NSW Combined Admitted Patient Epidemiology Data and ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.
Intentional self-harm includes purposely self-inflicted poisoning or injury or attempted suicide with intent based on notes recorded by the treating clinician. This indicator measures people admitted to hospital after self-harm. It is not a direct measure of the number of people in the NSW population who make suicide attempts.
Only NSW residents are included. Rehabilitation episodes are excluded. Figures are based on where a person resides, rather than where they are treated. Hospital separations were classified using ICD-10-AM. Rates were age-adjusted using the Australian population as at 30 June 2001.
A recent policy change (PD2017_015) resulted in patients treated solely within the emergency department being excluded from this indicator report. Please note that a minority of patients being managed in short stay areas of emergency departments are still included. Further information is found in a paper in the HealthStatsPLUS Methods tab on this website. While the volume (number) of admissions counted has decreased as a result of this policy change, the trend remains consistent.
Numbers for recent years include an estimate of the small number of hospitalisations of NSW residents in interstate public hospitals, data for which were unavailable at the time of production. Further details can be found in the Methods tab in the following HealthStats NSW indicator: http://www.healthstats.nsw.gov.au/Indicator/bod_hos_catHospitalisations for those aged under 10 years are not reported separately due to very small numbers per year, however these are included in the total.
Hospitalisation rates for intentional self-harm are consistently higher in females than in males, while the death rates from suicide are substantially higher in males than in females. This may be related to differences between the sexes in both the intent of the self-harm as well as the methods used for self-harm and suicide.
In 2016-17, the self-harm hospitalisation rate for females aged 15-24 years (367.7 per 100,000 population) reached its highest point compared with the previous 15 years and was just under 3 times higher than that for all females. In 2017-18, the rate for females aged 15-24 years decreased to 343.2 per 100,000 population with 1,656 females and 666 males hospitalised for self-harm compared with 4,525 females and 2,710 males of all ages in that year.
This indicator measures people admitted to hospital after self-harm. It is not a direct measure of the number of people in the NSW population who attempt suicide. This indicator only includes people who are admitted to hospital, and does not include people who were treated solely within the emergency department (ED). Therefore changes in this indicator over time may reflect changes in the number of people who come to hospital seeking help, or the proportion who are admitted for treatment rather than treated solely in the ED.
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 http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3303.0Main+Features100002016?OpenDocument (includes downloads for NSW data and for deaths from self-harm).
The NSW Combined Admitted Patient Epidemiology Data (CAPED) records all inpatient separations (e.g. discharges, transfers and deaths) from all public, private, psychiatric and repatriation hospitals in NSW, as well as public multi-purpose services, private day procedure centres and public nursing homes. The CAPED includes data on hospital admissions of NSW residents which occurred in public hospitals interstate.
In CAPED, Public Hospital data are recorded in terms of episodes of care. An 'episode of care' ends with the patient ending a period of stay in hospital (e.g. by discharge, transfer or death) or by becoming a different 'type' of patient within the same period of stay. For private hospitals, each CAPED record represents a complete hospital stay. CAPED records are counted based on the date of separation (discharge) from hospital.
Data from interstate hospitals for recent years may not yet be available when the data are analysed for publication. This may affect analyses and has a greater effect on rates for areas closer to an interstate boundary. Analyses by geographical regions and analyses involving uncommon diagnoses or procedures are particularly affected. Therefore, an estimate is made of interstate admissions for recent years of hospitalisations based on interstate admissions in the most recent year for which interstate data are available. Interstate admissions records from the most recent year for which interstate data are available are copied into the file for the most recent years, assuming that the attributes of these admissions (such as sex, age, geography, type of diagnosis or procedure) provide the best predictor of those for admissions in the recent years.
|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 except those involving rehabilitation, NSW residents only, all ages.
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.
• 15.1% of adults aged 16 years and over (12.9% of men and 17.3% of women) experienced high or very high levels of psychological distress, as estimated from the 2017 NSW Adult Population Health Survey (self-reported using Computer Assisted Telephone Interviewing or CATI).
• 11.0% of adults aged 18 years and over (9.0% of males and 12.5% of females) in NSW experienced high or very high levels of psychological distress, as estimated from the 2014-15 Australian Health Survey (interviewer-administered questionnaire).
• Overall suicide rates dropped in NSW between 1997 and 2007 but has increased since this time. In 2017, 868 people died by suicide and males accounted for around 77.6% of these deaths.
• In 2017-18, there were 7,236 hospitalisations of NSW residents for intentional self-harm. Females accounted for 63% 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