1351.0.55.062 - Research Paper: Psychosocial risk factors as they relate to coroner-referred deaths in Australia, 2017  
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ANNEX LISTING: PSYCHOSOCIAL CODES (INCLUSIONS AND EXCLUSIONS)

This annex is a resource to be used in conjunction with the information paper and related data tables for Research Paper: Psychosocial risk factors as they relate to coroner-referred deaths in Australia (cat. no. 1351.0.55.062). This annex contains a list of codes from Chapter 21 Factors Influencing Health Status and Contact with Health Services the International Classification of Disease 10th Revision (ICD-10) which have been used as the framework to identify and apply psychosocial risk factors to mortality coding. Traditionally codes in Chapter 21 Factors Influencing Health Status and Contact with Health Services of the ICD-10 are not used for mortality coding, however many of the circumstances align with known psychosocial risk factors which are not able to be coded elsewhere in the classification. The codes in Chapter 21 Factors Influencing Health Status and Contact with Health Services do not represent diseases, illness or injury, but rather, as the chapter name suggests, factors influencing health status. To enrich the current mortality dataset, and provide a richer understanding of the circumstances in which people die, the ABS has used the codes in this chapter as a resource to capture information which was provided, but historically not captured as part of the ABS Causes of Death dataset. The following descriptions have been constructed based on the coding of 2017 reference year data by the ABS Mortality Coding team and reflects how the codes from Chapter 21 of the ICD-10 have been used from a mortality perspective to capture risk factors surrounding deaths.

The circumstances or risk factors surrounding the death were captured as part of the usual process when coding a cause of death which has been referred to a coroner. Coders access a number of reports from the National Coronial Information System (NCIS) which outline the circumstances and events surrounding the death. Reports available to coders on the NCIS include police, toxicology, autopsy, and coronial findings, which, in line with ICD-10 coding principles, have been used to identify the underlying and associated causes of death. These reports contain much richer information regarding the circumstances surrounding the death than just the underlying and associated causes. Reports draw on information and investigation from multiple aspects of the deceased’s life including (but not limited to) family, friends, treating medical practitioners and health professionals, workplaces, neighbours, and community groups. Combined with toxicology, pathology, and police findings, these findings are able to provide an invaluable insight into both proximal and distal circumstances and risk factors surrounding an individual’s death.

As the pilot progressed it was identified that some of the names or descriptions of the codes were not able to accurately capture circumstances which were revealing themselves in the reports. It was decided that some of these names or descriptions would be expanded or modified to be able to better capture and represent these factors. An example includes Z63.4 Disappearance and death of family member. This was expanded to include those within the primary support group. Any codes which have been modified to fit the purpose of this project have been identified in the table below. For the majority of codes, names and descriptions have remained as in the ICD. The column labelled 'ABS Code Description' contains the codes as they have been applied to the project. These are the code descriptions that appear in the paper and the supplementary data cubes.

The codes in the table are listed in alphanumeric order and do not reflect the amount of times a code was assigned to a death. This information is provided in the paper and supplementary data cubes. The bulk of risk factors identified fall into the blocks of categories Z55-Z65 Persons with potential health hazards related to socioeconomic and psychosocial circumstances, Z70-Z76 Persons encountering health services in other circumstances, and Z80-Z99 Persons with potential health hazards related to family and personal history and certain conditions influencing health status.

The definitions listed are a reflection of the inclusions and exclusions based on reflection and revision at the completion of the 2017 reference year coding. The risk factors captured in this pilot are not representative of an exhaustive list of all circumstances surrounding external deaths. They are reflective of what was identified as part of usual practice when reading the reports listed on the NCIS. Due to the nature of obtaining the information by posthumous investigation, not all factors or circumstances can be obtained.

Table 1: Annex listing of psychosocial risk factor ICD-10 codes with inclusions and exclusions

Alphanumeric codeICD-10 Code DescriptionABS Code DescriptionInclusion and Exclusion terms (as applied by ABS)Additional comments

Z02.2Examination for admission to residential institutionExamination for admission to residential institution

Z02.4Examination for driving licenceExamination for driving licenceIncl:
  • Failed examination for driving licence
  • Revoked driving licence for health reasons

Z11.5Special screening examination for other viral diseasesSpecial screening examination for other viral diseasesExcl:
  • Viral intestinal disease (Z11.0)

Z33Pregnant state, incidentalPregnant state, incidentalIncl:
  • Pregnant, incidental
  • Miscarriage
  • Post-partum

Excl:
  • Maternal death
Z33 Pregnant state, incidental is used to capture deaths where the deceased is pregnant (or up to one year post partum/termination), but the pregnancy is not a contributory factor to death.

Z51.9Medical care unspecifiedMedical care unspecified

Z55.0Illiteracy and low-level literacyIlliteracy and low-level literacy

Z55.2Failed examinationsFailed examinationsIncl:
  • Failed exams
  • Exam pressure

Z55.3Underachievement in schoolUnderachievement in school

Z55.4Educational maladjustment and discord with teachers and classmatesEducational maladjustment and discord with teachers and classmatesAdd additional code Z60.8 Bullying if discord with teachers and classmates involves bullying. Dual code analysis: When Z55.4 Educational maladjustment and discord with teachers and classmates and Z60.8 Bullying are captured in tandem as contributing to an individual's death, it can be inferred that the bullying incident(s) occurred within the school or educational environment.

Z55.8Other problems related to education and literacyOther problems related to education and literacyIncl:
  • Study stress
  • Academic pressure
  • Struggling with studies
  • Change of education institutions
  • Loss of interest in studies

Excl:
  • Failed examinations (Z55.2)
  • Stress surrounding examinations (Z55.2)

Z55.9Problem related to education and literacy, unspecifiedProblem related to education and literacy, unspecified

Z56.0Unemployment, unspecifiedUnemployment, unspecifiedIncl:
  • Dole

Excl:
  • Unemployment of family member (Z59.8)

Z56.1Change of jobChange of jobIncl:
  • Promotion
  • Change of working contract
  • Demotion
  • New job or role

Z56.2Threat of job lossThreatened or actual job lossIncl:
  • Job loss
  • Firing
  • Redundancy
  • Threat (real or perceived) of job loss

Z56.3Stressful work scheduleStressful work schedule

Z56.4Discord with boss and workmatesDiscord with boss and workmatesIncl:
  • Disagreements
  • Lack of agreement or harmony
  • Conflict
  • Hostility
  • Disputes
  • Clashing
  • Workplace bullying

Add additional code Z60.8 if discord with boss and workmates involves bullying
Dual code analysis: When Z56.4 Discord with boss and workmates and Z60.8 Bullying are captured in tandem as contributing to an individual's death, it can be inferred that the bullying incident(s) occurred within the work environment.

Z56.5Uncongenial workUncongenial workIncl:
  • Difficult conditions at work
  • Work pressure
  • Uncongenial employment

Z56.6Other physical and mental strain related to workOther physical and mental strain related to workIncl:
  • Physical pain when performing work duties
  • Workplace injuries
  • Work stress
  • Unable to relax/wind down post-work
  • Unhappy at work

Excl:
  • Workplace bullying (Z56.4, Z60.8)

Z56.7Other and unspecified problems related to employmentOther and unspecified problems related to employmentIncl:
  • Inability to work or difficulty obtaining work
  • Intermittent employment
  • Failed/failing business
  • Change in work requirements
  • Any other and unspecified problems related to employment not coded to Z56.0-Z56.6

Excl:
  • Workplace bullying (Z56.4, Z60.8)

Z58.0Exposure to noiseExposure to noise

Z59.0HomelessnessHomelessnessIncl:
  • Primary homelessness
  • Sleeping rough
  • Rooflessness

Excl:
  • Secondary homelessness (Z59.1)
Persons suffering from different levels of homelessness often have different associated risk factors for many different outcomes and require different interventions. To capture this more effectively, this project has captured primary homelessness in Z59.0 (Homelessness) and secondary homelessness under Z59.1 (Inadequate housing). When considering the impact of homelessness as a broader concept it is advised to combine Z59.0 and Z59.1 in statistical output.

Z59.1Inadequate housingInadequate housingIncl:
  • Overcrowding
  • Physical hazards
  • Insufficient amenities & utilities (including heat, water, plumbing, electricity and sanitation)
  • Derelict dwellings
  • Uninhabitable dwellings
  • Secondary homelessness (including squatter, couch surfing)

Excl:
  • Primary homelessness (Z59.0)
Persons suffering from different levels of homelessness often have different associated risk factors for many different outcomes and require different interventions. To capture this more effectively, this project has captured primary homelessness in Z59.0 (Homelessness) and secondary homelessness under Z59.1 (Inadequate housing). When considering the impact of homelessness as a broader concept it is advised to combine Z59.0 and Z59.1 in statistical output.

Z59.2Discord with neighbours, lodgers and landlordDiscord with neighbours, lodgers and landlordIncl:
  • General discord
  • Fights with neighbours/tenants/roommates

Z59.3Problems related to living in residential institutionProblems related to living in residential institution

Z59.6Low incomeLow income

Z59.8Other and unspecified problems related to housing and economic circumstancesOther and unspecified problems related to economic circumstancesIncl:
  • Foreclosure on loan
  • Problems with creditors
  • Financial loss / difficulty / issues / troubles / concerns / problems / stress
  • Bankruptcy
  • Unemployment of family member
  • Unspecified financial issues
  • Any other specified economic circumstances which do not fit in Z59.0-Z59.7
The ICD-10 combines housing and economic circumstances together for some situations. Due to the marked differences in economic and housing issues, new categories were created to identify these risk factors separately in output.

Z59.9Problems related to housing and economic circumstances, unspecifiedOther and unspecified problems related to housing circumstancesIncl:
  • Temporary housing (e.g. hostel)
  • Eviction from housing (owner or renter)
  • Concerns over security of keeping or obtaining housing
  • Any other specified housing circumstances which do not fit in Z59.0-Z59.7
The ICD-10 combines housing and economic circumstances together for some situations. Due to the marked differences in economic and housing issues, new categories were created to identify these risk factors separately in output.

Z60.0Problems of adjustment to life-cycle transitionsProblems of adjustment to life-cycle transitionsIncl:
  • Anxiety surrounding retirement
  • Not wanting to retire
  • Worries about "getting old"
  • "Empty nest" syndrome

Excl:
  • Nursing home fear/avoidance (Z74.8)

Z60.2Living aloneLiving alone

Z60.3Acculturation difficultyAcculturation difficulty

Z60.4Social exclusion and rejectionSocial isolation, exclusion, and rejectionIncl:
  • Social isolation (actual and perceived)
  • Friendship fights
  • Loneliness

Excl:
  • Social exclusion due to bullying (Z60.8)

Z60.5Target of perceived adverse discrimination and persecutionTarget of perceived adverse discrimination and persecutionExcl:
  • Social exclusion and rejection (Z60.4)

Z60.8Other problems related to social environmentBullyingIncl:
  • Bullying
  • Bullying at school (add additional code with Z55.4)
  • Workplace bullying (add additional code with Z56.4)
This code has been used to capture bullying only. The impact of bullying as it relates to both mortality and mental health is of interest to a wide range of organisations and individuals. It is important that information on bullying can be disseminated in the dataset.

Dual code use: Bullying can be considered with other codes (e.g. Z55.4 Educational maladjustment) to understand the contextual environment in which the bullying may have occurred.


Z60.9Problem related to social environment, unspecifiedProblem related to social environment, unspecified

Z61.0Loss of love relationship in childhoodLoss of love relationship in childhood

Z61.1Removal from home in childhoodRemoval from home in childhood

Z61.2Altered pattern of family relationships in childhoodAltered pattern of family relationships in childhoodIncl:
  • Arrival of a new person into a family resulting in adverse change in child's relationships. May include new marriage by a parent or birth of a sibling.

Z61.3Events resulting in loss of self-esteem in childhoodEvents resulting in loss of self-esteem in childhoodIncl:
  • Failure in tasks with high personal investment
  • Disclosure or discovery of a shameful or stigmatizing personal or family event
  • Humiliation in childhood

Z61.4Problems related to alleged sexual abuse of child by person within primary support groupProblems related to alleged sexual abuse of child by person within primary support group Primary support groups include family, friends, and highly influential social groups involved in the exchange of love, caring, concern, animosity, support, and those who share close, personal, enduring relationships.

Z61.5Problems related to alleged sexual abuse of child by person outside primary support groupProblems related to alleged sexual abuse of child by person outside primary support group

Z61.6Problems related to alleged physical abuse of childProblems related to alleged physical abuse of child

Z61.7Personal or frightening experience in childhoodPersonal or frightening experience in childhood

Z61.8Other negative life events in childhoodOther negative life events in childhoodIncl:
  • Childhood family violence
  • Problems in childhood
  • Traumatic childhood
  • Childhood abuse NEC
  • Other specified negative life events in childhood not coded to Z61.0-Z61.7

Z61.9Negative life event in childhood, unspecifiedNegative life event in childhood, unspecified

Z62.2Institutional upbringingInstitutional upbringingIncl:
  • Any care upbringing (e.g. foster/orphanage)

Z62.4Emotional neglect of childEmotional neglect of child

Z62.5Other problems related to neglect in upbringingOther problems related to neglect in upbringing

Z62.6Inappropriate parental pressure and other abnormal qualities of upbringingInappropriate parental pressure and other abnormal qualities of upbringing

Z62.8Other specified problems related to upbringingOther specified problems related to upbringingIncl:
  • Poor upbringing
  • Strict parents
  • Contact with child services NOS
  • Adoption (where it has been stated adoption has had a negative effect on the deceased’s life)

Z62.9Problem related to upbringing, unspecifiedProblem related to upbringing, unspecified

Z63.0Problems in relationship with spouse or partnerProblems in relationship with spouse or partnerIncl:
  • Intimate partner violence
  • Relationship issues
  • Acute events as well as ongoing/reoccurring.
  • One-off events which have impacted the chain of events leading to death
  • Domestic violence

Excl:
  • Separation and divorce (Z63.5)
  • Domestic violence where children and other specified parties except spouse/partner were affected (Z61.- or Z638)

Z63.1Problems in relationship with parents and in-lawsProblems in relationship with parents and in-lawsIncl:
  • Arguments, disagreements, discord, conflict
  • Parents not approving of relationships or other lifestyle choices

Excl:
  • Problems in relationship with other family members who are not parents or in-laws (Z63.-)

Z63.2Inadequate family supportInadequate family supportIncl:
  • Lack of family support
  • Feelings of abandonment

Z63.3Absence of family memberAbsence of family memberIncl:
  • Inability to see family members (including children)
  • Estrangement from family members (including children)

Excl:
  • Disappearance and death of family member (Z63.4)

Z63.4Disappearance and death of family memberDisappearance and death of family member (or primary support group)Incl:
  • Death of pet
  • Assumed death of a family member
Primary support groups include family, friends, and highly influential social groups involved in the exchange of love, caring, concern, animosity, support, and those who share close, personal, enduring relationships.

Z63.5Disruption of family by separation and divorceDisruption of family by separation and divorceIncl:
  • Relationship breakdown
  • Separation
  • Divorce
  • Children affected by separation or divorce

Excl:
  • Relationship issues (Z63.0)

Z63.6Dependent relative needing care at homeDependent relative needing care at home

Z63.7Other stressful life events affecting family and householdOther stressful life events affecting family and householdIncl:
  • Anxiety (normal) about sick person in family
  • Health problems with family

Z63.8Other specified problems related to primary support groupOther specified problems related to primary support groupIncl:
  • Family fights
  • Problems with pets
  • Any other specified problems related to primary support group not able to be classified to Z63.0-Z63.7

Z63.9Problem related to primary support group, unspecifiedProblem related to primary support group, unspecifiedIncl:
  • Family difficulties, NOS
Primary support groups include family, friends, and highly influential social groups involved in the exchange of love, caring, concern, animosity, support, and those who share close, personal, enduring relationships.

Z64.4Discord with counsellorsDiscord with counsellorsIncl:
  • discord with probation officer or social worker

Z65.0Conviction in civil and criminal proceedings without imprisonmentConviction in civil and criminal proceedings without imprisonmentIncl:
  • Any mention of a conviction
  • Charged with an offence
  • Criminal history

Excl:
  • Problems related to release from prison (Z65.2)

Z65.1Imprisonment and other incarcerationImprisonment and other incarcerationIncl:
  • Current imprisonment/incarceration
  • Impending imprisonment/incarceration

Z65.2Problems related to release from prisonProblems related to release from prisonIncl:
  • Recent release from prison
  • Any mention where the deceased has been imprisoned

Z65.3Problems related to other legal circumstancesProblems related to other legal circumstancesIncl:
  • Domestic Violence Orders
  • Child custody or support proceedings
  • Litigation
  • Restraining Orders
  • Potential or impending legal circumstances or court appearances
  • Charges have been laid, awaiting/anticipation of commencement court proceedings
  • Circumstances where death occurs in relation to illegal activities, where it is not captured elsewhere (e.g. motor vehicle crash in a stolen vehicle, where crash was not in relation to police pursuit [Y35])

Z65.4Victim of crime and terrorismVictim of crime and terrorismIncl:

Victim of sexual assault


Z65.5Exposure to disaster, war and other hostilitiesExposure to disaster, war and other hostilitiesIncl:
  • Defence personnel with defence related PTSD
  • Natural disasters

Excl:
  • Post-traumatic stress disorder (F43.1)

Z65.8Other specified problems related to psychosocial circumstancesOther specified problems related to psychosocial circumstancesIncl:
  • Stressful life event, NEC

Excl:
  • Other stressful life events affecting family and household (Z63.7)

Z71.1Person with feared complaint in whom no diagnosis is madePerson with feared complaint in whom no diagnosis is made

Z71.5Drug abuse counselling and surveillanceDrug abuse counselling and surveillance

Z71.6Tobacco abuse counsellingTobacco abuse counselling

Z72.5High-risk sexual behaviourHigh-risk sexual behaviour

Z72.6Gambling and bettingGambling and bettingExcl:
  • Compulsive or pathological gambling (F63.0)

Z73.3Stress, not elsewhere classifiedStress, not elsewhere classifiedIncl:
  • Physical and mental strain NOS

Excl:
  • related to employment or unemployment (Z56.-)

Z73.6Limitation of activities due to disabilityLimitation of activities due to disability or chronic health conditionIncl:
  • all types of disabilities as well as health conditions which reduce an individual’s abilities (e.g. chronic conditions in the elderly, "declining health", terminal illness).
  • perceived limitation of ability due to newly diagnosed illness

Z73.8Other problems related to life-management difficultyOther problems related to life-management difficultyIncl:
  • Loss of licence
  • Unable to manage daily routine

Z74.0Need for assistance due to reduced mobilityNeed for assistance due to reduced mobility

Z74.1Need for assistance with personal careNeed for assistance with personal care

Z74.2Need for assistance at home and no other household member able to render careNeed for assistance at home and no other household member able to render care

Z74.8Other problems related to care-provider dependencyOther problems related to care-provider dependencyIncl:
  • Anxiety surrounding perceived or actual "burden" on primary support group
  • Worry/fear/anxiety/avoidance surrounding move to nursing home
  • Other problems related to care-provider dependence not coded to Z74.0-Z74.3

Z75.0Medical services not available in homeMedical services not available in homeExcl:
  • No other household member available to render care (Z74.2)

Z75.8Other problems related to medical facilities and other health careOther problems related to medical facilities and other health careIncl:
  • Medical facility avoidance

Z81.8Family history of other mental and behavioural disordersFamily history of suicideIncl:
  • Family history of suicide

Z86.0Personal history of other neoplasmsPersonal history of other neoplasmsExcl:
  • Malignant neoplasms (Z85.-)

Z87.8Personal history of other specified conditionsPersonal history of other specified conditionsIncl:
  • Conditions classifiable to S00-T98

Excl:
  • Personal history of self harm (Z91.5)

Z91.1Personal history of noncompliance with medical treatment and regimePersonal history of noncompliance with medical treatment and regimeIncl:
  • Current and past personal history

Z91.4Personal history of psychological trauma, not elsewhere classifiedPersonal history of psychological trauma, not elsewhere classifiedIncl:
  • Home invasion

Excl:
  • Physical trauma from home invasion (Z91.6)

Z91.5Personal history of self-harmPersonal history of self-harmIncl:
  • Deliberate self-injury
  • Causing self-inflicted pain
  • Suicidal and non-suicidal self-injury.
  • Actions can include, but are not limited to: Cutting the skin with sharp objects; burning the skin; hitting the body with objects or fists; scratching or picking at the skin causing bleeding or welts; deliberately ingesting an overdose of medication or other harmful substances; hanging, strangulation, or suffocation.

Excl:
  • Suicide ideation (R45.8)

Z91.6Personal history of other physical traumaPersonal history of other physical traumaIncl:
  • Sexual assault (not in childhood)
  • Physical abuse/assault NEC

Add additional code Z65.4 to identify victim of crime

Z91.8Personal history of other specified risk factors, not elsewhere classifiedPersonal history of other specified risk factors, not elsewhere classifiedIncl:
  • Abuse NOS
  • Maltreatment NOS

Z92.6Personal history of chemotherapy for neoplastic diseasePersonal history of chemotherapy for neoplastic disease