A contextual analysis of the Suicide Surveillance Indicators

The Federal Framework on Suicide Prevention¹ 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, metaanalyses, 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 illnesses^2,3 and suiciderelated behaviours (suicide thoughts, plans and/or attempts) using the 2012 Canadian Community Health Survey—Mental Health Component (CCHS-MH).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)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.

Table 1. SUICIDE SURVEILLANCE INDICATORS QUICK STATS, CANADA, 2017 EDITION.

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,^2,3 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 suiciderelated 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.

Table 2. Prevalence of select mental illnesses and suicide-related behaviours and bivariate associations, estimates for Canadians aged 15 years and older.

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.

Future work

The PASS Indicators are evergreen. Although measures and data exist to report on many indicators identified within the Indicator Framework, there are still gaps, especially at the environmental levels. Active enhancement and data development using surveys and nontraditional data sources, including administrative databases, is currently underway, as is targeted research and surveillance to address these data gaps.