Australian Youth Self-Harm Atlas
The Australian Youth Self-Harm Atlas study investigated regional variability in suicidality and self-harm, as well as risk and protective factors, for young people aged 12 to 17 years. Aspects of the quantitative component of the study are presented here. The full Australian Youth Self-Harm Atlas: Summary Report (Hielscher et al., 2022), includes a summary of both quantitative and qualitative study components.
Strengthening suicide prevention
The National Mental Health and Suicide Prevention Agreement (Commonwealth of Australia, 2022) identifies the importance of strengthening regional planning and evaluation of suicide prevention initiatives. To do this, detailed regional data are needed.
The Australian Youth Self-Harm Atlas study:
- Is the first national Australian study to estimate the variability of youth self-harm and suicidality, across small areas of geography (Hielscher et al., 2022).
- Distinguishes between self-harm without suicidal intent, suicidal ideation/planning, and suicide attempt. This differentiation has service and program planning implications but is not often available within administrative datasets.
- Data are representative of whole communities, rather than being limited to the experience of those using hospital (or other healthcare) services.
While identifying communities whose residents are not faring as well as others may be seen as stigmatising, the purpose for doing so is to provide evidence upon which community members and decision-makers can rely.
About the Study
The Australia Youth Self-Harm Atlas study generated synthetic estimates of youth suicidality and self-harm using:
Generating synthetic estimates
The Australian Youth Self-Harm Atlas study generated synthetic estimates to enable measurement of suicidality and self-harm prevalence, and related risk and protective factors for small areas.
The Young Minds Matter (YMM) survey data holds information about suicidality and self-harm among young people that completed the survey. While the sampling strategy used for the survey was scientifically robust, not every community across Australia was invited to participate (Hafekost et al., 2016). As such, it is not possible to use YMM data to directly measure suicidality and self-harm among the young people within each community across Australia. To solve this problem, small area estimation methods were used to produce synthetic prevalence estimates of youth suicidality and self-harm for Statistical Area level 1s (SA1) across Australia. SA1s are a standardised measure of geography and part of the Main Structure of the Australian Statistical Geography Standard (ASGS), developed by the Australian Bureau of Statistics. SA1s generally have a population of 200 to 800 people, and an average population of about 400 people.
The small area estimation undertaken involved linking Young Minds Matter survey data with 2016 Census data. Noting that 2016 Census data are available for all SA1 areas, whereas the survey data are only available for those SA1 areas that were invited to participate. Patterns in responding for those who completed both the Young Minds Matter (YMM) survey and the 2016 Census were then used to extrapolate responses to the youth suicidality and self-harm YMM survey questions for communities that were not actually invited to complete the survey. Data generated in this way, using sophisticated statistical models, are referred to as synthetic estimates. Synthetic estimates generated for SA1 areas were then summed together and presented at broader areas of geography. Synthetic estimates were presented in this publication at SA3, SA4 and Primary Health Network (PHN) areas.
Australian Bureau of Statistics Estimated Resident Population data for 2019 were used to calculate suicidality and self-harm prevalence estimates for geographic areas.
As a means of external validation, synthetic suicidality and self-harm prevalence estimates were compared to rates of death by suicide. At an SA2 level, each of the suicidality and self-harm measures used within the study were positively correlated with the average annual rate of death by suicide between 2010-2019.
Synthetic estimates based on small numbers of young people were suppressed to maintain confidentiality and avoid publishing statistics of low reliability.
The Australian Youth Self-Harm Atlas study includes the following suicidality and self-harm outcomes:
- Self-harm (regardless of intent): self-injurious behaviour irrespective of intent or motivation, including behaviours with either suicidal or non-suicidal intent, or where intent is ambiguous. This was the primary outcome of this study (inclusive of non-suicidal self-harm and suicide attempt behaviour).
- Non-suicidal self-harm: self-injurious behaviour for which there is evidence that the person did not intend to kill themselves.
- Suicidal ideation/plans: thoughts of engaging in or planning suicide-related behaviour; without engaging in suicidal behaviour.
- Suicide attempt: non-fatal, self-directed, potentially self-injurious behaviours with an intent to die.
- Suicidality: suicidal thoughts or behaviours, including ideation, plans, and attempts.
Study limitations and important data considerations
The information provided by the Australian Youth Self-Harm Atlas Study may be the best available small area data for youth suicidality and self-harm.
Even so, there are important limitations to consider included within the ‘Study limitations and important data considerations’ sections of this publication.
The study team
The Australian Youth Self-Harm Atlas study was undertaken by a team of researchers and clinicians, and at the heart of the project was a partnership between Queensland Institute of Medical Research (QIMR) Berghofer and Roses in the Ocean. Roses in the Ocean is a lead Australian organisation for lived experience of suicide.
The AIHW has worked in collaboration with Youth Self-Harm Atlas study authors, Dr Emily Hielscher (formerly of Queensland Institute of Medical Research (QIMR) Berghofer) and Professor David Lawrence (Curtin University), to integrate quantitative findings of the study into the AIHW Suicide and Self-Harm Monitoring website.