Export indicator metadata as an Excel file See Indicator Results: View indicator results as an interactive web page (opens in a new window) or download indicator results as a PDF

Indicator Metadata

Name

Self-Harm, Including Suicide

Short/Other Names

Not applicable

Description

Rate of self-harm hospitalizations and self-harm deaths (suicides) per 100,000 population age 10 and older

For further details, please see the General Methodology Notes.

Interpretation

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

The indicator captures only cases within the hospitalization data 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 for self-harm and should be considered a minimum rate of self-harm.

HSP Framework Dimension

Health System Outputs: Access to comprehensive, high-quality health services

Areas of Need

Not applicable

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Sex

Indicator Results

https://yourhealthsystem.cihi.ca/inbrief

Identifying Information
Name

Self-Harm, Including Suicide

Short/Other Names

Not applicable

Indicator Description and Calculation
Description

Rate of self-harm hospitalizations and self-harm deaths (suicides) per 100,000 population age 10 and older

For further details, please see the General Methodology Notes.

Calculation: 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

Calculation: Geographic Assignment

Place of residence

Calculation: Type of Measurement

Rate - Rate — per 100,000

Calculation: Adjustment Applied

Age-adjusted

Calculation: Method of Adjustment

Not applicable

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

Inclusions:

  1. Admission to hospital with self-harm diagnosis (diagnosis type 9, 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 data due to self-harm (underlying cause of death codes X60 to X84, Y87.0)


Additional notes on the inclusions:

  • Episode building was performed to accommodate multiple abstracts within a single episode of care.
  • Vital Statistics data is available by calendar year and DAD 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. Patients with a discharge disposition indicating medical assistance in dying.
Background, Interpretation and Benchmarks
Rationale Self-harm is defined as a deliberate self-inflicted bodily injury or poisoning that may or may not result in death. 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. A metric that captures both self-harm 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 within the hospitalization data 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 for self-harm and should be considered a minimum rate of self-harm.

HSP Framework Dimension

Health System Outputs: Access to comprehensive, high-quality health services

Areas of Need

Not applicable

Targets/Benchmarks

Not applicable

References

Not applicable

Availability of Data Sources and Results
Data Sources

DAD, HMDB, NACRS, OMHRS

Available Data Years

Type of Year:
Fiscal
First Available Year:
2018
Last Available Year:
2019

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Sex

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Your Health System: In Brief
URL: https://yourhealthsystem.cihi.ca/inbrief

Updates

Not applicable

Quality Statement
Caveats and Limitations

This indicator does not include cases of self-harm that are not admitted to hospital or do not end in death. Self-harm where no medical care is sought, or where a patient visits only a primary health care provider or emergency department, will not be captured. Thus this indicator cannot be used to estimate the prevalence of all self-harm in the general population.

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.

Trending Issues

2018–2019 death data for Yukon was obtained directly from the Yukon Bureau of Statistics.

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 Shared Health Priorities page.