mental Health First Aid instructors to 192 adult (i.e. 18 years of age or older) Aboriginal and Torres Strait Islander (n = 110) and non-Indigenous (n = 82) participants. Questionnaires capturing self-report outcomes were self-administered immediately before (n = 192) and after attending the training course (n = 188), and at four-months follow-up (n = 98). Outcome measures were beliefs about suicide, stigmatising attitudes, confidence in ability to assist, and intended and actual actions to assist a suicidal person. RESULTS: Despite a high level of suicide literacy among participants at pre-course measurement, improvements at post-course were observed in beliefs about suicide, stigmatising attitudes, confidence in ability to assist and intended assisting actions. While attrition at follow-up decreased statistical power, some improvements in beliefs about suicide, stigmatising attitudes and intended assisting actions remained statistically significant at follow-up. Importantly, actual assisting actions taken showed dramatic improvements between pre-course and follow-up. Participants reported feeling more confident to assist a suicidal person after the course and this was maintained at follow-up. The course was judged to be culturally appropriate by those participants who identified as Aboriginal and/or Torres Strait Islanders. IMPLICATIONS: The results of this uncontrolled trial were encouraging, suggesting that the Talking About Suicide course was able to improve participants' knowledge, attitudes, and intended assisting actions as well as actual actions taken.

Health Literacy in Male-Dominated Occupations.

Low levels of health literacy are associated with poorer health outcomes. Both individual- and social-level factors have been identified as predictors of low health literacy, and men are known to have lower health literacy than women. Previous research has reported that men working in male-dominated occupations are at higher risk of accidents, injury, and suicide than other population groups, yet no study to date has examined the effect of gendered occupational contexts on men's health literacy. The current article examined the association between occupational gender ratio and health literacy among Australian males. The Australian Longitudinal Study on Male Health (Ten to Men) was used to examine associations between occupational gender ratio (measured in Wave 1) and health literacy (measured in Wave 2) across three subscales of the Health Literacy Questionnaire. Multivariable linear regression analyses were used and showed that the more male dominated an occupational group became, the lower the scores of health literacy were. Results for the different subscales of health literacy for the most male-dominated occupational group, compared to the non-male-dominated group were: ability to find good health information, (Coef. -0.80, 95% CI [-1.05, -0.54], p < .001); ability to actively engage with health-care providers, (Coef. -0.35, 95% CI [-0.62, -0.07], p = .013); and feeling understood and supported by health-care providers, (Coef. -0.48, 95% CI [-0.71, -0.26],p = < .001). The results suggest the need for workplace interventions to address occupation-level factors as an influence on health literacy among Australian men, particularly among the most male-dominated occupational groups.

Similarities and differences in people accessing prevention and recovery care services and inpatient units in Victoria, Australia.

BACKGROUND: There is an emerging international literature demonstrating clinical and cost-effectiveness of sub-acute residential mental health services. To date, however, there is limited information on the profile of consumers accessing these models of care. This study aimed to understand the profile of the population served by adult sub-acute residential mental health services in Victoria, Australia (known as Prevention and Recovery Care; PARC) and to compare PARC service consumers with consumers admitted to psychiatric inpatient units within public hospitals. METHOD: Using 5 years (2012-2016) of a state-wide database of routinely collected individual level mental health service data, we describe the socio-demographic and clinical profile of PARC service consumers compared to consumers of psychiatric inpatient units including for primary diagnosis and illness severity. Using admissions as the unit of analysis, we identify the characteristics that distinguish PARC service admissions from psychiatric inpatient admissions. We also examine and compare length of stay for the different admission types. RESULTS: We analysed 78,264 admissions representing 34,906 individuals. The profile of PARC service consumers differed from those admitted to inpatient units including for sex, age, diagnosis and illness severity. The odds of an admission being to a PARC service was associated with several socio-demographic and clinical characteristics. Being male or in the youngest age grouping (< 20 years) significantly reduced the odds of admission to PARC services. The presence of primary diagnoses of schizophrenia and related disorders, mood, anxiety or personality disorders, all significantly increased the odds of admission to PARC services. Predictors of length of stay were consistent across PARC and inpatient admission types. CONCLUSIONS: Our findings suggest PARC services may serve an overlapping but distinguishably different consumer group than inpatient psychiatric units. Future research on sub-acute mental health services should be cognizant of these consumer differences, particularly when assessing the long-term effectiveness of this service option.

Mediated representations of violence against women in the mainstream news in Australia.

BACKGROUND: How the mainstream news media report violence against women is significant if levels of violence are to be reduced and ultimately eliminated. Media reporting is an important indicator through which to measure progress towards shifting social and cultural norms that reinforce or challenge the place of violence against women in our society. The current study, therefore, aimed to establish a baseline picture of the extent and nature of reporting of violence against women by the mainstream Australian news media. METHODS: Descriptive and content analysis of media reports on violence against women that were collected over four months in three states of Australia. Reports were from newspapers, broadcast (television and radio) and online news sites. RESULTS: Coverage of violence against women in the mainstream news media was extensive. Explicitly situating violent experiences for women within a broader social context was infrequent. Few news reports included information for women on where to seek help. Additionally, news reports rarely elevated the voices of survivors, advocates and other experts, with a disproportionate emphasis on law enforcement, political and criminal justice perspectives. CONCLUSIONS: Despite readiness among journalists and readers to engage in news about violence against women, reporting that promotes public understanding of the issue is not always the norm.

Australian Media Messages: Critical Discourse Analysis of Two Intimate Homicides Involving Domestic Violence.

This study uses critical discourse analysis to examine news reporting of two cases of intimate partner violence in Australia. The fine-grained analysis of newswriting and news-editing practices focuses particularly on the lexical features and referential strategies used to represent the perpetrator and the victim, the crime, and the location of the crime. Findings show that reporting often omits social context, sensationalizes, and acts to shift blame in ways that do not increase public understanding of the nature of domestic violence. These results build on international findings and add to the evidence base about media reporting of violence against women.

Working towards least restrictive environments in acute mental health wards in the context of locked door policy and practice.

There has been a shift towards provision of mental health care in community-based settings in Australia. However, hospitals continue to care for people in acute mental health wards. An increasing proportion of the people in wards are admitted involuntarily, subject to restrictions of movement to minimize risk of harm to self and others. In response to concerns about the safety of people absconding from care, Queensland Health introduced a policy requiring all acute mental health wards in the State to be locked. In response, the Queensland Mental Health Commission funded a project to understand the impact of this policy and develop evidence-based recommendations regarding provision of least restrictive, recovery-oriented practices in acute wards. Facilitated forums were conducted with 35 purposively selected participants who identified as consumers, carers, or staff of acute mental health hospital wards, to test the acceptability, feasibility, and face validity of a set of evidence-informed recommendations for providing least restrictive, recovery-oriented practices. Participant responses were recorded, and data were analysed through an inductive, thematic approach. A recovery-oriented approach was supported by all stakeholders. Reducing boredom and increasing availability of peer support workers were considered key to achieving this. Focusing less on risk aversion was reported as central to enabling true Recovery Orientation. This project enabled recognition of the perspectives of consumers, carers, and staff in the consideration of evidence-informed recommendations that could be implemented to provide least restrictive care in the context of locked doors.

Implementation and evaluation of the Victorian Suicide Register.

OBJECTIVE: The Victorian Suicide Register (VSR) is a state-based suicide surveillance system that contains detailed information on people who die by suicide and the circumstances surrounding their death. In this paper, we provide an overview of the VSR and then describe the evaluation, which used the Centres for Disease Control and Prevention guidelines for surveillance system evaluation as a framework. METHODS: The evaluation drew on three data sources to assess whether the VSR: i) embodies the attributes of a good public health surveillance system; and ii) can be used to inform community-based suicide prevention efforts. RESULTS: There was a high level of acceptability and enthusiasm for having an accessible data collection that can stimulate local action on suicide prevention planning. One of the key challenges identified was data quality, particularly around those data collected in the course of death investigations that are not designed for surveillance purposes. CONCLUSION: The VSR fills an important gap in the sustained and systematic collection of comprehensive information on suicide, with some key challenges identified. Implications for public health: Findings from the evaluation provide important strategic information for national and international jurisdictions seeking to establish their own suicide registers.

High rates of general practice attendance by former prisoners: a prospective cohort study.

OBJECTIVES: To determine the rates at which people recently released from prison attend general practitioners, and to describe service users and their encounters. DESIGN, PARTICIPANTS AND SETTING: Prospective cohort study of 1190 prisoners in Queensland, interviewed up to 6 weeks before expected release from custody (August 2008 - July 2010); their responses were linked prospectively with Medicare and Pharmaceutical Benefits Scheme data for the 2 years after their release. General practice attendance was compared with that of members of the general Queensland population of the same sex and in the same age groups. MAIN OUTCOME MEASURES: Rates of general practice attendance by former prisoners during the 2 years following their release from prison. RESULTS: In the 2 years following release from custody, former prisoners attended general practice services twice as frequently (standardised rate ratio, 2.04; 95% CI, 2.00-2.07) as other Queenslanders; 87% of participants visited a GP at least once during this time. 42% of encounters resulted in a filled prescription, and 12% in diagnostic testing. Factors associated with higher rates of general practice attendance included history of risky opiate use (incidence rate ratio [IRR], 2.09; 95% CI, 1.65-2.65), having ever been diagnosed with a mental disorder (IRR, 1.32; 95% CI, 1.14-1.53), and receiving medication while in prison (IRR, 1.82; 95% CI, 1.58-2.10). CONCLUSIONS: Former prisoners visited general practice services with greater frequency than the general Queensland population. This is consistent with their complex health needs, and suggests that increasing access to primary care to improve the health of former prisoners may be insufficient, and should be accompanied by improving the quality, continuity, and cultural appropriateness of care.

Self-harm following release from prison: A prospective data linkage study.

OBJECTIVE: Prisoners are at increased risk of both self-harm and suicide compared with the general population, and the risk of suicide after release from prison is three times greater than for those still incarcerated. However, surprisingly little is known about the incidence of self-harm following release from prison. We aimed to determine the incidence of, identify risk factors for and characterise emergency department presentations resulting from self-harm in adults after release from prison. METHOD: Cohort study of 1325 adults interviewed prior to release from prison, linked prospectively with State correctional and emergency department records. Data from all emergency department presentations resulting from self-harm were secondarily coded to characterise these presentations. We used negative binomial regression to identify independent predictors of such presentations. RESULTS: During 3192 person-years of follow-up (median 2.6 years per participant), there were 3755 emergency department presentations. In all, 83 (6.4%) participants presented due to self-harm, accounting for 165 (4.4%) presentations. The crude incidence rates of self-harm for males and females were 49.2 (95% confidence interval: [41.2, 58.7]) and 60.5 (95% confidence interval: [44.9, 81.6]) per 1000 person-years, respectively. Presenting due to self-harm was associated with being Indigenous (incidence rate ratio: 2.01; 95% confidence interval: [1.11, 3.62]), having a lifetime history of a mental disorder (incidence rate ratio: 2.13; 95% confidence interval: [1.19, 3.82]), having previously been hospitalised for psychiatric treatment (incidence rate ratio: 2.68; 95% confidence interval: [1.40, 5.14]) and having previously presented due to self-harm (incidence rate ratio: 3.91; 95% confidence interval: [1.85, 8.30]). CONCLUSION: Following release from prison, one in 15 ex-prisoners presented to an emergency department due to self-harm, within an average of 2.6 years of release. Demographic and mental health variables help to identify at-risk groups, and such presentations could provide opportunities for suicide prevention in this population. Transition from prison to the community is challenging, particularly for those with a history of mental disorder; mental health support during and after release may reduce the risk of adverse outcomes, including self-harm.

Agreement between self-reported healthcare service use and administrative records in a longitudinal study of adults recently released from prison.

BACKGROUND: Studies of healthcare service use often rely on self-reported data, especially in disadvantaged populations. Despite this, the reliability of self-reported healthcare service use is often questioned and routinely-collected, administrative data are usually considered preferable. In this paper we examine the agreement between self-reported healthcare service use and administrative records, in a large cohort of adults recently released from prison in Australia. METHODS: Baseline interviews within 6 weeks of expected release from prison and follow-up interviews at 1, 3 and 6 months post-release were linked to routinely-collected, administrative health records over the same time period. Outcomes of interest included use of primary care, emergency department presentation, hospitalisation and dispensing of subsidised pharmaceuticals. Kappa statistics and positive and negative predictive values were calculated for each service type and time point, and a modified Poisson regression was used to identify participant characteristics associated with better agreement. RESULTS: 864 participants completed interviews and were successfully linked to administrative records. There was good agreement between self-report and administrative health records. Agreement between data sources at 1 month was best for psychotropic medications (kappa = 0.79) and primary care visits (kappa = 0.69). CONCLUSION: Despite a common perception that studies using self-reported data are subject to bias, particularly among the disadvantaged, our findings suggest that self-reported healthcare may be valid in vulnerable populations.