Limitations
The findings in this research are subject to certain limitations due to the data sources and methodology used, including:
- Our estimates of health service use do not include non-Government funded health services (such as by private insurance, through workers compensation arrangements, or the individual), or services funded by Defence or Open Arms. As such, use of health services is likely an underestimate in this report.
- Use of a health service does not necessarily indicate that suicide risk was identified or treated within that interaction. Many people who die by suicide may have sought care for unrelated physical or mental health concerns, and their risk may not have been recognised at the time.
- Emergency department care and public hospital admitted patient care were analysed separately. Therefore, people who presented to ED and transferred to admitted care were counted as having used both services. This should be considered when interpreting the results.
- While ED presentations and admitted care that had a separation reason of death were excluded from the analysis, people that presented to ED and then transferred to admitted care before dying will have had the ED presentation included in the analysis. This may slightly overestimate ED presentations, particularly in the period close to death, but has not altered the patterns observed in the analysis.
- Comparisons of health service by ex-serving members who died by suicide using OR accounted for demographics and adjusted for comorbidities. Other relevant factors (such as ADF service or ADF service length) were examined in subgroup analyses, but not included in adjusted models, so a degree of residual confounding is likely to remain.
- The services that Medicare subsidises, and how similar services are coded has changed over time, particularly for mental health services provided by GPs and allied health professionals which can impact analysis of trends over time.
- Prior to 1 April 2012, the PBS/RPBS claims data did not collect data on under co-payment medications (medications that were not Government subsidised because they were priced under the co-payment threshold). Caution should be used when comparing data prior and after this period.
- The PBS/RPBS data does not include medicines supplied to public hospital in-patients, over the counter medicines or private prescriptions.
- There are differences between MBS services and DVA-funded MBS equivalent services. For example, DVA clients may be eligible to higher or ‘uncapped’ services than through MBS. DVA has also increased access to mental health services through various policy changes since 2001, most significantly in 2016 when eligibility was expanded to include all current and former ADF members with at least one day of continuous full-time service.
- DVA-funded MBS or MBS equivalent services were not included in the latent class analysis and the group-based trajectory analysis. Their exclusion may lead to underestimation of service use among DVA clients.
- There are multiple limitations that apply which relate to mental health analysis:
- Community mental health care services were not included in this report. These services often treat mental health conditions in specialised community and hospital-based outpatient psychiatric services provided by state and territory governments.
- Mental health items could be miscoded or reported, for example, many GP mental health services are billed under general GP consultations (see Medicare mental health services - Mental health).
- Mental health-related ED presentations refer to presentations that have a principal diagnosis that falls within the Mental and behavioural disorders chapter (Chapter 5) of ICD‑10‑AM (codes F00–F99). It should be noted that this definition does not encompass all mental health‑related presentations to ED (see Emergency departments - Mental health).
- Mental health admitted care is defined by a principal diagnosis in the Mental and behavioural disorders chapter. ‘Any mental health admitted care’ is defined by a principal or secondary diagnosis in the Mental and behavioural disorders chapter. It should be noted that this definition does not include all mental health-related admitted care (see Characteristics of ex-serving Australian Defence Force members hospitalised for suicidality and intentional self-harm).
- Analysis presented by separation reason only contains ex-serving ADF members who separated from 1 January 2003 onwards because of changes to the way the reason for separating the ADF was recorded in 2002.
- The analysis included persons from all jurisdictions except for Western Australia and Northern Territory, due to data limitations.