Self-Harm, Including Suicide

This indicator provides the rate of self-harm hospitalizations and self-harm deaths (suicides). Lower rates are desirable as they signal less frequent severe self-harm.

Lower rates are desirable as they signal less frequent severe self-harm.

The indicator captures only cases where intentional self-harm was noted in the medical chart or abstract by a physician or coroner. Injuries coded as accidental or undetermined are not included in this indicator, even though a portion of these injuries may have been intentional. As such, this indicator underestimates the true number of hospitalizations and deaths for self-harm and should be considered a minimum rate of self-harm.

Data updated:
Data availability: to (fiscal years)
Geographic coverage
All provinces/territories
Reporting level
National, Province/Territory
Calculation

(Total number of self-harm hospitalizations not ending in death for people age 10 and older + Total number of deaths from suicide for people age 10 and older) ÷ Total mid-year population age 10 and older × 100,000

Denominator

Total mid-year population age 10 and older

Numerator

Total number of self-harm hospitalizations and self-harm deaths (suicides) for persons age 10 and older.

Unit of analysis for self-harm hospitalizations: Episode of care. Episode building was performed among Discharge Abstract Database–Hospital Morbidity Database (DAD/-HMDB) records to accommodate multiple abstracts within a single episode of care.

An episode of care refers to all contiguous inpatient hospitalizations in general and psychiatric hospitals. For episodes with transfers within or between facilities, transactions were linked regardless of diagnoses. To construct an episode of care, a transfer is assumed to have occurred if either of the following conditions is met:

  1. An acute care hospitalization occurs less than 7 hours after discharge from the previous acute care hospitalization, regardless of whether the transfer is coded;
  2. An acute care hospitalization occurs between 7 and 12 hours after discharge from the previous acute care hospitalization, and at least one of the hospitalizations has coded the transfer.

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Name

Self-Harm, Including Suicide

Short/Other Names

Not applicable

Description

Age-standardized rate of self-harm hospitalizations in a general or psychiatric hospital and self-harm deaths (suicides) per 100,000 population age 10 and older.

For further details, please see the General Methodology Notes (PDF).

Rationale

Self-harm is defined as a deliberate self-inflicted bodily injury or poisoning that may or may not result in death. This type of injury is the result of either suicidal or self-harming behaviours, or both.  Completed suicides represent 1 outcome of self-harm.

Regardless of suicidal intent, acts of self-harm signal poor outcomes and severe distress among the population. Self-harm can be prevented, in many cases, by early recognition, intervention and treatment of mental disorders. An indicator that captures both self-harm hospitalizations and completed suicides is meant to provide a picture of self-harm in relation to access to community mental health care. While some risk factors for self-harm are beyond the control of the health system, a combined indicator can inform a lack of adequate access to mental health services across the country.

Interpretation

Lower rates are desirable as they signal less frequent severe self-harm.

The indicator captures only cases where intentional self-harm was noted in the medical chart or abstract by a physician or coroner. Injuries coded as accidental or undetermined are not included in this indicator, even though a portion of these injuries may have been intentional. As such, this indicator underestimates the true number of hospitalizations and deaths for self-harm and should be considered a minimum rate of self-harm.

HSP Framework Dimension

Access to comprehensive, high-quality health services

Areas of Need

Not applicable

Targets/Benchmarks

Not applicable

Available Data Years

to

Geographic Coverage

  • All provinces/territories

Reporting Level/Disaggregation

  • National
  • Province/Territory
  • Sex

Indicator Results

Web Tool:
Your Health System: In Brief
Region-level results for Self-Harm Hospitalizations (which is a subset of this indicator) are available in YHS: In Depth.

Update Frequency

Every year

Latest Results Update Date

Updates

Not applicable

Description

(Total number of self-harm hospitalizations not ending in death for people age 10 and older + Total number of deaths from suicide for people age 10 and older) ÷ Total mid-year population age 10 and older × 100,000

Type of Measurement

Rate

Rate — per 100,000

Denominator

Description:

Total mid-year population age 10 and older

Numerator

Description:

Total number of self-harm hospitalizations and self-harm deaths (suicides) for persons age 10 and older.

Unit of analysis for self-harm hospitalizations: Episode of care. Episode building was performed among Discharge Abstract Database–Hospital Morbidity Database (DAD/-HMDB) records to accommodate multiple abstracts within a single episode of care.

An episode of care refers to all contiguous inpatient hospitalizations in general and psychiatric hospitals. For episodes with transfers within or between facilities, transactions were linked regardless of diagnoses. To construct an episode of care, a transfer is assumed to have occurred if either of the following conditions is met:

  1. An acute care hospitalization occurs less than 7 hours after discharge from the previous acute care hospitalization, regardless of whether the transfer is coded;
  2. An acute care hospitalization occurs between 7 and 12 hours after discharge from the previous acute care hospitalization, and at least one of the hospitalizations has coded the transfer.

Inclusions:

  1. Admission to hospital with self-harm diagnosis (ICD-10-CA codes X60 to X84) for those age 10 and older, sex recorded as male or female, discharged alive
    • Includes Analytical Institution Type Code = 1 (general hospital) or 5 (psychiatric hospital) from the Discharge Abstract Database (DAD)
    • Includes Ontario Mental Health Reporting System (OMHRS) records for cases where the OMHRS stay was from an initial emergency department (ED) visit for intentional self-harm (X60 to X84 in the National Ambulatory Care Reporting System [NACRS]) within 7 days
  2. Deaths identified from Statistics Canada’s Vital Statistics and Yukon Bureau of Statistics’s Coroner data due to self-harm (underlying cause of death codes X60 to X84, Y87.0)

Additional notes on the inclusions:

  • Vital Statistics data is available by calendar year and hospitalization data is available by fiscal year. Each data set covers 12 months; however, January to March are not aligned.
  • At this time, we are unable to determine the rate for those not identified as male or female in the data.

Exclusions:

  1. 2018–2019 data onward: Medical assistance in  dying (MAID) (Discharge Disposition Code = 73)

Method of Adjustment

Direct standardization

Age adjustment based on 4 age groups: 10 to 24, 25 to 44, 45 to 64 and 65+. For each province, age-specific indicator rates for the 4 age groups are calculated. The provincial indicator value is a weighted sum of these rates, with the weights being determined by the age structure of the Canadian population in 2011 (mid-year).

Adjustment Applied

Age-adjusted

Geographic Assignment

Place of residence

Data Sources

  • DAD
  • HMDB
  • NACRS
  • OMHRS
  • Canadian Vital Statistics Death Database (CVSD)
  • Yukon Vital Statistics

Caveats and Limitations

The indicator captures only cases within the hospitalization data where intentional self-harm was noted in the medical chart or abstract by a physician. This indicator does not include cases of self-harm that are not admitted to hospital, nor injuries coded as accidental or undetermined, even though a portion of these injuries may have been intentional. In addition, self-harm where no medical care is sought (including deaths by suicide in the community) or where a patient visits only a primary health care provider or emergency department will not be captured. Thus, this indicator underestimates the true number of hospitalizations for self-harm and should be considered a minimum rate of self-harm.

Death data for January to March of each fiscal year is estimated based on January to March rates from the same period in the previous year to align the time frame with the most recent inpatient data. Suicide deaths in these 3 months are estimated to be about 4% of the indicator’s numerator.

Comments

Patients in the Discharge Abstract Database–Hospital Morbidity Database (DAD-HMDB) and OMHRS with invalid postal codes will not be included in the numerator of any province but will be included in the all-Canada numerator. An exception to this is patients who are identified as homeless (DAD-HMDB: diagnosis code = Z59.0 or postal code = XX; OMHRS: residential status code = 8); these patients will be assigned to the province of the facility.

More information on this indicator is available in the 2020 companion report on the

References

Not applicable

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