Introduction

Overview

This report analyses a cohort of ex‑serving ADF males who had at least one day of service since 1 January 2001 and died by suicide between 9 August 2011 and 31 December 2018. The AIHW has undertaken comprehensive analysis to identify potential demographic and socioeconomic factors related to death by suicide among ex-serving ADF males. The analysis compares the cohort with the total ex-serving ADF male population, and with the general Australian male population who died by suicide, where possible.

The analysis:

  • compares the socioeconomic characteristics of ex-serving ADF males who died by suicide with the total ex-serving ADF male population to provide insight into risk or protective factors for ex-serving ADF males.
  • compares the socioeconomic characteristics of ex-serving ADF males who died by suicide with Australian males who died by suicide to identify potential differences that may be associated with ADF service.

Background

This analysis was prepared for the Royal Commission into Defence and Veteran Suicide (Royal Commission) for its interim report that was published 11 August 2022.

The Royal Commission was established on 8 July 2021. Mr Nick Kaldas APM, the Hon James Douglas QC, and Dr Peggy Brown AO have been appointed as Royal Commissioners. The Royal Commissioners presented the Interim Report of the Royal Commission into Defence and Veteran Suicide to the Governor-General, His Excellency, General the Honourable David Hurley AC DSC (Retd) on 11 August 2022, and it was tabled in Parliament on 11 August 2022[1], and will subsequently be required to produce a final report by 17 June 2024. The Royal Commission will be conducted independently of Government, including the Department of Defence (Defence) and Department of Veterans’ Affairs (DVA).

The AIHW is engaging with the Royal Commission and providing technical expertise in veterans’ data linkage, integration and analysis relevant to the Terms of Reference[2] of the Royal Commission.

This project complements the existing AIHW veterans’ health and welfare program that aims to build a comprehensive profile of the health and welfare of Australia’s serving and ex-serving ADF population. This project also builds on the broader suicide work conducted by the AIHW about the whole Australian population.

Suicide prevention of ADF members is of significant public interest and a particular consideration for enabling positive health and welfare outcomes for ADF members. Understanding how selected demographic and socioeconomic characteristics affect the risk of death by suicide is important to better inform strategies to reduce suicide in Australia and may help in the planning of more effective evidence-based prevention and intervention programs.

The AIHW acknowledges that the data presented in this report represents human lives and we acknowledge all of those serving and ex-serving ADF members who have died by suicide. We also acknowledge all people who have been affected by suicide. We are committed to ensuring our work continues to inform improvements in mental health, suicide awareness and prevention.

About the MADIP project

This report is one of the first data integration projects to use Linkage Spine Interoperability (von Sanden 2020) that enables the Department of Defence (Defence) personnel data held at AIHW to be combined with data held at the Australian Bureau of Statistics (ABS) from the Multi-Agency Data Integration Project (MADIP) data asset without the need to share personal identifying information between each organisation. Linkage Spine Interoperability increases the efficiency of creating integrated data products between two agencies, reduces risks of sharing personal information, and facilitates better use of person-centred data enabling the expansion of research to be undertaken (PMC 2020).

Both the AIHW and the ABS are accredited Integrating Authorities. As such, they are responsible for ensuring data integration projects are conducted in sound, ethically approved and secure ways, and that researchers are provided safe and secure access to the integrated data. This data integration project was approved by both the AIHW Ethics Committee and the Departments of Defence and Veterans’ Affairs Human Research Ethics Committee (DDVA HREC).

The ABS is trusted as the accredited Integrating Authority for MADIP. The ABS collects and combines the data, provides access to authorised researchers, and protects individual privacy and keeps the information available in MADIP secure at all times. More information on MADIP is available from the ABS website.

This report used the same linked Defence data in MADIP as the following AIHW report: Understanding the wellbeing characteristics of ex-serving ADF members, Introduction published 1 September 2022 (AIHW 2022).

The main sources of data for this report were the 2011 Census of Population and Housing and ABS Cause of Death/Deaths Registrations data, to identify potential socioeconomic characteristics associated with greater risk of death by suicide among ex-serving ADF males.

Data Limitations

There are some challenges and limitations with the analysis of linked administrative data that should be noted, namely:

  • bias from linkage errors where records cannot be linked
  • data sources are of varying quality
  • limitations in the time period to which data are available
  • limitations with the study population.

Also, deaths by suicide are statistically rare events. Small numbers can raise privacy and confidentially issues but also statistical concerns. For this report, values based on small numbers of deaths have been suppressed in order to maintain data confidentiality, and/or avoid publishing statistics of low reliability. Statistics based on small numbers of deaths by suicide should be interpreted with caution and comparisons with other populations should be reported with context.  Further information can be found in the Technical notes

What is included in this report?

This report includes information on selected demographic and socioeconomic characteristics of ex-serving ADF members who had served at least one day since 1 January 2001. The total ex-serving ADF male population includes those who were alive or had died (including by suicide) during the study period (9 August 2011 to 31 December 2018). Socioeconomic characteristics analysed in this report include; marital status, education, employment, income, housing circumstances and living arrangements.

This report is based on ex-serving ADF members with at least one day of service since 1 January 2001 and were ex-serving as of 30 June 2011, to ensure they were ex-serving and alive at the time of the 2011 Census.

Of these 64,100 ex-serving ADF members, 7 in 10 (71%) linked to the 2011 Census data in MADIP which resulted in an in-scope population of 45,700 ex-serving ADF members (37,900 ex-serving ADF males and 7,800 ex-serving ADF females) aged between 17–80 years.

Of the in-scope 37,900 ex-serving ADF male population, the majority (98%) were alive for the duration of the study period and 1.9% had died between 9 August 2011 and 31 December 2018. Of the in-scope ex-serving ADF male population, 73 (0.2%) had died by suicide between 9 August 2011 and 31 December 2018.

The small number of observed deaths by suicide among ex-serving ADF females prevents robust statistical analysis and interpretation of data for females. Therefore, this report only considers ex-serving ADF males aged 17–80 years.

Further information on veteran population scope, analysis period and methodology can be found in the Technical notes.

Table 1: Ex-serving ADF males who were alive or had died 
  Number Proportion (%)

Alive(a)

37,236

98.1

Died(b)

711

1.9

     Died by suicide(c)

73

0.2

Total ex-serving ADF males(d)

37,947

100.0

Statistics based on small numbers of deaths by suicide should be interpreted with caution and comparisons with other populations should be reported with context. 

(a) Includes individuals who were alive at the time of 2011 Census, had a Census record and who were still alive during the study period between 9 August 2011 and 31 December 2018 inclusive.

(b) Includes individuals who were alive at the time of 2011 Census, had a Census record and who had died (including by suicide) during the study period between 9 August 2011 and 31 December 2018 inclusive. Includes all causes of death.

(c) Includes individuals who were alive at the time of 2011 Census, had a Census record and who had died by suicide between 9 August 2011 and 31 December 2018 inclusive.

(d) The total ex-serving ADF male population includes individuals who were alive at the time of 2011 Census, had a Census record, who were still alive or had died (including by suicide) during the study period between 9 August 2011 and 31 December 2018 inclusive.

Sources: AIHW analysis of linked PMKeyS - NDI - DSD 2001–2018 data and ABS MADIP – 2011 Census data (9 August 2011) – Cause of death/Deaths registrations data

Who is included in this report and what information is presented about them?

Population 1: Ex-serving ADF males with at least 1 day of service since 1 January 2001 who were ex-serving as of 30 June 2011 and were alive on 2011 Census night: Information presented for this population is sourced from 2011 Census and Personnel Management Key Solution (PMKeyS), and includes: marital status, education, employment, income, housing circumstances and living arrangements, demographic and service-related characteristics. This population includes those who were alive or had died (including by suicide) during the study period (9 August 2011 to 31 December 2018).

Population 2: Ex-serving ADF males with at least 1 day of service since 1 January 2001 who were ex-serving as of 30 June 2011, were alive on 2011 Census night but died by suicide between 9 August 2011 and 31 December 2018: Information presented for this population is sourced from 2011 Census, PMKeyS and ABS Cause of Death/Death Registrations, and includes: marital status, education, employment, income, housing circmstances and living arrangements, demographic and service-related characteristics. ABS Cause of Death/Death Registrations data was analysed in MADIP to identify those who died by suicide between 9 August 2011 and 31 December 2018. Population 2 is a subset of Population 1.

Population 3: Australian males who were alive on 2011 Census night: Information presented for this population is sourced from 2011 Census and includes: marital status, education, employment, income, housing circumstances and living arrangements. This population includes those who were alive or had died (including by suicide) during the study period (9 August 2011 to 31 December 2018).

Population 4: Australian males who were alive on 2011 Census night but died by suicide between 9 August 2011 and 31 December 2018: Information presented for this population is sourced from 2011 Census and ABS Cause of Death/Deaths Registrations, and includes: marital status, education, employment, income, housing circumstances and living arrangements. ABS Cause of Death/Deaths Registrations data was analysed in MADIP to identify those who died by suicide between 9 August 2011 and 31 December 2018. Population 4 is a subset of Population 3.

Further information on the data sources and population scope can be found in the Technical notes.

Notes on measures in this report

Information on suicide factors is presented in three ways in this report:

  • Counts and proportions, to give an indication of the size and distribution of the population.
  • Proportion ratios, to compare the proportions between two groups (e.g. to compare ex-serving ADF males who died by suicide with all ex-serving ADF males).
  • Risk ratios (RR), also referred to as relative risk, measure the risk between groups to a specific reference group. Risk ratios were calculated by dividing the risk (cumulative incidence) in one group by the risk (cumulative incidence) in a reference group.

Confidence intervals (CIs) of 95% are provided for proportion ratios and risk ratios to indicate the level of uncertainty around these estimates due to random fluctuations in the number of suicides. CIs give some indication of how close the true measure is likely to lie to the calculated measure. Narrower confidence intervals indicate more certainty in the result, and wider intervals means less certainty in the result.

More information on these measures is provided in the Technical notes.