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
Quintiles of socioeconomic status (Index of Relative Socioeconomic Disadvantage) based on the Australian Bureau of Statistics' Socio-Economic Indexes for Areas were allocated based on Statistical Local Area of residence (before 2009-10) or Statistical Area Level 2 of residence (2009-10 and after).
LL/UL 95%CI = lower and upper limits of the 95% confidence interval for the point estimate.
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 Admitted Patient Data Collection (APDC) or Inpatient Statistics Collection (ISC) is a census of all services for admitted patients provided by public hospitals, public psychiatric hospitals, public multi-purpose services, private hospitals and private day procedure centres in NSW. The APDC is a financial year collection from 1 July through to 30 June of the following year. The information it contains is provided by patients, health service providers, and the hospital's administration. The information reported includes patient demographics, source of referral to the service, service referred to on separation, diagnoses, procedures, and external causes.
For this report, the APDC was accessed via SAPHaRI. The APDC data is still called the 'ISC' data on SAPHaRI to maintain consistency in naming of SAS datasets.
The APDC includes data on hospital admissions of NSW residents which occurred in hospitals interstate. The only exception to this is that data from interstate hospitals for the last year of data which are not yet available when the data is analysed for publication. This may affect analyses and has a greater effect on rates for areas closer to an interstate boundary. Analyses by Local Health Districts, Local Government Areas, Medicare Locals and analyses involving uncommon diagnoses or procedures are particularly affected. Therefore, an estimate is made of interstate admissions for the last year of hospitalisations. This estimate is based on admissions in the preceding three years. The first step is to determine the proportion of total admissions for NSW residents in the preceding three years which were at interstate hospitals. That proportion is then used to multiply the number of admissions at hospitals in NSW in the last year of data, to obtain the estimate of the number of admissions expected to have occurred at interstate hospitals. The estimates are calculated for each age-sex stratum. Where hospitalisations are further categorised, for example by diagnosis, geographical place of residence or country of birth, the imputation procedure is carried out separately for each category, thus accounting for the uneven distribution of interstate hospital admissions.
From 1 July 1998, inpatient data on SAPHaRI (formerly HOIST) have been for episodes of care in hospital. Episodes of care end with the discharge, transfer, or death of a patient. A new episode of care may also start when the service category for an admitted patient is altered, as a result of a change in the on-going clinical care requirements for that patient during the one episode of accommodation in a single facility. APDC data on SAPHaRI up to 30 June 1998 were for periods of stay in hospital. A period of stay in hospital ends with the discharge, transfer, or death of a patient, and may consist of multiple episodes of care. The change from 'period of stay' to 'episode of care' causes a small increase in the apparent number of admissions.
The reason for a hospital admission is coded at the time of separation (discharge, transfer or death). Since 1 July 1998, coding has been according to the 10th revision of the International Classification of Diseases, Australian Modification ICD-10-AM. Updated ICD-10 coding manuals have been published by the National Centre for Classification in Health every two years since 1998. Prior to this, coding was according to the 9th revision of the International Classification of Diseases, Clinical Modification (ICD-9-CM), using the Australian version (National Coding Centre, 1996) from July 1995 and the US version prior to that.
Since 1 July 1998, procedures carried out during a patient's stay have been coded according to the MBS-Extended Procedure Classification, published as Volume 3 and Volume 4 of the 10th revision of the International Classification of Diseases, Australian Modification (ICD-10-AM). Updated ICD-10 coding manuals have been published by the National Centre for Classification in Health every two years since 1998. Prior to this, procedures were coded according to the 9th revision of the International Classification of Diseases, Clinical Modification (ICD-9-CM), using the Australian version (National Coding Centre, 1996) from July 1995 and the US version prior to that.
The numbers of diagnosis and procedure codes that may be recorded, at the time of separation, have varied over time, and are currently as follows:
· principal diagnosis (the principal reason for admission);
· up to 54 other diagnoses;
· up to 50 procedures and procedure blocks;
· up to eight external cause codes for injury and poisoning.
· up to three codes for place of occurrence injury or poisoning.
· up to three codes for activity at time of injury or poisoning.
Mapping tables between ICD-9-CM and ICD-10-AM disease codes, produced by the National Centre for Classification in Health, were used extensively to obtain the most appropriate match for individual codes between the two classification systems. The ICD-10-AM and ICD-9-CM codes used for each indicator are included in the Codes tab available with each indicator group in this report.
The Australian Bureau of Statistics (ABS) has produced measures of socioeconomic disadvantage since the 1971 Census. The Socio-Economic Indexes for Areas (SEIFA) were first produced in 1990 and consisted of five indexes formed from the 1986 Census data (ABS).
There are four SEIFA indexes currently produced. In each census year, the ABS assigns index SEIFA scores to non-overlapping geographical areas covering all Australia calculated from the various socioeconomic characteristics from the Census of the people living in areas.
Each index is a summary of a different subset of Census variables and focuses on a different aspect of socioeconomic advantage and disadvantage (ABS, 2018). The reference value for the whole of Australia is set to 1,000. Lower values indicate lower socioeconomic status.
The indexes are:
• Index of Relative Socio-Economic Disadvantage (IRSD)
• Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD)
• Index of Economic Resources (IER)
• Index of Education and Occupation (IEO).
In the IRSD, the constituent characteristics relate to occupation, education, non-English speaking background and the economic resources of the household. From 2011, the proportion of Aboriginal people is no longer a constituent variable of IRSD (ABS, 2011).
The score for each index is an ordinal measure with a mean of 1000 and standard deviation of 100 for Australia, and from 2011, based on the index scores of all Statistical Areas Level 1 (SA1) in Australia. Scores for larger geographic areas such as Local Government Areas (LGAs) and Postal Areas (POA) are population-weighted averages of scores in constituent SA1.
The overall scores for states are not available because as the size of an area increases, it becomes correspondingly more heterogeneous and the socioeconomic index becomes less and less meaningful. For very large areas, it is more useful to look at the distribution of SA1 scores within each area. The distributions of SA1 scores within each state and territory are available at the ABS web site (ABS).
The ABS has released SEIFA scores after the last five censuses. The methods used to calculate scores were similar in 1986, 1991 and 1996, but changed in 2001, 2006 and 2011. The major change in 2006 was that the census data used in the calculation of the indexes was based on people's usual area of residence rather than their location on census night (place of enumeration) and in 2011 a new geography standard was used and the proportion of Aboriginal people was no longer a constituent variable of IRSD (ABS 2013). SEIFA 2016 broadly uses the same method that was used for SEIFA 2011, though there were updates to SA1 boundaries in many areas (ABS 2018).
In the Index of Relative Socio-Economic Disadvantage (IRSD), the constituent characteristics relate to occupation, education, non-English speaking background and the economic resources of the household. There are currently 16 variables contributing to the index and the proportion of Aboriginal people is no longer a constituent variable of IRSD (ABS 2018). This is the most frequently used and quoted SEIFA index.
The Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD) consists of 25 contributing variables. They summarise information about the economic and social conditions of people and households within an area, including both relative advantage and disadvantage measures.
A low score indicates relatively greater disadvantage and a lack of advantage in general. For example, an area could have a low score if there are (among other things) many households with low incomes, or many people in unskilled occupations. A high score indicates a relative lack of disadvantage and greater advantage in general. For example, an area may have a high score if there are (among other things) many households with high incomes, or many people in skilled occupations (ABS 2016)
The Index of Economic Resources (IER) focuses on the financial aspects of relative socio-economic advantage and disadvantage, by summarising variables related to income and wealth. Education and occupation variables are excluded from this index because they are not direct measures of economic resources. Some relevant data on assets such as savings or equities are also not included because this information was not collected in the Census. There are 14 contributing variables. (ABS 2018)
The Index of Education and Occupation (IEO) is designed to reflect the educational and occupational level of communities. The education variables in this index show either the level of qualification achieved or whether further education is being undertaken. The occupation variables classify the workforce into the major groups and skill levels of the Australian and New Zealand Standard Classification of Occupations (ANZSCO) and the unemployed. This index does not include any income variables. There are 10 variables contributing to the total score. (ABS 2018)
Socioeconomic disadvantage is associated with a higher prevalence of health risk factors and higher rates of hospitalisations, deaths and other adverse health outcomes. Maps of socioeconomic disadvantage by LGA viewed in conjunction with maps of health outcomes can assist in identifying factors which may be associated with poorer outcomes.
The NSW population was divided into five groups based on the IRSD scores of their SA2 of residence. This means that SA2s were sorted by IRSD score and assigned to population-weighted quintiles, each containing close to one-fifth of the total population. In some charts and data tables on HealthStats NSW, the quintiles were divided into three groups: the lowest SES population-weighted quintile, the highest SES population-weighted quintile, and the rest of the population, comprising the remaining three population-weighted quintiles.
Postal Areas (POAs) were grouped into quintiles of socioeconomic status based on the IRSD.
Adhikari P. Socio-economic indexes for areas: Introduction, use and future directions. ABS Catalogue no. 1351.0.55.015. Canberra: ABS, 2006.
Australian Bureau of Statistics. Socio-Economic Indexes for Areas (SEIFA) - Technical Paper, 2011. SEIFA Cat no 2033.0.55.001. Canberra: ABS, 2013.
Australian Bureau of Statistics. Socio-Economic Indexes for Areas (SEIFA) - Technical Paper, 2016. SEIFA Cat no 2033.0.55.001. Canberra: ABS, 2018.
Australian Bureau of Statistics. 1996 Census of population and housing. Socioeconomic indexes for areas. 2039.0. Canberra: ABS, 1998. Available at http://www.ausstats.abs.gov.au/ausstats/free.nsf/0/C17E9A880591BB45CA256AE9001BCD57/$File/2039.0_1996.pdf
Australian Bureau of Statistics. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2016. Catalogue no 2033.0.55.001. Canberra: ABS, 2013. Available at http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2033.0.55.001~2016~Main%20Features~SOCIO-ECONOMIC%20INDEXES%20FOR%20AREAS%20(SEIFA)%202016~1
|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