Social Psychiatry and Psychiatric Epidemiology (2022) 57:1039–1047

https://doi.org/10.1007/s00127-022-02229-7

ORIGINAL PAPER

Suicide among hospitality workers in Australia, 2006–2017

Alexander Christopher Ryan Burnett1 · Q. Wong2 · D. Rheinberger1 · S. Zeritis1 · L. McGillivray1 · M. H. Torok1

Received: 22 July 2021 / Accepted: 6 January 2022 / Published online: 13 January 2022
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2022

Abstract
Purpose Suicide among hospitality workers has recently attracted attention in the media. To date, little is known about
suicide among hospitality workers in Australia.
Methods Suicide data were obtained from the National Coronial Information System (NCIS). Occupational suicide rates
were calculated using the Australian Bureau of Statistics population-level data from the 2011 census. Negative binomial
regression, univariate logistic regression, and multivariate logistic regression were used to estimate the association between
suicide and employment as a hospitality worker over the period 2006–2017, compared to all other occupations.
Results Suicide rates for chefs was significantly higher than for persons in non-hospitality occupations [incidence rate
ratio (IRR), 3.93; 95% CI 2.53–5.79; P < 0.001]. The interaction between occupation and sex was examined with follow-up
testing. Suicide rates for female chefs were significantly higher than for females in non-hospitality occupations (IRR, 3.93;
95% CI 2.60–5.94). Suicide rates for male chefs were also significantly higher than males in non-hospitality occupations
(IRR, 1.38; 95% CI 1.14–1.67). Compared with non-hospitality occupations, hospitality workers who died by suicide had
significantly greater odds of being female (OR 0.63, 95% CI 0.50–0.79), residing in residential Socio-Economic Indexes
for Areas (SEIFA) classified as most disadvantaged (OR 1.62, 95% CI 1.19–2.20), and being born outside of Australia (OR
1.74, 95% CI 1.34–2.25).
Conclusion Results indicate the need for targeted prevention of suicide by Australian hospitality workers. Overall, results
suggest that specific hospitality occupations present a higher risk of suicidal behaviour than other non-hospitality occupations.

Keywords Suicide prevention · Occupations · Epidemiology · Public Health

Introduction socio-economic conditions between the 1979 and 2005 in

England and Wales [6]. The second study was an analysis
The suicide deaths of several high-profile Australian [1, 2] of occupation-specific suicide risk in England between 2011
and international chefs [3–5] have brought suicide and men- and 2015, which found that females aged 20–64 years who
tal illness within the hospitality industry to the forefront in were bar staff and waitresses at their time of death had the
the past few years, yet there is limited research investigating second and fourth highest levels of suicide risk relative to
suicide risk among those employed in hospitality occupa- the general employed population [7]. For males, bakers and
tions. Only two occupational studies have examined hos- confectioners aged 20–64 years had the twelfth highest level
pitality employment at time of suicide death, one of which of risk relative to the general employed population [7]. Such
was a review of occupation-specific suicides in England and findings align with a comprehensive systematic review and
Wales [6]. This study found that suicide rates amongst butch- meta-analysis of suicide by occupation (not specifically hos-
ers increased by 45.1% between 1979–1980/1982–1983 pitality focused), which found that lower skilled occupations,
(16.1 per 100,000) and 2001–2005 (23.4 per 100,000) [6], including restaurant service workers, posed a considerably
and this increase was thought to be related to deteriorating greater risk of suicide than higher skilled occupations [8].
However, no study to date has examined hospitality occupa-
* Alexander Christopher Ryan Burnett
tions independently from other occupations.
[email protected] The health of the general working population is known
to be particularly affected by psychosocial working envi-
1
Black Dog Institute, University of NSW, Sydney, Australia ronments. Past research suggests that poor psychosocial
2
Western Sydney University, Sydney, Australia

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1040 Social Psychiatry and Psychiatric Epidemiology (2022) 57:1039–1047

working environments are a risk factor for male suicide, with risk factors for suicide in this sector, as this will enable the
those employed in occupations that are low in job control identification, development, and/or modification of interven-
and high in job demand being most at risk of suicide [9, tions that could help employers to respond appropriately to
10]. Job-related strain has also been shown to contribute to the needs of, and threats facing, their workforce to reduce
an inequitable depression risk among workers in lower skill suicide risk.
level jobs [11]. Hospitality work is typically characterised Using a national register of occupationally coded suicide
by high work intensity (high demand), limited autonomy incidents over a 12-year period (2006–2017) in Australia,
(low control), long and unsociable working hours, low pay, this study aims to:
and poor physical working conditions [12–14], which may
lead to adverse health outcomes. Low workplace support has 1. Examine rates of suicide by specific hospitality occupa-
specifically been observed amongst chefs, alongside high tions and compare these with data for suicides by people
rates of violence, aggression, and bullying within kitchen in other occupations.
environments [15, 16]. Most Australian hospitality workers 2. Determine whether suicide rates within specific hospital-
are employed on a casual basis (79%) resulting in irregular ity occupations differ between males and females.
hours and income instability [17], which may also negatively 3. Determine whether demographic and socio-economic
affect the mental health of this workforce [18]. characteristics differs for hospitality workers who die
Hospitality is among one of Australia’s biggest industries, by suicide compared with these data for people in other
providing jobs to 4% of the total employed population [19]. occupations.
Despite the size of this industry, the authors are not aware
of any published research on suicide risk among hospitality
workers, which is concerning insomuch that this means there Methods
is no evidence-base for which to draw on to determine the
optimal actions for workplace-specific suicide prevention Study design and sample
efforts. This lack of evidence to guide preventive efforts is
even more concerning when considering that this is a work- This retrospective cohort design utilised all closed suicide
force who are particularly susceptible to negative effects death cases from the National Coronial Information Sys-
from external forces, such as economic crises. As many tem (NCIS) for the period of 2006–2017 in Australia. The
hospitality businesses require a sustainable customer base NCIS is an online database that monitors and records deaths
to be economically viable, periods of recession in which reported to a coroner in Australia and New Zealand. The
people are less likely to spend money on non-essential items NCIS system is comprised of information collected from
may lead to an increase in job insecurity within hospitality source coronial file documents including coronial findings,
sector. There is evidence to suggest that insecure employ- police reports, autopsy reports, and toxicology reports.
ment may be as harmful to overall health as unemployment Fact of death and demographic information reported by the
[20]. Insecure employment has also been associated with coroner, including employment status and occupation, are
increased risk of suicidal ideation amongst persons aged abstracted by NCIS custodians. For this study, suicide was
18–37 years [21]. These findings are worrying given the classified according to the International Classification of
world has recently experienced another period of significant Diseases 10th revision (ICD-10), codes X60–X84 [26].
economic stress and recession as a result of the COVID-19 This study included all employed persons aged between16
pandemic, which saw the temporary closure of hospitality and 74 years who died by suicide with a known occupation at
businesses during lock down periods worldwide [22]. While the time of their death. Cases were excluded if unemployed
business closures may have been periodic and temporary, the at the time of death, employment status was unknown, or if
mental health effects resulting from temporary unemploy- the age at the time of death was not between 16 and 74 years,
ment can be enduring, with evidence that, on average, that which was the age range at death for recorded NCIS hospi-
people do not return to their baseline levels of life satisfac- tality occupation suicides.
tion even years after reemployment [23]. Job insecurity dur- Ethical approval was granted by the Justice Human
ing economic recession may also disproportionately affect Research Ethics Committee (CF/19/30711).
migrant workers, who comprise 39% of the hospitality work-
force in Australia [24], and are ineligible for state support Ascertainment of occupational groups
[25]. A better understanding of suicide risk in the hospitality
industry is timely, not only to understand if there is a suicide Employed persons were firstly identified from the NCIS
problem in Australia that needs addressing, but also which report and then mapped to Australian and New Zealand
hospitality occupations are most at risk, e.g., chefs, bar staff, Standard Classification of Occupations (ANZSCO) codes.
waiters, butchers. It will also be important to understand the The ANZSCO is used to classify occupations within the

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NCIS and are maintained by the Australian Bureau of Sta- Negative binomial regression models were used to inves-
tistics (ABS) [27]. Occupation text descriptions were coded tigate the rate ratios (RR) in suicide by hospitality work-
by at least three researchers according to ANZSCO up the ers, with all other occupations as the reference. Negative
6-digit level [28]. For records where there was disagreement, binomial regression was chosen over Poisson regression
the record was coded according to the two researchers in following identification of over-dispersion in the Poisson
agreement. regression model. The initial negative binomial regression
Occupations were then divided into two broad groups: model controlled for age group (16–29 years, 30–44 years,
hospitality occupations, and all other occupations. “Hospi- 45–59 years, 60–74 years), sex and year of death, with occu-
tality occupations” included all hospitality-related occupa- pation populations used as the offset. Variations between
tions classified by ANZSCO as professions, based on the occupation group and sex were tested by re-running the
educational and skill requirements for the job [28]. We aforementioned model but with an added interaction term.
analysed data for hospitality occupations (codes 351x and The interaction model was compared against the initial
431x) and seven hospitality occupation subgroups: bakers model with no interaction terms. The significance of the
and pastry cooks (code 3511), bar attendants and baristas interaction was assessed using the likelihood ratio test
(code 4311), butchers and smallgoods (i.e., processed meat) (LRT). Coefficients were transformed into rate ratios (RRs)
makers (code 3512), chefs (code 3513), cooks (code 3514), with corresponding 95% CIs to aid interpretation.
waiters (code 4315), and other hospitality professions, which Univariate and multivariate logistic regression analyses
included café workers (code 4312), food trades workers not were conducted to compare the hospitality group who have
further defined (nfd) (code 3510), gaming workers (code died by suicide and all other occupations group who have
4313), hospitality workers nfd (code 4310), hotel service died by suicide with respect to sex, age group, marital status,
managers (code 4313), and other hospitality workers (4319). residential SEIFA, and country of birth. Analyses applied
The “other hospitality professions” group was used due to logistic regression models with odds ratios (ORs) and 95%
low counts among these hospitality occupations. The “all CIs for categorical variables. For multivariate analysis, all
other occupations” comparison group included individuals variables were entered simultaneously into models, with
who were employed in any other occupation at the time of ORs and their 95% CIs reported.
death. All analyses were undertaken using R Studio [32] with
statistical significance established at the 0.05 level.
Ascertainment of population size

Occupation populations were extracted using the 2011 ABS Results

Census (midpoint of the study), by ANZSCO occupation
unit group of main job, age and sex, using ABS TableBuilder Descriptive analysis and age‑standardised suicide
[29]. Age was coded into 15-year bands. rates

Demographic and socioeconomic variables Between 2006 and 2017, there were 11,660 suicides in
Australia where the person was employed at the time of
Demographic and socio-economic variables considered were death and aged between 16 and 74 years (out of a total
sex, age at time of death, marital status, country of birth, 31,086 cases). The overall age-standardised suicide rate
and index of relative socio-economic advantage and disad- (ASR) in hospitality workers over this period was 10.8
vantage (IRSAD) score matched to national decile rankings (95% CI 9.5–12.0) per 100,000 for males and 3.1 (95% CI
from the socio-economic indexes for areas (SEIFA) [30]. 2.5–3.7) per 100,000 for females. The age-standardised
suicide rates in all other occupations were 10.7 (95%
Statistical analysis CI 10.5–10.9) per 100,000 for males and 2.4 (95% CI
2.3–2.6) per 100,000 for females. Hence, there were no
Age and sex were reported for individuals in hospitality significant differences in ASR between male hospitality
occupations, hospitality occupation subgroups and other workers and males in all other occupation, and between
occupations. Crude suicide rates per 100,000 person years female hospitality workers and females in all other occu-
were calculated for each group, stratified by sex. These pations. Table 1 describes the number of suicides for
rates were age-standardised to the 2001 Australian standard males and females in each occupational group, mean
population [31] limiting the standard population to those age, population, and age-standardised suicide rates. For
aged 16–74 years. Significant differences in these rates were males, the highest suicide rates were among butchers
indicated by non-overlapping 95% confidence intervals (95% and smallgoods makers (ASR 16.9, 95% CI 12.1–21.7)
CIs). and chefs (ASR 14.4, 95% CI 11.7–17.1). For females,

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Table 1  Age-standardised rates All persons Males Females

of suicide by employed adults
aged 16–74 years for hospitality All other occupations
occupation groups and for all
Number of suicides 11,243 9371 1872
other occupations, Australia,
2006–2017 Mean age (years) 41.2 41.3 40.9
­Populationa 9,612,765 5,153,786 4,458,979
Adjusted suicide rate (95% CI)b 6.9 (6.8–7.0) 10.7 (10.5–10.9) 2.4 (2.3–2.6)
Bakers and pastrycooks
Number of suicides 38 34–37 1–4
Mean age (years) 34.4 34.7 np
­Populationa 24,685 17,369 7316
Adjusted suicide rate (95% CI)b 8.7 (5.9–11.4) 11.5 (7.7–15.3) np
Bar attendants and baristas
Number of suicides 73 51 22
Mean age (years) 30.2 29.3 32.1
­Populationa 67,812 28,400 39,412
Adjusted suicide rate (95% CI)b 7.4 (5.7–9.1) 11.5 (8.3–14.6) 4.6 (2.7–6.6)
Butchers and smallgoods makers
Number of suicides 48 44–47 1–4
Mean age (years) 37.1 37.1 np
­Populationa 17,625 16,685 940
Adjusted suicide rate (95% CI)b 16.4 (11.7–21.0) 16.9 (12.1–21.7) np
Chefs
Number of suicides 133 110 23
Mean age (years) 33.5 33.6 33.2
­Populationa 57,538 43,562 13,976
Adjusted suicide rate (95% CI)b 13.0 (10.8–15.2) 14.4 (11.7–17.1) 8.8 (5.2–12.4)
Cooks
Number of suicides 17 11 6
Mean age (years) 34.9 29.8 44.3
­Populationa 46,911 21,896 25,015
Adjusted suicide rate (95% CI)b 2.2 (1.1–3.2) 2.4 (1.0–3.8) 1.5 (0.3–2.7)
Waiters
Number of suicides 35 14 21
Mean age (years) 29.1 30.3 28.2
­Populationa 90,831 20,580 70,251
Adjusted suicide rate (95% CI)b 2.6 (1.8–3.5) 5.0 (2.4–7.6) 2.0 (1.1–2.8)
Other hospitality w ­ orkersc
Number of suicides 73 46 27
Mean age (years) 31.5 32.8 29.3
­Populationa 49,800 15,797 34,003
Adjusted suicide rate (95% CI)b 8.6 (6.6–10.5) 18.4 (13.1–23.7) 4.2 (2.6–5.8)

Np counts not provided where they are < 5 for confidentiality reasons
a
Australian Bureau of Statistics 2011 census data
b
Age-standardised rate per 100,000 person-years
c
Café workers, food trades workers not further defined, gaming workers, hospitality workers not further
defined, hotel service managers were aggregated with other hospitality workers due to low incident counts

the highest suicide rates were in chefs (ASR 8.8, 95% CI chefs, and bakers and pastrycooks. Female-dominated
5.2–12.4) and bar attendants and baristas (ASR 4.6, 95% occupations included waiters, other hospitality workers,
CI 2.7–6.6). Population data show that male dominated and bar attendants and baristas.
occupations included butchers and smallgoods makers,

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Negative binomial analysis predicting suicide rate Table 2 also shows the interaction model. The interac-
tion tests indicated significant differences in the relationship
The main effects model can be seen in Table 2. After con- between occupation and suicide by sex (LRTx2(7) = 22.87,
trolling for sex, age, and year of death, chefs (RR 1.57, p = 0.002). Results of the interaction tests examining vari-
95% CI 1.31–1.86), butchers and small goods makers (RR ation in RRs in the hospitality occupation groupings (with
1.61, 95% CI 1.19–2.11), and other hospitality worker (RR all other occupations as the reference group) by sex (females
1.79, 95% CI 1.40–2.23) were shown to have significantly as the reference group), were significant for chefs only. This
elevated rates of suicide compared to other occupations. significant interaction was further examined with follow-up
Cooks (RR 0.35, 95% CI 0.21–0.55) and waiters (RR 0.58, tests. These follow-up tests showed in terms of RRs, and
95% CI 0.41–0.79) were found to have significantly lower holding other predictors constant, that: (i) male chefs had
rates of suicide compared to other occupations. These find- 1.38 (95% CI 1.14–1.67) times the suicide rate of males in
ings also suggest that suicide rates for the employed popu- all other occupations, and (ii) female chefs had 3.93 (95%
lation were higher for males (RR 4.26, 95% CI 4.03–4.50), CI 2.60–5.94) times the suicide rate of females in all other
and have increased slightly over time (RR 1.01, 95% CI occupations. The follow-up tests also showed in terms of
1.00–1.02). Furthermore, compared to the younger work- RRs, holding other predictors constant, that: (i) male chefs
ing population (16–29 years), suicide rates were higher had 1.53 (95% CI 0.98–2.41) times the suicide rate of female
among the middle aged (30–59 years) working population. chefs, although this was not significant, and (ii) males in all
other occupations had 4.36 (95% CI 4.12–4.61) times the

Table 2  The main effects model Main effects model Interaction model
and model with interaction
terms, rate ratios with 95% Rate ratio (95% CI) P Rate ratio (95% CI) P
confidence intervals comparing
suicide rate of hospitality Occupation
occupation groups and all other All other occupations (reference) Reference Reference
occupations, 2006 to 2017 Bakers and pastrycooks 1.12 (0.80–1.51) 0.502 0.99 (0.25–2.58) 0.991
Bar attendants and baristas 1.17 (0.92–1.47) 0.180 1.45 (0.92–2.15) 0.084
Butchers and smallgoods makers 1.61 (1.19- 2.11) 0.001 2.54 (0.14–11.18) 0.352
Chefs 1.57 (1.31–1.86) < 0.001 3.93 (2.53–5.79) < 0.001
Cooks 0.35 (0.21–0.55) < 0.001 0.58 (0.23–1.17) 0.177
Waiters 0.58 (0.41–0.79) 0.001 0.79 (0.50–1.18) 0.285
­ orkersb
Other hospitality w 1.79 (1.40–2.23) < 0.001 1.98 (1.32–2.84) < 0.001
Sex
Females Reference Reference
Males 4.26 (4.03–4.50) < 0.001 4.36 (4.12–4.61) < 0.001
Age group
16–29 years Reference Reference
30–44 years 1.32 (1.24–1.41) < 0.001 1.32 (1.24–1.41) < 0.001
45–59 years 1.25 (1.18–1.34) < 0.001 1.25 (1.18–1.34) < 0.001
60–74 years 0.92 (0.84–1.01) 0.070 0.92 (0.84–1.00) 0.062
Year 1.01 (1.00–1.02) 0.001 1.01 (1.00–1.02) 0.001
Occupation × sex (interaction)
Other occupations × females Reference
Bakers and pastrycooks × males 1.13 (0.41–4.69) 0.840
Bar attendants and baristas × males 0.75 (0.46–1.26) 0.255
Butchers and smallgoods makers × males 0.63 (0.14–11.09) 0.643
Chefs × males 0.35 (0.23–0.57) < 0.001
Cooks × males 0.50 (0.19–1.47) 0.178
Waiters × males 0.53 (0.26–1.03) 0.063
Other hospitality ­workersb × males 0.86 (0.53–1.40) 0.523
a
Australian Bureau of Statistics 2011 census data
b
Café workers, food trades workers not further defined, gaming workers, hospitality workers not further
defined, hotel service managers were aggregated with other hospitality workers due to low incident counts

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1044 Social Psychiatry and Psychiatric Epidemiology (2022) 57:1039–1047

suicide rate of females in all other occupations. It should compared to married/de facto, residing in residential SEIFA
also be noted that the significant main effects for butchers areas classified as either most disadvantaged (IRSAD quin-
and smallgoods makers, cooks, and waiters found previ- tile 1) (OR 1.60, 95% CI 1.78–2.17) or most advantaged
ously in the main effects model became non-significant in (IRSAD quintile 5) (OR 1.39, 95% CI 1.01–1.91) compared
the interactional model. to middle SEIFA areas (IRSAD quintile 3), and being born
outside of Australia (OR 1.40, 95% CI 1.01–1.79) compared
Logistic analyses predicting membership of those to being born in Australia. Those aged 30–44 years (OR
in hospitality occupations who have died by suicide 0.38, 95% CI 0.31–0.47), 45–59 years (OR 0.17, 95% CI
group 0.16–0.23), and 60–74 years (OR 0.19, 95% CI 0.11–0.33)
had lower odds of being in the hospitality occupations group
In the univariate analysis (Table 3), demographic character- compared to those aged 16–29 years.
istics and area-level socio-economic position were predictive
of suicide among the combined “hospitality occupations” Multivariate logistic analysis predicting
group compared to all other occupations. Specifically, the membership of those in hospitality occupations
hospitality occupations group had significantly greater odds who have died by suicide group
of: being female (OR 0.61, 95% CI 0.49–0.77) being sin-
gle/never married (OR 2.17, 95% CI 1.72–2.75) or unlikely In the multivariate analysis (Table 3), the hospitality occupa-
to be known marital status (OR 1.72, 95% CI 1.25–2.36) tions group had significantly greater odds of: being female

Table 3  Univariate and multivariate logistic analysis of all hospitality occupations relative to all other occupations
A. Hospital- B. All other A vs B (reference) P A vs B (reference) P
ity ­occupationsa occupations Univariate model Multivariate model
(N = 417) (N = 11,243)
% % Odds ratio (95% CI) Odds ratio (95% CI)

Sex
Male 75.3 83.3 0.61 (0.49–0.77) < 0.001 0.63 (0.50–0.79) < 0.001
Female 24.7 16.7 Reference
Age group
16–29 years 48.7 20.6 Reference
30–44 years 34.5 38.4 0.38 (0.31–0.47) < 0.001 0.40 (0.32–0.51) < 0.001
45–59 years 13.4 33.6 0.17 (0.16–0.23) < 0.001 0.18 (0.13–0.24) < 0.001
60–74 years 3.4 7.4 0.19 (0.11–0.33) < 0.001 0.20 (0.11–0.35) < 0.001
Marital status
Married/de facto 30.5 41.0 Reference
Single/never married 39.1 24.2 2.17 (1.72–2.75) < 0.001 1.20 (0.92–1.56) 0.186
Divorced/separated 16.3 23.2 0.95 (0.70–1.28) 0.714 1.04 (0.77–1.40) 0.812
Widowed 0.5 1.0 0.67 (0.16–2.72) 0.571 0.89 (0.21–3.73) 0.877
Unlikely to be known 13.7 10.7 1.72 (1.25–2.36) 0.001 1.24 (0.88–1.73) 0.220
SEIFA (National IRSAD quintile)
Most advantaged (5) 20.4 18.4 1.39 (1.01–1.91) 0.041 1.34 (0.98–1.85) 0.071
Second most advantaged (4) 18.0 18.6 1.21 (0.88–1.68) 0.243 1.16 (0.84–1.62) 0.366
Middle (3) 18.0 22.5 Reference
Second most disadvantaged (2) 18.7 21.2 1.11 (0.80–1.53) 0.538 1.17 (0.84–1.62) 0.351
Most disadvantaged (1) 23.7 18.6 1.60 (1.78–2.17) 0.003 1.62 (1.19–2.20) 0.002
No SEIFA 1.2 0.7 2.01 (0.79–5.10) 0.142 1.53 (0.59–3.98) 0.387
Birth country
Australia 56.8 60.0 Reference
Other than Australia 21.6 16.3 1.40 (1.09–1.79) 0.008 1.74 (1.34–2.25) < 0.001
Unlikely to be known 21.6 23.8 0.96 (0.45–1.23) 0.734 1.42 (0.83–1.42) 0.537

SEIFA socio-economic indexes for areas, IRSAD index of relative socio-economic advantage and disadvantage
a
Bakers and pastry cooks, bar attendants and baristas, butchers and smallgoods makers, café workers, chefs, cooks, food trades workers not fur-
ther defined, gaming workers, hospitality workers not further defined, hotel service managers, other hospitality workers, waiters

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Social Psychiatry and Psychiatric Epidemiology (2022) 57:1039–1047 1045

(OR 0.63, 95% CI 0.50–0.79), reside in residential SEIFA local settings or conditions. Male-dominated industries
areas classified as most disadvantaged (IRSAD quintile 1) have been previously linked to higher suicide rates, with
(OR 1.62, 95% CI 1.19–2.20) compared to middle SEIFA research showing that males in heavily male-dominated
areas (IRSAD quintile 3), and being born outside of Aus- occupations are most at risk [34]. While this study did
tralia (OR 1.74, 95% CI 1.36–2.25) compared to being born not examine the gendered context of hospitality suicide,
in Australia. Those aged 30–44 years (OR 0.40, 95% CI varying hospitality occupation risks for males and females
0.32–0.51), 45–59 years (OR 0.18, 95% CI 0.13–0.24), and suggest a need for nuanced examination of the mechanisms
60–74 years (OR 0.21, 95% CI 0.11–0.35), had lower odds through which gendered working environments influence
of being in the hospitality occupations group compared to suicide in hospitality.
those aged 16–29 years. Our examination of the relationship between occupation
type and risk factors showed that age may be of impor-
tance when trying to identify workforce suicide prevention
Discussion targets, with young people more likely to die by suicide
in hospitality than other occupations, compared to older
By investigating suicide rates in the Australian hospitality individuals. This finding is consistent with past research
industry, this is the first study to provide evidence of the in which older workers had significantly lower risk of
risk for suicide among this workforce. Overall, the findings suicide compared to younger workers [35]. It is possible
showed that the age-standardised rates for suicide among that hospitality workers aged 30–74 years were less sus-
males and females in hospitality occupations at time of death ceptible to risk factors related to hospitality employment.
were not significantly different from the general employed Given that approximately 43% of the Australian hospitality
population in Australia, suggesting that the hospitality sec- workforce are aged between 15 and 24 years, compared to
tor does not collectively carry a great suicide risk relative to 15.4% for the total employed population [36], interven-
other employment types. tions targeted to, and developed for, younger hospitality
Investigation into specific hospitality occupation types, employees may an important target for workplace suicide
however, showed that employment as a chef was associated prevention efforts.
with an elevated risk of suicide relative to all other occupa- Being born overseas was also identified as a significant
tions (e.g., male chef suicide rate 1.4 times that of males in risk factor for suicide among hospitality workers. Overseas-
all other occupations and female chef suicide rate 3.9 times born employees comprise approximately 39% of the Austral-
that females in all other occupations). In contrast, employ- ian accommodation and food services industry according to
ment as a cook was associated with decreased risk of suicide the 2016 Australian Census data [24]. It has been argued that
relative to all other occupations in the main effects model, the number of roles available and low-skill requirements for
however, this result was non-significant in the interaction hospitality make this a ‘refuge’ industry for migrant jobseek-
model. Whilst both chefs and cooks share an environment ers [37, 38]. Research that has explored employers’ willing-
which is both physically and psychologically stressful, chefs ness to offer jobs to migrant workers found that migrants are
require additional knowledge, skills, and abilities to maintain perceived as being more willing to accept difficult employ-
the operational success of restaurants [33]. It is possible that ment conditions and receive lower pay than the local (native)
the additional pressures associated of being a chef, opposed workforce [39, 40]. While there is limited evidence regard-
to a cook, may play a role in explaining the high rate of ing suicide among migrant workers in Australia [41], these
suicide among chefs. However, it is also possible that our poor employment conditions could feasibly contribute to
sample, which contains very few persons employed as cooks, an already vulnerable population [42]. For example, low
is insufficiently heterogeneous. Regardless, the potentially socio-economic status has been found to increase suicide
buffering effect associated with employment as a cook com- risk among male migrants from the UK, New Zealand, and
pared to chefs should be further examined. Asia residing in urban New South Wales [43], suggesting
There also appeared to be some additional gender- that low pay and affordability of living (or ‘economic dep-
specific effects between hospitality occupations, whereby rivation’) may be a mechanism underlying suicidal behav-
males employed as butchers and smallgoods makers iour in male migrant hospitality employees. Previous studies
should be considered as high risk, as should females work- of welfare support and suicide indicate that countries with
ing as bar attendants and baristas (ranked in the top two more generous welfare payments and active labour market
for female hospitality occupations with highest ASR). programs experience little or increase in suicide during eco-
These findings are consistent with the only other two prior nomic downturns [44]. Modification of welfare support poli-
studies in this area which were conducted in England and cies may be an important component of workplace suicide
Wales [6, 7], suggesting that these employment types prevention efforts to better support migrant workers facing
carry an occupational risk for suicide that extends beyond economic insecurity [45].

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1046 Social Psychiatry and Psychiatric Epidemiology (2022) 57:1039–1047

Limitations (e.g., reasonable working hours, zero tolerance to work-

place bullying, social support, improved working condi-
While these findings provide useful information on suicide tions), supporting the mental health and wellbeing of young
risk among those employed in hospitality occupations, some and migrant workers in particular, and ensuring access to
limitations should be noted. First, it is possible that the rates mental health support (e.g., through employee-assistance
of suicide reported in this study are higher given probable programs).
under-reporting and subsequent miscoding of suicide as
other causes of death (e.g., undetermined or accidental) by Acknowledgements The authors acknowledge the support from the
Department of Justice and Community Safety and the National Coro-
coroners in Australia, as with any authoritative record of nial Information System for provision of the data.
deaths [46]. Second, this study only included persons who
were determined by the investigating coroner to be employed Funding This work was supported in part by a grant from the Paul
with a known occupation at the time of death, it is pos- Ramsay Foundation.
sible that employed persons who had stopped working due
to illness, had retired, or were recently unemployed were Declarations
not included in this analysis. Additionally, it is possible
that occupation may have been miscoded during the coding Conflict of interest The authors declare that they have no conflict of
interest.
process, despite matched coding by at least two research-
ers. Third, we did not have sufficient data to analysis rates Ethical standards This study was approved by the Department of
within café workers, food trades workers not further defined, Justice and Community Safety Human Research Ethics Committee
gaming workers, hospitality workers not further defined, and (CF/19/30711).
hospital service managers. It is possible that persons work-
ing in these occupations may be at increased risk of suicide.
Fourth, mortality rates based on small numbers may be unre-
liable and should be interpreted with caution. For example, References
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