Alarming increase of suicide in a remote Indigenous Australian population: an audit of data from 2005 to 2014
Authors: Anita Campbell, Sivasankaran Balaratnasingam, Catherine McHugh, Aleksandar Janca, Murray Chapman
Journal: World Psychiatry (2016)

Early in 2016, a 10-year old Indigenous girl committed suicide in a remote desert community of Western Australia1. This tragedy triggered national and international media attention, followed by demands for increased resources to provide effective prevention of suicide in Indigenous Australians. Due to the absence of any reliable reference information regarding suicide trends, we conducted a de-identified retrospective audit of suicide deaths in this region between 2005 and 2014. Contemporaneous publications have described a worldwide increase in youth suicide, now among the top five causes of mortality in the 15 to 19 year age group. Research in other developed countries, including Canada and the US, has identified an Indigenous amplification of this phenomenon that gained international attention2. In each of these countries, Indigenous populations have their own unique history of social and cultural turmoil and ongoing post-colonial discrimination and adjustment difficulties3. Indigenous suicide appears to have been virtually unknown in Australia for the first 100 years following European colonization of the country4. Our audit revealed that the Kimberley region now has one of the highest rates of suicide in the world (age-adjusted rate of 174 per 100,000 in 2014). This region forms the northern-most part of the State of Western Australia, comprising 500,000 km2 of coastline to inland desert. Approximately one third of the 35,000 population are Indigenous Australians, scattered in 200 communities of varying size, many accessible only by air or dirt track, with poor living conditions and significantly low levels of education. Many have experienced complex trauma, including displacement of family, and have relatives who were forcibly taken into state or foster care as a child – the "stolen generations"5, 6. As the community mental health care provider covering the region, the Kimberley Mental Health and Drug Service recorded details of suicides in a de-identified register for the years 2005-2014. These reports, which were made internally by staff and externally by other health services and the police, have now been audited. Reported suicides in previous decades amongst Indigenous Australians in the region were as follows: 1 in the 1960s, 3 in the 1970s, 21 in the 1980s and 46 in the 1990s7. Our register recorded a total of 125 deaths during the period 2005-2014, which is likely to be an underestimate. Of these, 102 (81%) were identified as Indigenous Australians, and 91 (73%) were male. This provided an age adjusted suicide rate of 74 per 100,000 in the region, in contrast to 10.6 per 100,000 for the general Australian population in 2012, and 11.4 per 100,000 globally in the same year2. Of the 102 Indigenous suicides, 69 (67%) were less than 30 years old, and 28 (27%) were less than 20 years old. Indigenous child suicide increased dramatically during this period, with suicides in those aged 14 or under increasing from 1 in the first five years (2005-2009) to 5 in the second five years (2010-2014). When Indigenous suicides were stratified by month, there was a seasonal variation, with increased suicides during the "wet" tropical season. Only 30% of those who suicided had previously engaged with, or been referred to, the Kimberley Mental Health and Drug Service, suggesting that ICD-10 and DSM-5 diagnoses of mental disorders may not be a good predictor of Indigenous suicide. Instead, impulsivity (possibly due to alcohol and cannabis toxicity complicated by complex trauma) has been identified and correlated to increased rates of Indigenous suicide7. Hanging was the method of suicide in 88% of Indigenous cases. Current responses to this problem, though well intentioned, are fragmented and funded by various government programs. A culturally informed, long-term, collaborative approach focusing on resilience in young people may hold the key to effective suicide prevention in the Kimberley region7, 8. Cultural continuity factors identified in First Nations people in Canada have been associated with suicide prevention8. We recommend that further funding be focused on research and development of effective Indigenous youth resilience programs that bolster cultural identity. Anita Campbell1, Sivasankaran Balaratnasingam2,3, Catherine McHugh4, Aleksandar Janca3, Murray Chapman2,3 1Kimberley Aboriginal Medical Services Council, Broome, WA, Australia; 2Kimberley Mental Health and Drug Service, Broome, WA, Australia; 3School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia; 4Kimberley Population Health Unit, Broome, WA, Australia