Suicide is a devastating global problem that occurs throughout the lifespan. It is estimated that over 800,000 people die from suicide each year, representing an annual global suicide rate of 10.7 per 100,000 population [1
]. In Australia, the suicide rate is even higher, at 11.8 deaths per 100,000 [2
]. In 2016 alone, 2862 Australians lost their lives to suicide, which is almost twice that of all transport-related fatalities (n =
1453) and is comparable to deaths from breast cancer (n =
]. It is estimated that 370,000 Australians think about ending their life every year, 91,000 make a plan to suicide, and 65,000 suicide attempts occur each and every year [3
]. The impact of suicide extends far and wide, with evidence that for every death by suicide, another six people are severely affected by intense grief that can continue for many years [5
Of particular concern is the high level of suicidal behaviour among young people. Globally, suicide is the second most common cause of death among young people between 15 and 24 years of age [1
]. In Australia, suicide is the leading cause of death in people aged between 15 and 24 [4
]. Data from the Australian National Coronial Information System (NCIS), an online data repository of Australian coronial cases, suggest that between 2001 and 2014, 4460 young people in this age group died from suicide, equating to an average of 319 fatalities each year [2
]. This is equivalent to a crude rate of youth suicide (15–24-year-olds) of 11.6 per 100,000, higher than countries with similar economic prosperity (as measured by gross domestic product per capita), including Canada (11.2 per 100,000), Hong Kong (10.3 per 100,000), the Netherlands (5.9 per 100,000), Sweden (8.9 per 100,000), and Singapore (6.7 per 100,000) [6
Suicidal behaviour is often “the end result of the complex interaction between psychological, social, and biological factors” [7
] and a more impulsive act in young people who are more likely to be influenced by media presentations of suicide and to die in cluster suicides [8
]. Risks of suicidal behaviour increase in adolescence and young adulthood, particularly for the socially marginalized. The most prevalent risks include depression, alcohol abuse, mental disorders, antisocial behaviour, sexual abuse, physical abuse, poor peer relationships, suicidal behaviour by friends, family discord, family suicidal behaviour, unsupportive parents, living apart from parents, and social contagion [9
In spite of the significant burden of harm associated with suicide, there is a dearth of information on its economic impact [10
]. Most economic studies related to suicide and suicidal behaviour have concentrated on the impact for the wider population [11
] or specific industries [19
]. Only one study has considered the economic impact of youth suicide [21
]. That study was undertaken in the U.S. and reported the economic cost of youth suicide to be $
2.26 billion (in 1980 U.S. dollars). To the best of our knowledge, there has been no recent analysis eliciting the economic cost of youth suicide in Australia. These estimates can assist decision-makers to understand the magnitude of adverse outcomes associated with youth suicide and the potential benefits to be achieved by investing in effective strategies to address suicidal behaviour. The current study aims to quantify the economic cost of suicide among Australian youth (15–24 years old) using 2014 as a reference year.
This research estimated the economic cost of suicide among Australian youth (15–24 years old) in 2014. To the best of our knowledge, this is the first study in Australia that translates youth suicide mortality data into economic terms. Our findings suggest that 18,744 years of life were lost as a result of suicide. Of those lost years, 7869 would have been under the age of retirement (i.e., 66). The economic cost of youth suicide in Australia is estimated at $511 million a year ($460–586 million) in 2014 AU$. Direct costs account for $3 million (1% of the total cost); indirect costs at $482 million (94%); and intangible costs at $27 million (5%).
The cost of suicide increases by age cohort, from $192 million (for 15–19-year-olds) to $317 million (for 20–24-year-olds). This increase is attributable to the higher prevalence of suicide among 20–24-year-olds (12.0 per 100,000) compared to 15–19-year-olds (7.4 per 100,000). It is also worth noting that the cost of male youth suicide is significantly higher than the cost of female suicide ($406 million versus $102 million, respectively), again due to higher prevalence of suicide deaths in the former group (14.0 versus 5.4 per 100,000 population, respectively). Threats to breathing are the most common cause of death regardless of the age or gender and account for over $385 million (75%) of the estimated total cost.
When discussing these key findings, it is important to reflect on the strengths and limitations of our approach. The best way of interpreting the costs in this paper is as a valuation of how much better off the society might be if there were no or less deaths from suicide, including a reduced risk of premature death, gained productivity and income, and more importantly reduced pain and suffering. All of these factors contribute to improved welfare or wellbeing and are amenable to monetary valuation. The costs of suicide thus correspond to a measure of the benefits to be secured if suicides were reduced.
This study has several strengths. The analysis utilises current suicide statistics from the best available evidence of suicide fatalities in Australia recorded in the NCIS. Suicide statistics is complex and “a particularly challenging cause to record and classify” [35
]. The use of NCIS provides confidence in our estimates [36
]. The costing methodology builds on our previous research and earlier studies in this area [10
], but is also extended in several ways, in particular by focusing on youth from two age clusters, 15–19 and 20–24 years old. Unlike most suicide costing studies, our analysis factored in the postvention costs associated with bereavement and counselling [5
]. Our method for estimating the cost of suicide is derived from an existing costing framework used by SafeWork Australia in estimating the cost of workplace injury and disease [24
]. Key assumptions in our analysis and subsequent implications for results are tested using a range of sensitivity analyses.
Several limitations are also worth noting. By way of comparison with wider economic aggregates, we acknowledge that national income does not directly reflect human productivity loss and bereavement, but rather accounts for these costs indirectly through reduced output. The provisional nature of the human cost estimates should also be emphasised where the figures are based on assumptions, such as the probability of being employed and potential reduction in average weekly earnings. The coronial inquiry, police, and ambulance costs used in this analysis have been derived from published literature. However, these estimates are also derived using various assumptions that may impact on the ultimate accuracy of Australian-based values. Our analysis has made no attempt to estimate losses of quality of life to the victim’s family, friends, or others. Such an estimate would require survey data on psychological impacts and shall be pursued in future research. Further, according to Yang and Lester [38
], cost savings might arise as a result of not having to treat the depressive and other psychiatric disorders of those who kill themselves; or avoidance of pension, social security, and nursing home care costs. Our costing methodology does not include these potential impacts.
The economic argument is an important tool for informing the development of and investment into evidence-informed suicide prevention strategies. Understanding the magnitude of costs of suicide can serve many purposes [39
]. It can highlight the significant loss of productive capacity within a country and an estimate can be used to assess the potential benefits (or cost-savings) of implementing effective suicide prevention strategies to reduce youth suicide.
Reducing youth suicide requires a multifaceted approach. However, as pointed out by a number of systematic literature reviews, quality evidence of effective interventions for self-harming behaviours in young people is largely inadequate [40
]. Given the magnitude of youth suicide, a new approach to suicide prevention is needed, with strong national direction backed by comprehensive, coordinated planning and implementation at a regional level [45
]. This includes a better understanding of effective and cost-effective solutions to address this avoidable problem. A systems-based approach to suicide prevention in general was recently proposed in Australia that builds on nine strategies, including aftercare and crisis care; psychological and pharmacotherapy treatments; building the capacity and support of general practice teams; frontline staff training; gatekeeper training; school programs; community campaigns; media guidelines; and means restriction, which when implemented within a specific community at the same time are likely to lead to suicide reduction [46
]. Although the effectiveness of this approach is yet to be established, our findings suggest that the impact of meeting a 10% reduction in youth suicide could potentially save many lives and over $
51 million a year, including $
0.3 million) in direct costs, $
3 million as intangible and $
48 million as indirect costs.