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Chapter 2 Understanding Youth Suicide
To establish the basis for the Committee’s focus on the issue of youth
suicide and early intervention, this Chapter presents an overview of the
statistics on suicide in Australia, and youth suicide in particular. The
difficulties associated with collecting accurate and comprehensive suicide data
are considered. The Chapter also presents an overview of the factors which affect
the likelihood of youth suicide, and identifies groups that are at increased
risk of suicide.
Statistics on Suicide in Australia
Statistics on suicide in Australia are available from a number of
sources. National data on suicide is published in some years by the Australian
Bureau of Statistics (ABS). The most recent, published in 2007, contains
summary statistics on deaths registered in 2005 where the cause of death was
determined to be suicide. Even more recent, though
less comprehensive, statistics on suicides in Australia are published annually
in the ABS ‘causes of death’ reports. The 2011 Causes of Death Report provides
information on suicides based on mortality data from 2009.
Coroners, through the National Coroners Information System (NCIS), are another
significant source of suicide data. In addition, the Australian Institute of
Health and Welfare (AIHW) has also produced a number of publications based on
information extracted from the AIHW Mortality Database.
These data are supplemented by data collection and research conducted by
academic institutions and by community based organisations.
Although not intended to be a comprehensive review of suicide in
Australia, the following section provides key information on suicide rates,
trends and ‘at risk’ groups. According to the ABS, in the year 2009 suicide was
the registered cause of 2,132 deaths, making it the 14th most common
cause of death in the population generally. Across all age-groups suicide
is much more common in males than females, with over three-quarters (76.6%) of
suicides in 2009 being males. Suicide was the 10th most common cause
of death in males that year.
While suicide accounts for only a relatively small proportion (1.5%) of
all deaths in Australia, as shown in Figure 2.1, suicide is a disproportionate
cause of death in some age groups. In 2009, 24% of all male deaths aged 15 to
24 years were due to suicide. Similarly for females, suicide deaths comprise a
much higher proportion of total deaths in younger age groups.
Figure 2.1: Suicides by Selected Age Groups: 2009
Causes of Death, Australia 2009 (2011), cat no 3303.0 2009
Further examination of the data reveals a more complex picture of youth suicide.
Data from 2008 indicates that men aged 20 to 24 years were particularly
vulnerable to suicide, with a rate of around 19 suicides per 100,000. This is a
higher rate than for young men aged 15 to 19 years with around 9 suicides per
100,000 men in 2008. Data from 2008 for young women, records rates of 3
suicides per 100,000 women aged 15 to 19 years and 5 suicides per 100,000 women
aged 20 to 24 years.
Data from the ABS also shows that youth suicide rates fluctuate over
time (Figure 2.2). A general decline in youth suicide rates has been recorded since
the late 1990s. In 1997, suicide rates for 15 to 19 year old males peaked at
18.4 per 100,000, decreasing consistently over the next decade, and in 2009 the
rate was 9.3 per 100,000 in this age group. A more dramatic decrease
in suicide rates over the same period was observed in young men aged 15 to 24
years, decreasing from 42.8 per 100,000 in 1997 to 19 per 100,000 in 2009. In
contrast, the suicide rate for females aged 15 to 19 years has remained relatively
stable over the same period at around 3-5 per 100,000. In 2009, the suicide
rate in females aged 15 to 19 years was 3.4 per 100,000.
Figure 2.2: Age-Specific Suicide Rates: 1993 to 2003
Suicides: Recent Trends, Australia 1993-2003 (2004), cat no 3309.0.55.001
Suicide in children under the age of 15 years is rare. Over the period
1995 to 2005, the reported suicide rate in children under 15 years averaged
0.25 per 100,000.
A significant body of research also indicates that youth suicide differs
greatly across Australia and between social groups. Data indicates that
Indigenous young people aged 12 to 24 years had suicide rates up to four times
higher than non-Indigenous Australians in the same age group. Between 2001-03
suicide rates for Indigenous young people were 37 per 100,000 compared to 8 per
100,000 for non-Indigenous young people.
Data also suggests that suicide rates for young people aged 15 to 24
years were elevated for those living in rural and remote locations, with a suicide
rate three times that of their counterparts living in major cities.
This appears to be particularly the case for young men.
The AIHW also reports higher suicide rates for young people living in the most
socioeconomically disadvantaged areas of Australia, with rates of 13 per
100,000 compared to 9 per 100,000 in 2003-05.
Although there is a paucity of data on suicide in culturally and
linguistically diverse (CALD) populations, available research suggests that there
may be significant variation in patterns of suicide across cultures. For
example, while noting that the research referred to is not particularly recent,
the Diversity Health Institute notes that amongst people with a non-English
speaking background, suicide attempts are higher amongst females than males.
This represents a marked difference from the general population.
Although data is not routinely collected, research has also identified other
groups of young people who may be at increased risk of suicide. These include
(in no particular order):
- victims of bullying, including
cyber-bullying, harassment and discrimination;
- gay, lesbian,
bisexual, transgender and intersex individuals;
- those who are
socially isolated or homeless;
- individuals with
mental illnesses (especially depression and anxiety);
- those in the juvenile
- those using drugs and
- individuals who
engage in self harm or who have previously
attempted suicide; and
- individuals who have experienced
trauma (particularly where unresolved), grief, loss, and family breakdown.
Collecting and Reporting Suicide Statistics
Issues relating to the quality of suicide data were a common theme
raised in evidence. As indicated above,
there is a range of data currently collected around Australia relating to
suicide, with the main source of data being the ABS. However, it is also clear
that there are difficulties associated with collecting data on suicide. As a
consequence suicide data is acknowledged to be incomplete and of varying
ABS and AIHW reports on suicide and mortality include frequent
references to technical notes which emphasise that suicide statistics must be interpreted
cautiously. A significant concern is that official statistics of suicide rates
may be an underestimate. As the ABS notes:
... for a death to
be determined a suicide, it must be established by coronial enquiry that the
death resulted from a deliberate act [emphasis added] of the
deceased with the intention of ending his or her own life (intentional
There is an inherent difficulty for coroners in determining the ‘intent’
of a deceased person, notwithstanding the fact that many people who suicide
leave a record of their intentions. As a result, there may be some deaths which
are suicides as a matter of fact, but insufficient evidence before the
coroner precludes the finding of suicide as a matter of law.
ABS figures show that there are many deaths that occur as a result of
‘mechanisms’ that are common in
suicide, but where the element of intent differed or is unclear. For example, in
2009, 5,322 deaths were categorised as ‘accidental’, all of which were caused
by ‘mechanisms’ common in suicide. Of these there were almost 1000 deaths registered
as ‘undetermined intent’.
In addition, an ongoing issue for the ABS has been that the quality of
the suicide data can be affected by the length of time required for the
coronial process to be finalised and the coronial case to be closed. In the
absence of a coronial finding, other conclusive evidence of intent (e.g. a
suicide note), is required for a suicide to be recorded in the statistics. According
to Suicide Prevention Australia, the accuracy of suicide data is questionable,
and some experts suggest that the general rate of suicide may in fact be up to
16% higher than official figures.
Other issues affecting the quality of data may be a reluctance to record
a suicide due to the stigma attached to suicide, as well as recording/reporting
variations between jurisdictions, including different standards of proof of
intent and different coronial processes and a lack of systemic resourcing and
training. As pointed out during a
roundtable hearing, with regard to coronial outcomes there are different
approaches taken by different coroners which reflect competing but equally
valid priorities, such as providing concrete findings to bereaved families, or
leaving open findings in the absence of sufficient evidence.
However, it is abundantly clear that a complete picture of youth suicide in
Australia (and suicide generally) will be hampered by systemically embedded under-reporting
and by data collection differences across jurisdictions.
Another important consideration raised frequently in evidence relates to
the scope of data routinely collected and reported on. To develop a more
complete understanding of the complex picture of youth suicide (and suicide
generally), including identifying risk factors and emerging trends, and
appropriately targeting services, contributors to the inquiry called for the
routine collection of suicide data to include information on ethnicity, culture,
geography and socio-economic status. Presentation of
aggregated data also limits the capacity for organisations to gain an
understanding of the more complex picture of youth suicide.
It is clear that there is a range of information on suicide being
collected by different organisations, with different collection and reporting
standards. The Committee understands that the lack of a nationwide systematic
approach limits the usefulness of suicide information. However, it is also
evident that the issues associated with data collection and reporting of
suicide, including youth suicide, are well recognised.
In relation to this, the Committee acknowledges that the ABS has already made
significant efforts to implement reforms to improve the accuracy and quality of
suicide data, and that these processes are ongoing.
To address these issues, the National Committee for the Standardised
Reporting of Suicide (NCSRS) was created by Suicide Prevention Australia
with the support of the Australian Government Department of Health and Ageing
(DoHA). The NCSRS aims include to ‘achieve cross-jurisdictional and multi-party
agreement on adequate, standard and operationalised criteria and reporting
formats for suicide and related data.’ The NCSRS includes
representative coroners offices, the NCIS, the ABS, the AIHW, DoHA, State and
Territory Health Departments, police and crisis support services.
The Committee is also aware that the 2010 Senate report on suicide in
Australia dealt extensively with the issue of suicide data collection and
reporting. The Senate report makes eight recommendations on these issues, including
recommendations for governments, in consultation with the NCSRS, to improve the
accuracy of suicide data and reporting. The Committee supports
the Senate report’s recommendations in this regard, and is pleased to note the
Government’s positive response.
In addition to improved accuracy, the Committee considers that
consideration should also be given to the scope of information collected,
particularly social and demographic data which would assist with developing a better
understanding of the complex picture of youth suicide, and suicide more
broadly. The Committee also supports provision of more suicide data in
|The Committee recommends that the National Committee for the
Standardised Reporting of Suicide consider options for, and the feasibility
of, extending the scope of social and demographic suicide data routinely
collected and reported on, to include information on:
|The Committee recommends that the National Committee for the
Standardised Reporting of Suicide consider options for providing increased
access to disaggregated suicide data.
Of particular relevance to the issue of youth suicide, the Committee notes
Recommendation 28 of the Senate report which calls for the ABS (and other
relevant public agencies) to record and track suicides and attempted suicides
in children aged under 15 years. As noted earlier in this Chapter, registered
suicides in this group are relatively uncommon, though for a range of reasons
it is likely that the reported figures are an underestimate. While acutely
aware of the difficulties of establishing suicidal intent in this age group,
and the extreme sensitivity for the families concerned, the Committee is keen to
support initiatives which ensure that suicide in this demographic is not
‘hidden’. The Committee believes that appropriate recognition of suicide in the
under 15 year age group is needed to ensure that prevention initiatives do not
neglect these children. The Committee notes that the Senate recommendation has
been referred to the ABS.
Factors Affecting the Likelihood of Suicide
Understanding the factors that influence the likelihood of suicide will
assist in developing strategies to reduce suicide rates. A significant body of
research already exists which indicates that many factors contribute to the
likelihood that someone will consider or attempt suicide.
These factors generally act to either increase the likelihood of suicide
(risk factors) or decrease this likelihood (protective factors). Risk and
protective factors are also categorised according to the level at which they
are present; that is individual factors, social and broad contextual
factors. Figure 2.3 lists commonly cited risk and protective factors within
each of the three categories.
Figure 2.3 Examples of Suicide Risk and Protective Factors
Risk factors for suicide
Protective factors for suicide
mental illness or disorder
chronic pain or illness
alcohol and other drug problems
little sense of control over the
lack of meaning and purpose in
poor coping skills
guilt and shame
mental health and wellbeing
good physical health
physical ability to move about
no alcohol or other drug problems
positive sense of self
sense of control over life’s
sense of meaning and purpose in
good coping skills
positive outlook and attitude to
absence of guilt and shame
abuse and violence
family dispute, conflict and
separation and loss
poor communication skills
family history of suicide or
physical and emotional security
supportive and caring
supportive social relationships
sense of social connection
sense of self-determination
good communication skills
no family history of suicide or
neighbourhood violence and crime
unemployment, economic insecurity
social or cultural discrimination
exposure to environmental
lack of support services
safe and secure living
safe and affordable housing
positive educational experience
fair and tolerant community
little exposure to environmental
access to support services
Government Department of Health and Ageing, LIFE: Research and Evidence in
Suicide Prevention (2007),
Risk and protective factors do not explain everything about suicide. Importantly,
risk and protective factors operate differently in each individual,
particularly as similar events in life will affect people in different ways. Although
suicide is more frequent in individuals who exhibit multiple risk factors and
few protective factors, the majority of people in this higher risk group do not
attempt to take their own lives. In contrast, people with few or none of the
risk factors might suicide.
Risk and protective factors are also known to have greater or lesser
influence in specific social and demographic groups. Among young people some
factors might be more influential. As noted by the SPA, transitions from
childhood to adolescence and young adulthood are characterised by
self-exploration, and acceptance (particularly by peers) is crucial to a robust
sense of self worth. Therefore factors that may
increase the likelihood of young people feeling marginalised or socially
isolated may be particularly important. Issues associated with sexual
orientation, body image, bullying (including via social media) and learning
difficulties may be particularly relevant to this group.
As noted by Lifeline Australia, another characteristic that may be more significant
is that suicide among young people can sometimes be an impulsive act, which is
not always thought through or planned.
Importantly, as some factors are modifiable (such as drug use and
alcohol abuse) they can be directly targeted by programs, and are fruitful
areas for intervention. Other factors are non-modifiable (such as age or sex),
but programs can nevertheless try to reduce the impact of these factors on an
individual’s likelihood of suicide.
The Committee understands that there is a complex array of factors associated
with suicide, and cautions against an overly simplistic view of youth suicide
and its causes. Access to accurate and comprehensive data and an improved
understanding of the influence of risk and protective factors on young people
are needed to support an improved understanding. The Committee recognises
however, that while this will assist the identification of populations or
groups at increased risk of suicide, it will still not be possible to precisely
identify individuals at risk, hence the need for early intervention strategies.
The Committee understands that the main value of this information is to
provide a good evidence base to inform the development and appropriate
implementation of strategies for reducing rates of youth suicide, and to enable
effective evaluation of the impact of interventions. Current approaches to
suicide prevention in Australia are considered in Chapter 3, including recently
announced additional funding targeting suicide prevention.