International Journal of Mental Health & PsychiatryISSN: 2471-4372

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Research Article, Int J Ment Health Psychiatry Vol: 2 Issue: 4

The Economic Cost of Suicide and Non-fatal Suicidal Behaviour in the Australian Construction Industry

Christopher M Doran1-3*, Rod Ling2, Allison Milner4 and Irina Kinchin1
1School of Human Health and Social Sciences, Central Queensland University, Queensland, Australia
2Hunter Medical Research Institute, University of Newcastle, New South Wales, Australia
3Edith Cowan University, Western Australia, Australia
4University of Melbourne, Victoria, Australia
Corresponding author : Christopher M Doran
School Human Health and Social Sciences, Central Queensland University, Room 4.12, Level 4, 160 Ann Street, Brisbane, 4000, Australia
Tel: +61 7 3023 4245
E-mail: [email protected]
Received: April 18, 2016 Accepted: July 13, 2016 Published: July 16, 2016
Citation: Doran CM, Ling R, Milner A, Kinchin I (2016) The Economic Cost of Suicide and Non-fatal Suicidal Behaviour in the Australian Construction Industry. Int J Ment Health Psychiatry 2:4. doi:10.4172/2471-4372.1000130

Abstract

Objective: Suicide has gained recognition worldwide as a significant public health problem. This paper quantifies the economic cost of suicide and non-fatal suicide behaviour (NFSB) in the Australian Construction Industry (CI).

Methods: Suicide data were obtained from the National Coronial Information System and occupational information was coded according to Australian standards with CI workers falling into three major groups: technicians and trades worker; machine operators; and, drivers and labourers. The analysis used a costing methodology endorsed by the National Occupational Health and Safety Commission. Costs were derived for the year 2012 using an incidence-based approach with future costs discounted to 2012 dollars.

Results: In 2012, a total 169 male CI workers lost their life to suicide with an average age of 37 years. For those states where age standardised rates of suicide could be calculated, rates of suicide in the CI was higher than the state and national average with the exception of QLD where the CI had comparable rates to the state average. The economic cost is estimated at $1.57 billion cost. The cost of non-fatal suicidal behaviour resulting in full incapacity comprised the majority of these costs (76.5%) with loss of earnings the key cost driver.

Conclusion: The high economic cost of suicide and non-fatal suicide behaviour in the Australian CI warrants an appropriate response. There are a number of workforce strategies available to address mental health issues. We hope our up-to-date estimates of the burden on the Australian CI will fuel the national call to action.

Keywords: Suicide, Self-harm, Workplace, Cost, Impact, Assessment, Construction industry, Mental health

Keywords

Suicide; Self-harm; Workplace; Cost; Impact; Assessment; Construction industry; Mental health

Introduction

Suicide is significant health problem. It is a major cause of death in Australia (2,522 deaths aged over 15 years in 2013) and the leading cause of death in males aged 25-44 years and females aged 25-34 years [1]. A distinguishing feature of fatality by suicide is the impact it has on a range of individuals: police and first responders; immediate family and friends; work colleagues; councillors providing bereavement support; and, coronial staff. Each of these individuals inevitably suffers emotional distress in response to a fatality by suicide [2-4].
Given the significance of suicide as a major public health issue, particularly for people of working age, there is a surprising dearth of information on the economic impact of this behaviour by industry or occupation. There is even less research on the cost of non-fatal suicidal behaviours (NFSB), defined as a suicidal thoughts, plan and attempts to die or inflict bodily harm [5]. Although evidence suggests that employment lowers the overall risk of suicide, recent results indicate that suicide rates do vary across industry and occupational groups. For example, two studies conducted by Milner et al. found a stepwise gradient in the risk of suicide, with the lowest skilled occupations at greater risk of suicide than the highest skill-level group [6,7]. This objective of this research is to estimate the economic costs of suicide and NFSB in the Australian Construction Industry (CI) by state and territory.

Method

Approach to cost estimation
In 1995, the Industry Commission developed a methodology to examine the direct and indirect cost of work-related incidents [8]. The Industry Commission methodology was further refined based on the recommendations of independent reviews [9,10]. Further revisions were made to the methods in a 2004 report undertaken by the National Occupational Health and Safety Commission [11] and a 2012 report by Safe Work Australia [12,13]. This updated method was used in the current analysis to provide an estimate of the cost of suicide and NFSB across the Australian CI [14,15].
This cost analysis presented both direct and indirect costs for a range of economic agents (including employers, workers and the government) segregated by severity of injury. The classification structure for economic costs was based on six conceptual cost groups: production disturbance costs; human capital costs; medical costs; administrative costs; transfer costs; and, other costs (Table 1). A summary of the key parameters, assumptions and data sources for cost items is provided in the supplementary information.
Table 1: Economic cost borne by the employer, worker and government.
An incidence based approach was used to estimate the expected lifetime cost of a new case. Future costs due to an injury sustained today are converted to present values (i.e., constant 2012 Australian dollars), using an appropriate discount rate. Adopting an incidence based approach assumes that current costs accurately reflected future costs. The costing analysis also adopted an expost approach to costing. Under this method, costs are attributed post incidents. Both the incidence and expost approach are consistent with the method adopted by Safe Work Australia [12].
Sources and analysis of data
Suicide data were obtained from the National Coronial Information System (NCIS) for the period 2012. NCIS is a national internet based data storage and retrieval system for Australian coronial cases, established in 2001 [16,17].
Occupational information was coded according to the Australian and New Zealand Standard Classification of Occupations (ANZSCO) (up to the 6-digit level) and the Australian and New Zealand Standard Industrial Classifications (ANZSIC), Division E [18-21]. Occupations coded as being in the CI fell into three major ANZSCO groups: technicians and trades workers (ANZSCO 3); machine operators and drivers (ANZSCO 7); and, labourers (ANZSCO 8) [20]. For consistency with Milner et al (2013), cases in higher skilled occupations such as construction managers (ANZSCO 1) and architects were excluded as their skills were considered more relevant to other ANZSIC categories such as Division M Professional, Scientific and Technical Services. Due to small numbers among machine operators and drivers (ANZSCO 7) employed in construction; this group was combined with labourers (ANZSCO 8). The skill specialisation required in these two groups was similar; hence their combination was justified. Further detail on occupational coding can be found in the supplementary information.
NCIS suicide numbers, CI workers (technicians and trades workers; machine operators and drivers; and, labourers), and Census 2011 were used in calculation of age standardised rates of suicide.
Age standardised incidence was calculated by the direct standardisation method, using the 2001 standard population, consistent with the approach recommended by the Australian Institute of Health and Welfare (AIHW) [22,23]. Age-standardisation allows data from different populations to be compared by taking into account the variations in age structure between the populations being compared [24]. State and national age standardised male suicide rates were sourced from the Australian Bureau of Statistics (ABS) [1,25].
Levels of severity of work-related incidents
Safe Work Australia used the National Dataset for Compensation to develop cost estimates for five mutually exclusive categories of severity ranging from minor incidents involving little or no absence from work to fatalities (Table 2). This study draws on these definitions.
Table 2: Safe Work Australia categories of severity.
The World Health Organisation (WHO) estimates that between 20% - 30% of the workforce will suffer from serious a mental health problem and for every employee who dies by suicide, another 10-20 will make a suicide attempt (17% resulting in a permanent disability and 83% no disability) [26]. These statistics are supported by research in Australia [4,8,9]. In this analysis, for every 15 suicide attempts there is one fatality, and from the 15 attempts, 3 (17%) are classified as full incapacity and 12 (83%) classified as short absence. Corresponding duration of absence (for use in calculation of production disturbance costs) are 0.2 weeks for short absence; and, 2.6 weeks for full incapacity and fatality [27-30].
Study perspective and population
Our costing methodology adopted a work-place perspective. Only male workers were included in this study as there were very small numbers of female suicides in the CI, with resulting issues of confidentiality.

Results

Suicide and non-fatal suicide behaviour indicator data
In 2012, a total 169 male CI workers lost their life to suicide (Table 3). New South Wales (NSW) and Western Australia (WA) recorded 42 deaths followed by Queensland and Victoria with 36 and 33 deaths respectively. Age standardised CI death rates were considerably higher in all states except for QLD.
Table 3: Suicide indicator data related to the Australian construction industry by state and territory, 2012.
Using the WHO evidence on the relationship between suicide and NFSB, suggests there were 2,535 non-fatal suicide attempts with 431 resulting in full incapacity and 2104 resulting in a short absence from work.
Across all Australian states and territories, the average age of a suicide among CI workers was 37 years. This age varies from a low of 32.8 years in the Northern Territory (NT) to 59.5 years in the Australian Capital Territory (ACT). However, only one suicide was recorded in ACT during 2012. Victoria (VIC) had the second highest age of suicide at 40.4 years.
Average life expectancy is highest for those males living in ACT (81.2 years) and VIC (80.5 years) and lowest for those living in NT (74.7 years) and Tasmania (TAS) (78.7 years). Potential years of life lost (PYLL) are highest in QLD (43.3 years) and WA (43 years) and lowest in ACT (21.7 years) and TAS (39.2 years).
Average cost of suicide and non-fatal suicide behaviour
Table 4 provides an overview of the average cost associated with NFSB and suicide incidents in the Australian CI by state and territory for 2012. The cost of an incident involving a short-term absence ranges from $860 in TAS to $996 in WA. The cost of an incident resulting in full incapacity ranges from $1.12 million in ACT to $3.27 in WA. The cost of a suicide ranges from $0.75 million in TAS to $2.72 million in NT. The key cost driver in both full incapacity cases and a fatality is lost income (and taxes) and, for full incapacity only, the additional cost of welfare payments.
Table 4: Average cost of suicide and NFSB in the Australian construction industry by state and territory, 2012.
Total cost of suicide and non-fatal suicide behaviour
The total cost of suicide and NFSB in the Australian CI is estimated at $1.57 billion (Table 5). The cost of non-fatal suicidal behaviour resulting in full incapacity comprised the majority of these costs (76.5%) with loss of earnings the key cost driver. WA incurred the greatest cost ($461 million) accounting for 29.4% of total costs, followed by NSW (22.7% of total costs or $356 million), QLD (22.1% of total costs or $345 million) and VIC (16.6% of total costs or $259 million).
Table 5: Total cost of suicide and NFSB in the Australian construction industry by state and territory, 2012.

Discussion

The purpose of this study has been to examine the potential economic impact of self-harm in the work-place by quantifying the economic cost of suicide and NFSB in the Australian CI across states and territories. In undertaking this analysis, we relied on an accepted methodology developed by Safe Work Australia [12]. This methodology was adapted, where appropriate, to the current study. For example, unlike the Safe Work Australia study our estimates include postvention costs associated with suicide bereavement and counselling. The use of postvention is an appropriate response for both the community and the industry and failure to include these services would underestimate any cost estimate [3,31-33].
The analysis adopts an incidence based approach as opposed to the prevalence approach. The prevalence based approach to costing relies on the number of people within the system at a given point in time, irrespective of when the injury may have occurred. Costs are estimated using a top down approach, as opposed to the bottom up approach used in incidence costing, whereby total expenditures for a given year are divided by the total number of cases (either fatalities or NFSB) [34,35]. However, given the lack of available prevalence data, any estimate using the prevalence based approach is likely to result in inaccurate costing estimates. Further, the incidence based approach is considered more appropriate for comparative economic analyses as it allows an understanding of the potential savings if suicide and NFSB could be averted.
This analysis has assumed that for every suicide fatality there are 15 non-fatal suicide attempts. This relationship is supported by the World Health Organisation [26], Suicide Prevention Australia [33] and results from Australian National Survey of Mental Health and Wellbeing [35]. Data from the United States suggests that this relationship may be closer to 25:1, as opposed to 15:1 ratio used in this analysis. Where appropriate we have matched severity of injury using categories developed by Safe Work Australia using national compensation data [12,36]. This analysis, however, used three out of the five possible categories excluding long absence and partial incapacity. Our assumption that the majority of NFSB cases return to work after a short absence may underestimate the true prevalence of self-harm incidents that belong in either of these other two categories, hence underestimating the true cost of suicide to the CI.
In spite of these methodological challenges, the results provide a conservative and consistent assessment of the cost associated with suicide and NFSB in the Australian CI for the year 2012 across states and territories. Each incident involving a short-term absence is estimated to cost between $860 (TAS) to $996 (WA); each incident resulting in full incapacity is estimated to cost between $1.12 million (ACT) to $3.27 million (WA); and, and each suicide is estimated to cost between $0.75 million (TAS) to $2.72 million (NT). The average age of a suicide in 2012 ranges from 32.8 years (NT) to 59.5 years (ACT), equating to a loss of 32.2 years and 5.5 years of lost potential productive employment. Multiplying average costs estimates with NFSB and suicide by state and territory results in a total cost of suicide and NFSB in the Australian CI is estimated at $1.57 billion. Total costs varied by state from $3.62 million in the ACT to 461 million in WA.
These findings reinforce the importance of additional preventative measures for reducing the risk of suicide attempts. Evidence suggests that improved health care linkages could substantially reduce the future burden of suicide. As the medical costs were only 0.47% of the total economic cost of reported suicides and NFSB, the costs of strengthening these linkages would be relatively modest.
This study has a few limitations that are worth listing. The main limitation of this study is that the costing methodology captured costs of suicide and NFSB from the work-place perspective, and therefore, potentially under estimated some costs of suicide to society. It has not considered the wider implications to the Industry in terms of damage to property, loss of company image or the considerable investment the Industry makes complying with work health and safety regulations.
The analysis relied on the best available evidence and used NCIS data to identify fatalities by suicide in the CI. Data were, however, available for males only. Although males represent the majority of construction workers and have higher rates of suicide than females, the results will, nevertheless, be an underestimate of the true cost of suicide and suicide behaviour. National standards were used to classify CI workers with a focus on technicians, tradesmen, machine operators, drivers and labourers. However, these standards are not perfect and when matched with NCIS, certain construction-related employees such as managers and/or other professionals were omitted.

Conclusion

This study provides new evidence on the costs associated with suicide and non-fatal suicidal behaviour in the Australian Construction Industry. The total cost is estimated at $1.57 billion. The majority of this cost is attributed to the cost associated with non-fatal suicidal behaviours resulting in full incapacity.
According to the World Health Organisation and Suicide Prevention Australia, suicide is mostly preventable, yet significant gaps exist in our understanding of the relationship between work and suicide thereby limiting prevention efforts [26,33]. If employers were more aware of the economic consequences of the impact of mental disorders on their employees, the work-place could provide an ideal setting for mental health promotion and prevention.

Funding Source

This study is supported by research funding from MATES in Construction, a charity established in 2008 to reduce the high level of suicide among Australian construction workers.

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