Suicide in Australia

And how we talk about it.

As a paramedic, I see a lot of mental health cases. And I don’t mean “I get called out for mental health jobs a lot” (though that’s true), but that mental health issues permeate the community and impact on all of the other calls I get. Sometimes the ‘medical’ emergency we’re called for is psychogenic, actually a symptom of an inability to cope with a mental health problem. That alcohol intoxication or heroin overdose? That might’ve been because of an undiagnosed mental health problem (or undertreated existing one).

While plenty of people know suicide is bad and that it’s a problem in Australia, the media are intent on warping it in different ways. I present two different articles:

ABC.com.au: Australian suicide deaths rising among women and teenage girls, ABS figures show.

Sydney Morning Herald: Suicide rate: We need to stop the scourge killing our men

What do you notice about these two articles? Is it that the genders leap out at you? The two articles are from two slightly different time periods – in fact, separated by only a year – and yet both represent a gendered approach to the topic of suicide. Is this right? The ABC article notes a rise in suicide amongst women and teenage girls, and leads with this headline. The SMH notes that a significant number of suicide deaths in 2014 were males.

Should this be a gendered issue? In one way, no – both genders suffer from suicide, that much is clear. But one gender suffers to a much greater extent than any other, across almost every age group – males. Suicide isn’t unique to males, but it affects a far greater number of men than females, which suggests that there should be a greater focus there.

Note about transgender or LGBTQ+: The ABS data only lists ‘male’ and ‘female’ and is presumably sorted according to biological gender, not identified gender. As such, this article can’t comment on it.

What are the statistics?

ABS: Causes of Death 2015.

Intentional self harm is a major issue for Australians – and it’s on the rise. The standardised death rate for Intentional Self Harm (read: suicide) has been on the rise for both genders since 2013 – where it had declined from 2012. As a whole, the general trend since 2006 is an increase.

standardised20death20rates20for20intentional20self-harm202006-201520abc

This graphic from the ABS shows deaths per 100,000 of estimated mid-year population. To drill down into the raw data, the rate per 100,000 was 16 for males, and 4.7 for females in 2006. In 2015, it was 19.3 for males, and 6.1 for females. The dip in 2013? 16.6 for males, 5.5 for females.

Males are significantly more likely to commit suicide than females. This is borne out by the statistics shown above. The ratio is about 3:1. Three times as many males will successfully commit suicide than females. Even if you take into account a difference between males and females in terms of lifespan (males live shorter lives than females), males are still significantly more likely to commit suicide at two particular points in life: over the age of 85, and in their middle age of 40-50. This is over a decade of changes in mental health management and discussion (Burns, 2016 – see link). Notably, Burns finds that the suicide rate (except in males 20-34) either increased or stayed steady across the decade for age-standardised rates.

But what about the ABC’s suggestion that the number of women who end their lives is going up? The article is written like it’s a horrific epidemic that needs to be halted! Especially because young women are committing suicide in greater numbers! But what do the numbers say?

age-specific20death20rates20for20intentional20self-harm20by20sex20201520abc

Across every age range, males commit suicide at a higher rate than females. There are no exceptions. You will note that the 0-14 year group is not included: this is mostly because the rate of suicide in this group is so low to be negligible, but the rate for the 5-17 group was 2.4 in males, and 2.2 in females. This is a difficult thing to analyse – see the ABS 2016 report linked at the top.

Did the death rate for female deaths increase in 2014? Here’s the same chart, except from 2014:

age-specific20suicidea20ratesb202014c

The population adjusted rate for females in the 15-19 range was  5.3 in 2014, and 7.3 in 2015. For the 20-24 range it was 7.2 and 6.7 respectively. The jump in female suicide deaths in the 15-19 range is actually a decent increase: especially given the same rate for males of 12.1 and 11.8, where the suicide rate declined. However, it also increased in the 20-24 male range (20.6 vs 22.5).

As a matter of interest, women are more likely to self-harm than men, at least based on hospitalisation records. This doesn’t necessarily equate “self harm” with “suicidal intent” – self harm has many purposes, only one of which may have been as a suicide attempt.

There’s a difference between the genders when it comes to suicide methods too, at least according to Mindframe. The ABS statics for 2015 (3303.0 Causes of Death, Australia, 2015: Table 11.4) note the following:

  • Males predominately died by hanging (58%), with poisoning by drugs (including medications and illicit drugs, but not alcohol) coming second (10%), and firearms third (7%). Least popular was drowning or submersion (1%) and contact with sharp objects (3%).
  • Females also predominately died by hanging (48%), but poisoning by drugs was higher than males (26%) followed by other poisonings (including alcohol, inhaled gases, pesticides etc – 6%).

But what does this actually mean in terms of lives lost? Percentages and population adjusted figures don’t tug at the public’s heart quite like “X amount of people actually died.” From the Causes of Death 2015 report (ABS) we can glean the following raw numbers:

  • 2,292 males and 753 females died from intentional self harm in 2015.
    • In 2014, 2,160 males and 704 females died from the same.
  • In the 15-19 year group, 89 males and 56 females died from intentional self harm; in 2014 it was 92 and 38 respectively.
  • In the 0-14 group it was reversed; 6 males and 8 females died in 2015, and in 2014 it was 6 males and 15 females. However, as an age specific death rate, this represents 0.3 and 0.4 for males and females respectively; a tiny amount.
  • In every other age category in 2015, more males died than females – no age category had more than 82 female deaths (that being the 45-49 bracket).

But what about percentages of total deaths?

  • In the 15-19 age bracket, female suicides represent a higher percentage (33.9%) of total deaths than males (28.6%) – that is, 33.9% of all female deaths in that bracket were due to intentional self harm.
  • In every other category apart from 0-14 year olds (which is statistically insignificant), the percentage of male deaths was higher.
  • For all age ranges, male deaths by suicide make up 2.8% of male deaths. In females, it is only 0.9%.

So what’s the message?

The message is clear:

  • If you are male, you are at significant risk of suicide – especially as you approach middle age, and again as you approach over 85 (if you live that long – and your chances are limited).
  • If you are a female in the 15-19 bracket, you are also at a significant risk of suicide.
  • Mental health reform has failed to halt the rising trend towards suicide.

What do we make of our two articles, then? The ABC’s article seeks to create panic over the rise in female suicide rates, particularly in young women. The statistics show that the suicide rate is rising across both sexes and across almost all age brackets. The most significant exception is in the youngest brackets, where the rate for males 15-19 declined between 2014 and 2015 (marginally). Despite this, more men than women are killing themselves. While suicide isn’t a uniquely male problem, it is predominately a male problem. When the rise in female suicide is taken as part of the larger data, it seems somewhat absurd to focus on a rise in the suicide rate in one gender as something to write an alarmist piece about – because men are killing themselves at a faster rate too.

Significantly more men die than females; about 75% of the total suicide deaths are male. Yet the ABC published an alarmist article about the rise in female suicide – as if the concurrent rise in male suicide isn’t worth mentioning.

Does the SMH approach work better? While it correctly identifies that significantly more men kill themselves than women, it doesn’t help matters when it tries to focus suicide entirely on one gender. It does however provide a poignant reminder: in any other situation, where a particular gender has a significantly higher risk to their health, the focus on intervention and treatment goes to that gender. See domestic violence, where women, forming a majority of victims (how big that majority is depends on who you believe – but by any definition, it’s a majority) get the vast majority of support programs. For suicide though, that balance is lost; the male suicide rate isn’t thrust front and centre, and when the female suicide rate rises, that seems to attract more attention despite the male rate going up. At the same time, such a simplistic approach ignores the nuances in the data: the young female rate increased and represents a significant cluster of deaths; what happens here to cause this?

The real message is that mental health has universally failed those who have suicidal ideation – but it’s failing far more males and young females than any other group. Attempting to apply generic gender equations like the ABC ignores what the data is telling us. The ABC shrieks that more women killed themselves in 2015 than in 2014. So did more men – way more men. So what was their point?

The fact is that if we want to play a ridiculous game of “my gender is more important, yours is irrelevant to this discussion” then you can look at the horrific statistics and come to the conclusion that when we talk about suicide, males do the vast majority of the dying across the vast majority of age ranges by adjusted figures. But that ridiculous zero sum game is just going to bring about another failure of a mental health system – and the current one is bad enough already.

How do we fix it? By targeting the problem groups and figuring out why they’re killing themselves. And no, this doesn’t mean nebulously blaming ‘the patriarchy’ and blaming all males for male suicide, because despite the shouting about the evils of the patriarchy, people are still killing themselves. Instead, we need to target the major groups for suicide: that being middle aged males, elderly males, and young females. These groups are most likely to kill themselves. Beyond that, suicide needs to investigate males in general; we’re killing ourselves at a far high rate than females, and this is one instance where there needs to be a gender focus in general. Until we start recognising this epidemic in the male population, things are only going to get worse. It’s easy in the current sociopolitical climate to make young females killing themselves sympathetic – it’s much, much harder to do the same for a 45 year old male.

From the front lines…

As a paramedic, I’ve walked into plenty of attempted suicides. The vast majority were never going to actually successfully die; when I think back on the ones I’ve attended, the most common method was taking prescription medications (usually diazepam) at sub-toxic doses, and then immediately calling for an ambulance. I’ve been to quite a few successful suicides – all but one were men, and all but one was a hanging. The remainder was a male who overdosed – but he overdosed on an obscene amount of medications (polypharmacy overdose), mostly cardiac, at insane doses. All of them had a common theme – they either didn’t tell anybody, or they only told someone who was too far away to actually do anything and who didn’t believe them. Most weren’t found until a day or so later. All were well and truly beyond resuscitation.

Suicide is also a topic that weighs heavily on the minds of anyone in emergency medical services – our suicide rate is higher than the general population. The next suicide we go to might very well be one of our own.

While people seek to fight over genders and trying to focus the lens of healthcare policy on their specific demographic, people will keep dying, and we’ll keep picking up the pieces afterwards. The statics don’t tell us why people chose to kill themsleves. Only who is killing themselves, and how they did it. The ‘why’ is the eternal question, and until we start making progress on identifying it, males and young females will keep dying in increasing numbers.

 

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