Table 3 Overview of national health databases used in suicide surveillance

Suicide mortality

Canadian Vital Statistics Database - Deaths (2016)

ICD-9 (pre 2000); ICD-10 (2000 - present). Death certificate from physician or funeral director. For ‘non-natural’ deaths, cause codes are determined by coroner/medical examiners

National

None

No

Under-reporting of suicide due to misclassification as unintentional injuries or undetermined intent; extent of misclassification may vary by jurisdiction.

Self-inflicted injuries, Hospitalization

Hospital Morbidity Database (2011–2012)

Discharge Abstract Database (2015–2016)

ICD-10-CA. Does not distinguish between self-injury with suicidal intent (suicide attempt) and without suicidal intent (non-suicidal self injury); lacks suicide-specific codes.

National except Quebec (DAD), National (HMDB)

Patients admitted to acute care psychiatric hospitals;

Institutionalized populations;

No

Hospital separations include both discharges and deaths, therefore DAD has overlap with CVSD for suicide deaths that occurred during a hospitalization related to a suicide attempt; poor sensitivity in case coding contributes to undercounting.

Self-inflicted injuries, Emergency Department visit

National Ambulatory Care Database (2015)

ICD-10-CA. Does not distinguish between self injury with suicidal intent (suicide attempt) and without suicidal intent (non-suicidal self injury), and lacks suicide-specific codes;

Does not include data on visits related to suicidal ideation as these are not covered by ICD-10 codes.

64% of all EDs; Complete coverage for AB, ON, and YT; No coverage for 5 provinces/territories (QC, NL, NB, NWT, and NU)

None

No

Poor sensitivity in case coding contributes to undercounting and thus under-estimates of the population burden of self-harm.

Self-inflicted injuries, Emergency Department visit

Canadian Hospital Injury Registration and Prevention Program (2016)

Registry-specific case definitions with narrative component; does not use ICD coding scheme. Patient/parent and physician completed forms, and medical record review

17 hospitals (primarily urban, paediatric facilities)

Children that present to general hospitals; Adults aged 18 and older; Rural populations including Inuit, First Nations, and Métis living on reserve or in rural or northern communities;

No

Under-coverage of events with higher injury severity such as trauma and suicide attempts; reporting burden on patients and clinicians; Literacy and English/French language requirements; Population-based rate estimates not possible because of unknown denominators due to a lack of defined catchment

Suicide attempts

Canadian Community Health Survey (2015)

Standardized self-report questionnaire administered by telephone. Survey question: “Have you ever [and/or in the past 12 months] seriously attempted suicide?”

National sample, but elevated non-response rates in territories and rural regions

Excludes populations that tend to report higher rates of suicidal ideation and attempts: First Nations living on-reserve, military personnel, and institutionalized populations such as people in prison, hospital, or foster care.

Yes

n/a

Suicidal thoughts

Canadian Community Health Survey (2015)

Standardized self-report questionnaire administered by telephone. Survey question: “Have you ever [and/or in the past 12 months] seriously contemplated suicide?”

National sample, but elevated non-response rates in territories and rural regions

Excludes populations that tend to report higher rates of suicidal ideation and attempts: First Nations living on-reserve, military personnel, and institutionalized populations such as people in prison, hospital, or foster care.

Yes

n/a