Article Text

Download PDFPDF

Australian Suicide Prevention using Health-Linked Data (ASHLi): Protocol for a population-based case series study
  1. Kate M Chitty1,
  2. Jennifer L Schumann2,
  3. Andrea Schaffer3,
  4. Rose Cairns4,5,
  5. Nicole J Gonzaga1,
  6. Jacques E Raubenheimer1,
  7. Gregory Carter6,
  8. Andrew Page7,
  9. Sallie-Anne Pearson3,
  10. Nicholas A Buckley1
  1. 1Discipline of Pharmacology, Clinical Pharmacology and Toxicology Research Group, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  2. 2Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Clayton, Victoria, Australia
  3. 3Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
  4. 4NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
  5. 5Sydney Pharmacy School, University of Sydney, Sydney, New South Wales, Australia
  6. 6Calvary Mater Newcastle Hospital, University of Newcastle, Newcastle, New South Wales, Australia
  7. 7Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
  1. Correspondence to Dr Kate M Chitty; kate.chitty{at}


Introduction In Australia, suicide is the leading cause of death for people aged 15–44 years. Health professionals deliver most of our key suicide prevention strategies via health services, but other efficacious population-level strategies include means restriction and public awareness campaigns. Currently, we have no population-level data allowing us to determine which individuals, in what parts of Australia, are likely to use our most promising interventions delivered by health services. The aims of this study are to describe: (1) health service utilisation rates in the year prior to death by suicide, and how this varies by individual case characteristics; (2) prescribed medicines use in the year prior to death by suicide, medicines used in suicide by poisoning and how this varies by individual case characteristics.

Methods and analysis This is a population-based case series study of all suicide cases in Australia identified through the National Coronial Information System (NCIS) from 2013 to 2019. Cases will be linked to administrative claims data detailing health service use and medicines dispensed in the year before death. We will also obtain findings from the coronial enquiry, including toxicology. Descriptive statistics will be produced to characterise health service and prescribed medicine use and how utilisation varies by age, sex, method of death and socioeconomic status. We will explore the geographical variability of health service and medicine use, highlighting regions in Australia associated with more limited access.

Ethics and dissemination This project involves the use of sensitive and confidential data. Data will be linked using a third-party privacy-preserving protocol meaning that investigators will not have access to identifiable information once the data have been linked. Statistical analyses will be carried out in a secure environment. This study has been approved by the following ethics committees: (1) the Justice Department Human Research Ethics Committee (REF: CF/17/23250), (2) the Western Australian Coroners Court (REF: EC 14/18 M0400), (3) the Australian Institute of Health and Welfare (REF: EO2017/4/366) and (4) NSW Population & Health Services Research Ethics Committee (REF: 2017/HRE1204). Findings will be published in peer-reviewed journals, presented at conferences and communicated to regulatory authorities, clinicians and policy-makers.

  • retrospective
  • suicides
  • medicines
  • administrative data
  • data linkage
  • mental health
  • health service utilisation
  • epidemiology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @chitty_kate

  • Contributors KC (principal investigator) and NB: conceptualisation of ASHLi. KC, JS, RC, AS, NB, AP, GC, JR, S-AP: protocol design. KC and NJG: drafted the manuscript. All authors contributed to the final version.

  • Funding This study is funded by a grant from the National Health and Medical Research Centre (NHMRC, REF: APP1157757) and the Translational Australian Clinical Toxicology Research Group (TACT). An NHMRC Early Career Fellowship funds KC (Grant number: 1122362).

  • Disclaimer The funding organisations played no part in the design of the study nor in the preparation, review or approval of the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.

  • Data availability statement No data are available. The data used in this protocol are highly sensitive and confidential. Only approved personnel may access the data. Researchers interested in collaborations or further information are invited to contact KC at