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.
Patients treated solely within the emergency department are excluded from this indicator report due to a policy change (PD2017_015). 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_cat
Direct age standardisation was used to calculate standardised rates and counts; Spatial adjustment methods were used to calculate the adjusted rates.
Local Government Area boundaries used were defined in 2016.
LL/UL 95%CI = lower and upper limits of the 95% confidence interval for the point estimate.
The Local Government Area boundaries (LGAs) used in HealthStats NSW are an Australian Bureau of Statistics (ABS) approximation of officially gazetted LGAs as defined by the NSW Office of Local Government. The 2016 Australian Statistical Geography Standard (ASGS) edition of LGAs includes the nineteen New South Wales councils announced on the 12 May 2016 at https://www.strongercouncils.nsw.gov.au/. Based on the 2016 ASGS, there are 130 LGAs in NSW.
LGAs cover incorporated areas of Australia. Incorporated areas are legally designated parts of a State or Territory over which incorporated local governing bodies have responsibility. The major areas of NSW not administered by incorporated bodies include parts of far western NSW and Lord Howe Island. These regions are identified as ‘Unincorporated’ in the ABS Local Government Area structure.
Local Government Area population estimates used in HealthStats NSW
In HealthStats NSW, the total population used for each LGA in age-standardisation calculations is the Estimated Resident Population produced by the ABS and projections produced by the NSW Department of Planning, Industry, and Environment. As sub-state projections based on the 2016 Census are not yet available, population projections for LGAs (estimated population for 2017 and onwards) are based on Estimated Resident Populations produced by the ABS prior to the 2016 Census.
Methods used to adjust estimates for small areas
The term ‘small area’ refers to a small geographical area and a small population. Data from a small area are characterised by considerable variability. Smoothing is a general term for methods of minimising variability in data. Examples include rounding, moving averages, extending the period of time in which cases are counted or increasing the size of areas considered. In addition, statistical smoothing can be used to adjust raw estimates in small areas by taking into account information from adjacent areas (local or spatial variability) and from the whole state (global or non-spatial variability).
LGAs are the smallest level at which data are analysed in HealthStats NSW. 'Statistical smoothing' methods are used to control for random variability in the small area estimates and result in more conservative estimates for small areas. These methods are described in a paper in the HealthStatsPLUS Methods tab on this website.
The results of the spatial adjustment were used to determine whether the results obtained from individual areas are significantly different from NSW. The level of significance and the direction of difference from the NSW average is shown using plus and minus signs, as follows:
means more than 99.5% of the posterior distribution is above the unadjusted state rate. This indicates that the estimated LGA rate is significantly higher than the state average at the 1% level of significance.
means more than 97.5%, but less than 99.5% of the posterior distribution is above the unadjusted state rate. This indicates that the estimated LGA rate is significantly higher than the state average at the 5% level of significance.
means that between 2.5 and 97.5% of the distribution is above the unadjusted state rate. This indicates that the LGA rate is not significantly different to the state average.
means less than 2.5% of the posterior distribution is above the unadjusted state rate. This indicates that the LGA rate is significantly lower than the state average at 5% level of significance.
means less than 0.5% of the posterior distribution is above the unadjusted state rate. This indicates that the LGA rate is significantly lower than the state average at the 1% level of significance.
Australian Bureau of Statistics. Regional population growth, Australia. Cat no. 3218.0. ABS Canberra, 2019. Accessed 28 February 2020 at https://www.abs.gov.au/ausstats/abs@.nsf/latestProducts/3218.0Media%20Release12017-18
NSW Office of Local Government website at: https://www.olg.nsw.gov.au/
Australian Bureau of Statistics. Local Government Areas. Australian Statistical Geography Standard. Cat no. 1270.0.55.003. ABS Canberra, 2016. Accessed 28 February 2020 at: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/1270.0.55.003~July%202016~Main%20Features~Local%20Government%20Areas%20(LGA)~7
NSW Department of Planning, Industry, and Environment website at: https://www.dpie.nsw.gov.au/
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 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-10 & ICD-10-AM||Comments|
|Intentional self-harm||X60-X84, Y87.0 in first External Cause Code||
All records are included for NSW residents only. Records involving rehabilitation are excluded.
Episodes that are entirely within an emergency department are excluded.
Records relating to acute hospital transfer and statistical discharge are excluded.
Intentional self harm includes suicide (attempted) and purposely self-inflicted poisoning or injury (WHO 1992).
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