Rural youth in distress? Youth self-harm presentations to a rural hospital over 10 years

Abstract

IntroductionDespite growing awareness of increasing rates of youth suicide and self-harm in New Zealand, there is still little known about self-harm among rural youth. AimThis study compared: (1) rates of youth self-harm presentations between a rural emergency department (ED) and nationally available rates; and (2) local and national youth suicide rates over the decade from January 2008 to December 2017. MethodsData were requested on all presentations to Ashburton Hospital ED coded for ‘self-harm’ for patients aged 15–24 years. Comparative data were obtained from the coroner, Ministry of Health and the 2013 census. Analyses were conducted of the effects of age, time, repetition, method, ethnicity and contact with mental health services on corresponding suicide rates. ResultsSelf-harm rates in Ashburton rose in the post-earthquake period (2013–17). During the peri-earthquake period (2008–12), non-Māori rates of self-harm were higher than for Māori (527 vs 116 per 100000 youth respectively), reflecting the national trend. In the post-earthquake period, although non-Māori rates of self-harm stayed stable (595 per 100000), there was a significant increase in Māori rates of self-harm to 1106 per 100000 (Chi-squared = 14.0, P < 0.001). Youth living within the Ashburton township showed higher rates than youth living more rurally. DiscussionYouth self-harm behaviours, especially self-poisoning, have increased since the Canterbury earthquakes in the Ashburton rural community. Of most concern was the almost ninefold increase in Māori self-harm presentations in recent years, along with the increasing prevalence among teenagers and females. Possible explanations and further exploratory investigation strategies are discussed.

From the Editor: The essence of primary health care research

“…We have two research articles relating to these healthcare challenges and coming from a hospital perspective. One is an audit of a decade of youth self-harm presentations to a rural hospital's emergency department 16 and the other is a report of one tertiary hospital's efforts to understand how well it is doing in identifying and assisting people experiencing domestic violence. 17 As much excellent research tends to do, both articles raise as many questions as they answer.…”