Psychosocial risk factors and deaths by suicide

Capturing information on risk factors relating to deaths by suicide can highlight areas of a person's life experience that may need additional attention to provide the most effective suicide prevention interventions. However, it is important to note that the presence of one or more of these risk factors in an individual’s life does not necessarily mean they will have suicidal behaviours. The vast majority of people who experience these risk factors will not experience suicidal behaviours.

As part of the National Suicide and Self-harm Monitoring Project the AIHW has funded the Australian Bureau of Statistics (ABS) to identify and code (using ICD-10) psychosocial risk factors for deaths referred to a coroner, including deaths by suicide.

In 2020, the ABS added codes for the capture of the COVID-19 pandemic as a risk factor based on how it was described as part of the coronial investigation:

• F41.8 Pandemic-related anxiety and stress
• Z29.0 Isolation or quarantine (hotel or home), and
• Z29.9 Prophylactic measures put in place through health directives for pandemic response, including closure of business and stay at home measures.

Although there was a 5.4% reduction in the number of deaths by suicide from 2019 to 2020, there were 99 people who died by suicide in 2020 (3.2% of all suicides) who had the COVID-19 pandemic mentioned in either a police or pathology report, or a coronial finding. However, for people who died by suicide and had the COVID-19 pandemic mentioned as a risk factor, it did not appear as an isolated risk (they had, on average, 5 risk factors and 3 psychosocial risk factors). It is important to remember that circumstances relating to suicide are complex and multifaceted and a combination of multiple factors contribute to a person taking their own life rather than a single reason.

In 2020, of those who died by suicide with issues relating to the COVID-19 pandemic as a risk factor:

• almost 60% also had mood disorders, including depression
• over 50% also had problems relating to employment or unemployment
• 25 also had problems related to the social environment, including social isolation

When COVID-19 was mentioned as a risk factor it manifested in different ways. For some people direct impacts from the pandemic, such as job loss, lack of financial security, family and relationship pressures, and not feeling comfortable with accessing health care were noted. For others, a general concern or anxiety about the pandemic and societal changes were stated or anxiety about contracting the virus itself.

From 2017 to 2020, around two-thirds of all deaths by suicide had at least one or more psychosocial risk factor identified. The types of psychosocial risk factors associated with deaths by suicide were age dependent and differed throughout the lifespan.

From 2017 to 2020:

• the most commonly identified risk factor for males and females in all age groups except those 65 and over was a ‘personal history of self-harm’.
• ‘Limitation of activities due to disability’ was the most commonly identified risk factor in males and females aged 65 and over.
• ‘Disruption of family by separation and divorce’ and ‘problems in relationship with spouse or partner’ were generally the second- and third-most common risk factors in males and females aged under 55.
• ‘Problems related to other legal circumstances’ was also a common risk factor in males aged 25–34, 35–44 and 45–54 (associated with more than 10% of deaths by suicide).
• ‘Other problems relating to economic circumstances’ also emerged as a common risk factor in middle-aged males (45–54 and 55–64; associated with more than 10% of deaths by suicide in these age groups).
• ‘Disappearance and death of a family member’ was also identified as a frequently occurring psychosocial risk factor in males and females.
• ‘Prophylactic measure for pandemic response’ (including closure of business and stay at home measures) appeared as a one of the most frequently occurring psychosocial risk factors in males aged 55–64 (associated with 4% of deaths by suicide in 2020) and females aged 25–34, 55–64 and 65 and older (associated with 4% to 6% of deaths by suicide in these age groups in 2020).

There is no national standard for the collection of data on psychosocial factors—each state and territory has its own legislation and processes relating to coroner-certified deaths meaning that the type of information collected and held by the NCIS database differs slightly by jurisdiction. Also, due to the method used for the collection of data, protective factors are not included.

References

ABS (Australian Bureau of Statistics) 2021. Causes of Death, Australia 2020. ABS Catalogue number 3303.0.