Informing with Open Data:

Suicide in Nova Scotia

Every death or injury from suicide is a tragedy. These are Nova Scotians, each with a unique life journey. Many individuals, families, and communities are deeply affected by suicide. While there are many things that can contribute to suicidal behaviour, there are also many resources and supports that aim to be life promoting and protective against suicide. It is important to consider a broad range of data and information to guide decisions towards prevention.
On average, more than 130 Nova Scotians lose their lives to suicide each year, and over 1200 receive care due to self-harm (based on data from 2017-2021). Self-harm includes incidents of intentional suicidal and non-suicidal self-harm as captured in hospital, emergency health service, and physician billing records. Many more Nova Scotians may never interact with the system, and some find it very hard to seek help.
This perspective story aims to present areas of suicide mortality data where there is information, and to identify factors that may need to be explored further. If you are impacted by what you read here and need to talk to someone, help is available.
If you or someone you know is in a mental health crisis, call the Provincial Mental Health Crisis Line toll-free at 1-888-429-8167 or 911, or go to your nearest hospital or emergency department.

You can get support for non-urgent mental health, addiction and wellbeing by calling the provincial intake line at 1-855-922-1122.

Understanding Nova Scotia Data

The Department of Health and Wellness works with health authorities and government departments, including the Nova Scotia Medical Examiner Service (NSMES), as well as academics, and the community sector to support collaborative action toward clear and relevant information to address suicidality.
Data related to death by suicide are regularly reported to the public by NSMES through the Open Data Portal. There are other Nova Scotia data sources that require further understanding, like data related to suicide attempts and self-harm as well as mental health and quality of life survey data, that can provide insight into life promotion and suicide risk and protective factors.

Data from the Nova Scotia Medical Examiner Service (NSMES)

The information in the Nova Scotia Open Data Portal uses data from the NSMES, the provincial medical examiner service responsible for investigating and certifying deaths of persons who die from criminal violence, by accident, by suicide, suddenly when in apparent good health, when unattended by a physician, in a correctional facility, or in any suspicious or unusual manner. All suspected suicide deaths in the province are regularly referred to NSMES for investigation. The data include suicide fatalities that occurred, and were investigated in, the province. This includes a small number of suicide deaths among visitors to Nova Scotia.
Data does not include:
  • suicide deaths for which there is no body (for example a missing person who may have died by suicide but there are no identified remains).
  • a (presumed small) number of deaths of Nova Scotians who died by suicide outside of the province.
For these reasons as well as others related to administrative processes, the data provided by the NSMES may differ from those presented by Statistics Canada (Vital Statistics). These data are available for use by policy makers, academics, community-based organizations, and mental health care professionals.
The death investigation system does not include information on all the determinants of suicide, suicide prevention, and risk reduction. For example, over the years, information on gender, race, social support networks or childhood trauma had not been routinely collected. Research has demonstrated that these factors can impact suicide risk. The importance of understanding inequities in health outcomes experienced by different populations or groups affected by certain experiences are known, and work is underway to better gather the data and information needed to understand these issues and guide responses. An initiative to collect race-based and gender-based data that is informed by the community is currently underway in the Department of Health and Wellness.

Trends over time and space

The graph below shows annual suicide rates over time since 2008. Suicide rates among males are consistently higher than among females. Suicide rates show variation year to year. While an individual’s reasons for suicide are complex, research of historical data shows that social and economic events in the world have, at times, coincided with changes in rates of suicide in places affected. The somewhat higher rate of suicide in 2009 coincided with a time of economic recession. The small decrease in the suicide rate in 2020 shows that the early months of the COVID-19 pandemic were not associated with an increase in suicide deaths; these decreases were only transient, as suicide rates increased in 2021. Understanding any relationships between society-level events and rates of suicide require information beyond these surveillance data.

Suicide Rate per 100,000 Population by Sex

Monthly counts of suicide deaths in the province are also presented to allow for timely monitoring, including total suicide deaths and suicide deaths unrelated to acute drug toxicity. Counts are shown both ways because non-drug toxicity deaths are largely unaffected by lags in detection, while drug toxicity suicide deaths require toxicology results which lag in reporting by three or more months. These data may serve as an early warning of a shift in suicide trends. The small numbers show monthly fluctuations. Consideration of this month-to-month variability is required when interpreting the data. Considering seasonal trends, higher numbers of suicide deaths are typically observed in spring and summer months compared to fall and winter.

Frequency of Suicide Deaths by Month over Time

Suicide does not occur at the same rate in all communities. The graph below shows how suicide rates vary over time in each of the health zones in Nova Scotia. These rate calculations are based on health zone of residence of the individual.

Mean Annual Suicide Rate per 100,000 Population by Zone of Residence

*Note: deaths among individuals noted to be non-Nova Scotian residents are excluded

Trends by demographics

There is also variation in suicide rates in non-geographic communities, but only some are currently measured. Considering age and sex, males are more likely to die by suicide than females. This is true in almost all age groups. In the youngest age group (<19 years), numbers of deaths are very low and more similar between males and females. Research from outside Nova Scotia has shown us that people who identify as 2SLGTBQIA+ have a greater risk of suicide. Since this information has not been routinely collected in Nova Scotia, it cannot be assessed currently.

Mean Annual Suicide Rate per 100,000 Population by Age Group and Sex (Filter by Years Averaged)

Suicide data are presented by age group and sex below, showing differences in mortality across age groups and between sexes. The legend displays the colours for male and female. The mean (average) annual rate over a three-year period is presented. As the number of people who die by suicide each year is small, combining data over a three-year period provides a more stable estimate to look at trends in sex and age groups. Different time periods can be selected for display.

Mean Annual Suicide Rate per 100,000 Population by Age Group and Year (Filter by Sex)

The line graph below is another way to look at these same data, set up to show trends over time. It shows the suicide rate over time by age group, for either males or females (select sex to be displayed).

Suicide rates across communities with different characteristics

To look at differences in suicide rates across communities which have similar demographic and socioeconomic compositions, the Canadian Index of Multiple Deprivation (CIMD) can be used. The CIMD groups areas together based on similarities in ‘dimensions of deprivation’, including residential instability and situational vulnerability. Areas can be grouped into five levels (or quintiles) of ‘residential instability’ and into five levels (or quintiles) of ‘situational vulnerability’. More information about these composite measures based on census data is available through Statistics Canada. For these two measures, based on 10 years of mortality data, there was an increasing trend in suicide rates from the most stable to least stable, for both the residential instability dimension, and from the least vulnerable to most vulnerable, for the situational vulnerability dimension.

Mean Annual Suicide Mortality Rate per 100,000 population, NS, 2012-2021, by CIMD quintiles

Another CIMD dimension looks at a measure named the ‘ethno-cultural composition’. This dimension did not show the same pattern in suicide rates as the previous two dimensions. For this dimension, increased ethno-cultural composition was not associated with the highest suicide rates. The communities which ranked lowest for ethnocultural composition had the highest suicide rate.

Mean Annual Suicide Mortality Rate per 100,000 population, 2012-2021, NS, by CIMD quintiles

These composite measures can inform discussions on societal- and community-level life promotion and suicide prevention activities. While these census-derived dimensions came from a lens of community deprivation, community strengths can be observed.

Methods of suicide in our province and what it means for suicide prevention

One of the ways to prevent suicide is limiting access to lethal means for a person at risk of suicide, known as means restriction. The Harvard School of Public Health found that limiting access to lethal weapons is especially important if the person is experiencing a short-term crisis (http://www.hsph.harvard.edu/means-matter). Reducing access to lethal means such as guns and large volumes of medication is important when someone is feeling suicidal. Some lethal means are difficult to restrict because of their widespread availability.
In Nova Scotia, hanging is the most common method of suicide death, and this lethal means is not something that can be removed or restricted in most settings (an exception may be institutional settings). The graph below shows suicide deaths in Nova Scotia by suicide method by year.

Annual Frequencies of Suicide Deaths by Suicide Method

It is important to recognize that means restriction is one small piece of a larger suicide prevention and risk reduction strategy. Considering more upstream measures that address the social and economic factors that can cause or contribute to suicide risk together with contexts that support life promotion is an important part of Nova Scotia’s Suicide Prevention and Risk Reduction Framework.

Suicide is complex

The Nova Scotia mortality data tells us an important story of how suicide can vary across individual and community factors. Suicide prevention efforts should consider these factors. Suicide prevention efforts need to go beyond individual-level interventions. In addition to clinical treatments, suicide prevention and risk reduction includes prevention that happens at the community and societal levels. Prevention strategies can include increasing financial and housing stability, poverty reduction strategies, reducing stigma and discrimination, and increasing community belonging. Historical injustices, systemic discrimination and racism, and the impacts of intergenerational trauma need to be addressed.
In addition to considering how individuals can more easily access clinical interventions, using a public health approach allows us to focus on societal contexts and prevention strategies that impact communities. This approach will improve not only the health of individuals but also the health of populations. Life promotion is a broad term that includes factors that help people build resilience before a crisis happens. Taking a life promotion approach allows for focus on preventing suicide before people are in crisis and to understand and address a broad range of risk and protective factors.
While mortality data were the focus here, further information from several sources can contribute to understanding suicide prevention and life promotion. Sources may include health care utilization data, or visits to the health care system, and surveys of the population.

Links to Additional Sources

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