At-a-glance – A contextual analysis of the Suicide Surveillance Indicators

Robin Skinner, MSP; Brittany Irvine, MA; Gabriela Willams, MSc; Caryn Pearson, MA; Jaskiran Kaur, BHSc; Xiaoquan Yao, MSc; Lee Merklinger, MA; Tanya Lary, MA

https://doi.org/10.24095/hpcdp.37.8.05

Author reference:

Public Health Agency of Canada, Ottawa, Ontario, Canada

Correspondence: Robin Skinner, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON  K1A 0K9; Tel: 613-799-5434; Email: robin.skinner@phac-aspc.gc.ca

The Federal Framework on Suicide PreventionFootnote 1  was developed by the Public Health Agency of Canada (PHAC) to set out Canada’s strategic approach to suicide prevention, in accordance with An Act Respecting a Federal Framework for Suicide Prevention (“the Framework”), which became law in December 2012. The Framework included a commitment to publicly report statistics on suicide and associated risk factors. Towards this commitment, PHAC developed a set of indicators necessary for comprehensive suicide surveillance to inform suicide prevention initiatives. These indicators included measures of outcomes and risk and protective factors at the individual, family, community and societal level.

The Suicide Surveillance Indicators (SSI) were selected through a  review of relevant literature retrieved from select publication databases (e.g. PubMed) and restrictions on type of evidence were applied: only systematic reviews, meta-analyses, literature reviews or government reports, published in English or French within the last six years, were eligible for inclusion. From this body of evidence, indicators—and data sources to operationalize measurement of indicators—were identified. External and internal stakeholders were asked to comment on the indicators and their operationalization. It is important to note that the literature review focussed on the general population only.

This At-a-glance brief presents the most current statistics available for reporting on the SSI. In addition, there is a brief analysis of select elements of the SSI to present the magnitude of the associations between certain mental illnessesFootnote 2 Footnote 3  and suicide-related behaviours (suicide thoughts, plans and/or attempts) using the 2012 Canadian Community Health Survey—Mental Health Component (CCHS-MH).Footnote 4  Further studies should continue to explore and monitor  the association between suicide outcomes and other risk and protective factors (e.g. child abuse, social support)Footnote 5  listed in the SSI in order to apply this knowledge to suicide prevention initiatives.

Results and discussion

Table 1 displays the SSI Quick Stats and presents current Canadian incidence rates of suicide-related mortality, self-inflicted injury hospitalizations and emergency department presentations, along with prevalence of suicidal thoughts, plans and attempts, and a list of key risk and protective factors. Canadian Vital Statistics indicate the suicide mortality rate was 11.5 per 100 000 people in 2013. Data from the CCHS 2015 indicate 2.5% of the population aged 15 years or older reported having suicidal thoughts (serious thoughts of committing suicide or of taking their own life), 0.8% had made a plan and 0.4% had attempted suicide, in the past 12 months.

With respect to mental illness, data from the CCHS-MH 2012 indicate 6.5% (95% CI: 6.0–7.0) of Canadians aged 15 years and older had symptoms consistent with a mood or generalized anxiety disorder in the past 12 months, 1.3% (95% CI: 1.1–1.5) reported ever being diagnosed by a health professional with schizophrenia or psychosis and 1.7% (95% CI: 1.4–2.0) with posttraumatic stress disorder.

Table 2 displays unadjusted odds ratios calculated from the CCHS-MH between select mental illnesses and suicide-related behaviours. The goal at this phase of analysis was to assess known individual relationships with suicide; however, future work will control for confounding factors. In addition, breakdowns of the proportions by variables such as age and sex will be available on the Government of Canada’s Public Health Infobase in the future. Consistent with the literature,Footnote 2 Footnote 3  having symptoms consistent with a mood or an anxiety disorder was significantly associated with suicide-related behaviours (OR = 18.1, 95% CI: 14.3–23.0). In addition, reporting a diagnosis of schizophrenia/psychosis, posttraumatic stress disorder or an eating disorder was also significantly associated with suicide-related behaviours, with odds ratios of 10.6 (95% CI: 6.9–16.1), 15.5 (95% CI: 10.3–23.5) and 13.0 (95% CI: 5.6–30.3) respectively.  

The ongoing monitoring and sharing of surveillance data on suicide mortality, suicide-related behaviours and associated risk and protective factors is a foundational element for suicide prevention in Canada.  

Table 1 - Suicide Surveillance Indicators Quick Stats, Canada, 2017 Edition
Indicator Group Indicator Measure(s) Latest Estimate Data Source (Year)
Suicide and Self-inflicted Injury Outcomes
Suicide mortality Mortality rate due to suicide, total population 11.5 per 100 000 people CVS (2013)
Self-inflicted injuries, hospitalizations Hospitalization rate for self-inflicted injuries (excluding Quebec) 50.2 hospitalizations per 100 000 people DAD (2014/2015)
Self-inflicted injuries, emergency department Emergency department (ED) presentation rate for self-inflicted injuries, Ontario 113.9 ED visits per 100 000 people NACRS (2014/2015) (ON)
Emergency department (ED) presentation rate for self-inflicted injuries, Alberta 160.5 ED visits per 100 000 people NACRS (2014/2015) (AB)
Proportion of emergency department (ED) presentations for self-inflicted injuries of total eCHIRPP cases among 10- to 24-year-olds 1072.8 ED visits per 100 000 eCHIRPP cases eCHIRPP (2011–2016)
Suicidal thoughts % of the population aged 15+ who report ever having serious thoughts of suicide or taking their own life (lifetime) 12.3% CCHS (2015)
% of the population aged 15+ who report having serious thoughts of suicide or taking their own life in past 12 months 2.5% CCHS (2015)
Suicidal plans % of the population aged 15+ who report ever making a suicide plan (lifetime) 4.5% CCHS (2015)
% of the population aged 15+ who report making a suicide plan in past 12 months 0.8% CCHS (2015)
Suicidal attempts % of the population aged 15+ who report ever attempting suicide or to take their own life (lifetime) 3.4% CCHS (2015)
% of the population aged 15+ who report attempting suicide or to take their own life in past 12 months 0.4% CCHS (2015)
Individual-level Risk and Protective Factors
Health status % of the population aged 12+ who self-rate their health as fair or poor 10.7% CCHS (2015)
% of the population aged 12+ who self-rate their mental health as fair or poorTable 1 - Footnote a 5.9% CCHS (2015)
% of the population aged 12+ with moderate or severe disability, as per HUITable 1 - Footnote b 31.7% CCHS (2015)
% of the population aged 12+ with one or more of these major chronic diseases: cancer, diabetes, cardiovascular and/or respiratoryTable 1 - Footnote c 23.7% CCHS (2015)
Chronic pain % of the population aged 12+ who report having moderate to severe pain that prevents some or most activities  8.30% CCHS (2015)
Sleep disturbances % of the population aged 15+ who report having trouble going to sleep or staying asleep most or all of the time 14.50% CCHS—Mental Health (2012)
Stress % of the population aged 12+ who perceive most days as being quite a bit or extremely stressful in past 12 months 21.40% CCHS (2015)
Mental illness % of the population aged 15+ who report symptoms consistent with mood and/or generalized anxiety disorder (GAD) in past 12 months  6.50% CCHS—Mental Health (2012)
% of the population aged 15+ who report having been diagnosed with schizophrenia and/or psychosis by a health professionalTable 1 - Footnote d 1.30% CCHS—Mental Health (2012)
% of the population aged 15+ who report having been diagnosed with an eating disorder by a health professionalTable 1 - Footnote d 0.40% CCHS—Mental Health (2012)
% of the population aged 15+ who report having been diagnosed with posttraumatic stress disorder (PTSD) by a health professionalTable 1 - Footnote d 1.70% CCHS—Mental Health (2012)
Violence % of the population aged 15+ who, before age 15, report experiencing at least one: physical or sexual violence by someone 18+ and/or exposure to violence exhibited by parents or guardians 32.90% GSS—Victimization (2014)
% of the population aged 15+ who report experiencing physical or sexual violence in past 12 months 4.10% GSS—Victimization (2014)
% of Grade 6 to 12 students who report being bullied by other students in past 30 days 25.1% CSTADS (2014–2015)
Substance use % of the population aged 15+ whose reported alcohol consumption exceeds Canada’s Low-Risk Alcohol-Drinking GuidelinesTable 1 - Footnote e 15.70% CTADS (2013)
% of the population aged 15+ who report experiencing at least one harm in past year due to illicit drug useTable 1 - Footnote f 2.90% CTADS (2013)
School environment % of Grade 6 to 10 students who agreed or strongly agreed that they felt they belonged at their school  63.10% HBSC (2013–2014)
Personality In development
Family-level Risk and Protective Factors
Family relationship % of Grade 6 to 10 students who report getting the emotional help and support they need from own family  64.90% HBSC (2013–2014)
% of Grade 6 to 10 students who report having a lot of arguments with their parents 21.70% HBSC (2013–2014)
% of Grade 6 to 10 students who report it is  easy or very easy to talk to their  parents about things that really bother them  83.20% HBSC (2013–2014)
Family mental illness and substance use % of the population aged 15+ with a family member who has problems with their emotions, mental health or use of alcohol or drugs, and report that their life is affected a lot or some  by their family member’s problems 13.70% CCHS—Mental Health (2012)
Family history of suicide-related behaviour In development
Community-level Risk and Protective Factors
Social support % of the population aged 15+ who report having no  family or close friends to talk to about what is on their  mind, feel at ease with, or call on for help 6.00% GSS—Social Identity (2013)
% of the population aged 15+ who report being satisfied or very satisfied with the communication frequency with friends and relatives not living with them 91.50% GSS—Social Identity (2013)
Sense of community belonging % of the population aged 12+ who report a somewhat strong or very strong belonging to local community 67.90% CCHS (2015)
Suicide contagion/clusters In development
Societal Risk and Protective Factors
Mental health service access % of the population aged 15+ who perceived a need for mental care in past 12 months 17.5% CCHS—Mental Health (2012)
% of population aged 15+ who perceived a need for mental health care in past 12 months, but reported it was not met, or only partially met 33.3% CCHS—Mental Health (2012)
Firearm possession Number of individual firearm licence holders aged 18+ as of December 2016 (% of population aged 18+ possessing a firearm licence) 2 066 961 (7.3%) RCMP (2016)Table 1 - Footnote g
Mental health literacy In development
Media reporting guidelines (adherence to) In development
Stigma In development
Poisoning control In development
Table 2 - Prevalence of select mental illnesses and suicide-related behaviours and bivariate associations, estimates for Canadians aged 15 years and older
Risk factor Unweighted nTable 2 - Footnote a EstimateTable 2 - Footnote b (%) 95% CITable 2 - Footnote b, α=.05 Suicide-related behavioursTable 2 - Footnote c
EstimateTable 2 - Footnote b (%) 95% CITable 2 - Footnote b, α=.05 Unadjusted ORTable 2 - Footnote b 95% CITable 2 - Footnote b, α=.05
Mood and/or generalized anxiety disorder (GAD) symptoms in past 12 months
Yes 1 748 6.5 6.0–7.0 25.5 22.0–29.1 18.1 14.3–23.0
NoTable 2 - Footnote * 21 876 93.5 93.0–94.0 1.9 1.6–2.1 1.0
Reported schizophrenia and/or psychosis diagnosis by a health professional
Yes 381 1.3 1.1–1.5 25.4 17.8–33.1 10.6 6.9–16.1
NoTable 2 - Footnote * 23 268 98.7 98.5–99.0 3.1 2.8–3.5 1.0
Reported posttraumatic stress disorder (PTSD) diagnosis by a health professional
Yes 425 1.7 1.4–2.0 31.8 23.1–40.4 15.5 10.3–23.5
NoTable 2 - Footnote * 23 205 98.3 98.1–98.6 2.9 2.6–3.2 1.0
Reported an eating disorder diagnosis by a health professional
Yes 102 0.4 0.3–0.5 30.7E 14.1–47.2 13.0 5.6–30.3
NoTable 2 - Footnote * 23 546 99.6 99.5–99.7 3.3 2.9–3.6 1.0
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