PT  - JOURNAL ARTICLE
AU  - Simone N. Vigod
AU  - Serena Arora
AU  - Marcelo L. Urquia
AU  - Cindy-Lee Dennis
AU  - Kinwah Fung
AU  - Sophie Grigoriadis
AU  - Joel G. Ray
TI  - Postpartum self-inflicted injury, suicide, assault and homicide in relation to immigrant status in Ontario: a retrospective population-based cohort study
AID  - 10.9778/cmajo.20180178
DP  - 2019 Apr 01
TA  - CMAJ Open
PG  - E227--E235
VI  - 7
IP  - 2
4099  - http://www.cmajopen.ca/content/7/2/E227.short
4100  - http://www.cmajopen.ca/content/7/2/E227.full
SO  - CMAJ2019 Apr 01; 7
AB  - 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.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.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.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.