Have public health responses to COVID-19 considered social inequalities in health? Insights from Brazil, Canada, France & Mali
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School of Public Health (ESPUM), University of Montréal, Montréal, Canada
Centre Population et Développement (CEPED), University of Paris, Paris, France
Association Miseli, Bamako, Mali
Universidade Federal de Pernambuco, Recife, Brazil
School of Public Health (ESPUM), University of Montréal, Québec, Canada
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A366
Background: Research has indicated an increased risk of self-harm repetition and suicide among individuals with frequent self-harm episodes. Co-occurring physical and mental illness further increases the risk of self-harm and suicide. However, the association between this co-occurrence and frequent self-harm episodes is not well understood. We examined the profile of individuals with frequent self-harm episodes and the association between physical and mental illness comorbidity, self-harm repetition and highly lethal self-harm acts. Methods: The study included consecutive patients with five or more self-harm presentations to Emergency Departments across three general hospitals in the Republic of Ireland. The study included file reviews (n=183) and semi-structured interviews (n=36). Multivariate logistic regression models were used to test the association between the sociodemographic and the comorbidity variables on highly lethal self-harm acts. Thematic analysis was applied to identify themes related to the comorbidity and frequent self-harm repetition. Findings: Most of the participants were female (59.6%), single (56.1%) and unemployed (57.4%). The predominant current self-harm method was drug overdose (60%). Almost 90 % of the participants had history of a mental or behavioural disorder, and 56.8% had recent physical illness. The most common psychiatric diagnoses were alcohol use disorders (51.1%), borderline personality disorder (44.0%), and major depressive disorder (37.8%). Male gender (OR=2.89) and alcohol abuse (OR=2.64) were associated with highly lethal self-harm acts. Major qualitative themes were a) the functional meaning of self-harm b) self-harm comorbidity c) family psychiatric history and d) contacts with mental health services. Participants described experiencing an uncontrollable self-harm urge, and self-harm was referred to as a way to get relief from emotional pain or self-punishment to cope with anger and stressors. Conclusions: Physical and mental illness comorbidity was high among the participants. The mental and physical illness comorbidity of these patients should be addressed via a biopsychosocial assessment and subsequent interventions.