Are suicide rates for young australian males really falling the recent controversy explained- wallace
1. The Controversy Over
Australian Suicide Statistics
Dr Duncan Wallace
Consultant Psychiatrist
Australian Defence Force Centre for Mental Health
Joint Health Command
2. 2
Australian Suicide Statistics Controversy
⢠Has there been a major reduction in
suicides Australia since 1997?
⢠If so, what is the significance of this to the
ADF?
3. 3
Relevance to the ADF?
⢠Suicide accounts for only 1.6% of all deaths in
Australia
⢠But suicide comprises more than 20% of deaths
for men aged between 20 and 39 years
⢠Men remain four times more likely than women
to die by suicide [Goldney RD, Suicide in Australia: some good news. MJA 2006; 185: 304]
⢠Deaths from suicide exceed those from MVAs
[De Leo 2010]
4. 4
Suicide Trends in Australia
1964-1993
⢠Suicide âepidemicâ
⢠Suicides trebled in Males aged 15-24
⢠1964 Metro suicide rates higher
⢠1993 Rural suicide rates higher [Dudley M et al. Suicide
among young Australians, 1964-1993: an interstate comparison of metropolitan and rural trends MJA 1998; 169:
77-80]
5. 5
Suicide Trends in Australia
1964-1993
⢠Towns with population <4000 suicide rates
increased by up to 12X
⢠Methods- increased suicide by GSW in
rural areas despite overall reduction in
suicides by GSW [Dudley et al, ibid]
6. 6
Australian Suicide Statistics Controversy
⢠Media coverage
⢠Major Government and community response-
1995 National Youth Suicide Prevention
Strategy
⢠Increased awareness by medical profession
⢠Targeted rural programmes e.g., NSW Rural
Mental Health Skills Development Program [Owen C et
al, A model for clinical and educational psychiatric service delivery in remote communities. ANZJP 1999, 33: 372-
378]
7. 7
Goldney RD, Suicide in Australia: some good news. MJA 2006; 185: 304
⢠2004 ABS figures showed a sustained reduction in the
number of suicides each year from peak in 1997
⢠Age-standardised suicide rate reduced to 10.4 per
100 000 population in 2004
⢠29% lower than the rate of 14.7 per 100 000 in 1997
8. 8
Goldney RD, Suicide in Australia: some good news. MJA 2006; 185: 304
⢠There was a reduction in all 5-year age groups
for men and women between 1997 and 2004,
except for women in the 45â49-years age group
9. 9
Goldney RD, Suicide in Australia: some good news. MJA 2006; 185: 304
⢠Most striking for people aged 15â24 years, for
whom there was a reduction in suicide rates of
about 50% â
â from 19.3 per 100 000 in 1997
â to 9.6 per 100 000 in 2004
10. 10
Goldney RD, Suicide in Australia: some good news. MJA 2006; 185: 304
⢠The highest suicide rates in 1997 were for men
aged 15â24 years
⢠2004 the peak was in that same group of men,
now aged 25â44 years
⢠This is consistent with a âcohort effectâ
11. 11
Goldney RD, Suicide in Australia: some good news. MJA 2006; 185: 304
Why?
⢠Better community awareness of the antecedents of
suicide
⢠Suicide prevention programmes
⢠Provision of more accessible services
⢠Better recognition and treatment of depression
⢠? more prescription of antidepressants
12. 12
DeLeo D, Suicide mortality data need revision. MJA 2007; 186: 157-158
⢠In 2004, there were 580 cases of suicide in
Queensland, and not 453, as reported by the
Australian Bureau of Statistics (ABS) on
14 March 2006
⢠These data alone reverse the declining trend for
suicide mortality nationally in the most recent
years
13. 13
DeLeo D., Suicide mortality data need revision. MJA 2007; 186: 157-158
⢠Very large backlog of cases still under investigation
by coroners, a phenomenon that is reported as
increasing in recent years
⢠Claimed problems with ABS data from 2002
onwards
14. 14
Harrison J, Pointer S, Elnour AA. A review of suicide statistics in Australia.
Canberra: Australian Institute of Health and Welfare (AIHW), 2009.
⢠ABS reports contained a warning about possible
under-reporting from 2005 onwards
⢠Criticism about ABS procedures led the AIHW to
undertake a ârecountâ of the official suicide data
for 2004
⢠ABS had underestimated suicide for Australia by
16% in that year; Qld by 24.9%
â Counting errors
â Misclassification- open verdicts
15. 15
Williams R et al,
Accuracy of official suicide mortality data in Queensland. ANZJP, 2010,44: 815â822
⢠Prior to 2006, ABS staff visited coronersâ offices
to get data from files
⢠From 2006, reliance by ABS on electronic data
only recorded on the National Coroners
Information System (NCIS)
⢠NCIS becoming increasingly inaccurate
⢠inaccuracy from the lack of staff resources in the
coronersâ offices in the states and territories
⢠creating a backlog of closed cases to be entered
on the electronic system
16. 16
De Leo D et al, Achieving
standardised reporting of suicide
in Australia: rationale and
program for change MJA 2010;
192 (8): 452-456
17. 17
Support for a decline in Suicide Rates in Australia
⢠McPhedran S and Baker J. Recent Australian suicide trends for males and
females at the national level: Has the rate of decline differed? Health Policy
2008, 87; 350-358.
⢠Chapman S and Hayan A. Declines in Australian suicide: A reanalysis of
McPhedran and Baker (2008) Health Policy 2008, 88;152-154.
⢠Morrell, S et al. The decline in Australian young male suicide. Social
Science & Medicine. 64(3):747-54, 2007.
⢠Large M, Nielssen O and Lackersteen S. The rise and fall of suicide in
NSW. MJA 2009; 190: 282.
⢠Large M, Nielssen O. Suicide in Australia: meta-analysis of rates and
methods of suicide between 1988 and 2007. MJA 2010; 192: 432-437.
⢠Page A, Taylor R and Martin G. Recent declines in Australian male suicide
are real, not artefactual. ANZJP 2010,44,358-363.
18. 18
Large M, Nielssen O and Lackersteen S. The rise and fall of suicide in
NSW. MJA 2009; 190: 282.
19. 19
Large M, Nielssen O. Suicide in Australia: meta-analysis of rates and methods of
suicide between 1988 and 2007. Med J Aust 2010; 192: 432-437
⢠Meta-analysis of pooled ABS data for decade
long periods between 1988-2007
â 8% decline in national pooled estimates of
male suicide
â Significant local variation e.g. increase in rate
of male suicides in NT
â Reductions in shooting, gassing and
poisoning
20. 20
Large M, Nielssen O. Suicide in Australia: meta-analysis of rates and methods of
suicide between 1988 and 2007. Med J Aust 2010; 192: 432-437
Possible explanations?
⢠Gun control laws
⢠Catalytic converters in new cars
⢠Reduced TCA prescription
21. 21
Page A, Taylor R and Martin G. Recent declines in Australian male suicide
are real, not artefactual. ANZJP 2010,44,358-363.
⢠Two misclassification scenarios
â 9% (2000-2005 Change to ICD-10
misclassification to unintentional causes e.g.,
accidental hanging, poisoning )
â 17% (due to misclassification of open cases
and unintentional causes of death)
22. 22
Page A, Taylor R and Martin G. Recent declines in Australian male suicide are real,
not artefactual. ANZJP 2010,44,358-363.
⢠First scenario- male
suicide rates declined
38% to 24 per 100
000.
⢠Second scenario-
male suicide rates
declined 33% to 26
per 100 000
23. 23
Page A, Taylor R and Martin G. Recent declines in Australian male suicide
are real, not artefactual. ANZJP 2010,44,358-363.
⢠Australian all-cause
and selected cause-
specific mortality
rates in young men
(20-34years) (1979-
2005).
24. 24
Goldney RD, A note on the reliability and validity of suicide statistics.
Psychiatry, Psychology and Law 2010,71, 52-56
⢠Problems with reliability of suicide statistics
dating back to 1790 [Moore C. A full inquiry into the subject of suicide etc 2 vols.
London, 1790, JF and C Rivington]
25. 25
Goldney RD, A note on the reliability and validity of suicide statistics.
Psychiatry, Psychology and Law 2010,71, 52-56
Confounding variables in suicide statistics
⢠Insurance considerations
⢠State or religious sanctions
⢠Family and community sensitivity
26. 26
Goldney RD, A note on the reliability and validity of suicide statistics.
Psychiatry, Psychology and Law 2010,71, 52-56
Confounding variables in suicide statistics (ctd)
⢠Different professions recording suicide in
different jurisdictions
⢠Differences between âlegalâ and âclinicalâ suicide
â Legal- evidence of intent required to reach a
set standard
â Clinical- balance of probabilities
27. 27
DeLeo D., Suicide mortality data need revision. MJA 2007; 186: 157-158
⢠Some underreporting in suicide statistics is âvirtually
ubiquitousâ and has to be tolerated eg,
misclassification as
â accident
â disease-related esp. in the elderly
â cover-up because of stigma
â sociocultural norms
â insurance reasons
â remoteness of location
28. 28
Harrison J, et al. A review of suicide statistics in Australia. Injury research and statistics
series No 49. Australian Institute of Health and Welfare, Canberra July 2009. Viewed at
http://www.aihw.gov.au/publications/index.cfm/title/10754 on 7 October 2010
ABS revision process for causes of death
⢠Data on deaths registered before 2007 were
finalized by ABS before the annual release of
the report of causes of death
⢠Some cases were still âopenâ on NCIS
⢠No revision of ABS data after coroner closed
case
⢠New system- causes of death can be reviewed
for at least 2 years allowing longer for ABS to
receive final info from coroners
29. 29
⢠April 2009 establishment of National
Committee for Standardised Reporting of
Suicide
â To achieve cross-jurisdictional standardization
of all relevant procedures