Australian suicide trends 1964-1997: youth and beyond?
Christopher H Cantor, Kerryn Neulinger and Diego De Leo
MJA 1999; 171: 137-141
More articles on Psychiatry
Objective: To examine Australian suicide rates
across all ages, and compare Australian rates with those of other
Design: Australian Bureau of Statistics data were used to
examine Australian suicide trends, 1964-1997, by age and sex. For
comparison, suicide rates of 22 other Western nations, 1990-1994,
were obtained from the World Health Organization.
Results: Australian suicide rates for males 15-24 years
and 25-34 years rose from 1964-1997. Comparable rates for females
showed no significant change. Suicide rates for several of the older
age and sex groups declined over this period. Comparison with suicide
rates of other Western nations showed that, while Australian youth
suicide rates are relatively high, this is not the case for older age
groups. Australian suicide rates are higher than those in the
European nations of origin of our major migrant groups, but similar to
those of other Western nations also recently colonised by Europeans
(Canada, the United States and New Zealand).
Conclusions: Priorities for suicide prevention in
Australia are correctly concentrated on youth, but the targeted age
range should be extended to include men aged 25-34 years. A
comprehensive policy should also not neglect the needs of other age
groups. Further epidemiological study of national and
international data may suggest new approaches to suicide
It is well known that there is a high suicide rate in Australian males
aged 15-24 years, and previous and present governments have
instituted committees to address youth suicide rates.1 There have been
only sporadic reports of suicide rates in other age
groups,2 including suggestions of
high rates in elderly people.2,3|
We present suicide rates and trends across all ages, placing them in
context by comparing them with rates from other Western nations. The
national focus on youth suicide to the relative exclusion of older age
groups is examined in the light of these data.
Australian suicide and population data for
1964-1997 were obtained from the Australian Bureau of Statistics
(ABS) and annual suicide rates (per 100 000 estimated mean resident
population) were calculated (see Appendix). These
were plotted by 10-year age groups and sex over time. Change over time
was examined by comparing the suicide rate in 1964-1966 (rates were
averaged to smooth out random fluctuations within one-year periods)
with the suicide rate in 1995-1997; 95% confidence intervals were
calculated for these two time periods to assess the significance of
change. Variations in suicide rate trends over this 34-year period
were assessed by calculating the series autocorrelation suicide
rates and the values of Pearson's correlation coefficient.
Years of potential life lost (YPLL) were calculated
for 10-year age and sex groups for the most recent year (1997). The
formula used was adapted from that used by the Australian
Bureau of Statistics4 in order to incorporate age
groups (Box 1). The Australian population at 30 June 1991 was chosen as
the standard population, as suggested by the Australian Bureau of
International data were obtained from the World Health
Organization (WHO)5-8 and Lester and
Yang.9 Mean suicide rates were
calculated for 23 Western countries (including Australia),
averaged over 1990-1994, for 10-year age and sex groups. These
10-year age and sex rates were then ranked to compare Australia with
Figures 1-8 show suicide rates over time for sex and 10-year age
groups, as well as all ages combined.
Males Suicide rates overall and for those aged 15-24 and 25-34 years
increased significantly over time (1964-1966 to 1995-1997).
The rise in suicide rates from 1973-1997 for men aged 25-34 years was
of similar magnitude to the rise for those aged 15-24 years (Figures 2
Suicide rates in the older age groups (35 to 75 years and over)
declined (for men aged 35-44 years and 75 years and over these declines
were not statistically significant).
Significant autocorrelations (P < 0.01) were found in
each age group and for all ages combined.
Females Suicide rates overall and for each age group from 25 to 75 years and
over declined significantly (1964-1966 to 1995-1997).
There was no change in suicide rates for females aged 15-24 years.
Significant autocorrelations (P < 0.01) were found for
all ages combined and for most age groups (the exceptions were those
aged 15-24 years and 75 and over).
Years of potential life lost by suicide in 1997 are shown in Box 2.
Boxes 3a and 3b list the mean suicide rates (per 100 000 population) by
age group and sex for 23 Western nations, including Australia.
The priority accorded to youth suicide prevention by successive
Australian governments is supported by our data. In the last three
decades, when overall suicide rates were falling, the suicide rate of
males 15-24 years more than doubled. Suggestions of a plateauing of
this rate since 1989 are not supported by the latest figures for 1997,
although it is premature to draw conclusions either way. (It should
also be noted that at the time of submission of this article there were
significant concerns about the validity of the 1997 suicide rate
figures. For example, major rises in rates in New South Wales and
Victoria were absent from Queensland -- the next most populous State
-- suggesting the possibility of interstate data collection
From a policy perspective, the most important finding is that suicide
rate increases since 1973 for men aged 25-34 years have paralleled
those of 15-24 year olds, with even less evidence of a recent plateau.
Despite having shorter life expectancies, the toll in potential
years of life lost (in 1997) was greatest for 25-34 year olds. These
years are also the peak years for early parenthood, making the
likelihood of there being bereaved offspring greater than in the
younger group. These findings suggest that priority initiatives for
youth suicide prevention should be extended to those aged 15-34
years, if not further (the high level of potential years of life lost
continues to 44 years). The Federal Government's recently announced
National Suicide Prevention Policy provides for ages beyond youth,
by recognising that rising rates are not confined to the age group
15-24 years and that high suicide rates in the elderly should not be
It is unclear whether or to what extent the suicide phenomenon in boys
and young men might be a cohort effect -- a "damaged" generation. The
later commencement of the rise in suicide rate in men aged 25-34 years
and the, as yet, absence in this age group of the possible 1990s plateau
could be seen as consistent with this.
Rates in females aged 15-24 years showed no convincing rise. It has
previously been noted that suicide rates in females aged 15-19 years
rose modestly between 1960 and 1989, while rates for those aged 20-24
years showed no overall change over this period.10 However, much
of the rise in females aged 15-19 years was in the early 1960s,
predating the rise in rates of 15-19-year-old males, but coinciding
with a general, transient rise in suicide rates in females of all ages.
Perhaps the most important observation regarding young females in
the present study is that their suicide rates remained relatively
static at a time when rates for most other female age groups declined.
Suicide rates in children under 15 years of age have not significantly
altered over time, although the small numbers involved do not lend
confidence to rate estimates. The recording of suicide in children
under the age of 10 years is affected by the different criteria used by
the Australian Bureau of Statistics for determining suicide: it is
considered that children have a limited ability to form an intent to
suicide. Hence, more explicit evidence of suicidal intent is
required,11 usually a coroner having
stated explicitly that suicide was the cause of death. As most State
and Territory Coroners' Acts discourage if not prohibit such
findings (for all ages), such explicit statements are
Beyond 35 years in women, and 45 years in men, and up to 75 years and over
for both sexes, Australian suicide trends are striking. In both sexes
there have been major declines, and for much of the period these
declining male and female rates have been parallel, quite unlike the
trends for 15-24 year olds. It is unclear whether these declining
rates have as yet plateaued. Even if this were not the case, it is
inevitable that these declining rates will shortly level out and
increase again (from the trends over the complete period a number of
these age rates would reach zero in the early decades of the next
century). In the early 1960s, suicide rates, particularly in women
and in older age groups, rose in association with an epidemic of
barbiturate poisoning, subsequently to fall in the late 1960s,
reaching rates in the early 1970s similar to those before this
epidemic.12,13 The causal factors
determining the subsequent decline in rates of those between 35 and 74
years are yet to be determined. It is possible that such determination
might yield valuable clues as to the causes and possible methods of
preventing suicide in young people.
International comparisons should be interpreted conservatively,
as variations in data collection systems will account for
some of the variations. With these reservations in mind, among 23
Western nations, Australian suicide rates for 15-24 year olds ranked
fourth for males and eighth for females (Boxes 3a and 3b). Australian
rates for both sexes between the ages of 35 and 74 years, as well as
declining, compared favourably internationally (ranking in the
middle of or below those of other Western nations).
Although Australian suicide rates for those over 75 years were not
declining, they nevertheless again compared favourably from an
international perspective. Whereas the Australian suicide rate for
15-24-year-old males was over half that of the highest-placed nation
(Finland), the corresponding ratio for males 75 years and over was
about one-sixth. For females, these comparisons were even more
marked. Nevertheless, a comprehensive policy should not overlook
the needs of men over 75 years, especially as, in Australia, suicide
rates in this age group surpass those of all other age groups.
The Western nations with lower suicide rates include those that
provided most of the early immigrants to Australia: Greece, Italy
(except in the elderly), the United Kingdom and Ireland. The highest
suicide rates were in mainland Western Europe (especially Hungary)
and Scandinavia (especially Finland). Some of these nations, for
example Denmark, have profiles radically different from that of
Australia, with lower youth suicide rates but much higher rates in
those over 35 years of age.
Canada and, to a lesser extent, the United States and New Zealand are
the nations with suicide rate profiles most similar to Australia's.
All four of these nations have common characteristics of European
migration, a comparatively short history (apart from their
indigenous populations), geographical isolation, climatic
extremes and more.10 They serve as potentially
valuable nations to study shared characteristics that may affect
Studies have yet to provide explanations for these similarities and
differences which have often been overlooked, largely as a
consequence of the worldwide lack of epidemiological mental health
data. While differences in prevalence of psychiatric disorders are
potentially relevant, the magnitude of the different international
rates suggests other factors may operate. Hungary and Finland share
common cultural origins and high suicide rates. It has been suggested
that Finland's high suicide rates in young men may relate to cultural
expectations that men should be tough and resilient14 -- a
suggestion that might be equally relevant in Australia, New Zealand,
the United States and Canada. It is possible that a better
understanding of cultural influences and how to positively modify
them might be relevant to suicide prevention.
The study was funded by Griffith University and Queensland Health
through their co-funding of the Australian Institute for Suicide
Research and Prevention. We thank the Australian Bureau of
Statistics for providing information on suicide and population
- Commonwealth Department of Health and Family Services. Youth
suicide in Australia: a background monograph. 2nd edition.
Canberra: AGPS, 1997.
Snowdon J. Suicide rates and methods in different age groups:
Australian data and perceptions. Int J Geriat Psychiatry
1997; 12: 253-258.
Hassan R, Carr J. Changing patterns of suicide in Australia.
Aust N Z J Psychiatry 1989; 23: 226-234.
Australian Bureau of Statistics. Causes of death, Australia,
1996: 73. (Catalogue No. 3303.0.)
World Health Organization. World Health Statistics Annual 1992.
Geneva: WHO, 1993.
World Health Organization. World Health Statistics Annual 1993.
Geneva: WHO, 1994.
World Health Organization. World Health Statistics Annual 1994.
Geneva: WHO, 1995.
World Health Organization. World Health Statistics Annual 1995.
Geneva: WHO, 1996.
Lester D, Yang B. Suicide and homicide in the twentieth century:
Changes over time. Commack, NY: Nova Science, 1998: 165-204.
Cantor CH, Leenaars AA, Lester D, et al. Suicide trends in eight
predominantly English-speaking countries 1960-1989. Soc
Psychiatry Psychiatr Epidemiol 1996; 31: 364-373.
Cantor CH, Neulinger K, Roth J, Spinks D. The epidemiology of
suicide and attempted suicide among young Australians: a report to
the National Health and Medical Research Council: Australian
Institute for Suicide Research and Prevention. In press.
Oliver G, Hetzel BS. An analysis of recent trends in suicide rates
in Australia. Int J Epidemiol 1973; 2: 91-101.
Whitlock FA. Suicide in Brisbane, 1956-1973: The drug-death
epidemic. Med J Aust 1975; 1: 737-743.
Retterstol N. Suicide in the Nordic countries.
Psychopathology 1992; 25: 254-265.
(Received 14 Jan, accepted 7 Jun, 1999)
Australian Institute for Suicide Research and Prevention, Griffith
University, Nathan, QLD.
Christopher H Cantor, FRANZCP, MRCPsych, Senior Research
Kerryn Neulinger, BBehSc, GradDipPsych,
Diego De Leo, MD, PhD, Director.
Reprints will not be available from the authors.
Correspondence: Dr C
H Cantor, Australian Institute for Suicide Research and Prevention,
Griffith University, Nathan, QLD 4111.
|Back to text|
|Back to text|
|Back to text|
3a: Mean male suicide rates (per 100000 population) for 23 Western countries by 10-year age groups, 1990-1994|
|15-24 years||Finland 41.4|
New Zealand 39.0
N Ireland 17.6
|25-34 years||Finland 60.7|
New Zealand 32.0
|Scotland 26.1 |
N Ireland 22.4
|35-44 years||Hungary 82.0|
New Zealand 23.9
N Ireland 15.5
|45-54 years||Hungary 95.1|
New Zealand 24.2
N Ireland 15.1
|55-64 years||Hungary 84.6|
New Zealand 23.2
N Ireland 17.4
|65-74 years||Hungary 92.5|
New Zealand 21.2
N Ireland 12.8
|75+ years||Hungary 183.0|
New Zealand 29.8
N Ireland 13.3
|Back to text|
Appendix: Identifying suicide deaths in Australia11|
Coding deaths as suicide relies on an interaction between the Australian Bureau of Statistics (ABS) and State and Territory coroners and government medical officers. The six States and two Territories of Australia each have different Coroners' Acts. Most States and Territories discourage coroners from making formal pronouncements about suicide. Western Australia and New South Wales are the only States that routinely use suicide verdicts. ABS receives information from coroners that is generally sufficient for coding in most cases.
Deaths that were in reality suicides, but were not deemed as such by coroners or the ABS, will most likely be coded as undetermined deaths or accidents, and involve similar causes as suicide deaths (eg, poisoning). There has been a rise in both undetermined and accidental deaths in recent years. However, the impact of these uncertainties is unlikely to be sufficient to greatly alter our overall study findings.
|Back to text|
3b: Mean female suicide rates (per 100000 population) for 23 Western countries by 10-year age groups, 1990-1994|
|15-24 years||Finland 7.5|
New Zealand 6.2
N Ireland 2.4
|25-34 years||Finland 12.0|
New Zealand 7.3
N Ireland 3.9
|35-44 years||Hungary 20.3|
|New Zealand 6.9|
N Ireland 6.8
45-54 years||Hungary 26.5|
N Ireland 9.4
|New Zealand 8.9|
|55-64 years||Denmark 28.5|
New Zealand 7.7
N Ireland 4.8
65-74 years||Hungary 37.6|
New Zealand 6.6
N Ireland 3.9
|75+ years||Hungary 67.3|
New Zealand 4.3
N Ireland 2.5
|Back to text|