Psychosocial risk factors and deaths by suicide
Capturing information on risk factors relating to deaths by suicide can highlight areas of a person’s life experience that may need additional attention to provide the most effective suicide prevention interventions. However, it is important to note that the presence of one or more of these risk factors in an individual’s life does not necessarily mean they will experience suicidal behaviours. The vast majority of people who experience these risk factors will not experience suicidal behaviours.
As part of the National Suicide and Self-harm Monitoring Project the AIHW has funded the Australian Bureau of Statistics (ABS) to identify and code (using ICD-10) psychosocial risk factors for deaths referred to a coroner, including deaths by suicide.
From 2018 to 2022, around two-thirds of all deaths by suicide had at least one or more psychosocial risk factor identified (ABS, 2023). The types of psychosocial risk factors associated with deaths by suicide were age dependent and differed throughout the lifespan.
Most frequently occurring psychosocial risk factors in coroner-certified suicide deaths by age and sex, Australia, 2022.
The horizontal bar graph shows the proportion of coroner-certified deaths by suicide with psychosocial risk factors identified in males in Australia in 2022. The user can choose to view the data by sex, by age groups, and by the number of deaths by suicide with psychosocial risk factors identified.
In 2022, among those who died by suicide:
- ‘Personal history of self-harm (Z915)' was the most commonly identified risk factor in males and females in all age groups (except males aged 45–54 years and males and females 65 years and over). The percentage of all suicide deaths with this risk factor was almost twice as high among females (34.0%) compared to males (17.4%). This code includes both intentional self-harm as well as suicide attempts (ABS, 2019).
- ‘Limitation of activities due to disability (Z736)’ was the most commonly identified risk factor in males and females aged 65 and over (27.1% and 35.0% respectively in 2022). This code included all types of disabilities as and health conditions which affected the individual’s abilities, such as chronic conditions in the elderly) and/or a perceived limitation of ability due to a newly diagnosed illness (ABS 2019).
- ‘Disruption of family by separation and divorce (Z635)’ was a common risk factor in males and females aged under 55. The percentage of all suicide deaths with this risk factor was higher among males compared to females across all age groups. This code includes relationship breakdowns or separation, divorce, and was also applied to children who died by suicide and were affected by separation of divorce of their guardians (ABS 2019).
- ‘Problems related to other legal circumstances (Z653)’ was a common risk factor in males aged 25–54 (associated with more than 10% of deaths by suicide). This code included domestic violence orders, child custody or support proceedings, litigation, restraining orders, potential or impeding legal circumstances or court appearances, charges which had been laid or the person was awaiting/anticipating commencement of legal proceedings and circumstances where death occurred in relation to illegal activities and not captured in a different code (ABS 2019).
- ‘Problems in relationship with spouse or partner (Z630)’ was also identified as a frequently occurring psychosocial risk factor in males and females across most age groups. This code includes intimate partner violence, relationship issues, acute events as well as ongoing/reoccurring, one off events which impacted the chain of events (leading to death) and domestic violence (ABS, 2019).
- 'Other problems related to housing and economic circumstances' codes Z599 and Z598 emerged as another common risk factor in males aged 55–64 and females aged 45–54. According to the ABS (2019) annex, code Z598 refers to ‘Other and unspecified problems related to economic circumstances’. This code included foreclosures on loans, problems with creditors, financial loss/difficulty/issues/troubles/concerns/problems/stress, bankruptcy, unemployment of a family member, unspecified financial issues or any other specific economic circumstances which do not fit in Z590-Z597 (ABS, 2019). Code Z599 refers to ‘Other and unspecified problems related to housing circumstances’. This included temporary housing, evection from housing (owner or renter), concerns over security of keeping or obtaining housing, and other specified housing circumstances which did not fit within codes Z590-Z597 (ABS, 2019).
There is no national standard for the collection of data on psychosocial factors—each state and territory has its own legislation and processes relating to coroner-certified deaths meaning that the type of information collected and held by the NCIS database differs by jurisdiction. Also, due to the method used for the collection of data, protective factors are not included. For the full ABS annex and code definitions, please click here.
COVID-19 psychosocial risk factors
Risk factors which were prevalent among cases of death by suicide in 2020–2021, namely those related to the COVID-19 pandemic, are rarely among the those most frequently occurring risk factors in 2022. Risk factors related to the pandemic are therefore low in prevalence when looking at the 2020 and 2021 years.
In 2020, the ABS added codes for the capture of the COVID-19 pandemic as a risk factor based on how it was described as part of the coronial investigation:
- F41.8 Pandemic-related anxiety and stress
- Z29.0 Isolation or quarantine (hotel or home), and
- Z29.9 Prophylactic measures put in place through health directives, including closure of business and stay at home measures.
In 2022, there were 84 people who died by suicide (2.6% of all suicides) who had the COVID-19 pandemic mentioned in either a police or pathology report, or a coronial finding. However, for people who died by suicide and had the COVID-19 pandemic mentioned as a risk factor, it did not appear as an isolated risk (they had, on average, 6.5 risk factors and 3.5 psychosocial risk factors). It is important to remember that circumstances relating to suicide are complex and multifaceted and a combination of multiple factors contribute to a person taking their own life rather than a single reason.
In 2022, of those who died by suicide with issues relating to the COVID-19 pandemic as a risk factor:
- 47.6% also had problems relating to employment or unemployment
- 46.4% also had mood disorders, including depression
- 17 people also had problems related to the social environment, including social isolation (this is down from 33 in 2020 but increase from 11 in 2021)
- the majority of people lived in New South Wales, Victoria, or Queensland (ABS 2023).
When COVID-19 was mentioned as a risk factor it manifested in different ways. For some people direct impacts from the pandemic, such as job loss, lack of financial security, family and relationship pressures, and not feeling comfortable with accessing health care were noted. For others, a general concern or anxiety about the pandemic and societal changes were stated or anxiety about contracting the virus itself. For further information about how the pandemic affected suicide rates, please visit the Suicide and Self-harm Monitoring COVID-19 page, here.
The ABS reviewed and coded psychosocial risk factors (defined as social processes and social structures which can have an interaction with individual thought, behaviour and/or health outcomes) associated with deaths by suicide in 2017 through a review of police, toxicology and pathology reports and coronial findings held by the NCIS. The AIHW is working with the ABS to continue this work and embed psychosocial risk factors in future national mortality data sets.
ABS (Australian Bureau of Statistics) 2019, Psychosocial risk factors as they relate to coroner-referred deaths in Australia, ABS Website, accessed 4 October 2023.
ABS 2023. Causes of Death, Australia 2022. ABS Catalogue number 3303.0.