Mortality estimates for years up to 2005 are based on Australian Bureau of Statistics death registration data. Data from 2006 onwards were provided by the Australian Coordinating Registry, Cause of Death Unit Record File; the data for the most 2 recent years are preliminary (SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health)
Comprises any intentional self-harm with fatal result.
Only NSW residents are included. Deaths were classified using ICD-10 from 1997 onwards. Rates were age-adjusted using the Australian population as at 30 June 2001.Numbers for the latest year of data include an estimate of the small numbers of deaths that were registered in the subsequent year, data for which were unavailable at the time of production.
Where an accidental or violent death occurs, the determination of cause of death is referred to a Coroner and underlying cause of death is classified according to the circumstances of the fatal injury, called External cause of death in the ICD-10 classification, rather than the nature of the injury which is coded separately (ABS 3309.0 2007).
The Coroner investigates both the mechanism by which a person died, and the intention of the injury (whether accidental, intentional or assault). For a death to be determined a suicide, it must be established by coronial enquiry that the death resulted from a deliberate act of the deceased with the intention of ending his or her own life (Intentional self-harm).
Coronial processes to determine the intent of a death (whether intentional self harm, accidental, homicide, undetermined intent) are especially important for statistics on suicide deaths because information on intent is necessary to complete the coding under ICD-10 coding rules. Coroners' practices to determine the intent of a death may vary across the states and territories (ABS 3309.0 2007).
Up to 2006, about 8% of suicide deaths occurring in one year were not registered until the following year or later (ABS 3309.0 2007). The ABS used to publish death data by year of registration and once published the cause of death data had not been revised.
From January 2007 there have been significant improvements in the quality of the ABS death data collection. The ABS coders follow revised instructions to ensure consistency in the coding of suicide deaths and compliance with the revised notes for coding to the undetermined intent categories. Revisions of coronial open cases take place 12 and 24 months after the end of the year. Classification ‘Undetermined intent’ is used for a temporary coding of open cases. These measures may lead to a more specific cause of death code being assigned (ABS Cat. no. 3303.0 2010) in the longer term.
Attempted suicide and deliberate self-harm that is not suicidal in nature are very different behaviours. Nevertheless, it is not possible to distinguish between them on the basis of the ICD-10, which is used for coding of both death records and hospital separations in Australia. Making a distinction between attempted suicide and self-harm in hospital statistics would not be useful anyway, because the intent is often unclear at the time of separation and there are considerable difficulties with identifying cases of injury or poisoning as self-harm. A precise operational definition of 'intentional self-harm' is not available (Steenkamp et al. 2000).
The reliability of hospital records in reflecting the level of self-harm in hospitalised patients is untested and it is not known to what extent record of hospitalisation reflects self-harm in the community. Most people who contact health services after an episode of intentional self harm are seen by emergency departments. They may or may not be admitted as hospital inpatients, and the injury may or may not be recorded as intentional.
Australian Bureau of Statistics. Causes of Death, Australia. Cat. no. 3303.0. Available at https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3303.0Main+Features12018?OpenDocument (includes downloads for NSW data and for deaths from self-harm).
The Accessibility/Remoteness Index of Australia Plus (ARIA plus) is a remoteness index value (or score) based on road distance to major service centres (GISCA). In 2001, the Australian Bureau of Statistics (ABS) applied ARIA cut-off scores to define the Australian Statistical Geography Standard (ASGS) Remoteness Areas (ABS).
The service centre categories are based on population size, with the smallest centres in ARIA having populations of 1,000-4,999. Localities with populations greater than 1000 persons are considered to contain at least some basic level of services (e.g. health, education, or retail) (GISCA). Service centres with larger populations are assumed to contain a greater level of service provision. ARIA scores are based over 20,000 such localities throughout Australia.
In HealthStats NSW, remoteness areas are classified as Major cities; Inner regional or Outer regional areas (these two are referred to as regional when taken together); Remote and Very remote areas (remote when the last two are taken together). The term rural and remote is used when referring generally to areas outside Major Cities.
In this report, increasing the size of areas considered is used for estimates in analysis by remoteness from service centres. Very remote areas are often amalgamated with Remote areas and occasionally Very remote, Remote and Outer regional areas are amalgamated. Notes under the graphs confirm the extent of amalgamation. Extending the period of time in which cases are counted is also used in some indicators presenting health data by ARIA.
Postal areas are grouped according to the Australian Statistical Geographical Standard (ASGS) remoteness categories on the basis of Accessibility/Remoteness Index for Australia (ARIA+ version) score. For reporting purposes, outer regional, remote and very remote areas are aggregated in order to report reliable estimates of a range of health behaviours for non-metropolitan areas.
Australian Bureau of Statistics (ABS). 1270.0.55.005 - Australian Statistical Geography Standard (ASGS): Volume 5 - Remoteness Structure. Available at http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1270.0.55.005July%202011?OpenDocument
National Centre for Social Applications of Geographic Information Systems (GISCA). About ARIA (Accessibility/Remoteness Index of Australia). Available at http://gisca.adelaide.edu.au/projects/category/about_aria.html
In order to complete a death registration in Australia, the death must be certified by either a doctor using the Medical Certificate of Cause of Death, or by a coroner. Natural causes are predominantly certified by doctors, whereas External and Unknown causes or unaccompanied deaths are usually certified by a Coroner. Approximately 85-90% of deaths each year are certified by a doctor and the remainder is reported to a Coroner. The death is registered in the state in which the death occurred, rather than the state in which the person resides. The Australian Cause of Death Statistics System is outlined by the Australian Bureau of Statistics (ABS) at https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12018?OpenDocument
The ABS have implemented a revision process for Coroner certified deaths. Data are deemed preliminary when published for the first time, revised when published the following year and final when published two years after initial publication. This revision process, and the impact on specific causes are described at https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12018?OpenDocument.
The ABS publishes two publications every September concerning deaths in the previous calendar year: Deaths, Australia (Catalogue Number 3302.0) and Causes of death, Australia (Catalogue Number 3303.0), which include breakdowns at the State and Territory level. These are usually published nine months following the most recent reported year.
Prior to 2008, the NSW Ministry of Health obtained data on causes of death of all NSW residents from the Australian Bureau of Statistics (ABS). This covers deaths registered from 1964 to 2005.
For deaths registered from 2006 onwards, the NSW Ministry of Health receives coded cause of death data from the Australian Coordinating Registry (ACR). The ACR is an agency appointed to coordinate access of coded cause of death unit record data on behalf of the Registrars of Births Deaths and Marriages in each state or territory as well as the Australian Bureau of Statistics and National Coronial Information System. The coordinating registry undertakes the coordination and management of the designated activity. The underlying legal responsibility is retained by the collective Registrars. The coding of the causes of death is still undertaken by the ABS but the process to obtain the data is administered by the ACR.
The ACR provides the NSW Ministry of Health with a unit record file of all deaths, either occurring in NSW or to NSW residents who died interstate, approximately sixteen to seventeen months following the most recent reported year to allow a detailed analysis of deaths data. This analysis includes comparisons of causes of death in NSW by sub-state geographies (e.g. by Local Health District or Local Government Area) and by other dimensions and sub-populations, such as remoteness categories and socioeconomic groups. Causes of death data are also used throughout the NSW public health system for a variety of health system planning, reporting, research and evaluation needs.
There are differences in how deaths data are reported in HealthStats NSW and by the ABS, including differences in how deaths are allocated to specific years and differences in the populations used for calculating rates.
1. Death count by year of registration and by year of occurrence
There is usually an interval between the occurrence and registration of a death which is related to the time of year or whether a death is referred to a Coroner. The registration of deaths which occur in November and December are likely to be delayed until the following year, for example, of all deaths in NSW registered in 2013, 6.9% had occurred in 2012 or earlier (ABS 3302.0).Deaths data reported by the ABS for the latest year are based on the year of registration therefore do not include deaths which occurred in that year but where registration was delayed.
Deaths data reported in HealthStats NSW are based on the year of occurrence of the death to provide a better match for the population denominator when calculating rates. Estimates of missing deaths for the latest year due to delayed registration (i.e. due to time of year or Coronial cases) are imputed for each cause and included in the count reported in HealthStats NSW. A small percentage of death registrations may be delayed for more than one year. All deaths figures reported in HealthStats NSW are updated historically (e.g. in trends) when new data becomes available.
2. Different population projection data
For the calculation of rates, the NSW Ministry of Health uses population projection estimates from the NSW Department of Planning, Industry, and Environment. The estimated residential populations which are not projected are the same as those published by the ABS and are currently based on the 2016 Census. See Methods associated with indicators in topics Demography (or Population) for further discussion of population estimates.
Australian Bureau of Statistics. Deaths, Australia, latest year. 3302.0. Canberra: ABS, . Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/3302.0
Australian Bureau of Statistics. Causes of Deaths, Australia, latest year. 3303.0. Canberra: ABS, . Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/3303.0
Australian Bureau of Statistics. Multiple Cause of Deaths, Australia, 1997-2001. 3319.0.55.001. Canberra: ABS, . Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/3319.0.55.001
|Description||ICD-9 & ICD-9-CM||ICD-10 & ICD-10-AM||Comments|
|Suicide / Self harm||E950-E959||X60-X84, Y87.0||All records are included for NSW residents only. Records involving rehabilitation are excluded.
Episodes that are entirely within an emergency department are excluded.
Suicide comprises any self-harm with fatal result in this report and it refers to death records labelled: Suicide and self-inflicted injury in the International Statistical Classification of Diseases and Related Health Problems, 9 revision (ICD-9) (WHO 1968) and Intentional self-harm in the ICD-10 (WHO 1992).
Intentional self harm includes suicide (attempted) and purposely self-inflicted poisoning or injury (WHO 1992).
World Health Organisation. International Statistical Classification of Diseases and Related Health Problems, 9th revision (ICD-9). Geneva: WHO, 1968.
World Health Organization. International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). Geneva: WHO, 1992.
• 17.7% of adults aged 16 years and over (15.7% of men and 19.5% of women) experienced high or very high levels of psychological distress, as estimated from the 2019 NSW Adult Population Health Survey (self-reported using Computer Assisted Telephone Interviewing or CATI).
• 12.8% of adults aged 18 years and over (11.8% of males and 13.8% of females) in NSW experienced high or very high levels of psychological distress, as estimated from the 2017-18 Australian Health Survey (interviewer-administered questionnaire).
• Overall suicide rates dropped in NSW between 1997 and 2007 but have increased since this time. In 2017, 868 people died by suicide and males accounted for around 77.6% of these deaths.
• In 2018-19, there were 7,018 hospitalisations of NSW residents for intentional self-harm. Females accounted for 62% of these hospitalisations.
• In 2017, 14.0% of secondary school students reported high levels of psychological distress in the previous six months (9.7% of males and 18.2% of females). The proportion of students reporting high levels of psychological distress has remained stable over the last 3 years (2014 to 2017).
• Generally, a lower proportion of elderly adults have high levels of psychological distress than the overall adult population in NSW.
• The least socioeconomically disadvantaged adults had lower levels of psychological distress than the overall adult population in NSW.
• The proportion of adults reporting high and very high levels of psychological distress has remained fairly stable over the last decade.
Mental health disorders relate to behaviours and conditions which interfere with social functioning and capacity to negotiate daily life. Mental problems are also associated with higher rates of health risk factors, poorer physical health, and higher rates of deaths from many causes including suicide.
The classification of mental and behavioural disorders is difficult and warrants close attention to the types of disorders and syndromes which are included and excluded when comparing results from different sources. Further discussion of this issue is contained in the Methods tab.
Mental ill health is one of the leading causes of non-fatal burden of disease and injury in Australia. Mental ill health was estimated to account for 12% of the disease burden in Australia in 2015, with anxiety and depression, alcohol abuse and personality disorders accounting for almost three-quarters of this burden. Only 2.5% of the burden from mental disorders is due to mortality, most of which is accounted for by fatal outcomes associated with substance abuse (AIHW 2019).
Australian Institute of Health and Welfare 2019. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2015. Australian Burden of Disease Study series no. 19. BOD 22. Canberra: AIHW. Available at: https://www.aihw.gov.au/getmedia/c076f42f-61ea-4348-9c0a-d996353e838f/aihw-bod-22.pdf.aspx?inline=true
NSW has a range of mental health programs covering early intervention, prevention and promotion initiatives in place across the age spectrum. See http://www.health.nsw.gov.au/mentalhealth/Pages/default.aspx
Beyondblue at http://www.beyondblue.org.au
Black Dog Institute at http://www.blackdoginstitute.org.au
WayAhead: Mental Health Association NSW at https://wayahead.org.au
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
healthdirect at http://www.healthdirect.gov.au