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Education, and employment as risk factors for suicide

Educational attainment

The estimated suicide risk (measured as the age-adjusted cumulative incidence (risk) from 2011–2017) is higher among those with fewer years of education, as reported at Census 2011.

Among males with only secondary school or no education the cumulative suicide risk is 2.6 times higher than among males with a university degree (Table 1).

The education gradient in female suicide mortality was consistent with that seen for males, but the ratio is smaller (1.6 times) between the highest and lowest levels of educational attainment. These estimates are the first for Australia, and like other countries, show a strong relationship between educational attainment and the risk of suicide.

The estimated suicide risk is higher among males than females at all levels of educational attainment.

Among males with only secondary school or no education the cumulative suicide risk is 3.5 times higher than among females with the same level of educational attainment (Table 2).

The gap is smallest for those with a university degree with the suicide risk for males 2.2 times higher than females.

Estimated suicide risk, by highest educational attainment and labour force status, by sex, aged 25–54 years, Australia, 2011 to 2017.

The vertical bar chart shows age-adjusted cumulative risk of suicide for males and females by highest level of educational attainment (secondary school or lower; diploma, certificate; and bachelor degree or higher). Users can also choose to view age-adjusted cumulative risk or proportion by labour force status. The lowest age-adjusted cumulative suicide risk among males was in those with a bachelor degree or higher while the highest age-adjusted cumulative suicide risk was seen in those with secondary school or lower as their highest level of educational attainment.

Employment status

Estimated suicide risk (measured as the age-adjusted cumulative incidence from 2011–2017) is lower among those with a job, as reported at Census 2011.

Among males of prime working age (25–54 years) who were not in the labour force (people who are neither working nor looking for work):

  • cumulative suicide risk is 3.2 times higher than among males employed
  • for males unemployed the risk is 2.5 times higher than those employed (Table 1).

For males who were not in the labour force the cumulative suicide risk was actually a little higher (rate ratio of 1.3) than for males who were unemployed at the time of the 2011 Census. This reminds us that in thinking about the relationship between labour force status and suicide, it is important to focus on people of workforce age who are not employed, regardless of whether they are classified as being unemployed.

Among females, employment is also associated with the lowest suicide risk but did not vary greatly between those not in the labour force and those unemployed.

The cumulative suicide risk for females not in the labour force was:

  • 2.6 times higher than those employed
  • for females unemployed the risk was 2.7 times higher than those employed.
Table 1: Rate ratio of estimated suicide risk, by educational attainment or labour force status, by sex, 2011–2017
Educational attainment or labour force status Males Females

Year 12 and below : Bachelor degree and higher

 2.6 1.6
Unemployed : employed 2.5 2.7
Not in labour force : employed 3.2 2.6
Not in labour force : unemployed 1.3 1.0

Notes

  1. Estimated suicide risk is measured as the age-adjusted cumulative incidence (risk) from 2011–2017.
  2. Level of Highest Educational Attainment (HEAP) and Labour Force Status (LFS) is at Census 2011; death by suicide occurred between 2011 and 2017.
  3. Analysis includes prime working age group (age at Census 2011): 25–54 years.
  4. Year 12 and below includes no education.

A social gradient describes a spectrum from high to low socioeconomic position and shows that, in general, the lower an individual’s socioeconomic position the worse their health (WHO, 2020). While a social gradient was evident in both male and female employment circumstances, the estimated suicide risk is considerably higher for males than females across all 3 labour force categories (Table 2).

Among males not in the labour force the cumulative suicide risk is 4.4 times higher than among females not in the labour force.

Table 2: Male : female rate ratios of suicide risk, by educational attainment or labour force status, 2011–2017
Educational attainment or labour force status Males : Females

Year 12 and below

 3.5

Diploma or Certificate

 3.1

Bachelor degree and higher

 2.2
Employed 3.7
Unemployed 3.4
Not in labour force 4.4

Notes

  1. Estimated suicide risk is measured as the age-adjusted cumulative incidence (risk) from 2011–2017.
  2. Level of Highest Educational Attainment (HEAP) and Labour Force Status (LFS) is at Census 2011; death by suicide occurred between 2011 and 2017.
  3. Analysis includes prime working age group (age at Census 2011): 25–54 years.
  4. Year 12 and below includes no education.

Monitoring and analysing suicide risk by education and employment status can be very informative. Sweden regularly publishes data on suicide rates by level of education (e.g. Sweden; Socialstyrelsen National Board of Health and Welfare, 2017) and Case and Deaton (2015, 2017, 2020) and Phillips and Hempstead (2017) have shown that rises in suicide rates in the US may be associated with rises among people with a high school or lower level of education. That said, care is required in drawing causal inferences from the data. Education and employment are clearly associated; for example—adults of working age with a degree or higher level of education are considerably more likely to be employed than those with a high school or lower level of education. This means that some of the apparent association between education and suicide risk is explained by the association between education and employment status. These associations will be drawn out in data modelling.

Blakely et al. (2003) found similar associations between the risk of death by suicide by labour force status for New Zealand using linked data. However, they argue that while being unemployed was associated with a 2- to 3-fold increased relative risk of death by suicide compared with being unemployed, around half of this association might be explained by confounding mental illness, or other factors.

Addressing socioeconomic inequalities in mortality within countries is a key public health priority globally (WHO 2008). Analyses of education inequalities in Australia in both chronic disease mortality (AIHW 2019) and all-cause mortality (Korda et al. 2019) reveal a clear gradient across differing levels of education with the probability of dying in 2011–12 decreasing as education levels increase. Quantifying inequalities for specific mortality causes will provide a broader understanding of the experience of population groups, the relationships between health and welfare, and insights into underlying reasons for these inequalities.