Data sources

End of life service use for those who died from suicide in Australia

Data sources

Data are from the National Integrated Health Services Information Analysis Asset (NIHSI AA) version 0.5. This data asset includes mortality data together with information from hospital admissions, Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS) and residential aged care data.

The analysis population was those who had died between 1 July 2010 and 31 December 2017 in the linked National Deaths Index (NDI). Suicide was defined as the principal external cause of death in X60–X84 and Y87.0 based on the International Classification of Diseases, Tenth Revision (ICD-10) codes. Patient demographic information was taken from the NDI and is therefore accurate at the time of death not time of service. 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 2022a). People without a primary cause of death and with sex not stated were also removed from the analysis due to small cell sizes.

Method

The analysis included MBS, PBS emergency department presentation and outpatient services in addition to hospital admissions datasets. For more information on MBS item classification and PBS item classification, drawn from the Anatomical Therapeutic Chemical (ATC) codes (AIHW 2022b), visit Mental health services in Australia – Data source and key concepts.

Hospitalisation data was taken from two sources: admitted patients and emergency department (ED) presentations. The method for counting hospital admissions in this analysis based on the method in a similar study by Clapperton et al. (2021).

Within the NIHSI AA v0.5, hospital data pertains to only New South Wales (NSW), Victoria (Vic) (excluding Albury-Wodonga), South Australia (SA) and Tasmania (Tas) public hospitals. Admitted patient information also contains information from private hospitals in Victoria. To ensure accurate comparisons with hospitals data, only deaths registered in NSW, Vic, SA and Tas are included in the analysis.

Admitted patient data refers to only acute admitted and mental health separations (Admitted Patient Care National Minimum Data Set care types of 1, 7.1, 7.2, and 11). In scope separations where the patient was transferred from another hospital or had a change of care type in the same hospital are not counted in the total to avoid duplication.

Any hospital episode (ED presentation, hospital admission) that ended in “death” was excluded as it was considered to be a result of the fatal (suicide) incident. The only exception to this were episodes where the intentional self-harm was coded as occurring in a health service area–these episodes were retained as they were most likely inpatient suicides (Clapperton et al. 2021). 

For admitted patient data, the definitions for mental health and self-harm behaviours include:

For ED presentation data, the definitions ‘mental health-related ED presentations’ refers to presentations that have a principal diagnosis that falls within the Mental and behavioural disorders chapter (Chapter 5) of ICD‑10‑AM (codes F00–F99). It should be noted that this definition does not encompass all mental health‑related presentations to ED. See Mental health services in Australia for further information.

Note that diagnosis codes for intentional self-harm sit outside the Mental and behavioural disorders chapter (X60–X84). Additionally, an ED presentation for self-harm may have a principal diagnosis relating to the injury. These presentations cannot be identified as mental health-related presentations and are not included in this analysis (AIHW 2022).

Presentations to hospital emergency departments relating to suicide attempts or intentional self-harm cannot be easily identified in the current national emergency department data collection. Furthermore, ICD‑10‑AM diagnosis codes for intentional self-harm do not specify if there was suicidal intent or not— and therefore includes both suicide attempts and non-suicidal self-harming behaviours (AIHW 2022b). See Suicide & self-harm monitoring: Intentional self-harm hospitalisations for further information.

 

‘Any hospitalisation’ refers to any acute admitted/mental health care separation or ED presentation.

Limitations of this analysis includes:

  • Mental health items could be miscoded or reported, for example, GP mental health services are typically billed under general GP consultations.
  • Service use captured in the NIHSI is influenced by severity of condition, a person’s ability and desire to access a service, and the availability of alternative services not captured in the data (e.g. private community mental health services).

References

Australian Institute of Health and Welfare (AIHW)  (2022a) Deaths in Australia, AIHW, Australian Government, accessed 11 October 2022.

Australian Institute of Health andAIHW Welfare (2022b) Mental health services in Australia, AIHW, Australian Government, accessed 09 September 2022

AIHW (2022c) Suicide and self-harm monitoring: Intentional self-harm hospitalisations, AIHW, Australian Government, accessed 14 October 2022.

Clapperton A, Dwyer J, Millar C, Tolhurst P and Berecki-Gisolf J (2021) ‘Sociodemographic characteristics associated with hospital contact in the year prior to suicide: A data linkage cohort study in Victoria, Australia’, PLoS ONE, 16(6): e0252682, doi:10.1371/journal.pone.0252682.