A significant proportion of people who die by suicide have contact with the health system in their last year of life. These contacts points provide a potential touch point for suicide prevention activities. As Clapperton et al. (2021) argue, many prevention activities focus on people who access hospitals. However, Clapperton et al. (2021) also show significant proportions of people who die by suicide (particularly men) do not attend hospitals in their last year of life. It is important to focus not just on people who use services but also on people who do not access services.
Through this project we have used the National Integrated Health Services Information Analysis Asset (NIHSI AA) version 0.5 to look at patterns of health service use in the last year of life for people who have died by suicide. The main value add of this project, compared to earlier studies, comes from fact that the NIHSI AA includes both Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data. This is an important distinction as we show that people who die by suicide are considerably more likely to access MBS and PBS services in their last year of life than hospital services.
While this project provides the most comprehensive analysis of health service use in the last year of life for people who die by suicide it does have some important limitations. First the NIHSI AA does not include all health services. For example, it does not include community or residential mental health services. Second the emergency department (ED) data in the NIHSI AA does not identify intentional self-harm well as intentional self-harm is not identified well in ED data in most States and Territories (AIHW 2022a).
An additional limitation of this analysis relates to the fact that not all mental services under the MBS are billed as specific mental health items — some are billed under general GP items (AIHW 2022b).
The project has been established to measure and compare the patterns of health service use of Australians in their last year of life.
Specifically, in this analysis we aim to:
- measure the patterns of health service use in the last year of life
- identify key factors related to variation in the patterns of health service use in the last year of life such as age and sex.
Using linked datasets including the National Deaths Index, National Hospital Morbidity Database, National Non-admitted Patient Emergency Department Care Database, MBS and PBS, the NIHSI AA presents descriptive statistics to answer the research questions. While the MBS and PBS databases include national data, hospital data pertains to only New South Wales, Victoria (excluding Albury-Wodonga), South Australia and Tasmania public hospitals within the NIHSI AA v0.5. Admitted patient information also contains information from private hospitals in Victoria. To ensure accurate comparisons with hospitals data, only deaths registered in these jurisdictions are included in the analysis.
The analysis population was those who had died between 1 July 2010 and 31 December 2017 in the linked National Deaths Index. Only people whose age at death was between 15 to 64 years were included in the analysis. This was due to people in this age range making up the majority of those who die from suicide and to allow for better comparisons with deaths from other causes, which mostly occur in people older than 65 (AIHW 2022c). In the analysis population, people aged 15–64 years represented 82% of suicides (10,013 suicide deaths).
For further information on the dataset and methods used, visit Technical notes – Data sources.
People who died by suicide accessed fewer health services in their last year of life than those who died from other causes
Overall, 49% of 15–64 year olds who died by suicide did not have any contact with the hospital (emergency department (ED) presentation or hospital separation), compared to 24% who died by other causes. This is similar to results from Clapperton et al. (2021), who found that 50% of people who died by suicide in Victoria did not have any ED presentations or hospital separations in their last year of life, using data from the Victorian Suicide Register and including all age groups.
In addition to looking at overall access to hospitals it is also worth exploring access to individual services and how access to these services vary by age and sex.
- Females (59%) who died by suicide were considerably more likely than males to attend hospital for any reason in their last year of life (48%). There is also variation by age and sex with females aged 34–44 being the most likely to attend hospital (61%) and males aged 55–64 being the least likely to attend (45%).
- Females (53%) were more likely than males to attend an emergency department for any reason in their last year of life than males (44%). The highest rate was for females aged 25–34 (56%) while the lowest rate is for males aged 55–64 (39%).
- 9% of females and 6% of males who died by suicide had a mental health related ED presentation in their last year of life.
- While it is not possible to identify intentional self-harm ED presentations in the NIHSI AA it is possible to identify intentional self-harm ED presentations in Victoria. Clapperton et al. (2021) found that the vast majority of both males (92%) and females (84%) who died by suicide did not attend hospital for intentional self-harm in their last year of life as either an admitted patient or in an emergency department.
- A higher proportion of females (47%) who died by suicide were an admitted patient in hospital in their last year of life than males (32%). The highest proportion was for females aged 45–54 (49%) while the lowest proportion was for men aged 15–24 (26%).
- Only 13% of women and 6% of men who died by suicide were an admitted patient in hospital for intentional self-harm in their last year of life.
- Females (30%) who died by suicide were more likely than males (19%) to have had a mental health hospitalisation (this excludes ED presentations) in their last year of life.
- Both females (90% v 59%) and males (79% v 48%) who died by suicide were considerably more likely to have used MBS services than hospital services in their last year of life.
- Females who died by suicide (57%) were considerably more likely to have used MBS mental health services than males (37%) in their last year of life.
- Females (71%) who died by suicide were also more likely than males (50%) to have had a PBS mental health prescription in their last year of life.