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Suicide in Canada

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Suicide
Social aspects
Crisis
Types and methods
Epidemiology
History
In warfare
Related phenomena
By country
Organizations

Approximately 3,500 suicides take place in Canada annually, slightly below deaths due to cancers of the colon and breast.[1][2][3]

Suicide is the seventh-most common cause of death among Canadian males, and tenth-highest among both sexes combined.[1][2][3]

During 1999-2003, the suicide rate among Nunavut males aged 15 to 19 was estimated to exceed 800 per 100,000 population, compared to around 14 for the general Canadian male population in that age group.[4]

Suicide rate over time

Rates of suicide in Canada have been fairly constant since the 1920s, averaging annually around twenty (males) and five (females) per 100,000 population, ranging from lows of 14 (males, 1944) and 4 (females, 1925, 1963) to peaks of 27 (males, 1977, 1982) and 10 (females, 1973). During the 2000s, Canada ranked 34th-highest overall among 107 nations' suicide rates.

Suicide Rates (per 100,000 residents) in Canada, by year[5][6]
Year Rate (both genders)
1950 7.8
1951 7.4
1952 7.3
1953 7.1
1954 7.2
1955 7.0
1956 7.6
1957 7.5
1958 7.4
1959 7.1
1960 7.6
1961 7.5
1962 7.2
1963 7.6
1964 8.2
1965 8.7
1966 8.6
1967 9.0
1968 9.8
1969 10.9
1970 11.3
1971 11.7
1972 12.0
1973 12.2
1974 12.7
1975 12.1
1976 12.5
1977 14.0
1978 13.4
1979 13.9
1980 13.7
1981 13.7
1982 14.0
1983 14.8
1984 13.4
1985 12.6
1986 14.1
1987 13.6
1988 13.1
1989 12.8
1990 12.2
1991 12.8
1992 13.1
1993 13.3
1994 12.9
1995 13.5
1996 12.3
1997 12.3
1998 12.3
1999 13.4
2000 11.8
2001 11.9
2002 11.6
2003 11.9
2004 11.3
2005 11.6
2006 10.8
2007 11.0
2008 11.1
2009 11.5

Demographics and locations

Canada's incidence of suicide — deaths caused by intentional self-harm divided by total deaths from all causes — averaged over the period from 2000 to 2007 for both sexes, was highest in the northern territory of Nunavut, and highest across the country within the age group from 45 to 49 years.[7]

By gender

Canadian males experience two periods over their lives when they are most likely to die by suicide — in their late forties, and past the age of ninety — for females there is a single peak, in their early fifties. The peak male rates are 53% above the average for all ages, while for females, the peak is 72% greater.

By region

Rate of suicide, all ages, average over 2000-2007, according to province or territory

Age-standardized mortality rate per 100,000 population

Both Sexes Males Females
Canada 10.90 17.04 4.96
Alberta 13.13 19.81 6.41
British Columbia 9.73 14.95 4.68
Manitoba 12.04 18.04 6.13
New Brunswick 11.95 19.78 4.38
Newfoundland and Labrador 8.54 14.75 2.54
Northwest Territories 18.66 32.35 4.99
Nova Scotia 9.29 15.58 3.34
Nunavut 71.00 113.69 26.26
Ontario 7.86 12.16 3.80
Prince Edward Island 8.86 14.94 3.01
Quebec 15.20 24.05 6.53
Saskatchewan 11.46 17.83 5.19
Yukon 15.30 26.84 3.91

Source:[8]

Canada's regional rate of 71.0 in Nunavut would place Nunavut second highest in the world if it were a country.[9]

With 86.5 suicides per 100,000 population in 2006, males' rates over the age of 74 in the Russian Federation exceed by threefold Canadian males' rate among the same age cohort, however Canada's Nunavut males of all ages exceeded the elderly Russian male rate by thirty per cent.[10] During 2000-2007, there were between 13 and 25 male suicides recorded annually in the Nunavut territory, accounting for between 16% and 30% of total annual mortality.[8]

By age group

Rate of suicide, all Canadians, average over 2000-2007, according to age at death

Age-standardized mortality rate per 100,000 population

Both Sexes Males Females
All ages 11.48 17.81 5.24
1 - 4 0.00 0.00 0.00
5 - 10 0.01 0.01 0.00
10 - 14 1.61 1.71 1.54
15 - 19 9.53 13.75 5.06
20 - 24 13.24 20.84 5.26
25 - 29 12.15 19.26 4.88
30 - 34 13.09 20.48 5.60
35 - 39 15.76 24.36 7.00
40 - 44 16.56 25.49 7.56
45 - 49 17.86 26.96 8.78
50 - 54 17.26 25.63 9.03
55 - 59 14.99 22.98 7.15
60 - 64 12.31 19.40 5.46
65 - 69 10.73 16.50 5.33
70 - 74 10.38 17.54 4.20
75 - 79 11.33 21.30 3.84
80 - 84 9.76 19.74 3.55
85 - 89 10.80 25.74 3.43
90 and over 9.64 27.84 3.21

Source:[11]

Among Canadians aged 15 to 24, suicide ranked second among the most common causes of death during 2003-2007, accounting for one-fifth of total mortality.[11] In the 45 to 54 age group, its rank was fourth over these years, the cause of 6 per cent of all deaths.[11]

Military

An internal study of suicide rates among Canadian Forces staff deployed over the period 1995 to 2008 found the rate for males in the Regular Forces to be approximately 20% lower than that among the general population of the same age.[14]

However, mortality analysis of 2,800 former Canadian Forces personnel revealed statistically significant, higher likelihoods of death by suicide. The rate of suicide amongst former military personnel was 46% higher for males and 32% higher for females, relative to the civilian population. Released Canadian Forces males in the 16 to 24 age group showed the greatest deviations, with suicide rates more than two-fold in excess of their general population cohort.[15][16]

Methods

During the 1980s and 1990s, firearms (or explosives) and hanging were the first- and second-most frequent means of suicide among Canadian males, followed by poisoning, gases, and jumping, and collectively, nine-tenths of suicides were committed via these five methods; poisoning was responsible for forty per cent of female suicides, followed by hanging (20%), gases and firearms (10% each).[17] Analysis of coroners' reports has attributed overprescription practices, and deficiencies in patient screening and prevention by family physicians to recent Canadian suicide trends.[1][18]

A study of 20,851 suicides in Quebec from 1990 to 2005 found that hanging, strangulation and suffocation were the principal causes of death (males, age-adjusted rate of 15.6 per 100,000; females, 3.6), followed by poisoning (males: 5.7; females: 2.9).[19]

In 2009, 14 of 18 persons who jumped in front of oncoming subway trains in Toronto's mass transit system were killed by the direct impact, electrocution from the high voltage rail, or from entrapment underneath the cars.[20] Although 1,200 suicide attempts or deaths have occurred in the Toronto subway from 1954 to 2010, with a peak of 54 suicide incidents in 1984, the current rate represents four per cent of Toronto's annual suicides.[20] In 2010, the Toronto Transit Commission reported a total of 26 "suicide incidents" (attempts and deaths), and seven during the first five months of 2011.[21]

Among aboriginal people

Suicide has been acknowledged by the Royal Commission on Aboriginal Peoples as "one of the most urgent problems facing Aboriginal[22][Notes 1] communities."[23]: 1  The report described numerous aspects of the magnitude of the problem.[24]

In a 2002 article published in the Emergency Medicine journal, researchers[25] reported that there was a two- to seven-fold differential in suicide mortality rates among Canada's indigenous communities, relative to the general population. The rate of suicide among Aboriginal people of Canada, exceeded the two- to three-fold elevations reported among indigenous peoples in other countries of British colonisation, including Australia and the United States.[25]

In July, 2001 a Suicide Prevention Advisory Group (SPAG)[26]: 7  was jointly appointed by the Assembly of First Nations' former National Chief, Matthew Coon Come and former Minister of Health, Allan Rock, to "make recommendations regarding the prevention of suicide among First Nations youth."[26]: 182  In their 2002 report SPAG referred to the contributing factors [27] identified by the Royal Commission on Aboriginal Peoples:[28] psycho-biological factors, life history or situational factors, socio-economic factors, and cultural stress.[26][27]: 20  In 2006 Health Canada reported that suicide rates were "five to seven times higher for First Nations youth than for non-Aboriginal youth" and that suicide rates among Inuit youth "were among the highest in the world, at 11 times the national average."[29][30]

In their 2007 report,[31]: 189  This comprehensive report includes a lengthy biography of major research projects on suicide among Aboriginal people in Canada with detailed data and analysis by age group, gender, province.[31]: xv  the Aboriginal Healing Foundation (AHF) noted that while the suicide rate in Canada overall had declined, for Aboriginal people, particularly Aboriginal youth, the rates had continued to rise. The suicide rate in First Nations communities in general is about twice that of the total Canadian population. Among Inuit it is 6 to 11 times higher than the general population. "From the ages of 10 to 29, Aboriginal youth on reserves are 5 to 6 times more likely to die of suicide than their peers in the general population. Over a third of all deaths among Aboriginal youth are attributable to suicide. Although the gender difference is smaller than among the non-Aboriginal population, males are more likely to die by suicide, while females make attempts more often."[31]: xv 

In 2013, James Anaya, the UN’s special rapporteur on the rights of indigenous peoples[32] was deeply concerned by the suicide rate in aboriginal communities. He noted particularly that in Pukatawagan there has been a suicide (once) every six weeks since January 2013.[32] Since 2009, "there have been as many as 27 more suicides at Pukatawagan, which is home to 2,500 residents."[32] The "suicide rate among youth on reserves is "alarming" at a rate five times greater than that of all Canadians."[32]

Among the Inuit

By 2007 in a population of 30,000 that is mainly Inuit, "40 per cent of deaths investigated by the coroner's office were suicides. Many of the 222 suicide victims were young, Inuit and male."[33]

In 2007 an article by Nunavut a social science researcher Jack Hicks, entitled "The social determinants of elevated rates of suicide among Inuit youth" was published by the International Working Group of Indigenous Affairs in their journal Indigenous Affairs. Hicks described how the rate of suicide among the Inuit of the eastern Arctic rose from around 40 per 100,000 population in 1984 to about 170 in 2002. Some of the reasons given include adverse childhood experiences involving emotional neglect and abuse, family violence and substance abuse, as well as social inequalities brought on by government intervention.[4] In an interview with CBC, Hicks argued that the "Nunavut government and other public organizations [were] not doing enough to address suicide in the territory."[7]

"If we want to help the mental health of a lot of people who seek help, we have to deal with employment, housing, violence, substance abuse."

— Jack Hicks 2008 CBC

Forced relocations of entire Inuit communities, for example, "has been noted to have "devastating effects on psychological well-being."[31]: 59 [34]

In December 2007 Samuel Law published the findings of his study of Nunavut mental-health cases from his psychiatric practice at the Baffin Regional Hospital in Iqaluit, Nunavut in 2000 in the Canadian Journal of Community Mental Health.[7] He revealed that 22 per cent of the 110 mental-health cases he studied involved suicide risk assessments.[7] The population of Iqaluit in 2006 was 6,184.[35]: 6 

Suicide among Inuit was rare in the 1950s.[33] The reports of suicide among the elderly come from anthropologists in the 1950s, whose work may not be reliable.[36]: 92–3 [37][37]

Cultural and historical factors

Although data about suicide are limited regarding pre-contact period in North America, historical and ethnographic records suggest that suicide was rare.[31]: 59 [38] Because most Aboriginal cultures prohibited suicide and in some First Nations, for example, the Athabaskans,[31]: 59 [39] the Huron and Iroquois nations,[31]: 59 [40] those "who died by suicide were denied ordinary funeral and burial rites."[31]: 59 [41] Although many accounts make mention of altruistic suicide by the elderly, incurably ill, injured or disabled in response to periods of starvation or other desperate circumstances, Vogel[42] argued that "its true prevalence is unknown."[31]: 60 [42] Despair and grief at the loss of camp and family members to epidemics of smallpox, and other diseases introduced by Europeans, may have provoked suicides among Aboriginal survivors.[31]: 59 [39]

Other factors

High concentrations of air pollutants, particularly nitrogen oxide during the winter months, have been associated with a twenty per cent rise in suicidal attempt presentations at a Vancouver hospital emergency department.[43] Pathological gambling behaviour has been linked to a threefold increase in the likelihood of suicide attempts from a nationally representative sample.[44]

The same study found the overall incidence of attempted suicide to be 0.52% in 2002 from a survey of forty thousand individuals, with rates nine times higher among both persons aged 15 to 19 compared to those over age 55, and nine times higher among those who had major depressive episodes during the previous year; persons in the lowest income quintile were four times as likely to report suicide attempts than those in the top income bracket.[44]

Unattached Canadians between 45 and 59 years of age were in 2007 found to be 2.6 times more likely than their population share to fall within the low income category as defined by the low income cutoff measure, making them the most at-risk population group; they were followed by recent immigrants (2.0), lone parents and their children (1.9), and persons with work limitations (1.2).[45]

During the period from 2002 to 2005, residents of health regions of Quebec that were in the lowest socioeconomic decile, as defined by average household income, unemployment rate and education, were statistically found to have 85% (males) and 51% (females) higher incidences of suicide mortality than Quebeckers in regions in the highest socioeconomic decile, and these differences have either persisted or worsened since 1990.[19]

Government response

A survey of twenty-one advanced, industrialized nations during 2004 found that Canada was among ten lacking "countrywide integrated activities carried out by government bodies" to address the problem of suicide;[46] Canada is in company with Belgium, the Netherlands, and Switzerland, while the eleven countries implementing national programs include Australia, France, the United Kingdom, and the United States.[47][48]

According to a former president of the Canadian Association for Suicide Prevention, Canada's federal government has failed to implement the 1995 United Nations guidelines for national suicide prevention strategies, the government has never formally acknowledged that "suicide is a national public health issue", and while Quebec, Alberta and Nova Scotia have provincial strategies, both Ontario and Saskatchewan lack them.[49]

During 2005-2010, Canada's federal government allocated a total of $65 million to be administered by Health Canada and the Government of Nunavut for the National Aboriginal Youth Suicide Prevention Strategy (NAYSPS),[50] and by 2010, two hundred community-based programs including mental health service providers, native elders and teachers had benefited from this initiative.[51][52] The federal government extended the NAYSPS in 2010 for an additional five years, and increased the budget to $75 million.[53][54][55]

The National Strategy for Suicide Prevention Act, a private member's bill from New Democratic Party Member of Parliament Megan Leslie, received its first reading in 2010 in Canada's House of Commons.[49] Harold Albrecht (Kitchener—Conestoga, CPC) introduced in September 2011 a private member's bill, known as the Federal Framework for Suicide Prevention Act, which directs the government to take responsibility for information and knowledge sharing related to suicide and suicide prevention in consultation with various government levels and civil society.[56]

In October 2011, a day-long debate in the House of Commons resulted in passage of an opposition motion, by a vote of 272 yeas against 3 nays, to "urge the government to work cooperatively with the provinces, territories, representative organizations from First Nations, Inuit, and Métis people, and other stakeholders to establish and fund a National Suicide Prevention Strategy".[57]

Since the early 1970s, the Toronto Transit Commission's (TTC) policy was to suppress information concerning suicide jumpers in the Toronto subway, however data were publicly released following a request from journalists in 2009.[20] As an interim measure, in June 2011, the TTC implemented a "Crisis Link" campaign, with posters exhorting persons contemplating suicide to press an autodial button on one of 141 designated payphones located on 69 stations' platforms to speak directly with a trained counsellor with the Distress Centres of Toronto.[21] Platform screen doors have already been built in underground mass transit systems in cities in Europe and Asia, however the first screen doors in Canadian metro stations are scheduled for Toronto in 2013.[58]

See also

Notes

  1. ^ "The term Aboriginal People refers to the indigenous inhabitants of Canada when describing in a general manner the Inuit, and First Nations (Indians), and Métis people, without regard to their separate origins and identities."

References

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  3. ^ a b Statistics Canada. Leading causes of death in Canada, 2007. Highlights, Ottawa, ON: Statistics Canada; 2010. http://www.statcan.gc.ca/pub/84-215-x/2010001/hl-fs-eng.htm (Accessed 2011 Jan 14).
  4. ^ a b Hicks, Jack (2007), "The social determinants of elevated rates of suicide among Inuit youth" (PDF), Indigenous Affairs, 4, 07: 30–37
  5. ^ [1], 1950-2008 Canadian Suicide Rates
  6. ^ http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/hlth66d-eng.htm
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  14. ^ Zamorski, Mark A. (February 2010). Report of the Canadian Forces Expert Panel on Suicide Prevention. Ottawa: Canadian Forces Health Services Group Headquarters.
  15. ^ Statistics Canada. "Table 4. Causes of Mortality – released CF CAMS cohort. Table 5. Age–specific External Causes of Mortality – released CF CAMS cohort". Canadian Forces Cancer and Mortality Study: Causes of Death. Retrieved October 12, 2011.
  16. ^ Casey (Charlottetown, Lib.):, Hon. Sean. "Opposition Motion--National Suicide Prevention Strategy". Parliament, 1st Session, Edited Hansard, Number 026. Parliament of Canada. Retrieved October 12, 2011.{{cite web}}: CS1 maint: extra punctuation (link)
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  35. ^ (Report). March 15, 2015 http://www.city.iqaluit.nu.ca/sites/default/files/ced_plan_part1_overview_2015-19e.pdf. Retrieved April 18, 2016. {{cite report}}: Missing or empty |title= (help)
  36. ^ Spencer, Robert F. (1959), The North Alaskan Eskimo: A study in ecology and society, Smithsonian Institution, pp. 92–3
  37. ^ a b Leighton, A.H; Hughes, C.C. (1955), "Notes on Eskimo Patterns of Suicide", Southwestern Journal of Anthropology, 11 (4): 327–338
  38. ^ Pine, Charles J. (1981), "Suicide in American Indian and Alaska Native Tradition", White Cloud Journal (3): 3–8
  39. ^ a b Fortuine, R. (1989), Chills and Fever: Health and Disease in the Early History of Alaska, Fairbanks, Alaska: University of Alaska
  40. ^ Tooker, E. (1991), An Ethnography of the Huron Indians, 1615–1649, Syracuse, NY: Syracuse University Press
  41. ^ Hultkrantz, A. (1979), The Religions of the American Indians, Berkeley, CA: University of California Press
  42. ^ a b Vogel, V.J. (1990), American Indian Medicine, Norman, OK: University of Oklahoma Press
  43. ^ Szyszkowicz, Mieczysław; Jeff B. Willey; Eric Grafstein; Brian H. Rowe; Ian Colman (October 15, 2010). "Air Pollution and Emergency Department Visits for Suicide Attempts in Vancouver, Canada". Environmental Health Insights. 4: 79–86. doi:10.4137/EHI.S5662. PMC 2978939. PMID 21079694. {{cite journal}}: |access-date= requires |url= (help)
  44. ^ a b Newman, Stephen C.; Thompson, Angus H. (Sep 2007). "The association between pathological gambling and attempted suicide: Findings from a national survey in Canada". The Canadian Journal of Psychiatry. 52 (9): 605–612. PMID 17953165.
  45. ^ Zhang, Xuelin. 2010. "Low income Measurement in Canada: What do different Lines and Indexes tell us?", Ottawa: Statistics Canada, Income Research Paper Series – Research Paper 75F0002M. http://www.statcan.gc.ca/pub/75f0002m/75f0002m2010003-eng.htm (accessed August 26, 2011)
  46. ^ Matsubayashi, Tetsuya; Michiko Ueda (November 2011). "The effect of national suicide prevention programs on suicide rates in 21 OECD nations". Social Science & Medicine. 73 (9): 1395-1 400. doi:10.1016/j.socscimed.2011.08.022. PMID 21940085. Retrieved October 14, 2011.
  47. ^ Wasserman, Danuta; Ellenor Mittendorfer Rutz; Wolfgang Rutz; Arming Schmidtke. Suicide prevention in Europe: The WHO European monitoring survey on national suicide prevention programmes and strategies (PDF). NASP - Swedish National and Stockholm County Council’s Centre for Suicide Research and Prevention of Mental Ill-Health. p. 13. Retrieved October 16, 2011.
  48. ^ Canadian Association for Suicide Prevention / Association canadienne pour la prévention du suicide. "CASP National Suicide Prevention Strategy". CASP. Retrieved October 16, 2011.
  49. ^ a b Vogel, , Lauren (2011). "Canada suicide prevention efforts lagging, experts say". CMAJ. 183 (1): E27–E28. doi:10.1503/CMAJ.109-3724. PMC 3017278. PMID 21115679. {{cite journal}}: |access-date= requires |url= (help)CS1 maint: multiple names: authors list (link)
  50. ^ Health Canada. "First Nations & Inuit Health Program Compendium". Health Canada, Home > First Nations, Inuit & Aboriginal Health > Reports & Publications > Aboriginal Health. Government of Canada. Health Canada. Retrieved October 12, 2011.
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  53. ^ Aboriginal Affairs; Northern Development Canada. "Sustaining Momentum: The Government of Canada's Third Report in Response to the Kelowna Accord Implementation Act (2010-2011)". Government of Canada. {{cite web}}: Unknown parameter |lastauthoramp= ignored (|name-list-style= suggested) (help)
  54. ^ Flaherty, P.C., M.P., The Honourable James M. (March 4, 2010). Canada's Economic Action Plan. Year 2 (PDF). Ottawa: Government of Canada. House of Commons. p. 119.{{cite book}}: CS1 maint: multiple names: authors list (link)
  55. ^ Government of Nunavut., Health and Social Services. "National Aboriginal Youth Suicide Prevention Strategy (NAYSPS) Program". Government of Nunavut. Retrieved October 12, 2011.
  56. ^ Albrecht, Hon. Harold. "Private Member's Bill C-300 (41-1)". LEGISinfo. Parliament of Canada. Retrieved October 12, 2011.
  57. ^ Rae (Toronto Centre, Lib.), Hon. Bob. "Opposition Motion--National Suicide Prevention Strategy". 41st Parliament, 1st Session, Edited Hansard, Number 026. Parliament of Canada. Retrieved October 12, 2011.
  58. ^ Platform screen doors#Canada

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