@article{ref1,
title="Postpartum self-inflicted injury, suicide, assault and homicide in relation to immigrant status in Ontario: a retrospective population-based cohort study",
journal="CMAJ open",
year="2019",
author="Vigod, Simone N. and Arora, Serena and Urquia, Marcelo L. and Dennis, Cindy-Lee and Fung, Kinwah and Grigoriadis, Sophie and Ray, Joel G.",
volume="7",
number="2",
pages="E227-E235",
abstract="BACKGROUND: Intentional injury, including suicide and assault, is a leading cause of maternal morbidity and mortality. We aimed to determine whether immigrant and nonimmigrant women differ in their 1-year risk of intentional injury after birth. <br><br>METHODS: This population-based retrospective cohort study used administrative data from Ontario from 2002 to 2012. Risk of self-inflicted injury (self-harm or suicide), and injury inflicted by others (assault or homicide), were each analyzed within 1 year after delivery of a live-born infant for immigrant and nonimmigrant mothers. Relative risks (RRs) were adjusted for maternal age, parity, income, resource utilization and psychiatric history. <br><br>RESULTS: The study included 327 279 immigrant and 942 502 nonimmigrant mothers. Risk of self-inflicted injury was similar among immigrants and nonimmigrants (adjusted RR 0.91, 95% confidence interval [CI] 0.78-1.04), with no variation by duration of residence or refugee status. Immigrants were at lower risk than nonimmigrants for injury inflicted by others (adjusted RR 0.57, 95% CI 0.51-0.64); that risk was higher among refugees than among nonrefugee immigrants (adjusted RR 1.79, 95% CI 1.33-2.41), and it was higher among long-term (adjusted RR 2.27, 95% CI 1.76-2.91) and medium-term (adjusted RR 1.58, 95% CI 1.19-2.11) immigrants than among recent immigrants. Variability by country of origin was observed for both injury types. <br><br>INTERPRETATION: Immigrant mothers have a reported risk for self-inflicted injury after birth similar to that of their Canadian-born counterparts. The extent to which selective underreporting of intentional injury in immigrant women might explain our findings is a key consideration for future research.<br><br>Copyright 2019, Joule Inc. or its licensors.<p /> <p>Language: en</p>",
language="en",
issn="2291-0026",
doi="10.9778/cmajo.20180178",
url="http://dx.doi.org/10.9778/cmajo.20180178"
}