Suicide in selected occupations in Queensland:

evidence from the State suicide register

Kirsty Andersen, Jacinta Hawgood, Helen Klieve, Kairi Kõlves, Diego De Leo

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 occu-
pations 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, con-
struction, 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.
Key words: agriculture, Australia, epidemiology, occupation, suicide.

Australian and New Zealand Journal of Psychiatry 2010; 44:243–249

The protective effect of employment on suicidal
behaviour (attempts and completions) has been well
established in the literature [1–4]. In particular, unem-
ployment 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 increas-
Diego De Leo, Professor, Director (Correspondence); Kirsty Andersen,
Research Assistant; Jacinta Hawgood, Lecturer; Helen Klieve, Research
Fellow; Kairi Kõlves, Senior Research Fellow
Australian Institute for Suicide Research and Prevention, Griffith
University, Mt Gravatt Campus, Qld 4122, Australia (email: d.deleo@
griffith.edu.au); World Health Organization Collaborating Centre for
Research and Training in Suicide Prevention, Griffith University, Mt
Gravatt Campus, Qld 4122, Australia
Received 10 March 2009; accepted 27 July 2009.
ing 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 pro-
fessions [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 underrepre-
sented 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 sui-
cide in the Queensland (QLD) commercial building
construction industry accounted for 2.4% of male sui-
cides (15–64 years) for the 1995–2001 period, equating

© 2010 The Royal Australian and New Zealand College of Psychiatrists

244 SUICIDE IN SELECTED OCCUPATIONS IN QLD
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 sev-
eral methodological limitations that affect results com-
parability. For instance, prior work has been restricted
to investigation of a specific occupation and/or geo-
graphic location [11,15,35] or has used conflicting cat-
egories 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, aggre-
gation of labour force status, undifferentiated skill lev-
els and/or role in a given occupation [46], poor quality
of data (e.g. incomplete employment records, misclas-
sification 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 obsta-
cles to comparability of research data. The aim of the
present study was to address some of the aforemen-
tioned limitations and extend prior research by (i) deter-
mining 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 Preven-
tion 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.
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 reason-
able 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%).
 K. ANDERSEN, J. HAWGOOD, H. KLIEVE, K. KÕLVES, D. DE LEO 245

Table 1. Occupational groupings included in analysis (based on [56])

Occupation Groups included in each occupational category

Construction Bricklayers Structural steel and welding Drillers

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

n.f.d., not further defined.

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 relation-
ship (43.5%).
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.
In the occupations of interest the highest rates of suicide for all per-
sons 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 sig-
nificantly 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 signifi-
cantly higher male suicide rate was also seen in construction

Table 2. Characteristics of suicides in selected occupation categories in QLD 1990–2006 (based on [XX])

% male in % aged 15–34 years % aged 35–54 years % aged 55–64 years % married/de
suicides in suicides in suicides in suicides 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
246 SUICIDE IN SELECTED OCCUPATIONS IN QLD

and transport workers, in comparison to the employed population

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
0.84–2.46
1.33–4.67
0.92–2.21

1.71–3.28

2.13–2.63
0.42–1.02
suicide rate.
95% CI Female rates were highest for artists and nurses, both were signifi-
cantly 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 sig-

2.49∗

2.37∗

2.37∗
1.49

1.43
0.66
RR

nificantly) when compared to the employed population rate.

–
–

1
Female

Suicide
rate‡

4.7
8.0
4.6
2.1
7.6
3.2
7.6
–
–

Discussion

This study represents one of the few Australian studies

incidence†
Suicide

into suicide and occupation that combines (i) the use of

0
2
12
10
21
21
40
408
1,565

the employed population suicide rates as a comparison

group for occupation suicide rates; and (ii) inclusion cri-
Table 3. Suicide incidence (1990–2006) and rates per 100 000 in Queensland

teria based on occupation recorded at death rather than

1.69–2.24

0.81–2.51
1.01–1.28
1.04–1.44

0.68–1.39
1.00–1.70
0.60–1.04

1.70–1.86
95% CI

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,
1.23∗
1.94∗

1.30∗

1.78∗
1.14∗

0.97

0.79
1.43

failure to segregate employed from individuals not in the

RR

workforce (children, disabled, unemployed) potentially

Male

underestimates true rates of suicide within occupational

Suicide
rate‡

groups (which typically include only labour force partici-

19.0
20.4
32.3
16.1
21.7
13.2
23.7
16.6
29.6

pants) [10,17,58]. For these reasons, in the current study,

a group solely consisting of employed individuals was
incidence†

chosen as the comparison population. Indeed, the marked

Suicide

difference observed between the suicide rates for the

317
159
194
30
57
52
12
2,602
6,087

employed population and the QLD working age popula-

tion (age 15–64) suggests that there may be, as hypothe-
sized by prior researchers [2], a suicide protective effect
1.52–2.05
1.93–2.51

0.39–0.62
1.56–1.97

0.89–1.66
0.81–1.27

1.68–1.83
0.64–1.11
95% CI

provided through employment. Some of the selected occu-

pations 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
1.80∗
2.20∗

0.49∗

1.75∗
1.76∗

1.21
1.02

0.85

of suicide compared to the employed population was

RR

found for individuals aged 15–64 years and employed in

Persons

the QLD agricultural, artist, cleaner, construction and

Suicide

transport industries. Additionally, male employees of the

rate‡

18.6
19.1
24.1
12.8
10.8
5.2
9.0
10.6
18.5

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
incidence†
Suicide

professionals.
317
161
206
40
78
73
52
3,010
7,652

Associations between factors (e.g. psychiatric,

sociodemographic) that may have influenced suicidal-
ity in the selected occupations were not addressed in
the current study. It has been well established, how-
Education professionals

rate ratios. *p ⬍ 0.05.

Employed population

ever, that male gender and rural locality are risk fac-
tors for completed suicide, and thus higher rates of
Total population

suicide would be expected in occupations that are male

Construction

Agriculture

dominated (i.e. agriculture, construction and trans-

Transport

Cleaners

port), and occupations that are based in rural areas

Nurses
Artists

(such as agriculture) [53,59,60]. Equally, the higher

suicide rates observed in the agriculture and nursing
 K. ANDERSEN, J. HAWGOOD, H. KLIEVE, K. KÕLVES, D. DE LEO
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 occu-
pation-conferred risk factors [11,18,22,38,46,61,62].
Preference for suicide methods with increased acces-
sibility 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 lit-
erature 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 litera-
ture 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 indus-
tries. Based on the high suicide rates observed in transport
workers (male only) and cleaners in the present study, fur-
ther investigation into suicidal behaviour in this occupa-
tion 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 mis-
use, workplace culture and relationship issues may be
influential to suicidal behaviour in this group [17].
Limitations
The limitations of the present study should be acknowl-
edged 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 psycho-
logical autopsy interview or police reports. The accurate
identification of cases of suicide is an area of constant
concern in suicide research.
247
The suicide rates reported here are conservative, pos-
sibly representing an underestimation of the true rates.
For example, rates for agriculturalists were not as strik-
ing 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 uti-
lized in the present study [48]. A problem, particularly
characterizing the reporting of suicide in farmers, is the
degree of reliability in identifying the occupational sta-
tus. 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 sui-
cides and an underestimation of the population of agri-
cultural employees.
Information obtained from the QSR refers to deaths
occurring only in QLD, and thus results cannot be gen-
eralized 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 life-
time occupation.
As mentioned earlier, it was not possible to segregate
certain occupations due to difficulties in obtaining reli-
able population data. Occupational groupings therefore
remained broad and consisted of employees with differ-
ent skill levels. Finally, the available population data did
not allow for identification of possible confounding vari-
ables 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 popu-
lation, 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
248 SUICIDE IN SELECTED OCCUPATIONS IN QLD
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.
Acknowledgement
We gratefully thank Queensland Health for the con-
tinuing 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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