Appendix A The evidence profile This appendix provides a summary of each of the papers and reports included in the review and their degree of conformity to the three evaluation criteria—quality and risk of bias, quantity (that is, the number of study participants), and their generalisability to the population of interest. A.1 Suicidal behaviour and ideation in the Australian community Author(s) Country, study group and period Main measure Summary of results Evaluation criteria Rates/prevalence Risk factors/groups Quality and risk of bias Quantity (number of participants) Generalisability De Leo et al., 2005 Brisbane and Gold Coast residents from the general population Non-fatal suicidal behaviour in the Australian community through the WHO SUPRE-MISS study 0.4% of participants had attempted suicide in the preceding 12 months and 4.2% had attempted suicide in lifetime. 10.4% of the overall sample had seriously considered suicide in their lifetime and 4.4% had made a suicide plan Individuals reporting a suicide attempt or plan often had problems with their partners (40.7%), followed by financial difficulties (24.1%), problems with parents (22.8%) and difficulty in forming and sustaining social relationships (21.7%) Provides clearly defined population and reliable standardised data collection method 11,572 persons aged over 18 High generalisability to metropolitan Queensland Page et al., 2006 Australian suicide cases with status obtained from censuses from 1979 to 2003 Secular trends in SES differentials in suicides in Australia The largest disparities in suicide rates for different SES were witnessed in males, particularly young males. In the most recent period suicide rates among young males increased in the low SES group from 44.8 per 100,000 in 1994–1998 to 48.6 per 100,000 in 1999–2003 (an 8% increase). Suicide rates in the middle SES group decreased from a peak of 37.3 per 100,000 to 33.5 per 100,000 (a 10% decrease) and in the high SES group from 33.0 per 100,000 to 27.9 per 100,000 (a 15% decrease) Young males with low SES Provides clearly defined population and reliable standardised data collection method All suicides (Australian Bureau of Statistics) High generalisability to Australian community
Milner et al., 2014 Australian general population using data from the National Coroner’s Information System in 2001 to 2010 Association between suicide and employment status and suicide during the period of the recession compared with the preceding year (2006) During 2001–2010 the overall annual rate of suicide in economically inactive/unemployed males was 57.7 per 100,000 and 20.2 for females. For employed people the overall suicide rate was 10.5 per 100,000 males and 2.2 per 100,000 females. Suicide rates increased among economically inactive/unemployed and employed males during the recession and among economically inactive/unemployed females but not among employed females Economically inactive/unemployed males and females were at increased risk of suicide compared with employed males and females Provides clearly defined population and reliable standardised data collection method All suicides (Australian Bureau of Statistics) High generalisability to Australian community ABS, 2015 Australian general population in 2013 The prevalence and demographic variables of suicide in the Australian community There were 2,522 cases of suicide in Australia in 2013 (1,885 males and 637 females). Overall suicide rate was 10.9 per 100,000 (16.3 per 100,000 for males and 5.4 per 100,000 for females) Overall, the greatest risk was in the 85 year and over age group (17.7 per 100,000). In males the highest risk was also in the 85 years and older group (38.3 per 100,000), while in females the highest risk was in the 35–44 year age group (8.5 per 100,000) Provides clearly defined population and reliable standardised data collection method 2,522 suicides High generalisability to Australian community n.a. Not available. Table A.2 Suicidal behaviour and ideation among Australian serving military personnel Author(s) Country, study group and period Main measure Summary of results Evaluation criteria Risk factors/groups Quality and risk of bias Quantity (number of participants) Generalisability Hadfield & Sheffield, 2009 Australian serving military personnel 2000 to 2007 Suicide rate in serving military personnel Suicide rates in the Australian Defence Force from 2000 to 2007 were lower than in the male general population (13.8 per 100,000 compared with 23.6 per 100,000) n.a. Provides clearly defined population and reliable standardised data collection method n.a. High generalisability to Australian serving military personnel 2009)
McFarlane et al., 2010 Australian serving military personnel in 2010 Mental health of Australian serving military personnel, including non-fatal suicidal behaviour 3.9% of Australian Defence personnel reported suicidal ideation, 1.1% reported making a plan, and 0.4% reported attempting suicide Compared with the community, Australian Defence Force personnel had more than double the risk of suicidality (ideation and plans) but were equally likely to make an attempt. Mental illness was a major risk factor for suicide attempts in ADF personnel’ with 2.8% of personnel with a mental illness attempting suicide in the preceding year (compared with 0.1% with no disorder). This suggested that 90% of the ADF personnel who attempted suicide in the preceding 12 months had a psychiatric disorder (95% CI 75%, 100%) Provides clearly defined population and reliable standardised data collection method 24,481 Australian Defence Force personnel High generalisability to Australian serving military personnel Kõlves et al., 2012 Australian serving military personnel 2000 to 2010 Suicide rate in Australian military personnel, as retrieved from Australian Defence suicide database in the Australian Defence Force had significantly lower suicide rates than males in the general population in the 25–29 year age group (13.31 per 100,000 compared with 25.82 per 100,000), 30–34 year age group (15.08 per 100,000 compared with 28.61 per 100,000) and 35–39 year age group (2.81 per 100,000 compared with 26.78 per 100,000). Small numbers of females limited the ability to calculate female rates The mean annual crude suicide rate was highest in the Navy (16.6 per 100,000), followed by the Army (14.3) and the Air Force (7.4) Provides clearly defined population and reliable standardised data collection method 73 Australian Defence suicides (68 males and 5 females) Moderate generalisability to Australian serving military personnel number of females limited analysis for this group n.a. Not available. Table A.3 Suicide mortality among international serving military personnel Author(s) Country, study group and period Main measure Summary of results Evaluation criteria Rates/prevalence Risk factors/groups Quality and risk of bias Quantity (number of participants) Generalisability
et al., 2015 US Army personnel in 2005 to 2010 Risk for suicide among serving military personnel compared with suicide cases from the US general population n.a. The most common predictors of suicide for both groups were mental health problems, intimate partner problems, alcohol or substance problems, recent crises and job problems. Army suicide cases were significantly less likely to have previous suicide attempts or to have disclosed their intentions to others (p = <0.05) Provides clearly defined population and reliable standardised data collection method 141 active Army suicides and 563 civilian suicides Moderate generalisability to US serving military personnel Limited generalisablity to Australian serving military personnel Street et al., 2015 US active duty regular army soldiers in 2004 to 2009 Compared suicide rates in deployed soldiers with those for never deployed and previously deployed soldiers The suicide rate among currently deployed women (14.0 per 100,000 person-years) was 3.1–3.5 times the rate for other (never deployed and previously deployed) women. The suicide rate among currently deployed men (22.6 per 100,000 was 0.9–1.2 times the rate for other men The increased risk among female currently deployed soldiers compared with other female soldiers was greater than the increased risk among male currently deployed soldiers compared with other male soldiers. A significantly higher proportion of female than male soldiers had a history of health care visits with diagnoses of mental or behavioural disorders in the preceding 2–4 years (27.3% v. 19.6%; χ= 333.3, p = <0.001) Provides clearly defined population and reliable standardised data collection method 975,057 active duty army soldiers High generalisability to US serving military personnel Limited generalisablity to Australian serving military personnel n.a. Not available. Table A.4 Non-fatal suicidal behaviour and suicidal ideation among international serving military personnel Author(s) Country, study group and period Main measure Summary of results Evaluation criteria Rates/prevalence Risk factors/groups Quality and risk of bias Quantity (number of participants) Generalisability years)
Thompson et al., 2014 Canadian Armed Forces veterans who participated in the 2010 Survey on Transition to Civilian Life after separation from the forces between 1998 and 2007 Association between physical and mental illness and suicidal ideation The prevalence of suicidal ideation was 5.8% (95% CI 5.0–6.8) There was a significant association between suicidal ideation and gastrointestinal disorders (AOR 1.66; CI 1.03–2.65), depression or anxiety (AOR 5.06; CI 2.97–8.62) and mood disorders (AOR 2.91; CI 1.67–5.07); number of physical (AOR 1.22; CI 1.05–1.42) and mental conditions (AOR 2.32; CI 2.01–2.68); and SF-12 Health Survey physical health (AOR 0.98; CI 0.96–0.99 for each 1-point increase) and mental health (AOR 0.88; CI 0.87–0.89) Provides clearly defined population and reliable standardised data collection method 2,658 veterans who had been released from the Canadian Forces Regular Force High generalisability to Canadian personnel Moderate generalisability to Australian personnel due to similarities in military (size and structure) n.a. Not available.