Health service use in the year before and after intentional self-harm among ex-serving ADF members

This report compares the health service user class that ex-serving members were in before hospitalisation with the class they were in after the hospitalisation. Analysis of these transitions between classes showed different patterns for the self-harm and comparison cohort.

Among ex-serving members in the self-harm cohort who were in the low user class in the year before index admission, the majority transitioned to the medium user class (60%) with around a third (35%) remaining in the low user class. However, in the comparison cohort, most of those in the low user class in the year before remained in the low user class in the year after (55%), while most others transitioned to the medium user class (43%).

For those in the medium user class in the year before, most stayed in the class in the year after for the self-harm (71%) and comparison cohorts (78%). Of the remainder, in the self-harm cohort, ex-serving members were more likely to transition to the high user class (23%) compared with transitions to the low user class (6%). This pattern was the opposite of the comparison cohort who had more transition to the low user class (13%) than high user class (9%).

Among high users in the year before, the self-harm cohort were more likely to stay in the high user class in the year after (68%) than the comparison cohort (51%). They were less likely to transition to each of medium user and low user classes than the comparison cohort. Figure 8 shows the transition patterns for the self-harm cohort.

Based on these transition patterns, four transition groups were derived:

• Stable low: ex-serving members who were in the low user class in each year. This group was 6% of the self-harm cohort and 12% of the comparison cohort.
• Stable medium/high: ex-serving members who were in the medium user class in each year and those who were in the high user class in each period. This group was 59% of the self-harm cohort and 58% of the comparison cohort.
• Increasing: ex-serving members who transitioned to a higher user class in the year after such as from low to medium or medium to high. This group was 26% of the self-harm cohort and 16% of the comparison cohort.
• Decreasing: ex-serving members who transitioned to a lower user class in the year after such as from high to medium or medium to low. This group was 10% of the self-harm cohort and 14% of the comparison cohort.

In comparison with the stable medium/high transition group, ex-serving members in the self-harm cohort were 60% more likely to be in the increasing transition group than the comparison cohort. They were also 56% less likely to be in the stable low transition group and 32% less likely to be in the decreasing group.

In comparison with the stable low transition group, ex-serving members in the self-harm cohort were 262% more likely to be in the increasing transition group than the comparison cohort. They were also 126% more likely to be in the stable medium/high transition group and 54% more likely to be in the decreasing group. The greater likelihood for the decreasing group reflects that a relatively higher proportion of the self-harm cohort had decreasing use when compared with the comparison cohort and the relative proportion of each cohort in the stable low group.

Which ex-serving members changed their health services use before and after self-harm?

This report presents findings on whether any ex-serving member characteristics were more likely to be associated with increasing and decreasing health service use. Ex-serving members in the self-harm cohort in the increasing transition group were more likely to be aged 25 to 34 years, separated involuntary due to medical reasons, DVA white card holders, or have comorbidities (Figure 9).

Multinomial logistic regression was conducted to further examine the relationship between each characteristic and transition group in the self-harm cohort. Characteristics significantly associated with being in the increasing transition group compared with the stable medium/high transition group were being aged 25–34 years, involuntary medical separation, involuntary separation – retention not in service interest, or separation between 1 and 5 years ago.

Compared with the stable low transition group, decreasing users in the self-harm cohort were significantly more likely to have served for 5 or more years, be a DVA client, have comorbidities and less likely to have separated in the past 10 years.

Ex-serving members in the self-harm cohort who had decreasing health service use were more likely to be located in a low socioeconomic disadvantage area, and less likely to have separated involuntarily due to medical reasons, separated between 5 and 10 years ago and have no comorbidities (Figure 9).

Multinomial logistic regression was also conducted to further examine the relationship between each characteristic and transition group for the self-harm cohort. Compared with the stable medium/high group, those in the decreasing transition group were more likely to live in a high socioeconomic area. Compared with the stable low transition group, decreasing users were significantly less likely to live in a regional/remote area or have separated recently (not less than 10 years ago) and more likely to be a DVA client or have comorbidities.