Suicide In Australia Research Articles

Research Priorities in Suicide Prevention in Australia

This project sought to inform priority setting in Australian suicide prevention research, by empirically examining existing priorities and by seeking stakeholders' views on where future priorities might lie. Existing priorities were examined via reviews of Australian literature published and grants funded during the life of the National Suicide Prevention Strategy (1999-2006). Stakeholders' views of future priorities were elicited via a questionnaire administered to 11 groups comprising 231 individuals with an interest in suicide prevention. The study identified 263 journal articles and 36 grants. The journal articles most commonly reported on studies of descriptive epidemiology, while the grants tended to fund intervention studies. Both gave roughly equal weight to completed and attempted suicide, and gave little emphasis to studies of suicide methods. Young people were the most frequently-researched target group, with people with mental health problems and people who had attempted suicide or deliberately self-harmed also receiving attention. Stakeholders indicated that emphasis should be given to intervention studies, and that completed suicide and attempted suicide are both important. In terms of suicide method, they felt the focus should be on poisoning by drugs and hanging. They had mixed views about the target groups that should be afforded priority, although young people and people with mental health problems were frequently ranked highly. This paper presents a picture of the current focus with regard to suicide prevention research, identifying some areas where there are clear gaps and others where relatively greater efforts have been made. By combining this information with stakeholders' views of where future priorities should lie, the paper provides some guidance as to the shape a future suicide prevention research agenda for Australia should take. A strategic approach to suicide prevention research will help fill internationally-identified gaps in knowledge about what works and what doesn't work in suicide prevention.

Declines in Australian suicide: A reanalysis of Mcphedran and Baker (2008)

Declines in Australian suicide: A reanalysis of Mcphedran and Baker (2008)

Deaths due to suicide: the effects of certification and coding practices in Australia

To highlight issues relating to suicide coding that have an impact on the final reported mortality data by the Australian Bureau of Statistics. This paper presents an outline of the way in which the official Australian suicide data is captured and coded and highlights issues relating to the classification used, coronial processes, documentation requirements and data sources that have an impact on the final reported data, especially deaths associated with coronial investigations. Issues related to the coding of Australian suicide data are: *Disparity between jurisdictions due to differences in documentation about accidental or undetermined causes of death. *Lack of standardisation in the way that coronial deaths are reported across Australia. *Lack of a standard form for police reports. *Administrative processes that cause delays in reporting the results of coronial investigations. *Reluctance on the part of some coroners to report deaths as suicides. Researchers and policy makers need to be aware of the constraints under which suicide can be reported as such in the official data before interpreting time trends.

Recent Australian suicide trends for males and females at the national level: Has the rate of decline differed?

In keeping with international public health policy development, suicide prevention in Australia has received increasing attention. The mid to late 1990s saw the introduction of a range of co-ordinated national prevention programmes. Since 1997, suicides have decreased, but the comparative rates of decline for males and females have not been well studied at the national level. Standardised suicide rates were calculated for males and females, using data from 1997 to 2005. Linear models (ordinary least squares) were used to calculate rates of decline, with trends compared for males and females. Male suicides appear to have fallen more rapidly than female suicides. Australian males, an 'at risk' demographic, appear to be experiencing benefits from the existence of current national suicide prevention strategies and related social changes. It is recommended that greater consideration be given to researching risk factors such as intimate partner violence, sexual abuse, and substance dependence, for Australian female suicide.

Small shifts in diurnal rhythms are associated with an increase in suicide: The effect of daylight saving

Large disruptions of chronobiological rhythms are documented as destabilizing individuals with bipolar disorder; however, the impact of small phase altering events is unclear. Australian suicide data from 1971 to 2001 were assessed to determine the impact on the number of suicides of a 1-h time shift due to daylight saving. The results confirm that male suicide rates rise in the weeks following the commencement of daylight saving, compared to the weeks following the return to eastern standard time and for the rest of the year. After adjusting for the season, prior to 1986 suicide rates in the weeks following the end of daylight saving remained significantly increased compared to the rest of autumn. This study suggests that small changes in chronobiological rhythms are potentially destabilizing in vulnerable individuals.

The Cultural Context of Youth Suicide in Australia: Unemployment, Identity and Gender

This article considers the impact, in terms of life and death choices, of the economic exclusion of young people in Australia, where suicide is the leading cause of death by injury. In the two decades from 1980 there was a dramatic increase in suicide rates for young males. Research demonstrates a correlation between youth suicide and unemployment but the complex relationship between the two has not been fully investigated. This article explores the perceptions of young people, parents and service providers of the cultural context of suicide and how it comes to be constructed as an option for young people experiencing economic marginalisation.

Age and Gender Differences Among Australian Suicide Ideators

We investigated the prevalence and correlates of suicidal ideation in an Australian population sample at three stages of adulthood. Random sampling of a community acquired 7485 participants. Cohorts were 20 to 24, 40 to 44, or 60 to 64 years old. Twelve-month prevalence of suicidal ideation was 8.2%. Suicidal ideation was highest among the youngest cohort. Males with chronic physical illness were more prone to suicidal ideation, as were those aged 20 to 24 and 60 to 64. Furthermore, under-employed subjects 60 to 64 years old were seven times more likely to experience suicidal ideation than their counterparts working full-time. Childhood adversity and rumination had positive associations with suicidality; however, considering oneself more masterful was linked with lower levels of suicidal ideation. Contrary to clinical and popular views, our results highlight that proximal non-mental health variables such as employment, physical health, social factors, and personality are equally important to experiencing suicidal ideation as symptoms of psychological distress.

Secular Change in Mortality from Suicide in Australia during the 20th Century

To identify secular change in Australian suicide mortality over the period 1907-1998 and to seek possible explanations, a descriptive epidemiological study was conducted. Deaths due to suicide from 1907 to 1998 were identified according to the ICD-9. Trends in overall annual suicide mortality rates for all causes and individual causes were examined using the three-year moving average method, standardised by age and sex. Secular trends for mortality over the study period were examined in various age groups, using linear regression to test the slope. The results indicated that there has been a decline in overall age and sex standardised mortality from suicide over the study period. The death rate dropped from 15.2 per 100,000 in the early century to 13.9 per 100,000 in late century. Despite the overall decline, the female suicide mortality rates increased over the study period. Male suicide mortality rates were significantly higher than female rates over the study period (P<0.0001). Increased suicide rates were observed in the 15-24 and 25-44 year old age groups for both males and females. The group of 65+ year old females also had increased rates. Decreased rates were observed in both the male and female 45-64 year old age group and in the 65+ year old male age group. The three most common suicide methods used by males in 1907 were guns, poisoning and hanging, while for females they were drowning, hanging and poisoning. In 1998 they were changed to hanging, gas and guns for males and hanging, gas and drowning and poisoning (equally third) for females. These trends can be attributed to numerous factors such as economic crisis, world wars, the availability of suicide methods, a person's gender.

Media Reporting of Suicide Methods.

Internationally, media guidelines on the reporting of suicide suggest that the method of suicide should not be explicitly reported. This paper presents quantitative data on the reporting of suicide in Australia, which suggest that the media present a skewed image of reality with an over-reporting of suicide by violent and unusual methods. It also presents qualitative textual analyses of examples of newspaper reports of suicide in an attempt to examine differences in reporting practices across media and genres and to explore the limits of the notion of "explicitness." The paper concludes that journalistic decisions to maximize the newsworthiness of a story often conflict with the promotion of the accurate, ethical, and responsible reporting of suicide.

The decline in Australian young male suicide

Since the late 1990s there has been a sharp downward trend in Australian young male suicide. It is possible that a major government youth suicide prevention initiative, the National Youth Suicide Prevention Strategy (NYSPS), implemented during 1995–1999 may have influenced the decline. In this article, we examine time trends in age- and means-specific male and female Australian suicide rates in relation to unemployment rates and the NYSPS. Based on Australian suicide data over the period 1966–2003, we assess secular changes in the 20–24 year male suicide to total (crude) male suicide rate ratio in relation to the NYSPS, using interrupted time series analysis (ARIMA), since this was previously found to be significantly associated with the 20–24 year male unemployment to total employment ratio. Results show that a dramatic reduction in Australian young male (aged 20–34 years) suicide has occurred since 1997–1998, declining from approximately 40 per 100,000 in 1997–1998 to approximately 20 per 100,000 in 2003. Most of the decline is due to a decrease in suicide by hanging and to a lesser extent from motor vehicle carbon monoxide and other gases. Further, the previously established strong secular association (lasting over 3 decades from 1966) between the rate ratio of 20–24 year male suicide to total (crude) male suicide, and the rate ratio of 20–24 year male unemployment to total unemployment, appears to have been disrupted. ARIMA modelling of the suicide ratio against the initiative indicates a highly significant statistical association between the NYSPS and the suicide ratio reduction but not between the NYSPS and the unemployment indicator trend, suggesting a break in the link between young male suicide and unemployment. The recent sudden turnaround in Australian young male suicide trends and its extent appears to preclude explanations centring on slow-moving social indices traditionally associated with suicide, or on possible cohort effects. This sudden decrease has occurred mainly in non-impulsive means, and at the same time has broken a long-standing secular link between 20 and 24-year-male suicide and unemployment, lending plausibility to the case for the NYSPS having had an impact on young male suicide in Australia.

Suicide in Australia: some good news

Suicide in Australia: some good news

Divergent trends in suicide by socio-economic status in Australia

This study investigated secular trends in socio-economic status (SES) differentials in Australian suicide (1979-2003), which includes overall declines in male suicide from 1998. Suicide rates were stratified by approximate equal-population quintiles of area-based SES for the period 1979-2003 and examined across five quinquennia, centred on each Australian Census from 1981 to 2001, to determine if (1) SES differentials in suicide have persisted over time, and (2) if SES differentials have widened or narrowed. Suicide rates (per 100,000) were adjusted for confounding by sex, age, country-of-birth, and urban-rural residence using Poisson regression models, and secular changes in SES differentials were assessed using trend tests on suicide rate ratios (low to high SES quintiles). Socio-economic status (SES) differentials persisted across the study period for both males and females after adjusting for the effects of age, migrant status, and urban-rural residence, with the largest differences between low and high SES groups evident in males, and especially young males (20-34 years). For males, suicide rates increased significantly in all SES groups until 1998, before diverging significantly in the most recent 5-year period, particularly in younger males (P<0.0001). In young males, suicide rates in the most recent period increased in the low SES group from 44.8 in 1994-1998 to 48.6 in 1999-2003 (an 8% increase). In contrast, suicide rates in the middle SES group decreased from a peak of 37.3 to 33.5 (a 10% decrease), and in the high SES group from a peak of 33.0 to 27.9 (a 15% decrease). A similar statistically significant divergence of a lesser magnitude was also evident in all age males and younger females (20-34 years). This study shows that SES differentials in suicide persisted in Australia for most of the period 1979-2004. The decline in suicide in young males in the most recent quinquennium was limited to middle and high SES groups, while the low SES group displayed a continued increase. The continued increase in suicide in low SES males has implications for social and economic intervention and suicide control programs.

Students “at Risk”: Dilemmas of Collaboration

Students “at Risk”: Dilemmas of Collaboration

Number and Type of Substances in Alcohol and Drug-Related Completed Suicides in an Australian Sample

The association between substance use and suicide is well-established, but evidence is scant regarding the relationship between the number, type, and level of substances and other risk factors in completed suicide across the lifespan. To examine the relationship between social/demographic characteristics and the number, type, and level of drugs present in an unrestricted age sample of completed suicides in Australia. An analysis was undertaken of 893 substance-related suicides using data from the Government Statistician's Office for the years 1989-1992. The number and type of substances present in suicide victims was related to the individuals' gender, age, marital status, employment status, and method of suicide. Blood alcohol level was significantly different between the methods of suicide, but was unrelated to demographic characteristics of the individual. The level of antidepressants and minor tranquilizers in the individuals was also unrelated to demographic characteristics. Examination of the type and number of substances present in completed suicides is an important component in creating profiles of potential suicide victims.

The relationship between media reporting of suicide and actual suicide in Australia

This study aimed to determine whether media items about suicide were associated with differential increases in actual suicides. Data were available on 4635 suicide-related items appearing in Australian newspapers and on radio and television news and current affairs shows between March 2000 and February 2001. These data were combined with national data on completed suicides occurring during the same period, by a process that involved identifying the date and geographical reach of the media items and determining the number of suicides occurring in the same location in selected weeks pre- and post-item. Regression analyses were conducted to determine whether the likelihood of an increase in post-item suicides could be explained by particular item characteristics. We found that 39% of media items were followed by an increase in male suicides, and 31% by an increase in female suicides. Media items were more likely to be associated with increases in both male and female suicides if they occurred in the context of multiple other reports on suicide (versus occurring in isolation), if they were broadcast on television (versus other media), and if they were about completed suicide (versus attempted suicide or suicidal ideation). Different item content appeared to be influential for males and females, with an increase in male suicides being associated with items about an individual's experience of suicide and opinion pieces, and an increase in female suicides being associated with items about mass- or murder-suicide. Item prominence and quality were not differentially associated with increases in male or female suicides. Further research on this topic is required, but in the meantime there is a need to remain vigilant about how suicide news is reported. Mental health professionals and suicide experts should collaborate with media professionals to try to balance ‘public interest’ against the risk of harm.

A review of 156 local projects funded under Australia’s National Suicide Prevention Strategy: Overview and lessons learned

This paper presents an overview of 156 local suicide prevention projects funded under Australia's National Suicide Prevention Strategy (NSPS), and describes lessons elicited from a content analysis of the projects' progress and final reports. The purpose of the analysis was to maximize gains in Australian suicide prevention activities by highlighting promising processes and impacts and minimise repetition of less successful elements. The projects targeted 11 groups (with the most common being young people, Aboriginal and Torres Strait Islander people and people in rural/remote areas); occurred in various settings (with community-based projects being particularly popular); and employed different approaches (with training and support for health/community professionals or carers being favoured, along with public health interventions aimed at enhancing well-being and building resilience). Certain processes augured well for project success, including: understanding contextual factors; investigating participants' needs; drawing on sound evidence; developing multi-faceted strategies; garnering stakeholder support; and employing capable staff. The projects achieved improvements in knowledge about risk and protective factors for suicide, social connectedness and mental health literacy, and reductions in depressive symptomatology. Projects' sustainability was constrained by their short-term funding. These findings are discussed in the context of the NSPS entering a new funding phase.

Social and Psychiatric Influences on Urban–Rural Differentials in Australian Suicide

The purpose of this study was to investigate urban-rural differentials in Australian suicide rates, and to examine influences that previously have remained largely speculative. Suicide rates for males (all ages and young adults) were significantly higher in rural areas compared to urban areas. Urban-rural suicide rate differences in males were rendered nonsignificant after adjustment for migrant and area socioeconomic status. Adjusting for mental disorder prevalence, in addition to migrant status, reduced the excess suicide risk in rural areas; the excess was reduced further with addition of mental health service utilization. The implications of this study are that socioeconomic circumstances in rural populations contribute to higher male suicide rates compared to urban areas, but these conditions may be partly mediated by mental disorder prevalence and mental health service utilization.

Mental health and socio-economic variations in Australian suicide

This paper investigates the relationship between suicide rates and prevalence of mental disorder and suicide attempts, across socio-economic status (SES) groups based on area of residence. Australian suicide data (1996–1998) were analysed in conjunction with area-based prevalences of mental disorder derived from the National Survey of Mental Health and Well-Being (1997). Poisson regression models of suicide risk included age, quintile of area-based SES, urban–rural residence, and country of birth (COB), with males and females analysed separately. Analysis focussed on the association between suicide and prevalences of (ICD-10) affective disorders, anxiety disorders, substance use disorders and suicide attempts by SES group. Prevalences of other psychiatric symptomatology, substance use problems, health service utilisation, stressful life-events and personality were also investigated. Significant increasing gradients were evident from high to low SES groups for prevalences of affective disorders, anxiety disorders (females only), and substance use disorders (males only); sub-threshold drug and alcohol problems and depression; and suicide attempts and suicide (males only). Prevalences of mental disorder, other sub-threshold mental health items and suicide attempts were significantly associated with suicide, but in most cases associations were reduced in magnitude and became statistically non-significant after adjustment for COB, urban–rural residence, and SES. For male suicide the relative risk (RR) in the lowest SES group compared to the highest was 1.40 (95% CI 1.29–1.52, p < 0.001 ) for all ages, and 1.46 (95% CI 1.27–1.67, p < 0.001 ) for male youth (20–34 years). This relationship was not substantially modified in males when regression models included prevalences of affective disorders, and other selected mental health variables and demographic factors. From a population perspective, SES remained significantly associated with suicide after controlling for the prevalence of mental disorders and other psychiatric symptomatology. Mental conditions and previous suicidal behaviour may play an intermediary role between SES and suicide, but this study suggests that an independent relationship between suicide and SES also exists.

Medical disorders of suicides in Australia: analysis using a multiple-cause-of-death approach

The impaired health of a person who has committed suicide is often suggested among the proximate causes of suicidal behaviour. The introduction in 1997 of multiple-cause-of-death coding by the Australian Bureau of Statistics provided an opportunity to examine health impairments recorded on the death certificates of suicides. Data for the quinquennium 1997–2001 revealed a high prevalence of mental and behavioural disorders, in particular among women and among young and adolescent suicides. Comparison of multiple causes of death attributed to those who died in accidents with those recorded as suicides revealed that of the chronic and terminal illnesses, HIV and cancer were probably the conditions likely to trigger suicidal action.

Motives for suicide--a study of Australian suicide notes.

Analysis of a large sample of suicide notes from 262 suicides in Australia found that men less often had escape from pain as a motive for their suicides and more often had love/romantic problems. The suicides of older persons were more often motivated by escape from pain and less often had love/romantic problems.