Changes in the inequality of mental health: suicide in Australia, 1907–2003

Abstract

Rising suicide rates have been identified as a social problem in several Western countries. The application of a Welfare Economics argument justifies a role for policy that reduces the welfare impact of suicide, whereas the measurement of that impact can inform policy making. Two dimensions of the concept can be measured: the social loss from suicide, and the inequality in the distribution of that loss. In this study, an alternative measure of suicide to the conventional suicide headcount, viz. the potential years of life lost (PYLL), is employed. The PYLL measure is a proxy measure of the social impact of suicide, and involves the concept of 'premature' loss of life. The PYLL also lends itself to inequality measurement. We apply the approach to inequality measurement of health phenomena that was pioneered in the 1980s by Jacques Silber and Julian Le Grand, in a literature now described as measuring health inequality per se. The empirical part of the paper statistically estimates equations on Australian suicide data for the period 1907-2003 and determines the trends in the social loss from suicide and the inequality of its age distribution. Some illustrative examples assist in interpreting the welfare impact of suicide measured both ways, by the headcount rate and the PYLL rate.

The trend in mental health-related mortality rates in Australia 1916-2004: implications for policy

“…In the following paragraphs we argue that any such position is not the case. First, we have elsewhere reported the results of estimating equations to time-series data, in an article that focuses on the distribution of suicide [ 26 ]. In that paper, where the reported equations are for rates, both on headcount data and on PYLL data, we find that the trend is not cubic: there is no downturn in those data.…”

“…Currently, it is routine practice for the Australian Bureau of Statistics (ABS) [ 22 ] and the Australian Institute of Health and Welfare (AIHW) [ 23 ] to report both headcount and PYLL measures of suicide. A small number of Australian analyses have applied both headcount and PYLL measurement to suicide [ 24 - 26 ]. These studies show the added information gained by applying both headcount and PYLL metrics.…”

“…The present study has a narrower focus, by measuring mortality in levels only; the focus does not extend to studying its distribution. Measuring the (age) distribution of mortality (due to all causes, or any cause) through time is possible, by applying the analytical framework pioneered by Silber [ 28 - 30 ] and Le Grand [ 31 - 33 ]; there is one Australian study which has measured the distribution of suicide [ 26 ]. Distribution topics in mental health-related mortality need further attention, but here the focus is on levels only.…”

“…The most important is that government policies usually are designed to affect a particular variable or target. When forming policy, or evaluating existing policy, such as evaluating the expenditure on Australia's National Suicide Prevention Strategy [ 34 , 35 ], it is important to use appropriate measures, as discussed elsewhere [ 24 - 26 ], of the variable being targeted. The PYLL metric provides relevant information for societal or policy issues, because it is a weighted measure (Table 1 ).…”

A Reassessment of Suicide Measurement

“…This becomes quite clear when the PYLL measure is described in the context of the life table. These issues are considered in some detail elsewhere by Doessel, Williams, Robertson, and Whiteford (2006). With respect to issues associated with “competing risks” of death, in regard to mortality measurement, see Lai and Hardy (1999).…”