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Abstract

Objective: Prior research has suggested an association between suicide and certain occupations. The aim of the present study was to report on suicide rates in selected occupations in Queensland (QLD).

Method: Suicide mortality data from the QLD Suicide Register and population data from the Australian Bureau of Statistics were obtained for the period 1990–2006. Suicide rates were calculated for each occupational group and compared to rates within the general population (15–64 year age group) and the employed population of QLD.

Results: There was significantly higher risk of suicide for male subjects in the agricultural, transport and construction sectors of QLD. High suicide rates were also found in female nurses, artists, agricultural workers and cleaners, while education professionals (of both genders) appeared at lower risk.

Conclusions: The significantly higher suicide rates for employees of the agriculture, construction, and transport industries indicate a need for further research into the occupation-specific conditions and individual or other social–environmental factors that may accentuate suicide risk within these professions. Use of higher quality occupational data is also warranted in future studies.

Keywords

agriculture Australia epidemiology occupation suicide

The protective effect of employment on suicidal behaviour (attempts and completions) has been well established in the literature [1–4]. In particular, unemployment has been associated with a two–threefold higher risk of completed suicide compared to employed individuals [1,5], although Blakely et al. conceded that this association may be partially explained by factors such as psychiatric illness [5].

Despite the evidence for the protective effect of employment on suicidal behaviour, there is an increasing body of international research examining the link between suicide and certain occupations, particularly the law enforcement [6–10], medical [6,11–15], nursing [6,11,16], construction [17–20], and agricultural professions [2,21–28]. It is generally accepted that higher suicide rates occur in blue collar workers (including cleaners, labourers, seamen, forestry workers, miners, transport workers, factory workers, sex workers and construction workers) [11,17,19,29–42], with white collar occupations (with the exception of the medical/ veterinary, arts and police services) being underrepresented in suicide statistics [1,6,16,35,43–46].

Suicide in Australian occupations has remained a relatively neglected area of research [47]. The few available reports have for instance estimated that suicide in the Queensland (QLD) commercial building construction industry accounted for 2.4% of male suicides (15–64 years) for the 1995–2001 period, equating to rates 25% and 46% higher than QLD and Australian general population figures, respectively (40.3/100 000 vs 32.2/100 000 (QLD) and 27.6/100 000 (Australia)) [17].

Of particular interest in Australia has been suicide within the agricultural industry, where male suicide rates have been recorded as ranging from 33.8 per 100 000 (farm residents) to 51.4 per 100 000 (farm managers) [26,48]. Reasons for these high suicide rates remain unclear, but a recent Commonwealth report highlighted the uniquely stressful experience of farming as being characterized by financial insecurity, aging workforce, isolation and climatic events such as drought [49]. The ‘weather phenomenon’, in combination with continuing economic, market and demographic changes, is expected to place additional pressures on the mental health of Australian agriculturalists [49,50].

Despite existing findings, evidence for the link between suicide and occupation has been subject to several methodological limitations that affect results comparability. For instance, prior work has been restricted to investigation of a specific occupation and/or geographic location [11,15,35] or has used conflicting categories or differing definitions of occupation [2,6,11,25]. In addition, failure to differentiate suicide from other forms of sudden death [11], small sample sizes, aggregation of labour force status, undifferentiated skill levels and/or role in a given occupation [46], poor quality of data (e.g. incomplete employment records, misclassification of suicides) [8,17,27,46,51], failure to control for confounding variables (e.g. gender differences) [27,35,52], and study samples based on residency rather than occupation (e.g. [48]), have all constituted obstacles to comparability of research data. The aim of the present study was to address some of the aforementioned limitations and extend prior research by (i) determining the rates of suicide within selected occupations in QLD for the period 1990–2006; and (ii) using the employed population of QLD as a comparison group for occupation suicide rates.

Methods

Data sources

Records of all suicides occurring in the period 1990–2006, by people aged 15–64 (working-age population) at death and classified as ‘probable’ and ‘beyond reasonable doubt’ were identified from the QLD Suicide Register (QSR). The QSR is a comprehensive database designed by the Australian Institute for Suicide Research and Prevention that details QLD suicide cases from 1990 to the present [53] (see [54] for a more detailed description). Information in the database is based on postmortem, police and psychological autopsy reports and includes demographic, medical and psychiatric information regarding the deceased [53]. Cases are classified as ‘possible’, ‘probable’ and ‘beyond reasonable doubt’ using a decision-tree model [53] (only probable and beyond reasonable doubt cases were used in the present study). In beyond reasonable doubt cases the information regarding the death is sufficient to indicate that the death was due to suicide [53]. In contrast, probable suicide cases are deaths that are more likely to be due to suicide than any other cause, but these cases lack conclusive information that death was due to suicide [53].

Occupation was assigned to all cases in which the subject was recorded as employed (full-time or part-time) at time of death (Table 1) based on the Australian Standard Classification of Occupations (ASCO, 2nd edn) [55]. Identified occupations were aggregated into seven categories [56], which were further refined based on similar skill and task identification in order to obtain sufficient size in each cluster (minimum of 20 suicide cases). Suicide cases recorded within occupations not clustered within the seven categories of interest were excluded from analysis.

Table 1.

Occupational groupings included in analysis (based on [56])

Occupation	Groups included in each occupational category
Construction	Bricklayers Labourers (earthmoving, paving/surfacing/n.f.d.) Mobile construction plant operators Fibrous/solid plasterers Concreters Wall and floor tilers and stonemasons	Structural steel and welding tradespersons Structural steel construction workers/tradespersons Building and construction managers Tradespersons (Carpentry/joinery/plumbers/electricians)	Drillers Construction/plumbers assistants Floor/final finishers Painters/decorators Roof slaters/tilers Crane, hoist/lift operators
Transport	Drivers (automobile, bus and tram, delivery, freight and furniture, truck)	Road/rail transport drivers, n.f.d.	Train drivers/assistants
Agriculture	Farm hands and overseers Shearers	Farm overseers	Farmers and farm managers
Artists	Actors, dancers and related professionals Authors and related professionals Film, TV, radio and stage directors Designers and illustrators	Media presenters, media producers and artistic directors Performing arts support workers Signwriters Artists and related professionals, n.f.d.	Journalists and related professionals Musicians and related professionals Photographers Visual arts and crafts professionals
Cleaners	Domestic housekeepers	Cleaners	Laundry workers
Education professionals	Education aides, managers and officers Education professionals, n.f.d.	Teachers (English as second language, extra-systemic, pre-primary, primary, secondary university and vocational education)	Special education teachers Miscellaneous education professionals, n.f.d.
Nurses	Enrolled and registered nurses Nursing professionals, n.f.d.	Nurse educators and researchers	Midwives Nurse managers

n.f.d., not further defined.

Due to changes in ASCO codes during the study period, and the recognized difficulty in obtaining complete and reliable population data [26,48], several minor groups and occupations were excluded, as were suicide cases in which the subjects were employed in occupations other than the seven chosen occupations.

Population estimates for subjects aged 15–64 by gender, for the QLD total population, employed population, and selected occupation groups were obtained from the Australian Bureau of Statistics (ABS). For occupation categories, population data were obtained from the 2001 Census of Population and Housing (data available on request) [56]. For QLD total population and employed population, information was based on ABS Labour force data for 2001 [57].

Statistical analysis

Crude suicide rates per 100 000 were calculated for selected occupation groups, employed population and total population aged 15–64 by gender. Rate ratios (RRs) with 95% confidence intervals were calculated to compare the suicide rates of selected occupation categories to the suicide rate of the employed population. A probability level of 0.05 was used for all statistical tests. SPSS 15.0 (SPSS, Chicago, IL, USA) and StatsDirect 2.7.3 (StatsDirect Ltd, Altrincham, Cheshire, UK) were used for data analysis.

Results

Study sample

A total of 7652 suicides classified as ‘probable’ and ‘beyond reasonable doubt’ and falling within the 15–64 aged group (working age) was identified for the period 1990–2006 from the QSR; of these, 6087 (79.5%) involved male subjects. Occupational status could not be ascertained in 1073 cases (14.0%), and in 3569 (46.7%) this was recorded as either unemployed (1925) or out of the labour force (1644) at time of death. In a total of 3010 suicide cases (39.3%) the subjects were in current employment (either full time or part time) at death; of these, 1960 (65.1%) had an occupation classified other than those in the occupations of interest, and occupation could not be identified in 123 cases (4.1%).

Table 2 presents characteristics of employed suicide subjects. The subjects were predominately aged 35–54 years (46.7%), and male (86.5%), with more than one-quarter in a married/de facto relationship (43.5%).

Table 2.

Characteristics of suicides in selected occupation categories in QLD 1990–2006 (based on [XX])

	% male in suicides	% aged 15–34 years in suicides	% aged 35–54 years in suicides	% aged 55–64 years in suicides	% married/de facto in suicides
Construction	100	49.8	47.0	3.2	39.0
Transport	98.8	32.3	56.5	11.2	44.2
Agriculture	94.2	42.2	40.8	17.0	41.3
Artists	75.0	47.5	47.5	5.0	48.3
Cleaners	73.1	35.9	57.7	6.4	47.7
Education professionals	71.2	26.0	67.1	6.8	42.6
Nurses	23.1	40.4	51.9	7.7	51.4
Employed population	86.5	46.1	46.7	7.2	43.5
Total population	79.5	46.8	42.2	11.0	40.4

Suicide rates and rate ratios

Suicide rates and RRs are presented in Table 3. The suicide rates for all persons, male and female in the working age (15–64 years) QLD population, were significantly higher than suicide rates for the employed population.

Table 3.

Suicide incidence (1990–2006) and rates per 100 000 in Queensland

	Persons				Male				Female
	Suicide incidence ^†	Suicide rate ^‡	RR	95% CI	Suicide incidence ^†	Suicide rate ^‡	RR	95% CI	Suicide incidence ^†	Suicide rate ^‡	RR	95% CI
Construction	317	18.6	1.76∗	1.56–1.97	317	19.0	1.14∗	1.01–1.28	0	–	–
Transport	161	19.1	1.80∗	1.52–2.05	159	20.4	1.23∗	1.04–1.44	2	–	–
Agriculture	206	24.1	2.20∗	1.93–2.51	194	32.3	1.94∗	1.69–2.24	12	4.7	1.49	0.84–2.46
Artists	40	12.8	1.21	0.89–1.66	30	16.1	0.97	0.68–1.39	10	8.0	2.49∗	1.33–4.67
Cleaners	78	10.8	1.02	0.81–1.27	57	21.7	1.30∗	1.00–1.70	21	4.6	1.43	0.92–2.21
Education professionals	73	5.2	0.49∗	0.39–0.62	52	13.2	0.79	0.60–1.04	21	2.1	0.66	0.42–1.02
Nurses	52	9.0	0.85	0.64–1.11	12	23.7	1.43	0.81–2.51	40	7.6	2.37∗	1.71–3.28
Employed population	3,010	10.6	1		2,602	16.6	1		408	3.2	1
Total population	7,652	18.5	1.75∗	1.68–1.83	6,087	29.6	1.78∗	1.70–1.86	1,565	7.6	2.37∗	2.13–2.63

CI, confidence interval; RR, rate ratio. ^†QSR 1990–2006 [XX]; ^‡ rates calculated using ABS data for 2001 [XX]. Employed population’ has been used as a reference category for rate ratios. ∗p < 0.05.

In the occupations of interest the highest rates of suicide for all persons were in the agricultural, transport and construction professions, which were all significantly above that of the suicide rate for the employed population.

While education professionals and nurses had the lowest all person suicide rates, the RR indicated that only the former group had a significantly lower suicide rate compared to the employed population suicide rate.

Male rates of suicide were highest in agriculture and among nurses and cleaners, but only agriculturalist and cleaner groups had significantly higher rates than the employed population. A significantly higher male suicide rate was also seen in construction and transport workers, in comparison to the employed population suicide rate.

Female rates were highest for artists and nurses, both were significantly above that of the employed population female rate. Significantly elevated female rates were also observed for agricultural workers. Female rates for education professionals remained lower (but not significantly) when compared to the employed population rate.

Discussion

This study represents one of the few Australian studies into suicide and occupation that combines (i) the use of the employed population suicide rates as a comparison group for occupation suicide rates; and (ii) inclusion criteria based on occupation recorded at death rather than residency (e.g. farm residency).

Most prior research into suicide within occupations has been flawed by a reliance on the general population as a comparison group in rate calculations [6,10]. For example, failure to segregate employed from individuals not in the workforce (children, disabled, unemployed) potentially underestimates true rates of suicide within occupational groups (which typically include only labour force participants) [10,17,58]. For these reasons, in the current study, a group solely consisting of employed individuals was chosen as the comparison population. Indeed, the marked difference observed between the suicide rates for the employed population and the QLD working age population (age 15–64) suggests that there may be, as hypothesized by prior researchers [2], a suicide protective effect provided through employment. Some of the selected occupations in the current study showed significantly increased suicide rates above the suicide rate for employed persons (male and female). Thus, a higher than average risk of suicide compared to the employed population was found for individuals aged 15–64 years and employed in the QLD agricultural, artist, cleaner, construction and transport industries. Additionally, male employees of the construction, transport, agriculture and cleaner industries, and female nurses and artists appear to be at particular risk, while the all-persons suicide rate was lowest in education professionals.

Associations between factors (e.g. psychiatric, sociodemographic) that may have influenced suicidality in the selected occupations were not addressed in the current study. It has been well established, however, that male gender and rural locality are risk factors for completed suicide, and thus higher rates of suicide would be expected in occupations that are male dominated (i.e. agriculture, construction and transport), and occupations that are based in rural areas (such as agriculture) [53,59,60]. Equally, the higher suicide rates observed in the agriculture and nursing groups may be partially explained by access to suicide means, warranting further investigation. For example, prior literature linking suicide to choice of method provides convincing evidence that there may be occupation-conferred risk factors [11,18,22,38,46,61,62]. Preference for suicide methods with increased accessibility due to type of occupation has been documented in farm workers and police (firearms) [11,26,61] as well as medical workers (poison) [11,63]. For instance, relative to the general population, Agerbo et al. reported a 13-fold risk of poison-related suicides in physicians [11], and Hawton et al. observed that half of suicides in resuscitators involved anaesthetics [63]. Logically it may be assumed that use of such highly lethal methods would at least partially explain the elevated rates of suicide observed in these particular occupations [13].

The increased suicide rate in agricultural workers in the present study may also be explained by findings from literature that suggests that stressors unique to a particular occupation may increase suicide risk. For instance, long work hours, social isolation, aging population (i.e. older workforce within agriculturalists) and climatic variability may negatively affect mental health and contribute to the development of suicidality [64–66].

The significantly lower rate of suicide in the education group in the present study is consistent with prior literature that has identified teaching as a profession with a low risk of suicide [46]. Currently, it is unclear why the risk of suicide appears to be lower in certain occupations (such as education) and this is a promising avenue for future research.

To our knowledge, no previous study has investigated suicide rates in the Australian transport or cleaning industries. Based on the high suicide rates observed in transport workers (male only) and cleaners in the present study, further investigation into suicidal behaviour in this occupation is justified. It may be hypothesized, however, that, as identified by Heller et al. in the QLD building construction industry, issues such as long work hours, substance misuse, workplace culture and relationship issues may be influential to suicidal behaviour in this group [17].

Limitations

The limitations of the present study should be acknowledged when interpreting study results. First, reporting of suicide incidence is based on data aggregated for the years 1990–2006, with the identification of occupation reliant both on the reporting from next of kin via psychological autopsy interview or police reports. The accurate identification of cases of suicide is an area of constant concern in suicide research.

The suicide rates reported here are conservative, possibly representing an underestimation of the true rates. For example, rates for agriculturalists were not as striking as those reported in previous Australian studies [26,48]. The discrepancies between study results may be due to conflicting definitions of occupational status. For example, in the Miller and Burns study, inclusion was based on farm residency rather than employment status (i.e. farm worker), which was the criterion utilized in the present study [48]. A problem, particularly characterizing the reporting of suicide in farmers, is the degree of reliability in identifying the occupational status. For example, many farmers are reliant on off-farm income, which would not be classified as ‘agricultural’. This factor may result in both an underreporting of suicides and an underestimation of the population of agricultural employees.

Information obtained from the QSR refers to deaths occurring only in QLD, and thus results cannot be generalized to other regions of Australia. In addition, in the QSR the details on occupation and employment status are sometimes incomplete, absent or even contradictory, which resulted in failure to include these suicide cases. Furthermore, we used the occupation indicated at time of death, which may not be an adequate reflection of lifetime occupation.

As mentioned earlier, it was not possible to segregate certain occupations due to difficulties in obtaining reliable population data. Occupational groupings therefore remained broad and consisted of employees with different skill levels. Finally, the available population data did not allow for identification of possible confounding variables such as psychiatric history/mental illness, marital status, and other known risk factors for suicide. Despite these limitations, the results point to important areas for future investigations, specifically, the need for a detailed analysis of individual and occupation-related factors within identified high-risk occupations.

Conclusions

The present study provides evidence for significantly higher rates of suicide in the agriculture, construction and transport industries compared to other occupations in QLD. An advantage of the present study was the use of employed population data, which provided a more comparable reference population than the general population, as well as the use of reliable suicide mortality data. Future investigations should analyse the influence of factors such as method use/access, and gender in the first instance, and the role of other individual and work-related factors and their impact on suicide in these high-risk occupations. At the least, the present findings point to a need for increased awareness of the risk of suicide in several occupations in QLD.

Footnotes

Acknowledgements

We gratefully thank Queensland Health for the continuing support to the Queensland Suicide Register.

Declaration of interest : The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Suicide in Selected Occupations in Queensland: Evidence from the State Suicide Register

Abstract

Keywords

Methods

Data sources

Statistical analysis

Results

Study sample

Suicide rates and rate ratios

Discussion

Limitations

Conclusions

Footnotes

Acknowledgements

References