Emergency department mental health presentations by people born in refugee source countries: an epidemiological logistic regression study in a Medicare Local region in Australia
Joanne C. Enticott A G H , I-Hao Cheng A , Grant Russell A B , Josef Szwarc C , George Braitberg D , Anne Peek E and Graham Meadows F GA Southern Academic Primary Care Research Unit, Monash University, 314B Thomas Street, Dandenong, Vic. 3176, Australia.
B School of Primary Health Care, Monash University, Notting Hill Campus, c/- Wellington Road, Clayton, Vic. 3800, Australia.
C Victorian Foundation for Survivors of Torture, 4 Gardiner Street, Brunswick, Vic. 3056, Australia.
D Emergency Department, The Royal Melbourne Hospital, Level 1, Grattan Street, Parkville, Vic. 3050, Australia.
E South Eastern Melbourne Medicare Local, 314A Thomas Street, Dandenong, Vic. 3176, Australia.
F Monash University Department of Psychiatry, Dandenong Hospital, 126–128 Cleeland Street, Dandenong, Vic. 3175, Australia.
G Southern Synergy, The Southern Mental Health Centre for Research, Training and Evaluation, Dandenong Hospital, 126–128 Cleeland Street, Dandenong, Vic. 3175, Australia.
H Corresponding author. Email: joanne.enticott@monash.edu
Australian Journal of Primary Health 21(3) 286-292 https://doi.org/10.1071/PY13153
Submitted: 8 November 2013 Accepted: 23 May 2014 Published: 13 June 2014
Abstract
This study investigated if people born in refugee source countries are disproportionately represented among those receiving a diagnosis of mental illness within emergency departments (EDs). The setting was the Cities of Greater Dandenong and Casey, the resettlement region for one-twelfth of Australia’s refugees. An epidemiological, secondary data analysis compared mental illness diagnoses received in EDs by refugee and non-refugee populations. Data was the Victorian Emergency Minimum Dataset in the 2008–09 financial year. Univariate and multivariate logistic regression created predictive models for mental illness using five variables: age, sex, refugee background, interpreter use and preferred language. Collinearity, model fit and model stability were examined. Multivariate analysis showed age and sex to be the only significant risk factors for mental illness diagnosis in EDs. ‘Refugee status’, ‘interpreter use’ and ‘preferred language’ were not associated with a mental health diagnosis following risk adjustment for the effects of age and sex. The disappearance of the univariate association after adjustment for age and sex is a salutary lesson for Medicare Locals and other health planners regarding the importance of adjusting analyses of health service data for demographic characteristics.
Additional keywords: epidemiology, multivariate statistics, primary health.
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