Characterising mental health and addictions and assault-related health care use in the year prior to death: a population-based linked cohort study of homicide victims.

Meghan O'Neill,Laura Rosella,Peter D Donnelly,Emmalin Buajitti,Kathy Kornas

doi:10.23889/ijpds.v6i1.1410

Meghan O'Neill, Laura Rosella + Show 3 more

Open Access

https://doi.org/10.23889/ijpds.v6i1.1410

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Abstract

IntroductionHomicide is an important cause of death for older youth and adult Canadians; however, little is known about health care use prior to death among this population.ObjectivesTo characterise health care use for mental health and addictions (MHA) and serious assault (herein referred to assault) one year prior to death among individuals who died by homicide in Ontario, Canada using linked mortality and health care utilisation data.MethodsWe report rates of health care use for MHA and assault in the year prior to death among all individuals 16 years and older in Ontario, Canada, who died by homicide from April 2003 to December 2012 (N = 1,541). Health care use for MHA included inpatient stays, emergency department (ED) visits and outpatient visits, whereas health care use for assault included only hospital-based care (ED visits and inpatient stays). Sociodemographic characteristics and health care utilisation were examined across homicide deaths, stratified by sex.ResultsOverall, 28.5% and 5.9% of homicide victims sought MHA and assault care in the year prior to death, respectively. A greater proportion of females accessed care for MHA, whereas a greater proportion of males accessed assault-related health care. Males were more likely to be hospitalised following an ED visit for a MHA or assault related reason, in comparison to females. The most common reason for a MHA hospital visit was for substance-related disorders. We found an increase over time for hospital-based visits for assault prior to death, a trend that was not observed for MHA-related visits.ConclusionsA large proportion of homicide victims interacted with the health care system for MHA or assault in the year prior to death. An increase in hospital-based visits for assault-related reasons prior to death was observed. These trends may offer insight into avenues for support and prevention for victims of homicide.

Highlights

Homicide is an important cause of death for older youth and adult Canadians; little is known about health care use prior to death among this population
A large proportion of homicide victims interacted with the health care system for mental health and addictions (MHA) or assault in the year prior to death
Between April 2003 and December 2012, there were 1,541 homicide deaths registered in Ontario and linked to Registered Persons’ Database (RPDB) (Table 1)

Summary

Introduction

Homicide is an important cause of death for older youth and adult Canadians; little is known about health care use prior to death among this population. Individuals with mental health conditions have shown to be at increased risk of homicide compared to the general population [4,5,6,7,8,9]. This increased risk may be related to neighbourhood-level conditions [10], socioeconomic deprivation (e.g., unemployment, inadequate housing, limited social support) [11] or potential for victimisation due to stigma and discrimination [11, 12]. Research on victims of domestic homicide has suggested a considerable proportion experience physical violence prior to the lethal incident [14, 15], which has been supported by coroner examination [13, 16]

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