Final report to the Independent Review of Past Defence and Veteran Suicides

This chapter investigates risk factors for ADF members who died by suicide, including psychosocial risk factors, natural diseases and mental and behavioural disorders, and their mechanism of death. The study cohort covers ADF members who have died by suicide from 2001 to 2018. While the patterns of death by suicide among females in the study cohort were similar to males, comparisons are not presented for females because of small numbers.

Datasets used for the analysis include information from the National Coronial System for members of the study cohort who died by suicide between 2001 and 2018, coded by the ABS for psychosocial risk factors, natural diseases and mental and behavioural disorders. Comparisons are made between the study cohort and the Australian population of deaths by suicide, 2017 or 2018 using published results from ABS analysis of information from the National Coronial System (ABS 2018b; 2019b).

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What is a psychosocial risk factor?

In a previous report by the ABS, psychosocial risk factors were defined to be ‘social processes and social structures which can have an interaction with individual thought or behaviour and health outcomes’ (ABS 2019c). Examples of psychosocial risk factors include relationship status, employment status, bereavement, and contact with the legal system. The ABS coded psychosocial risk factors using the International Classification of Diseases (ICD-10) codes Z00-Z99 (see Technical notes for more information).

Natural disease, as defined by the ABS, includes “all disease and health related conditions with the exclusion of mental and behavioural disorders, injuries, and external causes” (ABS 2019c). These correspond with the ICD‑10 codes A00-E90 and G00-R99. Mental and behavioural disorders are psychological factors including those related to drug and alcohol use, ICD-10 codes F00-F99 (ABS 2019c). The ABS (2019c) defines ‘associated causes’ as psychosocial risk factors, mental and behavioural disorders, or natural disease. It is important to note that more than one of these types of risk factors may be present in the life of an individual, and they may interact with one another.

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Psychosocial risk factors and other associated causes

ADF males who died by suicide were more likely than Australian males to have all three kinds of associated causes: psychosocial risk factors, mental and behavioural disorders, and natural disease (Figure 11)

Figure 11: Proportion of ADF males^(a) who died by suicide, 2001 to 2018, and Australian males^(b) who died by suicide, 2017, with associated causes^(c)(d)

Notes:

1. Includes 425 male ADF members who died by suicide, 2001 to 2018, able to be identified in the National Coronial Information System. Four ADF member suicides during this period were not matched to coronial records and are excluded, see Technical notes.
2. Includes data for Australian males who died by suicide, registered in 2017. Data was published in 2019, totals may differ from revised coronial data published by the ABS in 2020.
3. Data in this figure indicate the number of deceased with each specified associated cause. Associated causes may not be mutually exclusive, and therefore people with multiple factors recorded may be counted in more than one category.
4. Mental and behavioural disorder includes ICD-10 codes F00-F99. Natural disease includes all disease and health related conditions with the exclusion of mental and behavioural disorders, injuries, and external causes. ICD-10 codes A00-E90 and G00-R99.For a complete list of psychosocial risk factors, refer to explanatory note Annex listing: Psychosocial codes (exclusions and inclusions) in Psychosocial risk factors as they relate to coroner-referred deaths in Australia (cat. No. 1351.0.55.062). ‘Any associated cause’ refers to having at least one ‘Mental and behavioural disorder’, ‘Natural disease’, or ‘Psychosocial risk factor’. The ABS coded associated causes of ADF member suicides based on the International Classification of Diseases.

Sources: AIHW analysis of linked PMKeyS–NDI data–ABS coded NCIS data 2001–2018; ABS 2019c.

Figure 12 presents the associated causes for male ADF members and Australian males who died by suicide:¹

• 4 in 5 (80%) male ADF members who died by suicide had at least one psychosocial risk factor, compared with around 3 in 5 (62%) Australian males.
• 58% of male ADF members who died by suicide had at least one natural disease, compared with just under half of the Australian males (47%).
• Three-quarters (75%) of male ADF members who died by suicide had at least one mental and behavioural disorder, compared with under two-thirds of Australian males (63%).

 

1. The difference between ADF members and Australian suicides may be partly explained by a higher proportion of open cases for the Australian cohort than in the ADF member cohort. Cases that remain open may have incomplete information on risk factors until finalised (Table B.2: Description of datasets in Data sources.

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Common psychosocial risk factors among ADF member suicides

The three most common psychosocial factors were the same for both ADF members in the study cohort and Australian suicide populations, yet were identified in a higher proportion of ADF members who died by suicide (Figure 12):

• around one in 3 (29%) male ADF members who died by suicide had a ‘personal history of self-harm’, compared with around 1 in 5 (21%) Australian males
• more than one quarter (27%) of male ADF members who died by suicide had experienced ‘disruption of family by separation’ and divorce, compared with around 1 in 6 (16%) Australian males
• one in 5 (21%) male ADF members who died by suicide had experienced ‘problems in relationship with spouse or partner’, compared with around one in 9 (11%) Australian males.

Figure 12: Common psychosocial risk factors^(a) identified among ADF males^(b) who died by suicide, 2001 to 2018,and Australian males^(c) who died by suicide 2017

Notes:

1. Data in this figure indicate the number of deceased with each specified psychosocial factor recorded. Risk factors may not be mutually exclusive, and therefore people with multiple factors recorded may be counted in more than one category. The ABS coded associated causes of ADF member suicides based on the International Classification of Diseases. For a complete list of psychosocial risk factors, refer to explanatory note Annex listing: Psychosocial codes (exclusions and inclusions) in Psychosocial risk factors as they relate to coroner-referred deaths in Australia (cat. No. 1351.0.55.062).
2. Includes 425 male ADF members who died by suicide, 2001 to 2018, able to be identified in the National Coronial Information System. Four ADF member suicides during this period were not matched to coronial records and are excluded, see Technical notes.
3. Includes data for Australian males who died by suicide, registered in 2017. Data was published in 2020, totals may differ from ABS data published in 2019 due to revision of coronial data.

Sources: AIHW analysis of linked PMKeyS–NDI – ABS coded NCIS data 2001–2018; ABS 2020.

Among male ADF members who died by suicide, around 1 in 6 experienced ‘Exposure to disaster, war and other hostilities’ (15%). While this risk factor was the 4^th most common among ADF members in the study cohort, it was not in the top 5 for Australian suicides. Around 1 in 6 male ADF members who died by suicide experienced ‘Defence force related deployment’ (15%), noting, this was only coded for ADF members in the study cohort.

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Psychosocial risk factors and service characteristics

Table 9 provides summary statistics for counts and proportions of ADF suicides by service characteristics and associated causes. Table 9 shows:

• 83% of ex-serving members who died by suicide had mental and behavioural disorders compared with 65% of serving/reserve members.
• More than 9 out of 10 ex-serving members who died from suicide with a length of service 5─10 years (93%) and 10─20 years (92%) had mental and behavioural disorders.
• Over 4 out of 5 (83%) suicide cases among members in the study cohort from the Navy had mental and behavioural disorders followed by 74% of Army and 70% of Air Force members.
• Of those who medically separated, nearly 9 in 10 (87%) had a psychosocial risk factor and around 9 in 10 (89%) had a mental and behavioural disorder.

Table 9: Numbers and proportions of ADF members who died by suicide with at least one associated cause, selected causes, by service characteristics, 2001 to 2018^(a)

	Suicides	Total suicides with mental and behavioural disorders(b)		Total suicides with reported natural disease(c)		Total suicides with psychosocial risk factors(d)
	Number	Number	%	Number	%	Number	%
Length of service(e)
Less than one year	61	44	72.1	36	59.0	45	77.8
1-<3 years	36	28	77.8	21	58.3	30	83.3
3-<5 years	32	28	87.5	23	71.9	25	78.1
5-<10 years	45	42	93.3	30	66.7	40	88.9
10-<20 years	53	49	92.5	39	73.6	44	83.0
20 or more years	40	30	75.0	24	60.0	33	82.5
Separation type(f)
Voluntary separation	111	88	79.3	69	62.2	88	79.3
Medical separation	63	56	88.9	44	69.8	55	87.3
Other involuntary separation	81	68	84.0	54	66.7	66	81.5
All Ex-serving ADF members	267	221	82.8	173	64.8	217	81.3
Service status
Serving/Reserve	194	127	65.5	98	50.5	155	79.9
Ex-serving	267	221	82.8	173	64.8	217	81.3
Branch of service
Army	287	213	74.2	173	60.3	229	79.8
Navy	100	83	83.0	61	61.0	81	81.0
Air Force	74	52	70.3	37	50.0	62	83.8
All ADF members(g)	461	348	75.5	271	58.8	372	80.7

Notes

1. Data in this table indicates the number of ADF members for whom a particular risk was identified through analysis of coronial information. Risk factors may not be mutually exclusive and therefore people may be counted in more than one category.
2. The ABS coded associated causes of ADF member suicides based on the International Classification of Diseases. Mental and behavioural disorder includes ICD-10 codes F00-F99.
3. Natural disease includes all disease and health related conditions with the exclusion of mental and behavioural disorders, injuries, and external causes. ICD-10 codes A00-E90 and G00-R99.
4. For a complete list of psychosocial risk factors, refer to ABS explanatory note Annex listing: Psychosocial codes (exclusions and inclusions) in ABS: Psychosocial risk factors as they relate to coroner-referred deaths in Australia (cat. No. 1351.0.55.062).
5. Length of service only analysed for ex-serving ADF members.
6. Separation type is presented for ex-serving ADF members only. 12 members who died by suicide separated due to contractual/administrative reasons, of whom, 9 (75%) had mental and behavioural disorders, 6 (50%) had natural diseases, and 8 (67%) had psychosocial risk factors.
7. Includes only 461 ADF members who died by suicide, 2001-2018, that were able to be identified within both the National Death Index and in the National Coronial System. There were 4 ADF member suicides during this period that were not matched to coronial records that are excluded, see Technical notes.

Sources: AIHW analysis of linked PMKeyS–NDI–ABS coded NCIS data 2001–2018.

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Common mental and behavioural disorders

Many of the same natural diseases and mental and behavioural disorders were common among ADF males in the study cohort and Australian males who died by suicide (Table 10).

Table 10: Most common of natural disease and mental and behavioural disorder^(a) associated causes^(b) among ADF males^(c) and Australian males who died by suicide (ranked by proportion of suicides)

	Proportion of ADF males, 2001─2018 (%)	Proportion of Australian males, 2017 (%)
Natural disease
Suicide ideation (R458)	32.2	21.0
Finding of alcohol in blood (R780)	12.7	6.8
Finding of psychotropic drug in blood (R785)	8.5	7.1
Finding of hallucinogen in blood (R783)	7.3	4.9
Other chronic pain (R522)	4.0	N/A
Mental and behavioural disorders
Depressive episode, unspecified (F329)	48.5	42.3
Mental and behavioural disorders due to use of alcohol, acute intoxication (F100)	16.7	10.7
Post-traumatic stress disorder (PTSD) (F431)	14.1	N/A
Anxiety disorder, unspecified (F419)	11.8	15.3
Mental and behavioural disorders due to use of alcohol, harmful use (F101)	9.2	5.6
Total number of deaths by suicide(c)	425	2,450

N/A – not reported in ABS analysis of the most common associated causes for Australian males and therefore unavailable for comparison.

Notes:

1. ABS coding of associated causes of ADF member suicides is based on the International Classification of Diseases (ICD). Natural disease includes all disease and health related conditions with the exclusion of mental and behavioural disorders, injuries, and external causes. ICD-10 codes A00-E90 and G00-R99. Mental and behavioural disorder includes ICD-10 codes F00-F99.
2. Data in this table indicates the number of deaths for whom the associated cause was identified in analysis of coronial information. Associated causes may not be mutually exclusive, and therefore people with multiple causes recorded may be counted in more than one category.
3. Includes only ADF member deaths by suicide, 2001 to 2018, that were able to be identified within both the NDI and in the NCIS. There were 4 ADF member suicides during this period that were not able to be matched to a record in the NCIS. These 4 deaths are excluded from these tables. See technical notes.

Source: AIHW analysis of linked PMKeyS–NDI–ABS coded NCIS data 2001–2018; ABS 2020.

Mechanism of death

Table 11 provides summary statistics of the mechanism of death for members of the study cohort who died by suicide and comparisons with the Australian suicide population.

Hanging was the most common mechanism among ADF members (61%), similar to the Australian population (57%). Firearms were involved in a similar proportion of ADF members and Australian population suicides (7% of compared with 5%).

Table 11: Mechanism of death^(a), ADF members^(b) who died by suicide and the Australian suicide population, number and proportion

	ADF Suicides, 2001─2018		Australian Suicides, 2017
Mechanism of death(a)	Number	Proportion (%)	Number	Proportion (%)
Hanging	283	61.4	1,881	57.3
Poisonings	95	20.6	683	20.8
Firearms	33	7.2	167	5.1
Other	24	5.2	211	6.4
Falls	14	3.0	179	5.4
Contact with sharp object	n.p	n.p	98	3.0
Drowning and submersion	n.p	n.p	66	2.0
Total(b)	461		3,285

Notes

1. "Hanging" includes ICD-10 code X70; "Poisonings" includes ICD-10 codes X60-X69 and Y14; "Firearms" includes ICD-10 codes X72-X74; "Other" includes ICD-10 codes X75-X84 (excluding X78 and X80) and Y870; "Firearms" includes ICD-10 codes X72-X74; "Falls" includes ICD-10 code X80; "Contact with sharp object" includes ICD-10 code X78; "Drowning and submersion" includes ICD-10 code X71.
2. Includes only ADF member deaths by suicide, 2001─2018, that were able to be identified within both the NDI and the NCIS. There were 4 ADF member suicides during this period that were identified in the defence suicide database and unable to be confirmed in the NDI, or confirmed in the NDI but not matched to a record in the NCIS (see Technical Notes). These 4 deaths are excluded from these tables.

Sources: AIHW analysis of linked PMKeyS–NDI–ABS coded NCIS data 2001–2018; ABS 2020.