Contributing Factors and Circumstantial issues of Suicides in Australia - Management Assignment Help

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Contributing factors and circumstantial issues of suicides in Australia with special reference to Queensland
Psychosocial risk factors and deaths by suicide in Australia
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 have suicidal behaviours. Approximately 2,000 deaths by suicide each year in Australia had one or more psychosocial risk factor identified—approximately two-thirds of all deaths by suicide registered each year (ABS 2020). The types of psychosocial risk factors associated with deaths by suicide were age dependent and differed throughout the lifespan.

From 2017 to 2019, the most commonly identified risk factors for males aged under 25 and 25–34 were a ‘personal history of self-harm’ (associated with about 20% of all deaths by suicide in these age groups in 2019), ‘disruption of family by separation and divorce’ (associated with 16% of all deaths by suicide in these age groups in 2019) and ‘problems in relationship with spouse or partner’ (associated with 12% of all deaths by suicide in males under 25 years and 17% of deaths by suicide in males aged 25–34).
These 3 risk factors featured across all male age groups to varying degrees; however, ‘problems related to other legal circumstances’ and ‘other problems related to housing and economic circumstances’ also emerged as common risk factors in middle-aged males (35–44, 45–54 and 55–64 years).
‘Limitation of activities due to disability’ was the most commonly identified risk factor in deaths by suicide in males aged 65 and over in 2017 to 2019.
In females, a ‘personal history of self-harm’ was the most common risk factor identified in all age groups, except for those aged 65 and older (for whom it was the second-most commonly identified risk factor in each year). In 2019, a ‘personal history of self-harm’ was associated with 19% of deaths by suicide in females aged 65 and older and 37% of deaths by suicide in females aged under 25.
For females aged 65 and over, ‘limitation of activities due to disability’ was the most common risk factor in each year (associated with 23% of deaths by suicide in this age group in 2019).
‘Disruption of family by separation and divorce’ and ‘problems in relationship with spouse or partner’ were generally the second- and third-most common risk factors in females aged under 45.
‘Disappearance and death of family member’ was also identified as one of the most frequently occurring psychosocial risk factors in each male and female age group.
Of note, ‘Social exclusion and rejection’ was only identified as a frequent risk factor for males aged under 25 (associated with 4% of deaths by suicide in this age group in 2019) while 'Bullying' was only commonly seen among females aged under 25 (associated with 4–10% of all deaths by suicide in females in this age group in 2017 to 2019).
‘Problems in relationship with parents and in-laws’ also only commonly occurred in those aged under 25 years (associated with 4–7% and 5–10% of deaths by suicide in males and females in this age group).
‘Unemployment, unspecified’ was a frequent risk factor in males in all age groups (associated with 2–6% of deaths by suicide in 2017 to 2019) except those aged 65 and older; however, this was not a common risk factor in females of any age.
There is no national standard for the collection of data on psychosocial factors—each state and territory has its own legislation and processes relating to coroner-certified deaths meaning that the type of information collected and held by the NCIS database differs slightly by jurisdiction. Also, due to the method used for the collection of data, protective factors are not included.
Mental health conditions – Queensland
In Queensland Over half (51.5%) of all people who died by suicide between 2014 and 2016 reportedly had one or more diagnosed mental health conditions. Depression was the most common, followed by anxiety and substance use conditions. A quarter (25.3%) of all people had seen a mental health professional in the last three months for a mental health condition. Suicide prevention interventions with people with mental health conditions work better when they explicitly discuss suicidality.55 QSR data from 2014 to 2016 showed that there was evidence of an untreated mental health condition (e.g. not taking medication) for 810 persons, 38% of all those dying by suicide.

Diagnosed mental health conditions of those dying by suicide, 2014–2016Life events before suicides – Queensland
Of the life events captured, relationship separation (27.2%) and conflict (15.3%) were the most frequent when combined. In all, 42.5% of suicides reportedly occurred during relationship difficulties. There were 145 domestic violence orders or applications involving the deceased, accounting for 6.9% of all suicides. In most instances (99, 4.7%), the deceased was the perpetrator (the respondent), then the victim (27, 1.3%), and in 19 cases (0.9%), the details were unknown. Financial problems were the next most frequent life event recorded (18.3%), followed by interpersonal or familial conflict (15.7%), bereavement (13.2%), recent or pending unemployment (12.7%), pending legal matters (11.6%) and work or school problems (8.9%). Of the life events captured, males dying by suicide were more likely than females to experience relationship separation (29.3% vs 20.3%) but not conflict (15.1% vs 15.9%); pending legal matters (13.2% vs 6.6%), financial problems (20.0% vs 13.1%), recent or pending unemployment (14.5% vs 7.0%), and child custody disputes (6.0% vs 4.6%). Action area 2, “Reducing vulnerability” in Every life,56 will involve a systemic review of male suicides that explores potential opportunities for reducing suicides involving relationships, employment issues, family law and alcohol and other drug misuse. Females dying by suicide were more likely than males to have experienced spousal bereavement (4.8% vs 2.3%), family (17.1% vs 9.3%) or interpersonal (5.8% vs 4.2%) conflict, childhood trauma (7.6% vs 3.4%), sexual abuse (6.4% vs 1.7%) and work or school problems that were not financial (10.0% vs 8.5%).

Employment status - Queensland
According to the Labour Market Information Portal (2021), Queensland records third highest unemployment rate (5.4) in Australia in last few years. Over a quarter (n = 569, 26.7%) of all those dying by suicide between 2014 and 2016 in Queensland were reportedly unemployed when they died. In contrast, the seasonally adjusted July 2015 unemployment rate in Queensland was 6.5%. The QSR recorded recent or pending unemployment as a life event in 270 (12.7% of) suicides occurring between 2014 and 2016. Almost a third (n = 633, 29.7%) of people dying by suicide were either unemployed or had experienced recent or pending unemployment
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Employment status of those dying by suicide in Queensland, 2014–2016Discussion
The current approach to suicide prevention has been criticised as being fragmented, with unclear roles and responsibilities across governments. This has led to duplication and gaps in services for consumers. Where there are competing or overlapping services, there is a lack of clarity about which services are most effective or efficient. (The Fifth National Mental Health and Suicide Prevention Plan)
Current suicide-prevention activities differ across levels of pre- vention. Activities at the universal level and those considering the continuing care of people with a history of suicidal behaviour are infrequently represented. More effort should be paid to implementing prevention activities in a coordinated way and avoiding undue duplication (given the limited resources avail- able). The overlapping of different programs also poses obvious obstacles to the correct identi?cation of what really works in suicide prevention. In this regard, increased emphasis should be put on the need for carefully evaluating implemented programs. For government-funded activities, evaluation should be compulsory. Ultimately, increased attention should also be dedicated to estimating the size of the population that actually benefits from a specific prevention program. Current suicide-prevention activities differ across levels of prevention. Activities at the universal level and those considering
the continuing care of people with a history of suicidal behaviour are infrequently represented. More effort should be paid to implementing prevention activities in a coordinated way and avoiding undue duplication (given the limited resources avail-
able). The overlapping of different programs also poses obvious obstacles to the correct identification of what really works in suicide prevention. In this regard, increased emphasis should be put on the need for carefully evaluating implemented programs. For government-funded activities, evaluation should be compulsory. Ultimately, increased attention should also be dedicated to estimating the size of the population that actually bene?ts from a
specific prevention program. Current suicide-prevention activities differ across levels of prevention. Activities at the universal level and those considering the continuing care of people with a history of suicidal behaviour are infrequently represented. More effort should be paid to implementing prevention activities in a coordinated way and avoiding undue duplication (given the limited resources available). The overlapping of different programs also poses obvious obstacles to the correct identification of what really works in suicide prevention. In this regard, increased emphasis should be put on the need for carefully evaluating implemented programs.
For government-funded activities, evaluation should be compulsory. Ultimately, increased attention should also be dedicated to estimating the size of the population that actually benefits from a specific prevention program.
There are limited suicide-prevention programs targeted people from culturally and linguistically diverse backgrounds. Migration has been considered a potential factor of stress, which may trigger mental health problems and suicidal behaviours. The existence of suicide-prevention programs for this population is important, given the substantial diversity of suicide rates by country of birth observed in first-generation migrants in Australia, and particularly in light of the growing number of Australian residents born overseas. Furthermore, second-generation migrants may be exposed to increased risk of suicide and there are rising concerns for refugees and asylum seekers. A very small number of programs targeted LGBT, veterans and people with chronic pain. Although two programs for LGBT were based on counselling and case-management services, no awareness-raising activities were available for this population. Awareness programs may be important to tackle stigma attached to non-heterosexuality, as well as for more accurate reporting of suicide in LGBT individuals, considering the lack of information on the sexual orientation of those who die by suicide, as noted by others.
There is limited evidence of effective interventions with older adults. A 2017 systematic review of 21 studies of older adult suicide prevention programs found that effective interventions included multifaceted primary care-based depression screening and management programs; treatment interventions (pharmacotherapy and psychotherapy); telephone counselling; and community-based programs that included education, gatekeeper training, depression screening, group activities, and referral for treatment (Okolie et al., 2017). The review also found that some interventions reduced the risk of suicide particularly among older females (Okolie et al., 2017). Only one intervention reduced suicides in elderly males: a 10-year program that included depression screening, followed by mental health care or treatment and education on depression (Oyama, Koida, Sakashita, & Kudo, 2004). Suicidal deaths decreased by 73% in males and 76% in females aged 65 and over in the geographic area receiving the intervention. De Leo and Arnautovska (2016), in a chapter on suicide in older adults, concluded that actively promoting adaptation to age-related conditions and changes to ensure successful ageing might best prevent suicidal behaviour in older adults. Lapierre et al., (2011) also suggested that innovative strategies were needed to improve resilience and positive ageing such as training and using family and community gatekeepers and using telecommunications with older adults who might be vulnerable. The most recent review noted that multifaceted interventions targeted towards primary care physicians and populations, and at-risk elderly individuals in the community may prevent suicidal behaviour (Okolie et al., 2017). In primary care settings, routine screening may focus on living conditions, depression and suicidal ideation (De Leo & Arnautovska, 2016).
Recommendations
More effective care during high-risk periods will be reflected in increased rates of follow-up for people seen in emergency departments after a suicide attempt (PI 21) or people discharged from hospital after care for a mental health condition (PI 16). Providing access to high-quality follow-up and support following a suicide attempt or crisis (known as ‘aftercare’), has been found to reduce the risk of further suicidal behaviours (Mann at el., 2005). Aftercare has been identified as a promising suicide prevention strategy by keeping high-risk individuals connected with support services and networks to promote safe living (Krysinska at el., 2016). A recent Australian study found that coordinated assertive aftercare has the potential to decrease suicide attempts by up to 19.8 % (Krysinska at el., 2016). However, there are very limited suicide Aftercare services in Queensland and this need to be seriously considered by Government and relevant authorities.
Improved data on care and outcomes following suicide attempts is a priority for future information development. The commitments in the Fifth Plan will support the development of better identification of suicide attempts in routine health data collections and better measurement of integrated care and follow-up after suicide attempts. Priority will be given to using data linkage to report on rates of suicide in the high-risk period following discharge from hospital.
Providing effective care and support for mental health conditions, including depression, is one essential strategy for preventing suicide. Better measures of access to and effectiveness of treatment and support services are therefore needed, particularly for people at high risk. Enhanced measures are also required to accurately measure the rate of suicide amongst people receiving community mental health care and support.
Conclusion and practical implications
Interventions can be targeted towards people experiencing the most common types of life events as mentioned in the report. Specifically, these include relationship separation and conflict, financial problems, recent or pending unemployment and pending legal matters. People experiencing multiple life events warrant a particular focus in suicide prevention initiatives. To this end, future directions for suicide prevention include increasing the breadth and depth of information collected on those who have died by suicide. Most importantly, this need to be accompanied by efforts to make that information available and timely to those who need to know through increased analysis, visualisation, and reporting. These efforts will ensure that the Queensland suicide prevention sector is well-informed of the characteristics of existing suicides occurring in their geographic areas and aware of the relevant literature on interventions to address various risk factors.
Current suicide-prevention activities differ across levels of prevention. Activities at the universal level and those considering the continuing care of people with a history of suicidal behaviour are infrequently represented. More effort should be paid to implementing prevention activities in a coordinated way and avoiding undue duplication (given the limited resources available). The overlapping of different programs also poses obvious obstacles to the correct identification of what really works in suicide prevention. In this regard, increased emphasis should be put on the need for carefully evaluating implemented programs. For government-funded activities, evaluation should be compulsory. Ultimately, increased attention should also be dedicated to estimating the size of the population that actually benefits from a specific prevention program.

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