Family and personal hardship: Psychosocial risk factors and deaths by suicide

Background

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 2023, around two-thirds of all deaths by suicide had at least one or more psychosocial risk factor identified (ABS 2024). The types of psychosocial risk factors associated with deaths by suicide were age dependent and differed throughout the lifespan.

Commonly identified risk factors in 2023

In 2023, among those who died by suicide:

• ‘Personal history of self-harm (Z915)' was the most commonly identified risk factor for females aged under 65 years and males aged 0 to 34 years and 55 to 64 years. The percentage of all suicide deaths with this risk factor was 32.5% for females and 17.7% for males. This code includes both intentional self-harm as well as suicide attempts (ABS 2019). 
• ‘Problems in relationship with spouse or partner (Z630)’ and ‘Personal history of self-harm (Z915)' were the two most commonly identified risk factors for males aged 35 to 44 years. ‘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).
• ‘Disruption of family by separation and divorce (Z635)’ was the most commonly identified risk factor for males aged 45 to 54 years and a common risk factor in males under 65 years and females aged under 45 years. The percentage of all suicide deaths with this risk factor was higher among females than males for ages under 35 years, and higher among males than females for ages 35 years and over. 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).
• ‘Limitation of activities due to disability (Z736)’ was the most commonly identified risk factor in males and females aged 65 years and over (25.0% and 27.1% respectively in 2023). This code included all types of disabilities as well as health conditions which reduced an 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).
• ‘Problems related to other legal circumstances (Z653)’ was another common risk factor in males aged 25 to 54 years and females aged 25 to 34 years (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).
• 'Other problems related to housing and economic circumstances (Z598)' was another common risk factor for males aged 45 to 54 years and females aged 55 to 64 years. For males, the percentage risk increased by age peaking for ages 45 to 54 years (12.0%) while for females the percentage risk continued to rise, peaking at 55 to 64 years (10.3%). According to the ABS (2019) annex, ‘Other and unspecified problems related to economic circumstances (Z598)' includes 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 Z590–597 (ABS 2019).

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, were rarely among the most frequently occurring risk factors in 2023. 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 2023, there were 29 people who died by suicide (0.9% of all suicides) who had identified COVID-19 as a risk factor (F41.8, Z29.0, Z29.9). Those who died by suicide between 2020–2023 with issues relating to COVID-19 as a risk factor represent 3.9% of all suicides during this period. 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, 7.4 risk factors and 3.7 psychosocial risk factors) (ABS 2024). 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 2023, of those who died by suicide with issues relating to the COVID-19 pandemic as a risk factor:

• 44.8% also had problems relating to employment or unemployment
• 41.4% also had mood disorders, including depression
• 10 people also had problems related to the social environment (this is down from 17 in 2022, 65 in 2021 and 66 in 2020).

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.

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Supplementary tables

Deaths due to suicide 2023 – National Mortality Database

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