suicide in the central health planning region, 2003-2008
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Suicide in the Central Health Planning Region, 2003-2008. Marc E. Leslie Coordinator, Virginia Violent Death Reporting System Office of the Chief Medical Examiner, Virginia Department of Health Presented by Stephanie Goodman Injury Data and Evaluation Coordinator - PowerPoint PPT PresentationTRANSCRIPT
Suicide in the Central Health Planning Region, 2003-2008Marc E. LeslieCoordinator, Virginia Violent Death Reporting SystemOffice of the Chief Medical Examiner, Virginia Department of Health
Presented by Stephanie GoodmanInjury Data and Evaluation CoordinatorOffice of Family Health Services, Virginia Department of Health
The Central Health Planning Region Suicide Prevention Summit June 1, 2011Chesterfield County, VA
Map of the Central Health Planning Region (HPR)
2
Halifax
Sussex
Surry
Brunswick
Mecklenburg
Charlotte
Dinwiddie
Lunenburg
Nottoway
Greensville
Prince Edward
Hanover
Amelia
Buckingham
Chesterfield
Henrico
Goochland
PowhatanCumberland New Kent
Prince George
Charles City
Richmond City
Petersburg
Hopewell
Emporia
Colonial Heights
3
Pop Quiz
In the Central Health Planning Region:
1. Average number of suicides per year? (Hint: average of 133 homicides per year).
2. Percentage of suicide victims who are White males?
3. Median age of a suicide victim?
4. Percentage of male and female suicides by firearm?
5
Suicide in the Central HPR, 2003-2008
Average 2003 2004 2005 2006 2007 20080
20406080
100120140160180
148 139 141 146167
139156
Number of Suicides by Year
Year
Num
ber o
f Sui
cide
s
6
Suicide in the Central HPR, 2003-2008
Total 2003 2004 2005 2006 2007 20080.02.04.06.08.0
10.012.014.016.018.020.0
11.4 11.1 11.1 11.312.8
10.511.7
11.3 10.8 11.0 11.3 11.4 11.2 12.0
Suicide Rate by Year
Central HPR Virginia
Year
Sui
cide
Rat
e P
er 1
00,0
00
7
Suicide in the Central HPR, 2003-2008
Suicide vs. Homicide (2003-2008)
• 888 suicides; rate of 11.4
• 799 homicides; rate of 10.3
• Suicide slightly more common than homicide
8
Suicide in the Central HPR, 2003-2008
Average 2003 2004 2005 2006 2007 20080
200
400
600
800
1000
1200
1400
1,096968 1,002 1,064 1,055
1,197 1,288
Number of Non-Fatal Suicide Attempts by Year
Year
Num
ber o
f Sui
cide
Atte
mpt
s
9
Suicide in the Central HPR, 2003-2008
Total 2003 2004 2005 2006 2007 20080.0
20.0
40.0
60.0
80.0
100.0
120.0
84.777.1 79.0 82.7 81.0
90.796.8
62.3 60.0 61.1 58.2 59.066.4 69.2
Non-Fatal Suicide Attempt Rate by Year
Central HPR Virginia
Year
Non
-Fat
al S
uici
de R
ate
Per
100
,000
12
Suicide in the Central HPR, 2003-2008
Race and Gender
• Male (77%, rate of 18.0)
• White (80%, rate of 14.3)
• White males (61%, rate of 21.9), White females (19%, rate of 6.8), and Black males (15%, rate of 10.6) are 95% of all suicide victims
(remember, overall rate for Central HPR is 11.4)
13
Suicide in the Central HPR, 2003-2008
Age
• Median age is 46
• Ages 45-54 most common age group (23%) and second highest rate (17.1)
• Highest rate for those 85 and over (17.7)
14
Suicide in the Central HPR, 2003-2008
Total
10-14
15-19
20-24
25-34
35-44
45-54
55-64
65-74
75-84
85 an
d olde
r0.02.04.06.08.0
10.012.014.016.018.020.0
Suicide Rate by Age Group
Central HPR Virginia
Age Group
Sui
cide
Rat
e P
er 1
00,0
00
15
Suicide in the Central HPR, 2003-2008
Race and Gender: Non-Fatal Attempts
• Most commonly by females (61%, rate of 100.9)
• Whites still most common and highest risk; but Black risk level rises notably (from rate of 6.3 to 69.6)
16
Suicide in the Central HPR, 2003-2008
Total Male Female0.0
20.0
40.0
60.0
80.0
100.0
120.0
11.4 18.0 5.2
84.767.6
100.9
Fatal and Non-Fatal Suicide Rates by Gender
Fatal Non-Fatal
Gender
Rat
e P
er 1
00,0
00
17
Suicide in the Central HPR, 2003-2008
Age: Non-Fatal Attempts
• Median age is 33
• Risk increases for all age groups except 85 and over
• 21 times increase for those ages 15-19
• In general, non-fatal attempt rate decreases with age
18
Suicide in the Central HPR, 2003-2008
Total
5-910
-1415
-1920
-2425
-3435
-4445
-5455
-6465
-7475
-84
85 an
d olde
r0.0
20.040.060.080.0
100.0120.0140.0160.0180.0
Non-Fatal and Fatal Suicide Rate by Age Group
Non-Fatal Fatal
Age Group
Rat
e P
er 1
00,0
00
At ages 85 and older, the fatal rate surpasses
the non-fatal rate
20
Suicide in the Central HPR, 2003-2008
Veterans
• 22% of all suicide victims (18 years and older)
• 21% of males; 1% of all females
• Unknown if veterans served in combat, but can generally tell if they are currently in the military
21
Suicide in the Central HPR, 2003-2008
Veterans
• Male veterans older than male non-veterans (median ages of 58 and 44, respectively)
• Median age suggests that those who are combat veterans generally not in the most recent conflicts
• 61% of males ages 65 and over are veterans compared to 20% of males ages 18-64
23
Suicide in the Central HPR, 2003-2008
Method of Fatal Injury
• More than one method of fatal injury can be used per suicide (e.g., combining poison and drowning)
• Firearm, poison, and hanging/suffocation account for 94% of suicides
• Most poisons are prescribed medications, primarily mental health medications and pain medications
24
Suicide in the Central HPR, 2003-2008
Total Males Females0.0
10.020.030.040.050.060.070.080.090.0
100.0
61.0 67.7
39.1
17.318.2
14.5
15.3 8.8
36.7
Selected Methods by Gender
PoisonHanging/SuffocationFirearm
Gender
Per
cent
age
Usi
ng M
etho
d
25
Suicide in the Central HPR, 2003-2008
Method of Fatal Injury: Non-Fatal Attempts
• Most common method for non-fatal attempts is poison (78%)
• Poison use is defining method difference between fatal and non-fatal attempts
27
Suicide in the Central HPR, 2003-2008
Geography
• Central HPR has 27 localities (22 counties and 5 cities)
• 12 of these localities (44%) have a suicide rate exceeding the rate for Virginia (11.3)
• In general smaller locality = lower number and higher rate
28
Suicide in the Central HPR, 2003-2008
# Rate
Five Highest Suicide Rates
Amelia 14 18.9
New Kent 18 18.3
Mecklenburg 35 18.0
Emporia 6 17.7
Prince George 34 15.9
# Rate
Five Lowest Suicide Rates
Surry 2 4.7
Greensville 4 5.8
Charles City 3 7.0
Cumberland 4 7.1
Hopewell 11 8.1
29
Suicide in the Central HPR, 2003-2008
Halifax
Sussex
Surry
Hanover
Brunswick
Mecklenburg
Charlotte
Amelia
Dinwiddie
Buckingham
Lunenburg
Chesterfield
Nottoway
Henrico
Greensville
Goochland
Powhatan
Prince Edward
New Kent
Prince George
Charles City
Cumberland Richmond City
Petersburg
Hopewell
Emporia
Colonial Heights
Rate per 100,0005 - 8
9 - 11
12 - 15
16 - 19
30
Suicide in the Central HPR, 2003-2008
Halifax
Sussex
Surry
Hanover
Brunswick
Mecklenburg
Charlotte
Amelia
Dinwiddie
Buckingham
Lunenburg
Chesterfield
Nottoway
Henrico
Greensville
Goochland
Powhatan
Prince Edward
New Kent
Prince George
Charles City
Cumberland Richmond City
Petersburg
Hopewell
Emporia
Colonial Heights
Rate per 100,0004.7 - 11.3
11.4 - 18.9
32
Suicide in the Central HPR, 2003-2008
Most Common Circumstances
• Mental health problem (57%)
• Crisis in past two weeks (39%)
• Intimate partner problem (36%)
• Problem with alcohol and/or other substances (25%)
• Physical health problem (21%)
33
Suicide in the Central HPR, 2003-2008
Circumstances: Mental Health
• Females (75%) more than males (51%)
• Most prevalent in ages 55-64 (70%); 33% or more of every age group
• 87% treated in past two months and/or prior
• 71% known to take mental health medications currently or in the past*
* 2007-2008 data
34
Suicide in the Central HPR, 2003-2008
Circumstances: Crisis in Past 2 Weeks
• 39% of all persons; 43% of males, 24% of females
• Most crises (72%) occurred in the past 24 hours*
• Indicator of reactive suicides
• 50% or more for age groups 15-19, 20-24, and 25-34
*2007-2008 data
35
Suicide in the Central HPR, 2003-2008
Circumstances: Intimate Partner Problems
• 36% having problems with current/former intimate partner at time of suicide
• 39% of males, 29% of females
• 64% also having a recent life crisis
• Shows volatility of intimate partner conflict
36
Suicide in the Central HPR, 2003-2008
Total
10-14
15-19
20-24
25-34
35-44
45-54
55-64
65-74
75-84
85 an
d olde
r0.0
10.020.030.040.050.060.070.080.090.0
100.0Intimate Partner Problems and Crisis by Age Group
Intimate Partner Problem Crisis in Past 2 Weeks
Age Group
Per
cent
age
with
Circ
umst
ance
37
Suicide in the Central HPR, 2003-2008
Circumstances: Alcohol and Other Substance Problems
• 25% of all persons
• Peaks at ages 35-44 (34%) and 45-54 (33%)
• 47% of those with alcohol problems had elevated levels of alcohol in their system (compared to 13% of those without alcohol problems)
38
Suicide in the Central HPR, 2003-2008
Circumstances: Physical Health Problems
• 21% of all suicide victims; 19% of males, 26% of females
• Median age of 58 compared to 44 for those without a physical health problem
• 45% or more of those ages 65 and older
39
Suicide in the Central HPR, 2003-2008
Circumstances: Physical Health Problems
• Explains majority of elder suicides
• Problems range from treatable (diabetes, mild pain) to severe (loss of vision, amputations) to terminal diseases and conditions
40
Suicide in the Central HPR, 2003-2008
Circumstances: Warning Signs
• 50% disclosed intent and/or had prior attempts
• Most commonly disclosed to intimate partners (53%), family (34%), or friends/acquaintances (18%)*
*2007-2008 data
41
Suicide in the Central HPR, 2007-2008
Actions Taken to Prevent Suicide*
• Sought/encouraged mental health treatment (38%)
• Limited access to firearms/ammunition (27%)
• Tried to persuade victim to not commit suicide (18%)
• Called 911/law enforcement (12%)
• Checked in on victim (12%)
*2007-2008 data (entire slide)
42
Suicide in the Central HPR, 2007-2008
Efforts to Limit Access to Firearms and/or Ammunition*
• 16 persons had friends or family members who restricted access to firearms or ammunition
• Includes 7 persons not known to disclose intent, but loved ones acted out of concern
• Variety of techniques used to restrict (hiding, removing, disassembling)
• Of these persons, 15 (94%) used a firearm to commit suicide
*2007-2008 data (entire slide)
43
Suicide in the Central HPR, 2003-2008
In the fatal suicide, those with prior attempts used less lethal methods than those without prior attempts
Firearm67%
Poison12%
Hanging/Suffocation
16%
Other5%
No Prior Suicide Attempts
Firearm37%
Poison28%
Hanging/Suffocation
23%
Other11%
Prior Suicide Attempts
44
Suicide in the Central HPR, 2007-2008
Other Warning Signs of Suicide*
• Sleeping too little (17%)
• Taking prescribed pain medication (16%)
• Unusual behavior, past two weeks (8%)
• Family history of suicide (5%)
• Family/friends expected suicide (4%)
*2007-2008 data (entire slide)
45
Suicide in the Central HPR, 2003-2008
Conclusions
• Suicide rates are highest among Whites, males, and middle-aged and older adults
• Most suicides involve use of a firearm to inflict fatal injury
• The majority of suicide victims have a mental health problem, and most of these persons were being treated
46
Suicide in the Central HPR, 2003-2008
Conclusions
• 50% of suicide victims are known to talk about plans or desire to commit suicide and/or have a history of suicide attempt(s)
• Fatal suicide and non-fatal suicide attempts present different pictures of risk and methods of fatal injury
47
Questions, Data Requests, Further Information
Marc Leslie, VVDRS Coordinator
737 N. 5th Street, Suite 301Richmond, VA 23219
804-205-3855
http://www.vdh.virginia.gov/medExam/NVDRS.htm
Our goal is to provide data and information that can be used for prevention and education; please let me know how I can help
49
Suicide in the Central HPR, 2003-2008
Information SlideDemographicsGender 51Race 51Ethnicity 51Race/Gender 52Age Group 53VeteransMale Age Group/Veteran 56Method of Fatal InjuryComplete List of Methods 57Selected Methods by Age 58Categories of Poison 59Most Common Poisons 60
Information SlideLocality-SpecificNumber/Rate by Locality 62-64CircumstancesRelationship Problems 65Life Stressors 65Alcohol/Other Substances 66Mental Health 67-68Warning Signs of Suicide 69Disclosed Intent 70Actions to Prevent Suicide 71-72Prior Suicide Attempts 73Other Warning Signs 74
Index: Fatal Suicide
50
Suicide in the Central HPR, 2003-2008
Information SlideNon-Fatal SuicideGender 54Race 54Ethnicity 54Age Group 55Method of Fatal InjuryComplete List of Methods 61
Index: Non-Fatal Suicide
51
Suicide in the Central HPR, 2003-2008
# % RateGenderMale 681 76.7 18.0Female 207 23.3 5.2RaceWhite 712 80.2 14.3Black 161 18.1 6.3Asian 9 1.0 4.8Native American 3 0.3 9.7Other 3 0.3 -EthnicityHispanic 14 1.6 5.6TOTAL 888 100.0 11.4
52
Suicide in the Central HPR, 2003-2008
# % RateSelected Race/GenderWhite male 540 60.8 21.9Black male 130 14.6 10.6White female 172 19.4 6.8Black female 31 3.5 2.3
The White male suicide rate is more than twice the rate for Black males, 3.2 times the rate for White females, and almost 10 times the rate for Black females.
53
Suicide in the Central HPR, 2003-2008
# % RateAge Group10-14 9 1.0 1.715-19 41 4.6 7.420-24 75 8.4 13.925-34 108 12.2 10.535-44 172 19.4 14.645-54 201 22.6 17.155-64 138 15.5 16.365-74 77 8.7 15.875-84 45 5.1 13.785 and older 22 2.5 17.7TOTAL 888 100.0 11.4
Highest risk: ages 85 and older
Largest percentage of victims: ages 45-54
54
Non-Fatal Suicide Attempts in the Central HPR, 2003-2008
# % RateGenderMale 2,566 39.0 67.6Female 4,007 61.0 100.9Unknown 1 <0.1 -RaceWhite 4,446 67.6 89.0Black 1,773 27.0 69.6Asian 45 0.7 24.0Native American 5 0.1 16.2Other 215 3.3 -Unknown 90 1.4 -EthnicityHispanic 142 2.2 57.0TOTAL 6,574 100.0 84.7
55
Non-Fatal Suicide Attempts in the Central HPR, 2003-2008
# % RateAge Group5-9 6 0.1 1.210-14 242 3.7 46.215-19 882 13.4 158.920-24 866 13.2 160.125-34 1,451 22.1 140.835-44 1,573 23.9 133.745-54 1,056 16.1 89.955-64 348 5.3 41.265-74 85 1.3 17.475-84 52 0.8 15.885 and older 12 0.2 9.6Unknown 1 <0.1 -TOTAL 6,574 100.0 84.7
Largest percentage: ages 35-44
Greatest risk: ages 20-24
56
Suicide in the Central HPR, 2003-2008
Total
18-19
20-24
25-34
35-44
45-54
55-64
65-74
75-84
85 an
d olde
r0%
10%20%30%40%50%60%70%80%90%
100%
27.5
0.0 13
.6
11.3 20
.0
21.5 34
.6 46.7
80.0
68.4
72.5
100.
0
86.4
88.8 80
.0
78.5 65
.4 53.3
20.0
31.6
Male Age Group and Veteran Status
Non-VeteranVeteran
Age Group
Per
cent
age
Who
are
Vet
eran
s
57
Suicide in the Central HPR, 2003-2008
# %Method of Fatal InjuryFirearm 542 61.0Hanging/Suffocation 154 17.3Poison 136 15.3Fall 22 2.5Drowning 13 1.5Motor Vehicle 8 0.9Sharp Instrument 8 0.9Fire or Burn 6 0.7Other 1 0.1
94% of all suicides
58
Suicide in the Central HPR, 2003-2008
Total
10-14
15-19
20-24
25-34
35-44
45-54
55-64
65-74
75-84
85 an
d olde
r0.0
10.020.030.040.050.060.070.080.090.0
100.0Selected Methods of Injury by Age
PoisonHanging/SuffocationFirearm
Age Group
Per
cent
age
Usi
ng M
etho
d
59
Suicide in the Central HPR, 2003-2008
# %General Category of PoisonPrescription Medication 97 71.3Carbon Monoxide 21 15.4Over-the-Counter Medication 21 15.4Alcohol 7 5.1Street Drugs 5 3.7Other 6 4.4
Percentages are based on the number of poisoning suicides (n = 136).
60
Suicide in the Central HPR, 2003-2008# %
Most Common PoisonsAmitriptyline* 17 12.5Methadone** 12 8.8Propoxyphene** 12 8.8Morphine** 11 8.1Diphenhydramine 10 7.4Acetaminophen 10 7.4Quetiapine* 9 6.6Citalopram* 9 6.6Alprazolam* 8 5.9Oxycodone** 7 5.1Bupropion* 7 5.1
Percentages based on the number of poisoning suicides (n = 136). Poisons used by 7 or more persons are listed.
* Commonly prescribed for mental health treatment
** Commonly prescribed for pain management
61
Non-Fatal Suicide Attemptsin the Central HPR, 2003-2008
# %Method of Fatal InjuryPoison 5,144 78.2Sharp Instrument 1,067 16.2Firearm 56 0.9Hanging/Suffocation 35 0.5Fall 29 0.4Fire or Burn 23 0.3Motor Vehicle 13 0.2Hot Object/Substance 3 <0.1Drowning 1 <0.1Other Natural/Environmental 1 <0.1Other 145 2.2Unspecified 57 0.9
62
Suicide in the Central HPR, 2003-2008
# RateAmelia 14 18.9Brunswick 13 12.1Buckingham 13 13.6Charles City 3 7.0Charlotte 7 9.4Chesterfield 185 10.6Colonial Heights 10 9.5Cumberland 4 7.1Dinwiddie 22 14.4Emporia 6 17.7
Number and Rate (per 100,000) of Suicides by Locality of Residence
63
Suicide in the Central HPR, 2003-2008
# RateGoochland 15 12.7Greensville 4 5.8Halifax 27 12.5Hanover 73 12.5Henrico 185 10.9Hopewell 11 8.1Lunenburg 12 15.3Mecklenburg 35 18.0New Kent 18 18.3
Number and Rate (per 100,000) of Suicides by Locality of Residence (continued)
64
Suicide in the Central HPR, 2003-2008
# RateNottoway 9 9.6Petersburg 18 9.2Powhatan 18 11.2Prince Edward 12 9.6Prince George 34 15.9Richmond City 130 11.1Surry 2 4.7Sussex 8 11.0Central HPR 888 11.4Virginia 5,146 11.3
Number and Rate (per 100,000) of Suicides by Locality of Residence (continued)
65
Suicide in the Central HPR, 2003-2008# %
Relationship CharacteristicsIntimate Partner Problem 314 36.2Non-intimate Relationship Problem 75 8.6Life Stressor CharacteristicsCrisis within Two Weeks of Suicide* 334 38.5Physical Health Problem 181 20.9Financial Problem 121 13.9Recent Criminal Legal Problem 113 13.0Job Problem 108 12.4Death/Suicide of Family/Friend 71 8.2Perpetrator of Interpersonal Violence 68 7.8
Percentages are based on the number of suicides with at least one known circumstance (n = 868).* Of these, 72% had a crisis in past 24 hours (2007-2008 data)
66
Suicide in the Central HPR, 2003-2008
# %Substance Use CharacteristicsProblem with Alcohol/Other Substances 219 25.2
Problem with Alcohol 89 10.3Problem with Other Substances 80 9.2Problem with Alcohol and Other Substances 50 5.8
Percentages are based on the number of suicides with at least one known circumstance (n = 868).
67
Suicide in the Central HPR, 2003-2008
# %Mental Health ProblemsCurrent Mental Health Problem 495 57.0Diagnosis: Depression 385 44.4Diagnosis: Bipolar 67 7.7Diagnosis: Anxiety Disorder 59 6.8Diagnosis: Schizophrenia 25 2.9Mental Health Treatment 429 49.4 Current Mental Health Treatment 385 44.4 Noncurrent Mental Health Treatment 44 5.1
Percentages are based on the number of suicides with at least one known circumstance (n = 868). Diagnoses are not exclusive, but represent the most common diagnoses.
68
Suicide in the Central HPR, 2007-2008
# %Use of Prescribed Mental Health MedicationsUsed in Past 31 Days and/or Prior 125 70.6
Used in Past 31 Days 109 61.6Used, But Not in Past 31 Days 16 9.0
Unknown/Never Used 52 29.4
Percentages are based on the number of victims with a mental health problem (n = 177). Data are from 2007-2008.
69
Suicide in the Central HPR, 2003-2008
# %Warning Signs of SuicideDisclosed Intent/History of Attempts 435 50.1 Disclosed Intent to Commit Suicide 339 39.1 History of Suicide Attempts 190 21.9
Percentages are based on the number of suicides with at least one known circumstance (n = 868).
70
Suicide in the Central HPR, 2007-2008
# %Person to Whom Victim Disclosed IntentIntimate Partner (Current/Former) 41 53.2Family Members 26 33.8Friends/Acquaintances 14 18.2Mental Health Professional 5 6.5Medical Personnel 3 3.9
Percentages are based on the number of victims who disclosed intent and where this information is known (n = 77). Data are from 2007-2008.
71
Suicide in the Central HPR, 2007-2008
# %Type of Action Taken to Prevent SuicideSought Mental Health Treatment 13 38.2Limited Access to Firearms and/or Ammunition 9 26.5Tried to Persuade Victim 6 17.6Called 911/Law Enforcement 4 11.8Checked on Victim 4 11.8Monitored Victim 2 5.9
Percentages are based on the number of suicides where someone took action to prevent the suicide (n = 34). Data are from 2007-2008.
Some victims had family, friends, or others who reacted to the disclosed intent and tried to prevent the suicide
72
Suicide in the Central HPR, 2007-2008
# %How Firearm Access was RestrictedRemoved; all firearms 6 42.9Hidden (not locked) 3 21.4Involuntary mental health commitment 1 7.1Removed; all but one firearm 1 7.1Removed; gave back later 1 7.1Removed; locked away 1 7.1Removed; victim purchased a new firearm 1 7.1
Percentages are based on the number of victims where it was known how firearm access was restricted (n = 14). Data are from 2007-2008.
73
Suicide in the Central HPR, 2007-2008
# %Number of Prior Suicide AttemptsOne 34 61.8Two 6 10.9Three 3 5.5Four or more 1 1.8Multiple, unspecified 11 20.0
Percentages are based on the number of victims with a known number of prior attempts (n = 55). Data are from 2007-2008.
74
Suicide in the Central HPR, 2007-2008
# %Other Warning SignsSleep Problems 51 17.6 Sleeping Too Little 49 17.0 Sleeping Too Much 2 0.7Took Prescribed Pain Medication, Past Two Months 45 15.6Unusual Behavior, Past Two Weeks 23 8.0Family History of Suicide 15 5.2Did Not Want to be a Burden 10 3.5Family/Friends Expected Suicide 10 3.5
Percentages are based on the number of suicides with at least one known circumstance (n = 289). Data are from 2007-2008.