Self-Harm, Including Suicide
Lower rates are desirable as they signal less frequent severe self-harm.
The indicator captures only cases 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 and deaths for self-harm and should be considered a minimum rate of self-harm.
(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
Total mid-year population age 10 and older
Total number of self-harm hospitalizations and self-harm deaths (suicides) for persons age 10 and older.
Unit of analysis for self-harm hospitalizations: Episode of care. Episode building was performed among Discharge Abstract Database–Hospital Morbidity Database (DAD/-HMDB) records to accommodate multiple abstracts within a single episode of care.
An episode of care refers to all contiguous inpatient hospitalizations in general and psychiatric hospitals. For episodes with transfers within or between facilities, transactions were linked regardless of diagnoses. To construct an episode of care, a transfer is assumed to have occurred if either of the following conditions is met:
- An acute care hospitalization occurs less than 7 hours after discharge from the previous acute care hospitalization, regardless of whether the transfer is coded;
- An acute care hospitalization occurs between 7 and 12 hours after discharge from the previous acute care hospitalization, and at least one of the hospitalizations has coded the transfer.
Methodology
Name
Self-Harm, Including Suicide
Short/Other Names
Not applicable
Description
Age-standardized rate of self-harm hospitalizations in a general or psychiatric hospital and self-harm deaths (suicides) per 100,000 population age 10 and older.
For further details, please see the General Methodology Notes (PDF).
Rationale
Self-harm is defined as a deliberate self-inflicted bodily injury or poisoning that may or may not result in death. This type of injury is the result of either suicidal or self-harming behaviours, or both. 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. Self-harm can be prevented, in many cases, by early recognition, intervention and treatment of mental disorders. An indicator that captures both self-harm hospitalizations 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 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 and deaths for self-harm and should be considered a minimum rate of self-harm.
HSP Framework Dimension
ºìÁì½í¹Ï±¨ system outputs: Access to comprehensive, high-quality health services
Areas of Need
Not applicable
Targets/Benchmarks
Not applicable
Available Data Years
to (fiscal years)
Geographic Coverage
- All provinces/territories
Reporting Level/Disaggregation
- National
- Province/Territory
- Sex
Indicator Results
Web Tool:
Region-level results for Self-Harm Hospitalizations (which is a subset of this indicator) are available in YHS: In Depth.
Update Frequency
Every year
Latest Results Update Date
Updates
Not applicable
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
Type of Measurement
Rate - Rate — per 100,000
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.
Unit of analysis for self-harm hospitalizations: Episode of care. Episode building was performed among Discharge Abstract Database–Hospital Morbidity Database (DAD/-HMDB) records to accommodate multiple abstracts within a single episode of care.
An episode of care refers to all contiguous inpatient hospitalizations in general and psychiatric hospitals. For episodes with transfers within or between facilities, transactions were linked regardless of diagnoses. To construct an episode of care, a transfer is assumed to have occurred if either of the following conditions is met:
- An acute care hospitalization occurs less than 7 hours after discharge from the previous acute care hospitalization, regardless of whether the transfer is coded;
- An acute care hospitalization occurs between 7 and 12 hours after discharge from the previous acute care hospitalization, and at least one of the hospitalizations has coded the transfer.
Inclusions:
- Admission to hospital with self-harm diagnosis (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 ºìÁì½í¹Ï±¨ 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
- Deaths identified from Statistics Canada’s Vital Statistics and Yukon Bureau of Statistics’s Coroner data due to self-harm (underlying cause of death codes X60 to X84, Y87.0)
Additional notes on the inclusions:
- Vital Statistics data is available by calendar year and hospitalization 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:
- 2018–2019 data onward: Medical assistance in dying (MAID) (Discharge Disposition Code = 73)
Method of Adjustment
Direct standardization
Age adjustment based on 4 age groups: 10 to 24, 25 to 44, 45 to 64 and 65+. For each province, age-specific indicator rates for the 4 age groups are calculated. The provincial indicator value is a weighted sum of these rates, with the weights being determined by the age structure of the Canadian population in 2011 (mid-year).
Adjustment Applied
Age-adjusted
Geographic Assignment
Place of residence
Data Sources
- DAD
- HMDB
- NACRS
- OMHRS
- Canadian Vital Statistics Death Database (CVSD)
- Yukon Vital Statistics
Caveats and Limitations
The indicator captures only cases within the hospitalization data where intentional self-harm was noted in the medical chart or abstract by a physician. This indicator does not include cases of self-harm that are not admitted to hospital, nor injuries coded as accidental or undetermined, even though a portion of these injuries may have been intentional. In addition, self-harm where no medical care is sought (including deaths by suicide in the community) or where a patient visits only a primary health care provider or emergency department will not be captured. Thus, this indicator underestimates the true number of hospitalizations for self-harm and should be considered a minimum rate of self-harm.
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.
References
Not applicable
How to cite:
Canadian Institute for ºìÁì½í¹Ï±¨ Information. Self-Harm, Including Suicide. Accessed April 8, 2025.
If you would like ºìÁì½í¹Ï±¨information in a different format, visit our Accessibility page.
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 ºìÁì½í¹Ï±¨ Priorities page.
Region-level results for Self-Harm Hospitalizations (which is a subset of this indicator) are available in .