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|4C Suicidal Thoughts and Attempts
Description | Specific Indicators | Ontario Public Health Standards (OPHS) | Corresponding Indicator(s) from Statistics Canada and CIHI | Corresponding Indicator(s) from Other Sources | Data Sources | Alternative Data Sources | Analysis Check List | Method of Calculation | Basic Categories | Indicator Comments | Cross-References to Other Indicators | Cited References | Other References | Changes Made | Acknowledgements
- Proportion of the population 15 years of age and over that have reported seriously considering committing suicide or that have ever attempted to commit suicide
|Specific Indicators |
- Proportion of the population that has ever considered committing suicide
- Proportion of the population that has considered committing suicide in past 12 months
- Proportion of the population that has ever attempted to commit suicide
- Proportion of the population that has attempted to commit suicide in the past 12 months
|Ontario Public Health Standards (OPHS)|
The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.
|Outcomes Related to this Indicator|
Board of Health Outcome (Prevention of Injury and Substance Misuse): The board of health is aware of and uses epidemiology to influence the development of healthy public policy and its programs and services for the prevention of injury and substance misuse.
Board of Health Outcome (Foundational Standard): The public, community partners and health care providers are aware of relevant and current population health information.
|Assessment and Surveillance Requirements Related to this Indicator (Prevention of Injury and Substance Misuse) |
- The board of health shall conduct epidemiological analysis of surveillance data....in the areas of injury and substance misuse outcomes, including violence and suicide prevention.
|Corresponding Indicators from Statistics Canada and CIHI|
|Corresponding Indicators from Other Sources |
Ontario Student Drug Use and Health Survey (OSDUHS), Centre for Addiction and Mental Health (CAMH)
- Percentage of students in grades 7 - 12 that attempted suicide in the past 12 months.
Available at: http://www.camh.ca/en/research/news_and_publications/ontario-student-drug-use-and-health-survey/Pages/default.aspx
|Data Sources (see Resources: Data Sources) |
Numerator & Denominator: Canadian Community Health Survey (CCHS)
Original source: Statistics Canada
Distributed by: Ontario Ministry of Health and Long Term Care (MOHLTC)
Suggested citation (see Data Citation Notes): Canadian Community Health Survey Cycle [year], Statistics Canada, Share File, Ontario MOHLTC
†Optional Module - refer to Indicator Comments for information on module selection
Suicidal Thoughts and Attempts
(asked of individuals ≥15 years of age)
Have you ever seriously considered committing suicide or taking your own life
Has this happened in the past 12 months?
Have you ever attempted to commit suicide or tried taking your own life?
Has this happened in the past 12 months?
*module not included in Ontario
Alternative Data Source(s)
Ontario Student Drug Use and Health Survey (OSDUHS)
In the last 12 months, did you ever seriously consider attempting suicide?
In the last 12 months, did you actually attempt suicide?
|Analysis Check List |
- It is recommended that public health units use the Share File provided by the Ministry of Health and Long-Term Care rather than public use file (PUMF) provided by Statistics Canada. The Share File has a slightly smaller sample size because respondents must agree to share their information with the province to be included; however, the share file has more variables and fewer grouped categories within variables. The Share File is a cleaner dataset for Ontario analysis because all variables that were not common content, theme content or optional content for Ontario have been removed.
- There may be slight differences between results from the share file and data published on the Statistics Canada website for the Health Indicators because rates calculated for Health Indicators use the master CCHS data file.
- Not applicable respondents should be excluded; however, it is important to understand who these respondents are from the questionnaire skip patterns to be able to describe the relevant population.
- Users need to consider whether or not to exclude the ‘Refusal, 'Don't Know' and ‘Not Stated' response categories in the denominator. Rates published in most reports, including Statistics Canada's publication Health Reports generally exclude these response categories. In removing not stated responses from the denominator, the assumption is that the missing values are random, and this is not always the case.This is particularly important when the proportion in these response categories is high.
- Estimates must be appropriately weighted (generally the share weight for the CCHS) and rounded.
- Users of the CCHS Ontario Share File must adhere to Statistics Canada's release guidelines for the CCHS data when publishing or releasing data derived from the file in any form. Refer to the appropriate user guide for guidelines for tabulation, analysis and release of data from the CCHS. In general, when calculating the CV from the share file using the bootstrap weights, users should not use or release weighted estimates when the unweighted cell count is below 10. For ratios or proportions, this rule should be applied to the numerator of the ratio. Statistics Canada uses this approach for the tabular data on their website. When using only the Approximate Sampling Variability (CV) lookup tables for the share file, data may not be released when the unweighted cell count is below 30. This rule should be applied to the numerator for ratios or proportions. This provides a margin of safety in terms of data quality, given the CV being utilized is only approximate.
- Before releasing and/or publishing data, users should determine the CV of the rounded weighted estimate and follow the guidelines below:
- Acceptable (CV of 0.0 - 16.5%) Estimates can be considered for general unrestricted release. Requires no special notation.
- Marginal (CV of 16.6 - 33.3%) Estimates can be considered for general unrestricted release but should be accompanied by a warning cautioning subsequent users of the high sampling variability associated with the estimates. Such estimates should be identified by the letter E (or in some other similar fashion).
- Unacceptable (CV greater than 33.3%) Statistics Canada recommends not to release estimates of unacceptable quality. However, if the user chooses to do so then estimates should be flagged with the letter F (or in some other fashion) and the following warning should accompany the estimates: "The user is advised that...(specify the data)...do not meet Statistics Canada's quality standards for this statistical program. Conclusions based on these data will be unreliable and most likely invalid". These data and any consequent findings should not be published. If the user chooses to publish these data or findings, then this disclaimer must be published with the data.
- Caution should be taken when comparing the results from Cycle 1.1 (2000/01) to subsequent years of the survey, due to a change in the mode of data collection. The sample in Cycle 1.1 had a higher proportion of respondents interviewed in person, which affected the comparability of some key health indicators. Please refer to http://www.statcan.gc.ca/imdb-bmdi/document/3226_D16_T9_V1-eng.pdf for a full text copy of the Statistics Canada article entitled "Mode effects in the Canadian Community Health Survey: a Comparison of CAPI and CATI".
|Method of Calculation |
|Proportion of the population that has ever considered committing suicide|
weighted number of respondents 15 years of age and older that have ever considered committing suicide
| x 100|
weighted total number of respondents 15 years of age and older
|Proportion the population that has considered committing suicide in past 12 months |
weighted number of respondents 15 years of age and older that considered committing suicide in the past 12 months
| x 100|
weighted total number of respondents 15 years of age and older
|Proportion the population that has ever attempted to commit suicide|
weighted number of respondents 15 years of age and older that have ever attempted suicide
| x 100|
weighted total number of respondents 15 years of age and older
|Proportion the population that has attempted to commit suicide in the past 12 months |
weighted number of respondents 15 years of age and older that have attempted suicide in the past 12 months
| x 100|
weighted total number of repondents 15 years of age and older
|Basic Categories |
- Suggested Age Groups:
- 15-19 yr, 20-44, 45-64, 65-74, 75+. (IntelliHEALTH Chronic Disease age groups -Age Group (CD)) or
- 15-19, then 5 yr groups to 90+. (IntelliHEALTH Infant + 5-yr age groups - (inf,5yr))
*Note: Health units may choose to merge age categories due to small numbers, or change age categories depending on the specific analysis questions. Examples of other potential age categories include:
- ‘Youth' could be analyzed as '15-24', a common category for analyzing self-harm data
- ‘Seniors/Older adults' could be analyzed as ages "65+"
- Sex: male, female and total
- Geographic areas: Ontario, public health unit.
|Indicator Comments |
Suicide Behaviour and Intentional Self-harm
- Suicidal behaviour consists of acts focused on taking one's life. Suicidal behaviour includes attempts (suicidal acts unsuccessful in causing death) and gestures (the verbalizing of an actual or potential intent to harm oneself) (1).
- Suicidal behaviour is an indicator of mental illness. Most mental health professionals consider suicidal behaviours to be a result of irrational mental states (distorted perceptions, impaired judgment, extreme moods, feelings of hopelessness, loss of interest or pleasure) brought on by mental illness (2,3).
- Suicidal behaviour is also associated with substance abuse and dependence, and terminal illness. Mental disorders such as schizophrenia, personality disorder or eating disorders may also lead to suicidal behaviours. Regardless of the strong association between mental illness and suicide, mental illness is not a sufficient cause for suicide given the large number of individuals who suffer from mental illness in the population who do not engage in suicidal behaviour (4).
- Intentional self-harm can encompass both non-suicidal and suicidal behaviours (5,6). Non-suicidal self-injury (NSSI) can take many forms, but some of the more common include cutting or burning of the skin, scratching, hitting objects or oneself or pulling out one's hair. In general, these behaviours are used as a coping strategy to deal with overwhelming negative emotions or to produce emotion when it is lacking. NSSI is seen in individuals from as young as five years old to those older than 65 years of age. However, it is most common among youth and young adults, and onset usually occurs among youth aged 12 to 15 years.
- While many intentional self-harm injuries are not intended as suicide attempts, research shows that those who self-injure are at greater risk of committing suicide later in life (6).
- Researchers rely on self-reports from surveys and interviews to study suicide behaviour (2). Survey methods and the time period under consideration (e.g. "over the last year" versus "ever") vary making comparisons among studies difficult (3).
- In 2002, 7% of youth aged 15 to 19 years and 4% of young adults reported that they had thought about committing suicide in the previous 12 months, compared to less than 4% of all Canadians aged 15 years and older (5,7).
- A higher proportion of adolescent girls reported suicidal thoughts than adolescent boys (9% and 5%, respectively), while the proportion of suicidal thoughts was the same among young women and young men (4%) (5).
- Suicidal thoughts and attempts are associated with mood disorders (e.g. depression, anxiety disorders) and deviant behaviour (e.g. conduct disorder, substance use and sexual activity) in youth (8).
- Each year many youth and young adults attempt suicide. While some of those attempts may go unrecognized, in 2005 there were more than 5,000 hospitalizations of Canadian (excluding Quebec, for which comparable data were not available) youth and young adults that were specifically classified as attempted suicide (5). Females accounted for two-thirds (66%) of those suicide attempts.
- According to the CCHS Mental Health and Well-Being Survey, 0.6% of Canadians reported a suicide attempt in 2002 (9). Suicide attempts were more commonly reported by females, those separated or divorced, unemployed, experiencing a chronic physical health condition or experiencing a major depressive episode in the same 12 month period as the act (9).
- Populations of special concern include Aboriginal people, certain age groups (adolescent/young adults and elderly), persons in custody, the lesbian, gay, bisexual, transgendered and queer (LGBTQ) population, and persons who have previously attempted suicide (2,3).
- CCHS relies on self-reported data. Some respondents may report self-harming (i.e. performed without the intent to die) as suicidal behaviour (9).
- Prior to 2007, CCHS data collection occurred every two years on an annual period. Data are available for the 2001, 2003 and 2005 periods. In 2007, major changes were made to the survey design with the goal of improving its effectiveness and flexibility through data collection on an ongoing basis. Data collection now occurs every year, from January through December, rather than every two years as was the case prior to 2007 (10).
- "Suicidal thoughts and attempts" is optional content in the CCHS and was selected as follows:
- Cycle 1.1 (2000/01): Algoma; North Bay; Northwestern; Peel; Porcupine; Sudbury; Thunder Bay; Toronto; and Timiskaming.
Cycle 2.1 (2003): Algoma; North Bay; Northwestern; Porcupine; Sudbury; Thunder Bay; Timiskaming; Elgin/St. Thomas; Middlesex/London; Oxford; Hamilton; Hastings & Prince Edward; Kingston, Frontenac, Lennox & Addington; Leeds/Grenville/Lanark; Huron; Perth; Grey Bruce; Chatham Kent; Lambton; Eastern Ontario; Ottawa; Renfrew; Windsor Essex; and York.
- Cycle 3.1 (2005): all Ontario health regions.
- 2007/2008: all Ontario health regions.
- 2009/2010: not available in Ontario.
- Since not all health regions chose "suicidal thoughts and attempts" as optional content in Cycles 1.1 and 2.1, provincial estimates are not available from those surveys.
|Cross-References to Other Indicators |
|Cited References |
- British Columbia Injury Research and Prevention Unit. Intentional self-harm factsheet. Vancouver: British Columbia Injury Research and Prevention Unit; 2007 [cited 2012 May 22]. Available from: http://www.injuryresearch.bc.ca/docs/3_20070207_124936intentional%20self%20harm%20factsheet%20final.pdf.
- Health Canada. Suicide in Canada: update of the report of the Task Force on Suicide in Canada. Ottawa, ON: Her Majesty the Queen in Right of Canada; 1994 [cited 2012 May 22]. Available from: http://www.phac-aspc.gc.ca/mh-sm/pdf/suicid_e.pdf.
- Diekstra RFW, Gulbinat W. The epidemiology of suicidal behaviour: a review of three continents. World Health Stat Q 1993;46(1):52-68.
- Health Canada. A report on mental illnesses in Canada. Ottawa, ON: Health Canada Editorial Board Mental Illnesses in Canada; 2002 [cited 2012 May 22]. Available from: http://www.phac-aspc.gc.ca/publicat/miic-mmac/pdf/men_ill_e.pdf.
- Public Health Agency of Canada [homepage on the Internet]. The Chief Public Health Officer's Report on the State of Public Health in Canada, 2011. Ottawa: Public Health Agency of Canada; 2011 Oct 25 [cited 2012 May 22]. Chapter 3, The health and well-being of Canadian Youth and Young Adults. Available from: http://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2011/cphorsphc-respcacsp-06-eng.php.
- Cornell University Bronfenbrenner Center for Translational Research [homepage on the Internet]. Ithaca: Cornell University Bronfenbrenner Center for Translational Research; c2012 [cited 2012 May 22]. What do we know about self-injury? Available from: www.crpsib.com/whatissi.asp.
- Statistics Canada [homepage on the Internet]. Ottawa: Statistics Canada; 2003 Aug 31[cited 2012 May 22]. Canadian Community Health Survey Cycle 1.2 - Mental Health and Well-being. Cycle 1.2 [Share Microdata File]. Ottawa, Ontario: Statistics Canada. All computations on these microdata were prepared by Public Health Agency of Canada and the responsibility for the use and interpretation of these data is entirely that of the author(s). Available from: http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SurvId=20251&SurvVer=1&InstaId=20892&InstaVer=1&SDDS=5015&lang=en&db=imdb&adm=8&dis=2.
- Peter T, Roberts LW. ‘Bad' boys and ‘sad' girls? Examining internalizing and externalizing effects on parasuicides among youth. J Youth Adolescence. 2010; 39:495-503.
- Blackmore ER, Munce S, Weller I, Zagorski B, Stansfeld SA, Stewart E, et al. Psychosocial and clinical correlates of suicidal acts: results from a national population survey. Br J Psychiatry. 2008 [cited 2012 May 22]; 192:279-84. Available from: http://bjp.rcpsych.org/content/192/4/279.full.pdf+html.
- Statistics Canada [homepage on the Internet]. Ottawa: Statistics Canada; 2012 Nov 27 [cited 2012 Dec 14]. Canadian Community Health Survey 2010. Available from: http://www.statcan.gc.ca/cgi-bin/imdb/p2SV.pl?Function=getSurvey&SDDS=3226&lang=en&db=imdb&adm=8&dis=2.
- Public Health Agency of Canada. The human face of mental health and mental illness in Canada 2006. Cat. No. HP5-19/2006E. Ottawa, ON: Minister of Public Works and Government Services Canada; 2006 [cited 2012 May 22]. Available from: http://www.phac-aspc.gc.ca/publicat/human-humain06/pdf/human_face_e.pdf.
- Correctional Service Canada [homepage on the Internet]. Ottawa: Correctional Service Canada; 2010 Mar 23 [cited 2012 May 22]. Self-Injurious Behaviour: A Review of the literature and implications for corrections. Available from: http://www.csc-scc.gc.ca/text/rsrch/reports/r216/r216-eng.shtml.
- Interdisciplinary National Self-Injury in Youth Network Canada [homepage on the Internet]. Interdisciplinary National Self-Injury in Youth Network Canada; n.d.[cited 2012 May 22]. General information on self-injury. Available from: http://www.apheo.ca/www.insync-group.ca/information.php.
- Nixon MK, Cloutier P, Jansson SM. Nonsuicidal self-harm in youth: a population-based survey. Can Med Assoc J. 2008 [cited 2012 May 22];178(3):306-312. Available from: http://canadianmedicaljournal.ca/content/178/3/306.full.pdf+html.
Type of Review (Formal Review or Ad Hoc?)
Changes made by
July 30, 2012
Injury and substance misuse prevention sub-group
- Combined "Suicidal Thoughts" and "Suicide Attempts" into one indicator.
- Added specific descriptions and specific indicators for Suicidal Thoughts and Attempts.
- Replaced Mandatory Health Programs section with updated Ontario Public Health Standards outcomes.
- Added OSDUHS as an alternate data source
- Updated age groupings.
- Updated indicator comments and references.
- Suzanne Fegan, KFL&A Public Health (Subgroup Lead)
- Natalie Greenidge, Public Health Ontario
- Lee-Ann Nalezyty, Northwestern Health Unit
- Injury and Substance Misuse Prevention Subgroup
- Christina Bradley, Niagara Region Public Health
- Badal Dhar, Public Health Ontario
- Jeremy Herring, Public Health Ontario
- Sean Marshall, Public Health Ontario
- Jayne Morrish, Parachute
- Michelle Policarpio, Public Health Ontario
- Narhari Timilshina, Toronto General Hospital
- Jessica Deming, Waterloo Region Public Health
- Luanne Jamieson, City of Hamilton Public Health Services (Core Indicators Work Group Member)