This article contains a list of psychosocial codes from 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. These codes have been taken from Chapter 21 Factors Influencing Health Status and Contact with Health Services of the ICD-10. It represents an update to the list that was previously published in the research paper Psychosocial risk factors as they relate to coroner referred deaths in Australia.
Listing of psychosocial risk factor ICD-10 codes with inclusions and exclusions
Psychosocial risk factors as they relate to deaths in Australia
Released
10/10/2024
Introduction
Background
From 2017 the ABS has been including coded information on psychosocial risk factors to the National Mortality Dataset (NMD). Psychosocial risks are psychological, social and environmental factors which may adversely influence an individual's health status. Inclusion of psychosocial risk factors on the NMD enhanced the dataset as this information provides more insights into the complex interaction of the biological, psychological and psychosocial factors that may contribute to death.
Information on psychosocial risk factors in the NMD are more commonly coded for coroner referred deaths and are sourced by the ABS mortality team from National Coronial Information System (NCIS). The NCIS is a medico-legal database holding a range of information pertaining to each death, including reports from police, toxicologists, and pathologists as well as the coroner. These reports contain information not only on diseases, mental health conditions and external events and injury, but also a wealth of information on psychosocial factors as they relate to the deceased individual. These findings provide valuable insights into the circumstances and risk factors surrounding an individual’s death. At an aggregate level, this information can help guide prevention and intervention activities.
Psychosocial risk factors are less commonly coded for deaths certified by a doctor. This is because psychosocial factors are not systematically recorded on medical certificates of cause of death (MCCD) in Australia. Psychosocial risk factors for doctor certified deaths most commonly relate to medical care.
The psychosocial risk factors recorded on the NMD are not a complete representation of psychological, social and environmental factors present for individual's at death. A psychosocial risk must be mentioned in either a coronial report or the MCCD and made available to the ABS for it to be coded and included in outputs. While there are still some data gaps, there has been improvement over time, both in information made available to the ABS and the coding process of the mortality team.
Psychosocial factors are usually assigned a code from Chapter 21 Factors Influencing Health Status and Contact with Health Services of the ICD-10. This article includes a list of the most commonly used codes from this chapter. The article also includes terms pertaining to psychosocial risk factors and what codes these terms are assigned to. The reason for this is that one ICD-10 code may have a number of terms included. This article is designed to assist with the interpretation of psychosocial risk factors in the NMD and as they appear in the Causes of Death, Australia publication. It is an updated to the list first published as part of the 2017 coding. This listing has also been updated to include psychosocial risk factors that may be reported on the Medical Certificate of Cause of Death for deaths certified by a doctor.
How to use this listing
The table below presents the latest version of the listing of psychosocial risk factors as they relate to deaths in Australia.
- Column 1: Alphanumeric code
- This is a list of ICD-10 code blocks and individual codes (presented to four digit level), listed in alphanumeric order.
- Column 2: ICD-10 code description
- This contains the official ICD-10 code description.
- Column 3: ABS code description
- This contains the code description as applied by the ABS. The descriptions in this column are used for reporting purposes.
- Column 4: Inclusion and exclusion terms (as applied by the ABS)
- This columns contains lists of psychosocial risk factors which are assigned to the code. When an inclusion term states "code with" this means that two codes are assigned to a term. This column also contains a list of exclusion terms that are coded elsewhere.
- Column 5: Additional comments
- This column provides comments that assist with interpretation of the code or terms as applied by the ABS.
The codes listed reflect the definitions, inclusions and exclusions investigated at the completion of the cause of death coding of 2023 data. The risk factors listed are not representative of an exhaustive list of all circumstances surrounding external and natural deaths, rather they reflect what was identified as part of the coding process when analysing the MCCD and the reports on the NCIS. Coding undertaken by the ABS is undertaken at a point in time - this means that the codes reflect what was available at a certain point. As coronial investigations progress psychosocial risk factor codes may change, with updates being made as part of the ABS revisions process.
Risk factors in ABS outputs
Risk factors are included and made available as associated causes in the NMD. Data on risk factors captured for intentional-self harm deaths (suicide) is available in the Causes of Death, Australia annual publication presented by characteristics such as age, sex and co-occurring risk factors.
The ABS uses, and supports the use of the Mindframe guidelines on responsible, accurate and safe reporting on suicide, mental ill-health and alcohol and other drugs. The ABS recommends referring to these guidelines when reporting on psychosocial risk factors.
Future considerations
The ABS continues to refine the coding of risk factors, including those which are psychosocial in nature. The future implementation of ICD-11 will also provide a more detailed framework for capture of psychosocial risk factors and may also enable capture of other types of risk factors.
Listing of psychosocial risk factor ICD-10 codes with inclusions and exclusions
| Alphanumeric code | ICD-10 code description | ABS code description | Inclusion and exclusion terms (as applied by ABS) | Additional comments |
|---|---|---|---|---|
| Z00-Z13: Persons encountering health services for examination and investigation | ||||
| Z02.2 | Examination for admission to residential institution | Examination for admission to residential institution | ||
| Z02.4 | Examination for driving licence | Issues relating to driver's licence | Incl:
| |
| Z04.0 | Blood-alcohol and blood-drug test | Blood-alcohol and blood-drug test | Incl:
| |
| Z04.2 | Examination and observation following work accident | Examination and observation following work accident | Incl:
| |
| Z04.6 | General psychiatric examination, requested by authority | General psychiatric examination, requested by authority | ||
| Z10.0 | Occupational health examination | Occupational health examination | Incl:
Excl:
| |
| Z10.2 | Routine general health check-up of armed forces | Routine general health check-up of armed forces | Incl:
| |
| Z20-Z29: Persons with potential health hazards related to communicable diseases. These codes were introduced into the ABS mortality dataset at the start of the COVID-19 pandemic. Their purpose is to capture the direct and indirect effects of social factors during the pandemic. | ||||
| Z29.0 | Isolation | Isolation | Incl:
| |
| Z29.9 | Prophylactic measure, unspecified | Prophylactic measure for pandemic response | Incl:
Excl:
| This code is used when the social aspects of the COVID-19 pandemic were described as a factor related to death, but were not due to compulsory isolation. Dual code analysis: This code is used in conjunction with other codes to identify the specific risk factor. 'Code with' in the inclusion terms specifies additional codes that can be used to provide a greater understanding of risk factors related to the pandemic. |
| Z30-Z39: Persons encountering health services in circumstances related to reproduction | ||||
| Z33 | Pregnant state, incidental | Pregnant state, incidental | Incl:
Excl:
| This code is used to capture deaths where the deceased was pregnant at the time of death, or up to one year post partum or termination, but the pregnancy was not a contributory factor to death. |
| Z35.3 | Supervision of pregnancy with history of insufficient antenatal care | Supervision of pregnancy with history of insufficient antenatal care | Incl:
| |
| Z38.1 | Singleton, born outside hospital | Singleton, born outside hospital | Incl:
| |
| Z40-Z54: Persons encountering health services for specific procedures and health care | ||||
| Z41.1 | Other plastic surgery for unacceptable cosmetic appearance | Other plastic surgery for perceived unacceptable cosmetic appearance | ||
| Z51.5 | Palliative care | Palliative care | Incl:
| This code is not designed to be a count of people in palliative care or on palliative pathways. It is most commonly used for doctor certified deaths where the certifier lists palliative care on the medical certificate of cause of death. |
| Z51.8 | Other specified medical care | Other specified medical care | Incl:
Excl:
| |
| Z51.9 | Medical care unspecified | Medical care unspecified | ||
| Z53.1 | Procedure not carried out because of patient's decision for reasons of belief and group pressure | Procedure not carried out because of patient's decision for reasons of belief and group pressure | Incl:
| The term "procedure" is used to reflect medical care including surgery, medication and other treatments. |
| Z53.2 | Procedure not carried out because of patient's decision for other and unspecified reasons | Procedure or health care not carried out because of patient's decision for other and unspecified reasons | Incl:
| The term "procedure" is used to reflect medical care including surgery, medication and other treatments. |
| Z55-Z65: Persons with potential health hazards related to socioeconomic and psychosocial circumstances | ||||
| Z55.0 | Illiteracy and low-level literacy | Illiteracy and low-level literacy | ||
| Z55.2 | Failed examinations | Failed examinations | ||
| Z55.3 | Underachievement in school | Underachievement in school | ||
| Z55.4 | Educational maladjustment and discord with teachers and classmates | Educational maladjustment and discord with teachers and classmates | Incl:
| Dual code analysis: When Z55.4 Educational maladjustment and discord with teachers and classmates and Z60.8 Bullying are captured in tandem, it may indicate that the bullying incident(s) occurred within the school or educational environment. |
| Z55.8 | Other problems related to education and literacy | Other problems related to education and literacy | Incl:
| |
| Z55.9 | Problem related to education and literacy, unspecified | Problem related to education and literacy, unspecified | ||
| Z56.0 | Unemployment, unspecified | Unemployment, unspecified | Incl:
Excl:
| |
| Z56.1 | Change of job | Change of job | Incl:
| |
| Z56.2 | Threat of job loss | Threatened or actual job loss | Incl:
| |
| Z56.3 | Stressful work schedule | Stressful work schedule | ||
| Z56.4 | Discord with boss and workmates | Discord with boss and workmates | Incl:
| 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 may indicate that the bullying incident(s) occurred within the work environment. |
| Z56.5 | Uncongenial work | Uncongenial work | Incl:
| |
| Z56.6 | Other physical and mental strain related to work | Other physical and mental strain related to work | Incl:
Excl:
| |
| Z56.7 | Other and unspecified problems related to employment | Other and unspecified problems related to employment | Incl:
Excl:
| |
| Z57.8 | Occupational exposure to other risk factors | Occupational exposure to other risk factors (means) | Incl:
| |
| Z57.9 | Occupational exposure to unspecified risk factors | Occupational exposure to risk factors | Incl:
Excl:
| This code may be assigned when a person is exposed to traumatic, stressful or confronting situations in the workplace. |
| Z58.7 | Exposure to tobacco smoke | Exposure to tobacco smoke | ||
| Z58.8 | Other problems related to physical environment | Other problems related to physical environment | Incl:
| |
| Z59.0 | Homelessness | Homelessness | Incl:
Excl:
| Persons suffering from different levels of homelessness often have different associated risk factors for many different outcomes and require different interventions. To enhance analysis, primary homelessness and secondary homelessness are classified under two distinct codes: Primary homelessness under Z59.0 (Homelessness) and secondary homelessness under Z59.1 (Inadequate housing). When considering the impact of homelessness as a broader issue it is advised to combine Z59.0 and Z59.1 in statistical output. |
| Z59.1 | Inadequate housing | Inadequate housing | Incl:
Excl:
| Persons suffering from different levels of homelessness often have different associated risk factors for many different outcomes and require different interventions. To enhance analysis, primary homelessness and secondary homelessness are classified under two distinct codes: Primary homelessness under Z59.0 (Homelessness) and secondary homelessness under Z59.1 (Inadequate housing). When considering the impact of homelessness as a broader issue it is advised to combine Z59.0 and Z59.1 in statistical output. |
| Z59.2 | Discord with neighbours, lodgers and landlord | Discord with neighbours, lodgers and landlord | Incl:
| |
| Z59.3 | Problems related to living in residential institution | Problems related to living in residential institution | ||
| Z59.6 | Low income | Low income | ||
| Z59.7 | Insufficient social insurance and welfare support | Insufficient social insurance and welfare support | Incl:
| |
| Z59.8 | Other and unspecified problems related to housing and economic circumstances | Other and unspecified problems related to economic circumstances | Incl:
| |
| Z59.9 | Problems related to housing and economic circumstances, unspecified | Other and unspecified problems related to housing circumstances | Incl:
| The ICD-10 combines housing and economic circumstances together for some situations. Due to the marked differences in economic and housing issues, the ABS has created new categories to identify these risk factors separately in output. |
| Z60.0 | Problems of adjustment to life-cycle transitions | Problems of adjustment to life-cycle transitions | Incl:
Excl:
| |
| Z60.1 | Atypical parenting situation | Atypical parenting situation | ||
| Z60.2 | Living alone | Living alone | ||
| Z60.3 | Acculturation difficulty | Acculturation difficulty | Incl:
| |
| Z60.4 | Social exclusion and rejection | Social isolation, exclusion, and rejection | Incl:
Excl:
| |
| Z60.5 | Target of perceived adverse discrimination and persecution | Target of perceived adverse discrimination and persecution | Incl:
Excl:
| This code is not used as a flag to capture personal characteristics (e.g. particular race, sexuality). Rather, this code is used when personal characteristics have been a stressor or factor in death. |
| Z60.8 | Other problems related to social environment | Bullying | Incl:
| This code is 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. |
| Z60.9 | Problem related to social environment, unspecified | Problem related to social environment, unspecified | Incl:
Excl:
| |
| Z61.0 | Loss of love relationship in childhood | Loss of love relationship in childhood | ||
| Z61.1 | Removal from home in childhood | Removal from home in childhood | ||
| Z61.2 | Altered pattern of family relationships in childhood | Altered pattern of family relationships in childhood | Incl:
| |
| Z61.3 | Events resulting in loss of self-esteem in childhood | Events resulting in loss of self-esteem in childhood | Incl:
| |
| Z61.4 | Problems related to alleged sexual abuse of child by person within primary support group | Problems related to alleged sexual abuse of child by person within primary support group | Primary support group includes 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. | |
| Z61.5 | Problems related to alleged sexual abuse of child by person outside primary support group | Problems related to alleged sexual abuse of child by person outside primary support group | ||
| Z61.6 | Problems related to alleged physical abuse of child | Problems related to alleged physical abuse of child | ||
| Z61.7 | Personal or frightening experience in childhood | Personal or frightening experience in childhood | ||
| Z61.8 | Other negative life events in childhood | Other negative life events in childhood | Incl:
| |
| Z61.9 | Negative life event in childhood, unspecified | Negative life event in childhood, unspecified | ||
| Z62.0 | Inadequate parental supervision and control | Inadequate parental supervision | ||
| Z62.2 | Institutional upbringing | Institutional upbringing | Incl:
| |
| Z62.4 | Emotional neglect of child | Emotional neglect of child | ||
| Z62.5 | Other problems related to neglect in upbringing | Other problems related to neglect in upbringing | ||
| Z62.6 | Inappropriate parental pressure and other abnormal qualities of upbringing | Inappropriate parental pressure and other abnormal qualities of upbringing | ||
| Z62.8 | Other specified problems related to upbringing | Other specified problems related to upbringing | Incl:
| |
| Z62.9 | Problem related to upbringing, unspecified | Problem related to upbringing, unspecified | ||
| Z63.0 | Problems in relationship with spouse or partner | Problems in relationship with spouse or partner | Incl:
Excl:
| |
| Z63.1 | Problems in relationship with parents and in-laws | Problems in relationship with parents and in-laws | Incl:
Excl:
| |
| Z63.2 | Inadequate family support | Inadequate family support | Incl:
| |
| Z63.3 | Absence of family member | Absence of family member | Incl:
Excl:
| |
| Z63.4 | Disappearance and death of family member | Disappearance or death of family member or member of primary support group | Incl:
| Primary support group includes 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. |
| Z63.5 | Disruption of family by separation and divorce | Disruption of family by separation and divorce | Incl:
Excl:
| |
| Z63.6 | Dependent relative needing care at home | Dependent relative needing care at home | ||
| Z63.7 | Other stressful life events affecting family and household | Other stressful life events affecting family and household | Incl:
| |
| Z63.8 | Other specified problems related to primary support group | Other specified problems related to primary support group | Incl:
| |
| Z63.9 | Problem related to primary support group, unspecified | Problem related to primary support group, unspecified | Incl:
| Primary support group includes 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. |
| Z64.0 | Problems related to unwanted pregnancy | Problems related to unwanted pregnancy | ||
| Z64.4 | Discord with counsellors | Discord with health professionals | Incl:
| |
| Z65.0 | Conviction in civil and criminal proceedings without imprisonment | Conviction in civil and criminal proceedings without imprisonment | Incl:
Excl:
| |
| Z65.1 | Imprisonment and other incarceration | Imprisonment and other incarceration | Incl:
| |
| Z65.2 | Problems related to release from prison | Problems related to release from prison | Incl:
| |
| Z65.3 | Problems related to other legal circumstances | Problems related to other legal circumstances | Incl:
| |
| Z65.4 | Victim of crime and terrorism | Victim of crime and terrorism | Incl:
| |
| Z65.5 | Exposure to disaster, war and other hostilities | Exposure to disaster, war and other hostilities | Incl:
| |
| Z65.8 | Other specified problems related to psychosocial circumstances | Other specified problems related to psychosocial circumstances | Incl:
Excl:
| |
| Z65.9 | Problem related to unspecified psychological circumstances | Military deployment overseas | Incl:
| |
| Z70-Z76: Persons encountering health services in other circumstances | ||||
| Z71.1 | Person with feared complaint in whom no diagnosis is made | Person with feared complaint in whom no diagnosis is made | Incl:
| |
| Z71.5 | Drug abuse counselling and surveillance | Drug abuse counselling and surveillance | ||
| Z71.6 | Tobacco abuse counselling | Tobacco abuse counselling | ||
| Z72.1 | Alcohol use | Alcohol use | Excl:
| |
| Z72.4 | Inappropriate diet and eating habits | Poor diet | ||
| Z72.5 | High-risk sexual behaviour | High-risk sexual behaviour | Incl:
Excl:
| |
| Z72.6 | Gambling and betting | Gambling and betting | Excl:
| |
| Z73.0 | Burn-out | Burn-out | Incl:
| |
| Z73.3 | Stress, not elsewhere classified | Stress, not elsewhere classified | Incl:
| |
| Z73.6 | Limitation of activities due to disability | Limitation of activities due to disability or chronic health condition | Incl:
| |
| Z73.8 | Other problems related to life-management difficulty | Other problems related to life-management difficulty | Incl:
| |
| Z74.0 | Need for assistance due to reduced mobility | Need for assistance due to reduced mobility | ||
| Z74.1 | Need for assistance with personal care | Need for assistance with personal care | ||
| Z74.2 | Need for assistance at home and no other household member able to render care | Need for assistance at home and no other household member able to render care | ||
| Z74.8 | Other problems related to care-provider dependency | Other problems related to care-provider dependency | Incl:
| |
| Z75.0 | Medical services not available in home | Medical services not available in home | Excl:
| Z75 includes risk factors where circumstances relating to the health service/facility/care itself have been a stressor for the deceased. |
| Z75.1 | Person awaiting admission to adequate facility elsewhere | Person awaiting admission to adequate facility elsewhere | Incl:
| See note on Z75 above. |
| Z75.2 | Other waiting period for investigation and treatment | Other waiting period for investigation and treatment | Incl:
| See note on Z75 above. |
| Z75.3 | Unavailability and inaccessibility of health-care facilities | Unavailability and inaccessibility of health-care facilities | See note on Z75 above. | |
| Z75.8 | Other problems related to medical facilities and other health care | Other problems related to medical facilities and other health care | Incl:
Excl:
| See note on Z75 above. |
| Z76.5 | Malingerer [conscious simulation] | Malingerer | Incl:
| Z76 includes risk factors related to how the individual interacts with health services/facilities/care. |
| Z76.8 | Persons encountering health services in other specified circumstances | Persons encountering health services in other specified circumstances | Incl:
| See note on Z76 above. |
| Z80-Z99: Persons with potential health hazards related to family and personal history and certain conditions including health status | ||||
| Z80.9 | Family history of malignant neoplasm, unspecified | Family history of malignant neoplasm, unspecified | Incl:
| |
| Z81.1 | Family history of alcohol abuse | Family history of alcohol abuse | ||
| Z81.2 | Family history of tobacco abuse | Family history of tobacco abuse | Excl:
| |
Z81.3 | Family history of other psychoactive substance abuse | Family history of other psychoactive substance abuse | ||
| Z81.8 | Family history of other mental and behavioural disorders | Family history of suicide | Incl:
| |
| Z82.4 | Family history of ischaemic heart disease and other diseases of the circulatory system | Family history of ischaemic heart disease and other diseases of the circulatory system | ||
| Z84.8 | Family history of other mental health conditions | Family history of other mental health conditions | Excl:
| |
| Z85.0 - Z85.9 | Personal history of malignant neoplasm | Personal history of malignant neoplasm | Incl:
| |
| Z86.0 | Personal history of other neoplasms | Personal history of other neoplasms | Excl:
| |
| Z86.4 | Personal history of psychoactive substance abuse | Personal history of psychoactive substance abuse (not current) | Excl:
| |
| Z86.5 | Personal history of other mental and behavioural disorders | Personal history of other mental and behavioural disorders (no current symptoms) | Incl:
| |
| Z87.3 | Personal history of diseases of the musculoskeletal system and connective tissue | Personal history of back pain | Incl:
| |
| Z87.5 | Personal history of complications of pregnancy, childbirth and the puerperium | Personal history of complications of pregnancy, childbirth and the puerperium | Excl:
| |
| Z87.8 | Personal history of other specified conditions | Personal history of other specified conditions | Incl:
Excl:
| |
| Z89.0 - Z89.9 | Acquired absence of limb | Acquired absence of limb | Incl:
| |
| Z90.0 - Z90.9 | Acquired absence of organ, not elswhere classified | Acquired absence of organ | Incl:
| |
| Z91.1 | Personal history of noncompliance with medical treatment and regime | Personal history of noncompliance with medical treatment and regime | Incl:
| |
| Z91.2 | Personal history of poor personal hygiene | Personal history of poor personal hygiene | ||
| Z91.3 | Personal history of unhealthy sleep-wake schedule (Sleep disorders; Nonorganic sleep disorders) | Poor sleep/wake schedule | Incl:
Excl:
| |
| Z91.4 | Personal history of psychological trauma, not elsewhere classified | Personal history of psychological trauma, not elsewhere classified | Incl:
Excl:
| |
| Z91.5 | Personal history of self-harm | Personal history of self-harm | Incl:
Excl:
| |
| Z91.6 | Personal history of other physical trauma | Personal history of other physical trauma | Incl:
Excl:
| |
| Z91.8 | Personal history of other specified risk factors, not elsewhere classified | Personal history of other specified risk factors, not elsewhere classified | Incl
| |
| Z92.6 | Personal history of chemotherapy for neoplastic disease | Personal history of chemotherapy for neoplastic disease | ||
| Z96.6 | Presence of orthopaedic joint implants | Presence of orthopaedic joint implants | Incl:
| |
| Z98.8 | Other specified postsurgical states | Other specified postsurgical states | ||
| Z99.1 | Dependence on aspirator | Dependence on aspirator | Incl:
| |
| Z99.2 | Dependence on renal dialysis | Dependence on renal dialysis | Excl:
| |
| Z99.3 | Dependence on wheelchair | Dependence on wheelchair | ||