title: Ambulance attendances resulting from self-harm after release from prison: a prospective data linkage study.
abstract: OBJECTIVE
  Incarcerated adults are at high risk of self-harm and suicide and remain so after release into the community. The aims of this study were to estimate the number of ambulance attendances due to self-harm in adults following release from prison, and to identify factors predictive of such attendances.
  
  
  METHODS
  Baseline surveys with 1309 adults within 6 weeks of expected release from prison between 2008 and 2010 were linked prospectively with state-wide correctional, ambulance, emergency department, hospital and death records in Queensland, Australia. Associations between baseline demographic, criminal justice and mental health-related factors, and subsequent ambulance attendances resulting from self-harm, were investigated using negative binomial regression.
  
  
  RESULTS
  During 4691 person-years of follow-up (median 3.86 years per participant), there were 2892 ambulance attendances in the community, of which 120 (3.9%) were due to self-harm. In multivariable analyses, being Indigenous [incidence rate ratio (IRR): 2.10 (95% CI 1.14-3.86)], having previously been hospitalised for psychiatric treatment [IRR: 2.65 (95% CI 1.44-4.87)], being identified by prison staff as being at risk of self-harm whilst incarcerated [IRR: 2.12 (95% CI 1.11-4.06)] and having a prior ambulance attendance due to self-harm [IRR: 3.16 (95% CI 1.31-7.61)] were associated with self-harm attendances.
  
  
  CONCLUSIONS
  Ambulance attendances resulting from self-harm following release from prison are common and represent an opportunity for tertiary intervention for self-harm. The high prevalence of such attendances, in conjunction with the strong association with prior psychiatric problems, reinforces the importance of providing appropriate ambulance staff training in the assessment and management of self-harm, and mental health problems more broadly, in this vulnerable population.
authors.affiliation: Centre for Adolescent Health, Murdoch Childrens Research Institute, Royal Children's Hospital, 50 Flemington Road, Melbourne, 3052, Australia. rohan.borschmann@mcri.edu.au.|Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia. rohan.borschmann@mcri.edu.au.
authors.forename: Rohan
authors.identifier: http://orcid.org/0000-0002-0365-7775
authors.initials: R
authors.lastname: Borschmann
authors.affiliation: Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia.|Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, WA, 6009, Australia.|National Drug Research Institute, Curtin University, Perth, WA, 6008, Australia.
authors.forename: Jesse T
authors.initials: JT
authors.lastname: Young
authors.affiliation: Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Moran
authors.affiliation: Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Spittal
authors.affiliation: Queensland Forensic Mental Health Service, Herston, Brisbane, 4006, Australia.
authors.forename: Ed
authors.initials: E
authors.lastname: Heffernan
authors.affiliation: The Black Dog Institute, Randwick, New South Wales, Australia.
authors.forename: Katherine
authors.initials: K
authors.lastname: Mok
authors.affiliation: Centre for Adolescent Health, Murdoch Childrens Research Institute, Royal Children's Hospital, 50 Flemington Road, Melbourne, 3052, Australia.|Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia.|Mater Research Institute, University of Queensland, Brisbane, Australia.|Griffith Criminology Institute, Griffith University, Brisbane, Australia.|School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Kinner
mesh_terms: D000293:Adolescent; D000328:Adult; D000552:Ambulances / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016247:Information Storage and Retrieval; D008297:Male; D015995:Prevalence; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D011446:Prospective Studies; D011793:Queensland / Q000453:epidemiology; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult
keywords: Ambulance; Data linkage; Emergency service; Prisons; Self-injurious behaviour