Suicide along the Australian coast: Exploring the epidemiology and risk factors

Abstract

Suicide is an increasing global concern with multiple risk factors, yet location-based understanding is limited. In Australia, surf lifesavers (SLS) and lifeguards patrol the coast, performing rescues and assisting injured people, including people who suicide. This study is a descriptive epidemiological analysis of Australian coastal suicide deaths. The results will be used to inform training and support surf lifesaving personnel and suicide prevention organisations. This is a population-based cross-sectional study of suicide deaths at Australian coastal locations (between 1 January 2005 and 31 December 2019). Data were sourced from the National Coronial Information System and SLS Australia’s Incident Report Database. Analyses explored decedent, incident, and risk factors by sex and method. Across the study period, there were 666 coastal suicide deaths (71.0% male, 43.4% jumping from high places [X80]). Males were more likely to suicide by other means (hanging, self-poisoning, firearm discharge; n = 145, 83.8%), compared to females who were more likely to suicide by drowning ([X71]; n = 77, 37.7%). In one third (n = 225, 38.3%) toxicology was a contributing factor. The risk of coastal suicides was 10.3 times higher during the seven-days prior to their birthday (p<0.001). Evidence of mental ill health was reported in 61.4% (n = 409) of cases and evidence of suicidal behaviour was reported for 37.4% of decedents (n = 249), more prevalent in females. SLS responded in 10.7% (n = 71) of coastal suicides (most jumps from high places; n = 36, 50.7%). Coastal suicides differ to national trends suggesting that location-based differences should be considered during development of preventative and protective measures, especially at a community level. Accessibility, availability, perceived lethality and symbolic qualities are proposed to influence suicide location decisions. These results will guide support and education strategies for surf lifesaving personnel, contributes to established, ongoing suicide surveillance efforts (including hot-spot identification) and add to the limited literature exploring place-based suicide.

Circumstances of suicide after registration with a national digital mental health service: an analysis of coroners’ reports

“… 27 In addition to diagnosed depression, 18/81 (22%) of those who died by suicide in our study had a severe mental illness, based on the reported diagnosis, the medications prescribed and the history of recent hospital admission. Comorbid substance misuse was known to be present in 38% of deaths by suicide in the systematic review of psychological autopsies 27 and in a similar proportion in a large Australian study that also used NCIS data; 28 this is a little higher than the diagnoses of substance use disorder recorded in our study, although 41.6% of the present sample had alcohol present and 20.8% had illegal drugs present at the time of death. The results suggests that substance use, particularly the use of substances likely to exacerbate low mood, reduce inhibition and increase the tendency to act on impulse (such as alcohol and amphetamine), is a significant risk factor for suicide.…”

Pre-Existing Medical Conditions: A Systematic Literature Review of a Silent Contributor to Adult Drowning

“…With respect to grouped medical conditions, diseases of the nervous system [ 7 , 11 , 19 , 20 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ] and mental and behavioural conditions [ 7 , 37 , 42 , 43 , 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , …”

“…There were a total of 17 studies that discussed 26 unique strategies for preventing drowning related to pre-existing medical conditions [ 7 , 11 , 19 , 31 , 34 , 41 , 44 , 47 , 48 , 53 , 57 , 59 , 68 , 77 , 89 , 91 , 96 ]. The majority of strategies were administrative in nature when aligned to the Hierarchy of Control (n = 24; 92.3%) and all were proposed, as opposed to implemented and/or evaluated.…”

“…Comprehensive psychiatric assessment and management and education in alcohol and substance misuse were recommended as education-based primary prevention strategies for intentional drowning involving mental and behavioural disorders, as well as bystander rescue and CPR training as secondary and tertiary measures [ 7 ]. Suicide response training for lifeguard and lifesavers has also been proposed, but not yet implemented or evaluated [ 68 ].…”

Increase in Search Interest for “Suicide” and “Depression” for Particular Days of the Week and Times of Day: Analysis Based on Google Trends

“…153-162). On the other hand, in Australia, researcher found that the number of suicides increased in a week before and a week after public holidays (J.C. Lawes et al [26]). Research in Japan over 1979-1994 showed that the rate of suicides was the lowest on the days before a holiday and the highest on the days after a holiday (M. Nishi et al [27], pp.…”