Attempted suicide includes attempts that result in hospitalization as well as attempts that do not result in medical attention and, consequently, are not reported in hospitalization statistics. Furthermore, suicide attempters who receive medical attention are often identified only by the nature of their medical problem, such as
poisoning or lacerations and do not appear in suicide attempt data. As a result, assessing the incidence of attempted suicide is very difficult. According to Statistics Canada’s 2002 Mental Health and Well-being Survey (Canadian Community Health Survey (CCHS) 1.2), 3.1% of adults aged 15 years and over reported that they had attempted suicide in their lifetime: 2.0% of men and 4.2% of women. In addition, 0.5% reported having attempted suicide in the previous 12 months: 0.4% of men and 0.6% of women.
Women in all age groups were more likely than men to have attempted suicide at some point in their lives. (Figure 8-3) While reported suicide
attempts decreased with age among women, reported attempts remained fairly constant among men.
Individuals are sometimes hospitalized both for their own protection and to address the
underlying factors that precipitated the crisis. Hospitalization data provide some insight into attempted suicide, but must be interpreted with caution because they only provide part of the picture.
In 2002/03, hospitalization rates for attempted suicide were higher among women than among men in all age groups up to the age of 70 years. (Figure 8-4) Among women, hospitalizations peaked in the 15–19 year age group then rose again in the years approaching mid-life. Between the ages of 10 and 14 years, hospitalizations among women were 5 times those reported among young men; among 15–19 year-olds, the hospitalization rate among young women was 2.5 times the rate among young men.
Figure 8-4 Hospitalizations for attempted suicide* in general hospitals per 100,000, by age group and sex, Canada excluding Territories, 2002/03
0 50 100 150 200 250 <1 1-4 5-9 10- 14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
Age Group (years)
H os p it al iz ati on s p er 1 00, 000 Women Men
* Using most responsible diagnosis only
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada using data from Hospital Morbidity File, Canadian Institute for Health Information. Figure 8-3 Proportion of population who reported a
suicide attempt in lifetime, by age and sex, Canada, 2002 0 5 10 15 20 P ercen t Women 5.9 4.9 3.9 * Men 2.2 2.5 2.0 * Both 4.0 3.7 2.9 *
15-24 years 25-44 years 45-64 years 65+ years
* Sample size too small.
Source: Statistics Canada, Canadian Community Health Survey, 2002, Mental Health and Well-being Cycle 1.2
Between 1996/97 and 2002/03, hospitalization rates for attempted suicide decreased for both sexes. (Figure 8-5) This decrease was mostly due to a decrease in hospitalization rates for attempted suicide among the 15–24 and 25-44 year age groups. (Figures 8-6 and 8-7)
Suicide
Early in 2002, in a summary report on suicide deaths and attempted suicide in Canada, Statistics Canada reported that suicide is one of the leading causes of death for both men and
women from adolescence to middle age.2
In 2003, suicide caused the deaths of 3,765 Canadians (11.9 per 100,000): 27 individuals aged under 15 years; 522 aged 15–24 years; 1,437 aged 25–44 years; 1,337 aged 45–64 years; and 442 aged 65 years and over. This represented 1.7% of all deaths in Canada.
information about the nature of the death may only become available after the original death certificate is completed, or because assessing whether the death was intentional may be
difficult in some situations.3
When the cause of death is uncertain, a coroner may initially code the death as "undetermined", and later, after further investigation, confirm the death as a suicide. This change does not appear in the mortality database. The decision as to the coding on the death certificate may Figure 8-6 Hospitalizations for attempted suicide* in
general hospitals among women, by age, Canada excluding Territories, 1990/91- 2002/03 (standardized to 1991 Canadian population) 0 50 100 150 200 250 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year R at e pe r 10 0, 00 0
<15 years 15-24 years 25-44 years 45-64 years 65+ years
* Using most responsible diagnosis only
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada using data from Hospital Morbidity File, Canadian Institute for Health Information.
Figure 8-7 Hospitalizations for attempted suicide* in general hospitals among men by age, Canada excluding Territories, 1990/91-2002/03 (standardized to 1991 Canadian population)
0 50 100 150 200 250 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year R at e pe r 1 00, 00 0
<15 years 15-24 years 25-44 years 45-64 years 65+ years
* Using most responsible diagnosis only
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada using data from Hospital Morbidity File, Canadian Institute for Health Information. Figure 8-5 Hospitalizations for attempted suicide* in
general hospitals, by sex, Canada excluding Territories, 1990/91-2002/03 (standardized to 1991 Canadian population) 0 20 40 60 80 100 120 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year R ate p er 100,000
Women Men Women & Men
* Using most responsible diagnosis only
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada using data from Hospital Morbidity File, Canadian Institute for Health Information.
In 2003, overall mortality rates due to suicide among men were nearly 4 times higher than among women (18.5 per thousand versus 5.4 per thousand).
Mortality rates due to suicide are much higher among adult men than adult women in all age groups. (Figure 8-8) Among men, suicide rates increase to the age of 45–49 years, then decrease to age 65–69 years, then increase again. Among women, suicide rates increase after age 10–14 years until age 55–59 years. After age 60 to 64 the rate decreases considerably.
Over 1 in 5 of all deaths among young adults 15–24 years of age was due to suicide. (Figure 8-9) The percentage of all adult deaths due to suicide decreased with age, and the percentage is higher among men than women in all adult age groups.
While the overall mortality rate due to suicide decreased slightly between 1990 and 2003, the decrease was greater among men than among women. (Figure 8-10)
While suicide rates among women
of all ages fluctuated between 1990 and 2003, the overall changes have been small. A slight decrease in rates is seen for women aged 25–44 and 65–74 years. (Figure 8-11) Rates among seniors aged 75 to 84 and 85+ fluctuate considerably from year to year, but when 5 year averages are considered, little changes are indicated in recent years.
Figure 8-8 Mortality rates due to suicide per 100,000, by age and sex, Canada, 2003
0 5 10 15 20 25 30 35
Age Group (years)
R at e per 100, 000 Women 0.0 0.0 0.0 0.8 5.3 5.4 4.6 6.0 7.4 7.8 9.7 10.7 6.6 4.6 5.5 3.2 3.3 2.5 6.1 Men 0.0 0.0 0.0 1.8 14.8 22.1 18.3 20.3 27.4 26.1 26.4 26.5 25.3 22.5 19.7 17.9 19.2 19.8 27.8 <1 1-4 5-9 10- 14 15- 19 20- 24 25- 29 30- 34 35- 39 40- 44 45- 49 50- 54 55- 59 60- 64 65- 69 70- 74 75- 79 80- 84 85+
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada using data from the Mortality File, Statistics Canada
Figure 8-9 Percent of all deaths due to suicide, by age and sex, Canada, 2003 0 5 10 15 20 25
Age Group (years)
Per
cen
t
Women 0.7 17.9 9.8 2.3 0.3 0.1 0.0 Men 1.3 24.5 19.3 4.5 0.8 0.3 0.2 Women & Men 1.0 22.7 16.0 3.6 0.6 0.2 0.1
<15 years 15-24 years 25-44 years 45-64 years 65-74 years 75-84 years 85+ years
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada using data from the Mortality File, Statistics Canada
Figure 8-10 Mortality rate per 100,000 due to suicide, by sex, Canada, 1990-2003 (standardized to 1991 Canadian population) 0 10 20 30 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Year R at e p er 10 0, 00 0
Women Men Women & Men
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada using data from the Mortality File, Statistics Canada
The mortality rate due to suicide for men aged 15–24 and 25–44 years has decreased between 1995 and 2003. The small numbers of deaths and the small population size among men aged 75–84 and 85+ years results in unstable
mortality rates in these groups. However, the rates among men aged 85 years and over are consistently higher than the other age groups. (Figure 8-12)
Discussion
The difference in rates of suicide and attempted suicide among men and women has several
possible explanations.4 Men may more often
express their despair through fatal acts by, for example, the use of a firearm (26%) or hanging (40%). Although women are now using more violent methods, such as hanging, they are still more likely to choose non-fatal methods, such as an overdose of pills, where there is a greater probability of saving the individual’s life. Suicidal men are less likely than women to seek help and confide their problems to others.
Youth suicide relates in part to events associated with this life stage. Resolving the challenges that are part of youth development, such as identity formation, gaining acceptance and approval among peers, and gaining acceptance from families is a stressful time for
teenagers.5 Loss of a valued relationship or
interpersonal conflict with family and friends and
developmental stressors can create a serious crisis for which suicide seems to be the only solution. The impulsiveness of youth and their lack of experience in dealing with stressful issues also contribute to the higher risk of suicide.
Seniors face related challenges. They also experience the loss of relationships, but more through the death and chronic illness of their life partners and friends. They may also experience loss of their physical and mental abilities. Symptoms of depression may not be recognized and treated as such. Primary care physicians as well as family and friends have an important role in detecting mental illness that can lead to
suicide.6 In addition, being constantly faced with
their own mortality, they may choose death on their own terms.
Suicide rates are much higher in some Figure 8-12 Mortality rate per 100,000 due to suicide
among men, by age, Canada, 1990-2003 (standardized to 1991 Canadian population)
0 10 20 30 40 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Year R at e per 10 0, 000
<15 years 15-24 years 25-44 years 45-64 years 65-74 years 75-84 years 85+ years
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada using data from the Mortality File, Statistics Canada
Figure 8-11 Mortality rate per 100,000 due to suicide among women, by age, Canada, 1990-2003 (standardized to 1991 Canadian population)
0 2 4 6 8 10 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Year R at e p er 100,000
<15 years 15-24 years 25-44 years 45-64 years 65-74 years 75-84 years 85+ years
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada using data from the Mortality File, Statistics Canada