Suicide in the Northern Territory, 2001-2006

Review of Australia's funding commitments for suicide prevention from 2021-22 to 2026-27

Objective Examine the distribution of funding for suicide prevention in Australia from 2021-22 to 2026-27. Methods Government websites were reviewed to locate budget documents related to suicide prevention funding. Information was extracted on the program/service to be funded, and the funder entity, duration, and year allocation. Extracted data was reviewed to identify commonly targeted sub-populations. Results The majority of suicide prevention-related funding was allocated to aftercare for persons who have attempted suicide, consistent with the effectiveness of these services, followed by programs targeting the general population. Little funding was allocated to other specific sub-populations, such as young people and Aboriginal and Torres Strait Islander peoples. The amount of funding allocated to suicide prevention varied across jurisdictions, which is only partially explained by suicide rates. Conclusions There is a need for greater investment in care for specific sub-populations who are at higher risk of suicide. This study provides a baseline for comparing future investments in suicide prevention in Australia.

Suicide rates amongst individuals from ethnic minority backgrounds: A systematic review and meta-analysis

BACKGROUND

Existing evidence suggests that some individuals from ethnic minority backgrounds are at increased risk of suicide compared to their majority ethnic counterparts, whereas others are at decreased risk. We aimed to estimate the absolute and relative risk of suicide in individuals from ethnic minority backgrounds globally.

METHODS

Databases (Medline, Embase, and PsycInfo) were searched for epidemiological studies between 01/01/2000 and 3/07/2020, which provided data on absolute and relative rates of suicide amongst ethnic minority groups. Studies reporting on clinical or specific populations were excluded. Pairs of reviewers independently screened titles, abstracts, and full texts. We used random effects meta-analysis to estimate overall, sex, location, migrant status, and ancestral origin, stratified pooled estimates for absolute and rate ratios. PROSPERO registration: CRD42020197940.

FINDINGS

A total of 128 studies were included with 6,026,103 suicide deaths in individuals from an ethnic minority background across 31 countries. Using data from 42 moderate-high quality studies, we estimated a pooled suicide rate of 12·1 per 100,000 (95% CIs 8·4-17·6) in people from ethnic minority backgrounds with a broad range of estimates (1·2-139·7 per 100,000). There was weak statistical evidence from 51 moderate-high quality studies that individuals from ethnic minority groups were more likely to die by suicide (RR 1·3 95% CIs 0·9-1·7) with again a broad range amongst studies (RR 0·2-18·5). In our sub-group analysis we only found evidence of elevated risk for indigenous populations (RR: 2·8 95% CIs 1·9-4·0; pooled rate: 23·2 per 100,000 95% CIs 14·7-36·6). There was very substantial heterogeneity (I²  > 98%) between studies for all pooled estimates.

INTERPRETATION

The homogeneous grouping of individuals from ethnic minority backgrounds is inappropriate. To support suicide prevention in marginalised groups, further exploration of important contextual differences in risk is required. It is possible that some ethnic minority groups (for example those from indigenous backgrounds) have higher rates of suicide than majority populations.

FUNDING

No specific funding was provided to conduct this research. DK is funded by Wellcome Trust and Elizabeth Blackwell Institute Bristol. Matthew Spittal is a recipient of an Australian Research Council Future Fellowship (project number FT180100075) funded by the Australian Government. Rebecca Musgrove is funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003).

A Systematic Review of the Antecedents and Prevalence of Suicide, Self-Harm and Suicide Ideation in Australian Aboriginal and Torres Strait Islander Youth

Suicide and self-harm represent serious global health problems and appear to be especially elevated amongst indigenous minority groups, and particularly amongst young people (aged 24 years or younger). This systematic review investigates for the first time the antecedents and prevalence of suicide, self-harm and suicide ideation among Australian Aboriginal and Torres Strait Islander youth. Web of Science, PubMed, PsychINFO, CINAHL databases and grey literature were searched from earliest records to April 2019 for eligible articles. Twenty-two empirical articles met the inclusion criteria. The data confirmed that indigenous youth in Australia have elevated rates of suicide, self-harm and suicidal ideation relative to the nonindigenous population. Risk factors included being incarcerated, substance use and greater social and emotional distress. Notably, though, information on predictors of suicide and self-harm remains scarce. The findings support and justify the increasing implementation of public health programs specifically aimed at tackling this crisis. Based on the review findings, we argued that Aboriginal communities are best positioned to identify and understand the antecedents of youth self-harm, suicide ideation and suicide, and to take the lead in the development of more effective mental health preventive strategies and public policies within their communities.

Global incidence of suicide among Indigenous peoples: a systematic review

BACKGROUND

Suicide is the second leading cause of death among adolescents worldwide, and is a major driver of health inequity among Indigenous people in high-income countries. However, little is known about the burden of suicide among Indigenous populations in low- and middle-income nations, and no synthesis of the global data is currently available. Our objective was to examine the global incidence of suicide among Indigenous peoples and assess disparities through comparisons with non-Indigenous populations.

METHODS

We conducted a systematic review of suicide rates among Indigenous peoples worldwide and assessed disparities between Indigenous and non-Indigenous populations. We performed text word and Medical Subject Headings searches in PubMed, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), PsycINFO, Latin American and Caribbean Health Sciences Literature (LILACS), and Scientific Electronic Library Online (SciELO) for observational studies in any language, indexed from database inception until June 1, 2017. Eligible studies examined crude or standardized suicide rates in Indigenous populations at national, regional, or local levels, and examined rate ratios for comparisons to non-Indigenous populations.

RESULTS

The search identified 13,736 papers and we included 99. Eligible studies examined suicide rates among Indigenous peoples in 30 countries and territories, though the majority focused on populations in high-income nations. Results showed that suicide rates are elevated in many Indigenous populations worldwide, though rate variation is common, and suicide incidence ranges from 0 to 187.5 suicide deaths per 100,000 population. We found evidence of suicide rate parity between Indigenous and non-Indigenous populations in some contexts, while elsewhere rates were more than 20 times higher among Indigenous peoples.

CONCLUSIONS

This review showed that suicide rates in Indigenous populations vary globally, and that suicide rate disparities between Indigenous and non-Indigenous populations are substantial in some settings but not universal. Including Indigenous identifiers and disaggregating national suicide mortality data by geography and ethnicity will improve the quality and relevance of evidence that informs community, clinical, and public health practice in Indigenous suicide prevention.

The utility of medico-legal databases for public health research: a systematic review of peer-reviewed publications using the National Coronial Information System

BACKGROUND

Medico-legal death investigations are a recognised data source for public health endeavours and its accessibility has increased following the development of electronic data systems. Despite time and cost savings, the strengths and limitations of this method and impact on research findings remain untested. This study examines this issue using the National Coronial Information System (NCIS).

METHODS

PubMed, ProQuest and Informit were searched to identify publications where the NCIS was used as a data source for research published during the period 2000-2014. A descriptive analysis was performed to describe the frequency and characteristics of the publications identified. A content analysis was performed to identify the nature and impact of strengths and limitations of the NCIS as reported by researchers.

RESULTS

Of the 106 publications included, 30 reported strengths and limitations, 37 reported limitations only, seven reported strengths only and 32 reported neither. The impact of the reported strengths of the NCIS was described in 14 publications, whilst 46 publications discussed the impacts of limitations. The NCIS was reported to be a reliable source of quality, detailed information with comprehensive coverage of deaths of interest, making it a powerful injury surveillance tool. Despite these strengths, researchers reported that open cases and missing information created the potential for selection and reporting biases and may preclude the identification and control of confounders.

CONCLUSIONS

To ensure research results are valid and inform health policy, it is essential to consider and seek to overcome the limitations of data sources that may have an impact on results.

The quality of health research for young Indigenous Australians: systematic review

OBJECTIVE

To assess the extent and quality of the evidence base related to the health and wellbeing of young Indigenous Australians.

STUDY DESIGN

Systematic review of peer-reviewed literature; grading of quality of literature; mapping of sample characteristics and study foci.

DATA SOURCES

English language publications, 1 Jan 1994 - 1 Jan 2011 in MEDLINE, ERIC, CINAHL, EMBASE, ATSIhealth, PsycINFO, the Cochrane Library and the Australian Indigenous HealthInfoNet.

STUDY SELECTION

Inclusion criteria were: published 1 Jan 1994 - 1 Jan 2011; original peer-reviewed research; reported data for Australian Aboriginal and Torres Strait Islanders aged 10-24 2013s; focused on health and wellbeing. Grading for quality included ascertainment of Indigenous status, representativeness of the sample for the target population, and quality of measures of exposure and outcome.

DATA SYNTHESIS

360 peer-reviewed publications met inclusion criteria; 90 (25%) exclusively sampled Indigenous young people. 250 studies (69%) were of good-quality design; 124 of these focused on health outcomes (15 of these evaluated an intervention) and 116 focused on health-risk exposure (26 evaluative). The methodological quality of data improved during 1994-2010; however, only 17% of studies focused on urban populations. A third of good-quality studies of health outcome focused on communicable diseases such as sexually transmitted infections and tuberculosis. There was good-quality data for oral health and substance use, and some data for adolescent pregnancy. Data on mental disorders, injury and cause-specific mortality were limited.

CONCLUSIONS

Despite improvements, there are important gaps in the evidence base for the health of young Indigenous Australians. Our study points to the need for greater research investment in urban settings and with regard to mental disorders and injury, with a further emphasis on trials of preventive and clinical intervention.

The 'Operationalized Predicaments of Suicide' (OPS) applied to Northern Territory coroners' reports

OBJECTIVE

To apply the "Operationalized Predicaments of Suicide" (OPS) to coroners' reports with a view to classifying the drivers/triggers of suicide in the Northern Territory (Australia) for the years July 2000-December 2010, with attention to the total population, and to a comparison of suicide triggers for the Indigenous and non-Indigenous communities.

METHODS

A total of 411 reports (Indigenous, 198; non-Indigenous, 213) were obtained from the National Coroners Information System (NCIS). A research officer thematically analysed each case report and classified each according to the four categories of the OPS. Calculations were performed for the entire sample and comparisons were made between Indigenous and non-Indigenous groups.

RESULTS

For the total sample, 20% of suicides were triggered by mental illness, and 58% were triggered by social/environmental events. In 9% there were both mental illness and social/environmental factors, and in 14% no triggers could be identified. There were group differences; the non-Indigenous group was over represented in the mental illness category and the Indigenous group was over represented in the social/environmental category (χ(2) (3) = 41.5, p = 0.000).

CONCLUSIONS

Social/environmental stressors are important triggers of suicide in the Northern Territory. Social/environmental stressors were more often the suicide trigger in Indigenous community suicide compared to non-Indigenous community suicide.

Suicide mortality in São Gabriel da Cachoeira, a predominantly indigenous Brazilian municipality

OBJECTIVE

To describe the characteristics and the raw suicide mortality rates (RSMR) during the period 2000-2007 in the municipality with the largest proportion of self-reported indigenous people in Brazil, São Gabriel da Cachoeira (SGC), State of Amazonas.

METHOD

A retrospective descriptive study was carried out using data from the Information Department of the Brazilian Unified Health System (DATASUS). We considered suicide the cause of death coded in the records as voluntary self-Inflicted injuries according to the International Classification of Diseases and Related Health Problems, 10th revision.

RESULTS

Forty-four suicide cases were registered in this period. The average RSMR was 16.8 per 100,000 inhabitants (male, 26.6; female, 6.3). The highest rates were observed in the age groups 15-24 years and 25-34 years, with RSMR of 43.1 and 30.2 per 100,000 inhabitants, respectively. Most suicides occurred among indigenous people (97.7%), males (81.8%), and unmarried people (70.5%). In most cases, deaths occurred at home (86.4%), during weekends (59.1%) and mainly by hanging (97.7%).

CONCLUSION

Suicide is a significant health and social problem in SGC. The suicide profile observed in this municipality was, as a whole, more similar to that observed in certain indigenous communities than that found in most urban and non-indigenous environments, demonstrating the sociocultural specificity of these events in Brazil.

Spatial analysis of suicide mortality in Australia: investigation of metropolitan-rural-remote differentials of suicide risk across states/territories

Studies of suicide epidemiology in regions of Australia have been conducted, but the spatial pattern in the whole country has not been fully investigated. This study aimed at visualizing the sex-specific suicide pattern over the country from 2004 to 2008, and studying the metropolitan-rural-remote differentials of suicide across all states/territories. We applied a Poisson hierarchical model to yield smoothed sex specific, age standardized mortality ratios of suicide in all postal areas, and compiled the age-standardized suicide rates across different levels of remoteness and different jurisdictions. We identified the area variation of suicide risk across states/territories, and metropolitan-rural-remote differential with rates higher in rural and remote areas for males. Spatial clusters of some high risk postal areas were also identified. Socio-economic deprivation, compositional factors, high risks for Indigenous people and low access to mental health service are the underlying explanations of the elevation of suicide risk in some areas. These findings suggest that it is important to take geographical variations in suicide risk into account in national policy making. Particular suicide prevention interventions might be targeted at males living in remote areas, and some localized areas in metropolitan zones.

Mental disorders and communication of intent to die in indigenous suicide cases, Queensland, Australia

In comparing Indigenous to non-Indigenous suicide in Australia, this study focussed on the frequency of the association between some psychiatric conditions, such as depression and alcohol abuse, and some aspect of suicidality, in particular communication of suicide intent. Logistic regression was implemented to analyze cases of Indigenous (n = 471) versus non-Indigenous suicides (n = 6,655), using the Queensland Suicide Register as a data source. Compared to non-Indigenous suicides, Indigenous cases had lower odds of being diagnosed with unipolar depression, seeking treatment for psychiatric conditions or leaving a suicide note. Indigenous suicides had greater odds of verbally communicating suicide intent and having a history of alcohol and substance use. The magnitude of these differences is remarkable, underscoring the need for culturally sensitive suicide prevention efforts.

Spatial distribution of suicide in Queensland, Australia

BACKGROUND

There has been a lack of investigation into the spatial distribution and clustering of suicide in Australia, where the population density is lower than many countries and varies dramatically among urban, rural and remote areas. This study aims to examine the spatial distribution of suicide at a Local Governmental Area (LGA) level and identify the LGAs with a high relative risk of suicide in Queensland, Australia, using geographical information system (GIS) techniques.

METHODS

Data on suicide and demographic variables in each LGA between 1999 and 2003 were acquired from the Australian Bureau of Statistics. An age standardised mortality (ASM) rate for suicide was calculated at the LGA level. GIS techniques were used to examine the geographical difference of suicide across different areas.

RESULTS

Far north and north-eastern Queensland (i.e., Cook and Mornington Shires) had the highest suicide incidence in both genders, while the south-western areas (i.e., Barcoo and Bauhinia Shires) had the lowest incidence in both genders. In different age groups (≤ 24 years, 25 to 44 years, 45 to 64 years, and ≥ 65 years), ASM rates of suicide varied with gender at the LGA level. Mornington and six other LGAs with low socioeconomic status in the upper Southeast had significant spatial clusters of high suicide risk.

CONCLUSIONS

There was a notable difference in ASM rates of suicide at the LGA level in Queensland. Some LGAs had significant spatial clusters of high suicide risk. The determinants of the geographical difference of suicide should be addressed in future research.