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Table Cell (td)
Name
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Self-Injury Hospitalization Harm Hospitalizations
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Short/Other Names
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Not applicable

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Description
Table Cell (td)

Age-standardized rate of hospitalization in a general or psychiatric hospital due to self-

injury

harm, per 100,000 population

.

For further details, please see the General

Methodological

Methodology Notes

document

.

Table Row (tr)
Table Cell (td)
Interpretation
Table Cell (td)

Lower rates are desirable

.Using the available data sources, capturing intention is difficult. This indicator cannot distinguish whether or not the self-injury was intended to result in death (self-harming or suicidal behaviour). In addition, this indicator might provide biased estimates of the true number of hospitalizations for self-injury, due to the manner in which intent is captured in the data sources available. For example, poisoning can be coded as "unintentional"—an overdose—or "undetermined"—reflecting an uncertainty between unintentional and intentional motives. Neither unintentional nor undetermined injuries were

as they signal less frequent severe self-harm.

This indicator includes both suicidal and non-suicidal self-harm within the hospitalization data.

The indicator captures only cases within the hospitalization data where intentional self-harm was noted in the medical chart or abstract by a physician. Injuries coded as accidental or undetermined are not included in this indicator, even though

it is assumed that a small number of these cases were, in fact, intentional.

a portion of these injuries may have been intentional. As such, this indicator underestimates the true number of hospitalizations for self-harm and should be considered a minimum rate of self-harm.

Table Row (tr)
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HSP Framework Dimension
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Health System Outcomes: Improve health status of Canadians

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Areas of Need
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Not applicable

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Geographic Coverage
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All provinces/territories

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Reporting Level/Disaggregation
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National, Province/Territory, Region, Neighbourhood Income Quintile, Sex

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Latest Result Update DateIndicator Results
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Identifying Information

Accessing Indicator Results

Table Cell (td)

09/2014

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Table Cell (td)

Data results will be available in September 2014

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on Your Health System: In Depth

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<div role="button" class="expandableTitle" aria-controls="identifyingInfoRegion">Identifying Information</div>
HTML Table
ididentifyingInfoRegion
Table Row (tr)
Table Cell (td)
Name
Table Cell (td)
Self-Injury Hospitalization Harm Hospitalizations
Table Row (tr)
Table Cell (td)
Short/Other Names
Table Cell (td)

Not applicable

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Indicator Description and Calculation
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Table Row (tr)
Table Cell (td)
Description
Table Cell (td)

Age-standardized rate of hospitalization in a general or psychiatric hospital due to self-

injury

harm, per 100,000 population

.

For further details, please see the General

Methodological

Methodology Notes

document

.

Table Row (tr)
Table Cell (td)
Calculation: Description
Table Cell (td)
(Total number of discharges for a self-injury harm for patients age 15 10 and older ÷ Total mid-year population age 15 10 and older) × 100,000 (age-adjusted)
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Table Cell (td)
Calculation: Geographic Assignment
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Place of residence

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Table Cell (td)
Calculation: Type of Measurement
Table Cell (td)

Rate - Rate: per 100,000

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Table Cell (td)
Calculation: Adjustment Applied
Table Cell (td)

Age-adjusted

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Table Cell (td)
Calculation: Method of Adjustment
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Direct Standardization
Standard Population:
Canada

1991

2011

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Table Cell (td)
Denominator
Table Cell (td)

Description:
Total mid-year population age

15

10 and older

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Table Cell (td)
Numerator
Table Cell (td)

Description:
Total number of

discharges for a

self-

injury

harm hospitalizations for patients age

15

10 and older
Inclusions:
1.

Self-injury is identified by the following external cause of injury codes with a diagnosis type of 9:

Admission to hospital with self-harm diagnosis (diagnosis type 9, ICD-10-CA codes X60 to X84


Exclusions:
1. Cases of self-injury involving outpatient treatment in hospital emergency departments or other medical facilities or completed suicide prior to hospital admission

2. Patients who were institutionalized in a psychiatric hospital and were self-injured during their stay but did not require admission to a general hospital

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Background, Interpretation and Benchmarks

) for those age 10 and older, sex recorded as male or female

2. Analytical Institution Type Code = 1 (general hospital) or 5 (psychiatric hospital) from the Discharge Abstract Database (DAD)

Wiki Markup
3. Ontario Mental Health Reporting System (OMHRS) records for cases where the OMHRS stay was from an initial emergency department (ED) visit for intentional self-harm (X60 to X84 in the National Ambulatory Care Reporting System \[NACRS\]) within 7 days 

Additional notes on the inclusions:

  • Episode building was performed to accommodate multiple abstracts within a single episode of care.
  • At this time, we are unable to determine the rate for those not identified as male or female in the data.

Exclusions:
1. Cadaveric donor or stillbirth records (Admission Category Code = R or S)

2. Patients with an indication of medical assistance in dying

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Table Row (tr)
Table Cell (td)
Rationale
Table Cell (td)

Self-

injury

harm is defined as a deliberate bodily injury that may or may not result in death. This type of injury is the result of either suicidal or self-harming behaviours, or both. Self-

injury

harm can be prevented, in many cases, by early recognition, intervention and treatment of mental illnesses. While some risk factors for self-

injury

harm are beyond the control of the health system, high rates of self-

injury hospitalization

harm hospitalizations can be interpreted as the result of a failure of the system to prevent self-

injuries

harms that are severe enough to require hospitalization.

Table Row (tr)
Table Cell (td)
Interpretation
Table Cell (td)

Lower rates are desirable

.Using the available data sources, capturing intention is difficult. This indicator cannot distinguish whether or not the self-injury was intended to result in death (self-harming or suicidal behaviour). In addition, this indicator might provide biased estimates of the true number of hospitalizations for self-injury, due to the manner in which intent is captured in the data sources available. For example, poisoning can be coded as "unintentional"—an overdose—or "undetermined"—reflecting an uncertainty between unintentional and intentional motives. Neither unintentional nor undetermined injuries were

as they signal less frequent severe self-harm.

This indicator includes both suicidal and non-suicidal self-harm within the hospitalization data.

The indicator captures only cases within the hospitalization data where intentional self-harm was noted in the medical chart or abstract by a physician. Injuries coded as accidental or undetermined are not included in this indicator, even though

it is assumed that a small number of these cases were, in fact, intentional.

a portion of these injuries may have been intentional. As such, this indicator underestimates the true number of hospitalizations for self-harm and should be considered a minimum rate of self-harm.

Table Row (tr)
Table Cell (td)
HSP Framework Dimension
Table Cell (td)

Health System Outcomes: Improve health status of Canadians

Table Row (tr)
Table Cell (td)
Areas of Need
Table Cell (td)

Not applicable

Table Row (tr)
Table Cell (td)
Targets/Benchmarks
Table Cell (td)

Not applicable

Table Row (tr)
Table Cell (td)
References
Table Cell (td)

Canadian Institute for Health Information. National Trauma Registry Analytic Bulletin: Hospitalizations Due to Suicide Attempts and Self-Inflicted Injury in Canada, 2001-2002. Ottawa, ON: CIHI; 2004.

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Availability of Data Sources and Results

Not applicable

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Table Cell (td)
Data Sources
Table Cell (td)

DAD,

Demography division, Statistics Canada, MED-ÉCHO,

HMDB, NACRS, OMHRS

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Table Cell (td)
Available Data Years
Table Cell (td)

Type of Year:
Fiscal
First Available Year:

2009

2016
Last Available Year:

2012

2018

Table Row (tr)
Table Cell (td)
Geographic Coverage
Table Cell (td)

All provinces/territories

Table Row (tr)
Table Cell (td)
Reporting Level/Disaggregation
Table Cell (td)

National, Province/Territory, Region, Neighbourhood Income Quintile, Sex

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Table Cell (td)
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Result Updates
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<div role="button" class="expandableTitle" aria-controls="resultRegion">Result Updates</div>
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idresultRegion
Table Row (tr)
Table Cell (td)
Update Frequency
Table Cell (td)

Every year

Indicator Results
Table Row (tr)
Table Cell (td)
Latest Result Update Date
Table Cell (td)

09/2014

Table Row (tr)
Table Cell (td)
Table Cell (td)

Web Tool:

Interactive Facility/Regional Website

Your Health System: In Depth
URL:

Data results will be available in September 2014

Accessing Indicator Results on Your Health System: In Depth

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Table Cell (td)
Updates
Table Cell (td)

Not applicable

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Quality Statement
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Table Row (tr)
Table Cell (td)
Caveats and Limitations
Table Cell (td)

This indicator does not include cases of self-

injury involving outpatient treatment in hospital emergency departments or other medical facilities or completed suicide prior to hospital admission

harm that are not admitted to hospital. Self-harm where no medical care is sought (including deaths by suicide in the community), or where a patient visits only a primary health care provider or emergency department, will not be captured. Thus this indicator cannot be used to estimate the prevalence of all self-

injury

harm in the general population.

Also not included are patients who were institutionalized in a psychiatric hospital and were self-injured during their stay but did not require admission to a general hospital. For a broader estimate of self-injury, please refer to the In Focus section of Health Indicators 2012.

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Trending Issues
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Weyburn Mental Health Centre in Saskatchewan is not included in all mental health–related indicators as requested by the facility. As a result, rates for Sun Country Health Region (4701) in 2009 are not comparable with those reported in subsequent years.

Brant Community Healthcare System: Brantford General Hospital did not submit its 2009–2010 data to the Ontario Mental Health Reporting System as of the reporting deadline; therefore, it is not included in the indicator calculation. Rates for North East Local Health Integration Network (3513) are not comparable with those reported in subsequent

Beginning in 2020, this indicator replaced the Self-Injury Hospitalization indicator. Results for the 3 fiscal years 2016–2017 to 2018–2019 were calculated, with annual updates planned for future years.

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Comments
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Results for this indicator are also available on

The Health Indicators e-publication (data results will be available in July 2014): http://www.cihi.ca/hirpt/?language=en

Patients in the Discharge Abstract Database–Hospital Morbidity Database (DAD-HMDB) and OMHRS with invalid postal codes will not be included in the numerator of any province but will be included in the all-Canada numerator. An exception to this is patients who are identified as homeless (DAD-HMDB: diagnosis code = Z59.0 or postal code = XX; OMHRS: residential status code = 8); these patients will be assigned to the province of the facility.

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