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• W2808103669 abstract "High rates of Indigenous suicide are a distressing phenomenon that plague several postcolonial countries.1, 2 In Australia, suicide is a leading cause of mortality for Aboriginal and Torres Strait Islander people.3 Indigenous suicide prevention has become a major theme of the Close The Gap Campaign,4 given that premature mortality from suicide is a major contributor to the life expectancy gap between Indigenous and non-Indigenous Australians. In the period 2012 to 2016, the suicide rate for Indigenous Australians was estimated to be 23.7 per 100,000, twice the rate (11.6 per 100,000) for non-Indigenous Australians.3 A recent publication from the National Coronial Information System (NCIS)5 compiled data on suicide deaths disaggregated by Indigenous status for the period 2001 to 2013. The data they presented highlights a major disparity in suicide rates between Indigenous and non-Indigenous Australians in younger age groups; the Indigenous suicide rate was 31.5 per 100,000 among those aged 15–44 years, compared to 11.1 per 100,000 for non-Indigenous people. Meanwhile, among those aged 45 years and older, there appeared to be no or minimal disparity in suicide rates by Indigenous identification. However, the NCIS data excludes the high number of suicide deaths where the Indigenous status was listed as ‘unknown’. Between 2000 and 2013, 4,896 of the total 32,032 suicide deaths in Australia were classified as unknown with respect to Indigenous status and 1,478 were classified as Indigenous.6 The proportion of deaths classified as unknown was substantially lower in states and territories with higher proportions of Indigenous Australians in the population, such as the Northern Territory, Western Australia and to some extent Queensland. The identification of a person as being Aboriginal and/or Torres Strait Islander is problematic within many health datasets, and this is amplified in Coronial datasets, given there is no possibility for self-identification of the deceased person. Nonetheless, Indigenous identification has improved in many jurisdictions over the past few decades, with greater efforts being made to capture Indigenous status in birth registrations.7 However, many Indigenous Australians, particularly middle-aged and older-aged Indigenous Australians, do not have their Indigenous status captured in official records. Consequently, we reason that the high number of suicide deceased persons whose Indigenous identification is classified as unknown could be impeding accurate estimates of the Indigenous suicide rate, particularly in those older groups where there are higher proportions of unknowns. To explore this, we had previously requested data from the NCIS on suicide deaths between 2000 and 2013, which revealed that, in older age groups compared to younger age groups, there is a marked increase in the proportion of suicide deaths with an unknown Indigenous status relative to those classified as Indigenous.6, 8 For example, among those aged 21 to 30 years, there was a ratio of 1.7 suicide deceased classified as unknown for every person classified as Indigenous, compared to a dramatically higher ratio of 6.7:1 among those aged 41 to 50 years. The ratio became more extreme with age. This would mean that if a percentage of those with unknown Indigenous identification are actually Indigenous people, then we are potentially underestimating the Indigenous suicide rate in older age groups more severely than in younger age groups. To further illustrate this point, we have generated a new graphic that outlines the potential impact of this phenomenon. Figure 1 shows the percentage increase in the number of Indigenous suicide deaths in each age group, based on conservative hypothetical scenarios in which small percentages (1%, 2.5%, 5% or 10%) of the unknowns are re-classified as Indigenous. Percentage increases in Indigenous suicide deaths within age groups, based on hypothetical scenarios where small percentages of suicide deceased classified as “unknowns” are re-classified as Indigenous. Source: National Coronial Information System, Intentional Self-Harm Fatalities of Aboriginal and Torres Strait Islander Australians, 2000–2013. Note: Figure 1 shows the percentage increase in the number of Indigenous suicide deaths within age groups based on conservative hypothetical scenarios in which very small percentages (1%, 2.5%, 5% or 10%) of suicide deceased persons who had been classified as having an “unknown” Indigenous status are re-classified as Indigenous If 5% of unknowns were re-classified as Indigenous, there would be relatively inconsequential percentage increases in Indigenous suicide deaths in the 11–40-year-old age groups. However, there would be quite substantial percentage increases in Indigenous suicide deaths in the middle- and older-aged groups. For example, in the 41–50 years age group, the number of Indigenous suicide deaths would increase by 33.3% if 5% of the unknowns were re-classified as Indigenous. Given that the denominator (i.e. the size of the Indigenous population in that age group) in our suicide death rate calculations remains unchanged while the numerator is increased, this would represent an equivalent increase of 33.3% in the suicide death rate for this age group. Figure 1 demonstrates that the proportional increases in Indigenous suicide deaths only continued to get larger with age, with potentially major implications for our calculation of suicide death rates for middle- and older-aged Indigenous Australians. What is the relevance of this? The findings presented by the above-mentioned NCIS report5 and others point to a clear need for concerted efforts in the area of Indigenous youth suicide prevention. Hopefully such data is legitimately resulting in suicide prevention funding for younger Indigenous Australians, such as the recent National Health and Medical Research Council’s targeted call for research into Aboriginal and Torres Strait Islander youth suicide prevention.9 However, our analysis of the interaction between unknown Indigenous status and age suggests that we may be underestimating the issue of suicide among middle- and older-aged Indigenous Australians. Interestingly, our recently published analyses of data from the Australian Longitudinal Study on Male Health (Ten to Men) found that the prevalence of suicidal thoughts in the preceding two weeks was highest among 40–55-year-old Indigenous males (28.7%), the oldest age-group in that particular dataset.8 Clearly there is an imperative to devote resources and further research to the area of Indigenous suicide prevention, with a view to increasing the availability of culturally appropriate and holistic suicide prevention supports that target Indigenous Australians of all ages." @default.
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• W2808103669 date "2018-08-01" @default.
• W2808103669 modified "2023-10-18" @default.
• W2808103669 title "Are we underestimating the suicide rate of middle and older‐aged Indigenous Australians? An interaction between ‘unknown’ Indigenous status and age" @default.
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• W2808103669 doi "https://doi.org/10.1111/1753-6405.12795" @default.
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