About The New Zealand Suicide Prevention Strategy

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SPINZ Symposium Presentation, Dunedin, 29 November 2006. Maria Cotter and Dr Sarb Johal, Ministry of Health. http://www.spinz.org.nz

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  • Risk factors for different age groups Specific importance and risk factors for suicide and attempted suicide tend to vary with age. For younger people - childhood adversity and recent life stress tend to be more influential. Mood disorder plays an increasingly significant role with increasing age and makes a greater contribution to suicide risk among older adults than among youth.   The typical profile of youth (< 25 years) suicide describes a young male, characterised by family and social disadvantage, a history of attempted suicide, current mood disorder, and stressful interpersonal and legal life events.   Among adult suicides, males predominate, and mental disorder (particularly mood disorder) and a history of psychiatric hospitalisation play a dominant role. Against this background of mental health problems, recent interpersonal and legal life events increase suicide risk.   Among older adults, depression and a history of psychiatric hospitalisation are the major contributions to suicide risk.
  • Less is known about protective factors. These are some that have been suggested
  • Seven goals The understanding of the factors the can lead to suicide provide the foundation for the 7 goals of the Strategy. These outline the spectrum of suicide prevention and the direction for a NZ wide approach for the next 10 years. GOAL 1. To develop policies and services and strategies that: Reduce the population exposure to the range of social, familial and individual risk factors that contribute to MH problems and suicidal behaviour, and Promote resilience following exposure. Rationale: there is a substantial research that has shown that social, familial, individual and related factors contribute to the development of suicidal behaviour and to the development of mental disorders. Areas for action: Extremely broad, most have multiple outcomes, not just prevention of suicide. Eg: Supporting people to be more responsive of emotional distress and early signs of mh problems Initiatives targeting those factors that demote mh, eg discrimination, violence, abuse, neglect. Initiatives that encourage coping and problem solving skills Initiatives that affirm identity, including positive sexual orientation and cultural identity Current initiatives School based initiatives, eg Mentally Healthy Schools, Wellbeing programme, Travellers, Employment based initiatives, eg working Well,
  • About The New Zealand Suicide Prevention Strategy

    1. 1. The New Zealand Suicide Prevention StrategyLooking back to move forward Dr Sarb Johal and Maria Cotter Ministry of Health
    2. 2. Suicide Facts• 2004 - 486 people died by suicide compared to 517 in 2003• Males have higher rate of death by suicide than females - 3.1:1 in 2002-2004, unchanged from 2001-2003• 2005 - 4,433 hospitalisations for intentional self-harm, virtually same as 2004• Women have higher rate than men, 2:1• Maori hospitalisation rate is almost 1.5 x non-Maori rates
    3. 3. Te Rau Hinengaro - The NZ Mental Health Survey• About 1 in 5 experienced a mental disorder in last 12 months• About half of population will meet criteria for a mental disorder by age 75 years• 15.7% reported having thought seriously about suicide at some time• 4.5% report having made a suicide attempt• Suicide Trends reports trends / patterns in suicidal morbidity and mortality from 1921 to 2003 but does not provide explanations for these behaviours
    4. 4. New Zealand Suicide Trends• Mortality 1921-2003• Hospitalisations for Intentional Self-Harm 1978-2004• Data broken down into specific population groups, i.e. age, ethnicity, sex• To inform prevention efforts and to show whether progress is being made in reducing suicidal behaviour
    5. 5. Three-year moving averages• These are the average age-standardised rates for three year periods• i.e. 1983-1985, 1984-1986 1985-1987 and so on…• These allow for underlying trends over time to be more clearly illustrated• They also provide for a more reasonable level of certainty as to the level of change than would a rate for only one year
    6. 6. Summary• Overall pattern• Then, suicide and hospitalisation trends by:• Sex• Ethnic Group• Age• Socioeconomic Status• Method• DHB area
    7. 7. Leading causes of death for the total population, 2003 Major cause Heart disease Cancers RespiratoryUnintentional injury Endocrine Nervous system Mental disorders Digestive system Suicide Genitourinary 0 5 10 15 20 25 30 35 40 45 50 Percentage
    8. 8. 0 2 4 6 8 10 12 14 16 18 20 1923 1925 1927 1929 1931 1933 1935 1937 1939 1941 1943 Age-standardised rate per 100,000 1945 1947 1949 1951 1953 1955 1957 1959 1961 1963 1965 1967 1969 1971 1973Midpoint year of moving average 1975 1977 1979 averages, 1921-2003 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 Age-standardised suicide rates, 3-year moving
    9. 9. Overall trends• From 1921 – 2003, two peaks in • Hospitalisation for intentional overall suicide rate self-harm, similar trend to increases in suicide rate since• the mid 1970s. 1927-1929 – 18.5/100,000• Steep period of decline to 1942 • 1978-1980 period –• Relatively stable to mid-1980s 76.6/100,000• 1996-1998 second peak at • 1994-1996 – increased to 16.7/100,000 104/100,000• Rate declined to 14.2/100,000 in 2001-2003 • Change of data coding in 1999 & 2000 – further increases • 2002-2004 – 150.5/100,000
    10. 10. Beneath the overall trends• Overall trends conceal trends within sex, age and ethnic groups• Many of the trends in the document are primarily driven by changes of pattern in suicide in younger age groups and by differences between males and females
    11. 11. 0 5 10 15 20 25 30 35 1923 1925 1927 1929 1931 1933 1935 1937 1939 1941 1943 Age-standardised rate per 100,000 1945 1947 1949 1951 1953 1955 1957 1959 1961 1963 1965 1967 1969 1971 1973Midpoint year of moving average 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 Males Females 2001 Suicide rate, by sex, 3-year moving average, 1921-2003
    12. 12. Age-standardised intentional self-harm hospitalisation rates, by sex, 3-year moving averages, 1978-2004 Age-standardised rate per 100,000250 Females Males200150100 50 0 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Midpoint year of moving average
    13. 13. Trends by Sex• Overall trends in suicide mortality driven by male rates of suicide• Trends in hospitalisation are driven by female rates
    14. 14. Age-standardised suicide rates, by ethnicity, 3- year moving averages 2000-2003 Age-standardised rate per 100,00020 2000–02 17.7 17.8 2001–031816 13.5 13.71412 11.110 9.6 9.4 8.2 8 6 4 2 0 Māori European/Other Pacific Asian Ethnic group
    15. 15. Age-standardised intentional self-harm hospitalisationrates, by ethnicity, 3-year moving averages, 1978-2004 Age-standardised rate per 100,000 250 Māori Pacific Asian European/Other 200 150 100 50 0 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Midpoint year of moving average
    16. 16. Age-standardised intentional self-harm hospitalisation rates, by ethnicity and sex, 3-year moving averages, 1978-2004 Age-standardised rate per 100,000300 Māori males Non-Māori males Māori females250 Non-Māori females200150100 50 0 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Midpoint year of moving average
    17. 17. Trends by Ethnic Group• Highest suicide rate is for Maori, then European / Other, Pacific, then Asian ethnic groups• Disparity between Maori and all other ethnic groups is particularly high for Maori males < 35years• Disparity disappears for Maori males > 45• Maori females had higher rate of hospitalisation than all other combinations of sex & ethnic group• Maori males had higher rates of hospitalisation than non-Maori males
    18. 18. Age-specific suicide rate, by age group, 3-year moving average, 1921-2003 Age-specific rate /100,00045403530 5–14 years 15–24 years25 25–34 years 35–44 years20 45–64 years 65+ years1510 5 0 1923 1925 1927 1929 1931 1933 1935 1937 1939 1941 1943 1945 1947 1949 1951 1953 1955 1957 1959 1961 1963 1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 Midpoint year of moving average
    19. 19. Age-specific intentional self-harm hospitalisation rates, by age group, 3-year moving averages, 1978-2004 Age-specific rate per 100,000 350 5–14 years 15–24 years 300 25–34 years 35–44 years 45–64 years 250 65+ years 200 150 100 50 0 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Midpoint year of moving average
    20. 20. Age-specific intentional self-harm hospitalisation rates by sex, 15-24 years, 3-year moving averages, 1978-2004 Age-specific rate per 100,000500 Males450 Females400350300250200150100 50 0 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Midpoint year of moving average
    21. 21. Trends by Age Group• Major changes in pattern over time• 1921-1987 suicide deaths most common in those aged > 45 years• 1987 onwards, suicide deaths more common in those 15-24 years, then 25-34 years• Changes seem to have begun in the mid-1970s, though disparity between age groups have reduced over time
    22. 22. Age-standardised suicide rates, by quintile of deprivation (NZDep01), 3-year moving averages, 1983-2004 Age-standardised rate per 100,00025 Quintile 1 Quintile 2 Quintile 3 Quintile 420 Quintile 515 a10 5 0 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Midpoint year of moving average
    23. 23. Age-standardised intentional self-harm hospitalisation rate, by quintile of depression, 3-year moving averages, 1983-2003 Age-standardised rate per 100,000 250 Quintile 1 Quintile 2 Quintile 3 Quintile 4 200 Quintile 5 150 100 50 0 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Midpoint year of moving average
    24. 24. Trends by socioeconomic status• Over last 20 years, clear, unambiguous trend of higher rates of suicide in more deprived areas of NZ• Suicide rates in the least deprived areas are higher than any other time in last 20 years• Rates of hospitalisation have increased since 1983-1985 at all levels of deprivation - least deprived = biggest increases
    25. 25. Suicide rate, by method, 3-year moving average, 1921-2003 Age-standardised rate per 100,0008 Poisoning by solid or liquid substances Poisoning by gases and vapours7 Hanging, strangulation and suffocation Drowning6 Firearms and explosives Cutting and piercing Jumping from a high place543210 1925 1933 1941 1949 1957 1959 1965 1967 1973 1975 1981 1983 1989 1991 1999 1923 1927 1929 1931 1935 1937 1939 1943 1945 1947 1951 1953 1955 1961 1963 1969 1971 1977 1979 1985 1987 1993 1995 1997 2001 Midpoint year of moving average
    26. 26. Maps of age-standardised suicide rates, by District Health Board (DHB), three-year moving averages,1983–1985, 1992–1994 and 2001–2003
    27. 27. Maps of age-standardised intentional self-harm hospitalisation rates, by District Health Board (DHB), three-year moving averages, 1983–1985, 1992–1994, 2001–2003
    28. 28. Trends by DHBs• No consistent trends in suicide and intentional self- harm hospitalisation rates across DHBs• However, some indication that DHBs with high suicide rates have low rates of hospitalisation• Those with low rates of suicide have high rates of hospitalisation• HOWEVER, low numbers of suicide at DHB level of analysis so comparisons need to be interpreted cautiously
    29. 29. Why do we need a Strategy?• Suicide is complex• Contributing factors are many and varied• Requires a multi-sectoral approach• Linking of individual and population approaches• Need for a mechanism to organise and mobilise these efforts nationally, to address gaps and monitor progress.
    30. 30. Purpose• To reduce the rate of suicide and suicidal behaviour• To reduce the harmful effect and impact associated with suicide and suicidal behaviour on families/whanau, friends and the wider community• To reduce inequalities in suicide and suicidal behaviour
    31. 31. Principles• Be evidence based• Be safe and effective• Be responsive to Maori• Recognise and respect diversity• Reflect a coordinated multisectoral approach• Demonstrate sustainability and long term commitment• Acknowledge that everyone has a role in suicide prevention• Have a commitment to reduce inequalities
    32. 32. Pathways to suicidal behaviour• Wide range of factors – individual to macro-social• These can contribute directly, but also indirectly by influencing susceptibility to mental health problems
    33. 33. Pathways to suicidal behaviour (ctd)• Contextual factors also influence the extent to how these factors contribute to suicidal behaviours, eg:  Cultural factors may modify risk and protective factors  Institutional settings (school, workplaces, hospitals and prisons) may influence risk  Media climates may influence extent and expression of suicidal tendencies  Physical environments may influence availability of methods
    34. 34. Risk factors• A mix of conditions that contribute to the end point of suicide:  Mental disorders, including depression, bipolar disorders, schizophrenia, anxiety disorders, substance use disorders, antisocial and offending behaviours  Exposure to recent stress or life difficulty  Exposure to childhood adversity and trauma  Tendencies to react impulsively or aggressively under stress  Socioeconomic and educational disadvantages
    35. 35. Protective factors• Good coping and problem solving skills• Positive beliefs and values• Feelings of self-esteem and belonging• Social connections• Secure cultural identity• Supportive and nurturing family• Responsibility for children• Social support and access to services• Holding attitudes against suicide
    36. 36. Goal 1.• Promote mental health and wellbeing, and prevent mental health problems.
    37. 37. Goal 2.• Improve the care of people who are experiencing mental disorders associated with suicidal behaviour.
    38. 38. Goal 3.• Improve the care of people who make non-fatal suicide attempts.
    39. 39. Goal 4.• Reduce access to the means of suicide.
    40. 40. Goal 5.• Promote the safe reporting and portrayal of suicidal behaviour by the media.
    41. 41. Goal 6.• Support families/whanau, friends and others affected by a suicide or suicide attempt.
    42. 42. Goal 7.• Expand the evidence about the rates, causes and effective interventions.
    43. 43. Next steps• Identify what works• Take stock of what we have, what we don’t have, and what we need more of• Agree to a plan of action for the next 5 years• Establish a system to monitor our efforts nationally

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