National clinical assessment data of Indigenous Traveller women attending 24 Irish emergency departments, between 2018–2022, in a suicidal crisis: a sequential mixed method study

Abstract

Objective: We aimed to present the hospital presented age-specific rate ratio of Traveller women with self-harm or suicide-related ideation and further explore their experiences when attending hospitals in Ireland with thoughts of suicide. Methods: A sequential mixed method analysis was adopted. National presentation data from 24 Irish Emergency Departments (EDs) for suicidal thoughts or self-harm, between 2018–2022 and qualitative interviews were conducted. Descriptive statistics, Poisson regression and rate ratios (95% confidence intervals), were used. Interpretative Phenomenological Analysis (IPA) was conducted on interviews with Traveller women presenting to EDs with suicidal thoughts in 2023. We involved lived experience women in the research. Results: 693 Traveller women presentations were assessed in the 5-year period. Traveller women between 40–49 years of age had 7·81 (95% CI 6·39– 9·55) times higher risk of ideation presentation and those 50+ had 6·41 (95% CI 5·04–8·15) times higher risk of self-harm, when compared to White Irish females. One in four Traveller female presentations, requested no next of kin involvement when discharged. The ‘Power of human connection’ theme emerged from two Traveller women interviewed, reflecting the powerfulness of support in the participants experiences of suicidal ideation. Conclusions: Results highlight the potential suicide risk of Traveller women over the age of 40 and the significant issue of social isolation when all forms of interpersonal support-family, Traveller organisations, and public health services-are lacking, but crucial for a collaborative safety plan upon ED discharge. Cúlra: Is féidir le Reanna Éigeandála (EDs) a bheith ina bpointí idirghabhála roimh fhéinmharú, agus altraí cliniciúla iontu a bhfuil speisialtóireacht acu chun idirghabháil a dhéanamh i ngéarchéim féinmharaithe. Sprioc: Bhí sé d’aidhm againn an ráta chóimheas den teacht i láthair chun ospidéil aois-shonrach i measc mhionlach eitneach mhná den Lucht Siúil le hidéú féin-ghortaithe nó féin-mharaithe a chur i láthair agus tuilleadh iniúchaidh a dhéanamh ar a dtaithí agus iad ag freastal ar ospidéil in Éirinn agus iad ag fulaingt le smaointe féinmharaithe. Modhanna: Baineadh úsáid as anailís modh measctha sheiceamhach. Sonraí náisiúnta de theacht i láthair chun ospidéil ó 24 ED Éireannach de dheasca smaointe féinmharaithe nó féínghortaithe, idir 2018–2022 agus reachtáladh agallaimh cháilíochtúla. Baineadh úsáid as staitisticí tuairisciúla, dul ar gcúl Poisson agus rátaí cóimheasa (eatramh muiníne (CI) 95%). Rinneadh Anailís Feiniméanoleaíochta Léirmhínithí (IPA) ar agallaimh le mná den Lucht Siúil le smaointe féinmharaithe ag teacht i láthair chun rannóige éigeandála ospidéil. D’áiríomar mná le taithí saoil sa taighde. Torthaí: Deineadh measúnú ar 693 mná den Lucht Siúil ag teacht i láthair chun ospidéil sa tréimhse cúig bliana. Bhí riosca theacht i láthair chun ospidéil de dheasca ídéithe 7.81 uair níos airde ag mná den Lucht Siúil idir 40–49 bliain d’aois (95% CI 5.04–8.15) agus bhí riosca 6.41 (95% CI 5.04–8.15) uair níos airde féinghorthaithe ag mná a bhí 50+, i gcomparáid le mná geala Éireannacha. Dhiúltaigh bean as ceathrar a tháinig i láthair chun ospidéil aon bhaint a bheith ag daoine muinteartha agus iad á scaoileadh amach as ospidéal. D’eascair an téama ‘cumhacht an naisc daonna’ as agallaim a rinneadh le beirt bhan den Lucht Siúil, rud a mheabhraíonn an tábhacht a bhaineann le tacaíocht i dtaithí na rannpháirtithe d’ídéú féinmharaithe. Conclúidí: Is é cumhacht an naisc daonna cuid lárnach de phlean comhoibríoch slandála ar scaoileadh amach as ED d’iad siúd de mhionlach eitneach agus ba chóir do chliniceoirí ED díriú ar cheist shainiúil an uaignis shóisialta nuair a bhíonn gach saghas tacaíochta idirphearsanta easnamhach.