Download files
Abstract
As a leading cause of mortality worldwide and a source of considerable morbidity, suicidality is a major public health issue. Substantial investments in suicide prevention have been made, but yet there are important gaps in the knowledge required to guide and evaluate these investments. The aim of this thesis was to address gaps in local and universal knowledge through examining the epidemiology of suicidal ideation, suicide attempts and suicide in the Australian general population. Data from the Australian National Surveys of Mental Health and Wellbeing conducted in 1997 (n=10,641) and 2007 (n=8,841) were analysed in conjunction with national suicide data.
Study 1 presented the first nationally representative prevalence estimates for suicidal ideation and suicide attempts in Australia for a decade. An analysis of correlates confirmed the much greater specificity of factors associated with the progression from suicidal ideation to suicide attempts compared to those associated with suicidal ideation. Further work in this area could greatly improve the accuracy of risk assessments.
In study 2 changes in the prevalence of suicidal ideation, suicide attempts and rates of suicide were examined concurrently. With the exception of the most recent birth cohort, the decline in suicide did not reflect a decline in experiences of suicidality more broadly, more likely it reflected changes in the availability of suicide methods.
Study 3 was unique in examining the temporal order and sex differences in the onset of suicidality and Substance Use Disorders (SUD). Females with suicide attempts were identified as a distinct group in terms of their age of onset of suicidality and in terms of their risk of SUD.
Study 4 revealed that in the Australian health-care system suicidality independently predicts access to general, specialist, inpatient and outpatient services. Given that treatment is an important tool in suicide prevention this was a positive finding. Nonetheless, access to one or more areas of the health-care system was problematic for males, older adults and people outside major urban centres.
The findings of this thesis highlighted a number of areas for further research that hold considerable promise for better informing clinical practice and suicide prevention.