suicide in the eastern health planning region, 2003-2008

Suicide in the Eastern Health Planning Region, 2003-2008

Marc E. LeslieCoordinator, Virginia Violent Death Reporting SystemOffice of the Chief Medical Examiner, Virginia Department of Health

The Eastern Health Planning Region Suicide Prevention Summit June 15, 2011Hampton, VA

Map of the Eastern Health Planning Region (HPR)

2Suffolk

Southampton

Isle of Wight

Chesapeake

Essex

Accomack

York

King William

Gloucester

Richmond

Virginia Beach

King and Queen Lancaster

Middlesex

Westmoreland

James City

Northumberland

Northampton

Mathews

Norfolk

Newport NewsHampton

Portsmouth

Poquoson

Williamsburg

Franklin City

3

Pop Quiz

In the Eastern Health Planning Region:

1. Average number of suicides per year? (Hint: average of 139 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?

4

Suicide in the Eastern HPR, 2003-2008

Overview of the Problem

5


Average 2003 2004 2005 2006 2007 20080

50

100

150

200

250

191 186 191171

197 188210

Number of Suicides by Year

Year

Nu

mb

er

of

Su

icid

es

6


Total 2003 2004 2005 2006 2007 20080.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

10.6 10.5 10.79.6

11.0 10.411.7

11.3 10.8 11.0 11.3 11.4 11.2 12.0

Suicide Rate by Year

Eastern HPR Virginia

Year

Su

icid

e R

ate

Pe

r 1

00

,00

0

7


Suicide vs. Homicide (2003-2008)

• 1,143 suicides; rate of 10.6

• 832 homicides; rate of 7.7

• Suicide 1.4 times more common than homicide

8


Average 2003 2004 2005 2006 2007 2008600

650

700

750

800

850

749

682

799

718

684

799 809

Number of Non-Fatal Suicide Attempts by Year

Year

Nu

mb

er

of

Su

icid

e A

tte

mp

ts

9


Total 2003 2004 2005 2006 2007 20080.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

41.8 38.344.7

40.1 38.244.4 44.9

62.3 60.0 61.1 58.2 59.066.4 69.2

Non-Fatal Suicide Attempt Rate by Year


Year

No

n-F

ata

l Su

icid

e R

ate

Pe

r 1

00

,00

0

10


Who is at Risk?

11


Selected Demographic Elements

Gender

Race

Age

12


Race and Gender

• Male (76%, rate of 16.5)

• White (81%, rate of 13.6)

• White males (61%, rate of 20.4), White females (20%, rate of 6.8), and Black males (14%, rate of 9.7) comprise 95% of all suicide victims

(remember, overall rate for Eastern HPR is 10.6)

13


Age

• Median age is 45

• Ages 45-54 most common age group (22%)

• Highest rate for those 85 and over (21.8)

14


Total

10-1

415

-19

20-2

425

-34

35-4

445

-54

55-6

465

-74

75-8

4

85 a

nd o

lder

0.0

5.0

10.0

15.0

20.0

25.0

Suicide Rate by Age Group


Age Group

Su

icid

e R

ate

Pe

r 1

00

,00

0

15


Race and Gender: Non-Fatal Attempts

• Most commonly by females (59%, rate of 48.3)

• Whites still most common and highest risk

• Black risk level rises notably (from rate of 5.5 to 31.1)

• Asian risk level doubles

16


Total Male Female0.0

10.0

20.0

30.0

40.0

50.0

60.0

10.616.5

4.9

41.835.0

48.3

Fatal and Non-Fatal Suicide Rates by Gender

Fatal Non-Fatal

Gender

Ra

te P

er

10

0,0

00

17


Age: Non-Fatal Attempts

• Median age is 36

• Risk increases for all age groups except 75-84 and 85 and over

• Rate for those ages 15-19 increases 9 times (from 6.5 to 59.7)

• In general, non-fatal attempt rate decreases with age

18


Total 5-

910

-14

15-1

920

-24

25-3

435

-44

45-5

455

-64

65-7

475

-84

85 a

nd o

lder

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0Non-Fatal and Fatal Suicide Rate by Age Group

Non-Fatal Fatal

Age Group

Ra

te P

er

10

0,0

00

At ages 75-84, the fatal rate surpasses

the non-fatal rate

19


Veterans

20


Suffolk

Essex

Southampton

Isle of Wight

Chesapeake

York

Richmond

Accomack

King William

Gloucester

Virginia Beach


Middlesex

Westmoreland

James City

Northumberland

Northampton

Mathews

Norfolk

Newport NewsHampton

Portsmouth

Poquoson

Williamsburg

Franklin City

Percentage of Male Suicide Victims who are Veterans

0.0 - 16.7

16.8 - 33.4

33.5 - 50.0

50.1 - 66.7

21


Veterans

• 32% of all suicide victims (18 years and older)

• 40% of males; 7% of females

• Unknown if veterans served in combat, but can generally tell if they are currently in the military

22


Veterans

• Male veterans older than male non-veterans (median ages of 55 and 40, respectively)

• Median age suggests that those who are combat veterans generally not in the most recent conflicts

• 71% of males ages 65 and over are veterans compared to 33% of males ages 18-64

23


Method of Fatal Injury

24



• 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

25


Total Males Females0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

54.5 60.3

35.9

23.625.2

18.5

15.6 9.0

36.7

Selected Methods by Gender

Poison

Hanging/Suffocation

Firearm

Gender

Pe

rce

nta

ge

Usi

ng

Me

tho

d

26


Method of Fatal Injury: Non-Fatal Attempts

• Most common method for non-fatal attempts is poison (84%)

• Poison use is defining method difference between fatal and non-fatal attempts

27


Geography

28


Geography

• Eastern HPR has 26 localities (16 counties and 10 cities)

• 12 of these localities (46%) have a suicide rate exceeding the rate for Virginia (11.3)

• In general smaller locality = lower number and higher rate

29


# Rate

Five Highest Suicide Rates

King and Queen 10 24.5

Richmond County 12 22.0

Gloucester 43 18.9

Westmoreland 19 18.4

Northumberland 13 16.9

# Rate

Five Lowest Suicide Rates

Isle of Wight 14 6.9

Accomack 17 7.3

Franklin City 4 7.7

Suffolk 40 8.4

Newport News 95 8.8

30


Suffolk

Essex

Southampton

Isle of Wight

Chesapeake

York

Richmond

Accomack

King William

Gloucester

Virginia Beach


Middlesex

Westmoreland

James City

Northumberland

Northampton

Mathews

Norfolk

Newport NewsHampton

Portsmouth

Poquoson

Williamsburg

Franklin City

Rate per 100,000

7 - 9

10 - 14

15 - 19

20 - 25

31


Suffolk

Essex

Southampton

Isle of Wight

Chesapeake

York

Richmond

LancasterAccomack

King William

Gloucester

Virginia Beach

King and Queen

Middlesex

Westmoreland

James City

Northumberland

Northampton

Mathews

Norfolk

Newport NewsHampton

Portsmouth

Poquoson

Williamsburg

Franklin City

Rate per 100,000

6.9 - 11.3

11.4 - 24.5

32


Selected Circumstances

33


Most Common Circumstances

• Mental health problem (50%)

• Crisis in past two weeks (34%)

• Intimate partner problem (34%)

• Problem with alcohol and/or other substances (26%)

• Physical health problem (18%)

34


Circumstances: Mental Health

• Females (71%) more than males (44%)

• Most prevalent in ages 55-64 (60%); 30% or more of every age group

• 83% treated in past two months and/or prior

• 56% known to take mental health medications currently or in the past*

* 2007-2008 data

35


Circumstances: Crisis in Past 2 Weeks

• 34% of all persons; 35% of males, 31% of females

• Most crises (73%) occurred in the past 24 hours*

• Indicator of reactive suicides

• 38% or more for age groups 15-19, 20-24, 25-34, and 35-44

*2007-2008 data

36


Circumstances: Intimate Partner Problems

• 34% having problems with current/former intimate partner at time of suicide

• 34% of males and females

• 61% also having a recent life crisis

• Shows volatility of intimate partner conflict

37


Total

10-1

415

-19

20-2

425

-34

35-4

445

-54

55-6

465

-74

75-8

4

85 a

nd o

lder

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0Intimate Partner Problems and Crisis by Age Group

Intimate Partner Problem Crisis in Past 2 Weeks

Age Group

Pe

rce

nta

ge

with

Cir

cum

sta

nce

38


Circumstances: Alcohol and Other Substance Problems

• 26% of all persons

• Peaks at ages 35-44 (38%)

• 50% of those with alcohol problems had elevated levels of alcohol in their system at death (compared to 15% of those without alcohol problems)

39


Circumstances: Physical Health Problems

• 18% of all suicide victims; 19% of males, 15% of females

• Median age of 65 compared to 41 for those without a physical health problem

• 45% or more of those ages 65 and older

40


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

41


Circumstances: Warning Signs

• 41% disclosed intent and/or had prior attempts

• Most commonly disclosed to family (54%), intimate partners (35%), friends/acquaintances (17%), medical/mental health professionals (4% each)*

• Disclosure of intent similar for males (31%) and females (30%)

• Prior attempts more common for females (31%) than for males (16%)

*2007-2008 data

42


Actions Taken to Prevent Suicide*

• Sought/encouraged mental health treatment (35%)

• Called 911/law enforcement (25%)

• Tried to persuade victim to not commit suicide (25%)

• Checked in on victim (5%)

*2007-2008 data (entire slide)

43


In the fatal suicide, those with prior attempts used less lethal methods than those without prior attempts

Firearm60%Poison

13%

Hanging/Suffocation

22%

Other5%

No Prior Suicide Attempts

Firearm28%

Poison29%

Hanging/Suffocation

33%

Other11%

Prior Suicide Attempts

44


Other Warning Signs of Suicide*

• Sleeping too little (10%)

• Taking prescribed pain medication (10%)

• Unusual behavior, past two weeks (4%)

• Family history of suicide (2%)

• Family/friends expected suicide (1%)

*2007-2008 data (entire slide)

45


Conclusions

• Suicide rates are highest among Whites, males, and older adults

• Most suicides involve use of a firearm to inflict fatal injury

• Half of suicide victims have a mental health problem, and most of these persons were being treated

46


Conclusions

• 41% 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

[email protected]

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

48

Appendix: Additional Information and Complete Tables

49


Information Slide

Demographics

Gender 51

Race 51

Ethnicity 51

Race/Gender 52

Age Group 53

Veterans

Male Age Group/Veteran 56


Complete List of Methods 57

Selected Methods by Age 58

Categories of Poison 59

Most Common Poisons 60

Information Slide

Locality-Specific

Number/Rate by Locality 62-64

Circumstances

Relationship Problems 65

Life Stressors 65

Alcohol/Other Substances 66

Mental Health 67-68

Warning Signs of Suicide 69

Disclosed Intent 70

Actions to Prevent Suicide 71

Prior Suicide Attempts 72

Other Warning Signs 73

Index: Fatal Suicide

50


Information Slide

Non-Fatal Suicide

Gender 54

Race 54

Ethnicity 54

Age Group 55


Complete List of Methods 61

Index: Non-Fatal Suicide

51


# % Rate

Gender

Male 873 76.4 16.5

Female 270 23.6 4.9

Race

White 927 81.1 13.6

Black 193 16.9 5.5

Asian 19 1.7 5.5

Native American 3 0.3 5.6

Other 1 0.1 -

Ethnicity

Hispanic 30 2.6 7.5

TOTAL 1,143 100.0 10.6

52


# % Rate

Selected Race/Gender

White male 697 61.0 20.4

White female 230 20.1 6.8

Black male 162 14.2 9.7

Black female 31 2.7 1.7

The White male suicide rate is 3 times the rate for White females, more than twice the rate for Black males, and 12 times the rate for Black females.

53


# % Rate

Age Group

10-14 7 0.6 0.9

15-19 52 4.5 6.5

20-24 113 9.9 13.4

25-34 182 15.9 12.5

35-44 217 19.0 13.5

45-54 249 21.8 16.3

55-64 139 12.2 13.4

65-74 74 6.5 11.2

75-84 76 6.6 17.6

85 and older 34 3.0 21.8

TOTAL 1,143 100.0 10.6

Highest risk: ages 85 and older

Largest percentage of victims: ages 45-54

54

Non-Fatal Suicide Attempts in the Eastern HPR, 2003-2008

# % Rate

Gender

Male 1,849 41.2 35.0

Female 2,642 58.8 48.3

Race

White 3,243 72.2 47.6

Black 1,098 24.4 31.1

Asian 40 0.9 11.5

Native American 2 <0.1 3.8

Other 65 1.4 -

Unknown 43 1.0 -

Ethnicity

Hispanic 41 0.9 10.2

TOTAL 4,491 100.0 41.8

55

Non-Fatal Suicide Attempts in the Eastern HPR, 2003-2008

# % Rate

Age Group

5-9 4 0.1 0.6

10-14 99 2.2 13.0

15-19 478 10.6 59.7

20-24 506 11.3 60.1

25-34 1,016 22.6 69.7

35-44 1,084 24.1 67.5

45-54 819 18.2 53.7

55-64 293 6.5 28.3

65-74 107 2.4 16.2

75-84 66 1.5 15.3

85 and older 19 0.4 12.2

TOTAL 4,491 100.0 41.8

Largest percentage: ages 35-44

Greatest risk: ages 25-34

56


Total

18-1

920

-24

25-3

435

-44

45-5

455

-64

65-7

475

-84

85 a

nd o

lder

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

40

.1

8.7

29

.3

21

.8 30

.1

33

.3

62

.1 72

.6

80

.0

48

.3

59

.9

91

.3 70

.7

78

.2 69

.9

66

.7

37

.9 27

.4

20

.0

51

.7

Male Age Group and Veteran Status

Non-Veteran

Veteran

Age Group

Pe

rce

nta

ge

Wh

o a

re V

ete

ran

s

57


# %


Firearm 623 54.5

Hanging/Suffocation 270 23.6

Poison 178 15.6

Drowning 25 2.2

Sharp Instrument 24 2.1

Fall 12 1.0

Motor Vehicle 5 0.4

Fire or Burn 4 0.3

Other Transport Vehicle 3 0.3

Intentional Neglect 1 0.1

Other 4 0.3

94% of all suicides

58


Total

10-1

415

-19

20-2

425

-34

35-4

445

-54

55-6

465

-74

75-8

4

85 a

nd o

lder

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0Selected Methods of Injury by Age

Poison

Hanging/Suffocation

Firearm

Age Group

Pe

rce

nta

ge

Usi

ng

Me

tho

d

59


# %

General Category of Poison

Prescription Medication 127 71.3

Alcohol 31 17.4

Carbon Monoxide 24 13.5

Over-the-Counter Medication 24 13.5

Street Drugs 16 9.0

Other 11 6.2

Percentages are based on the number of poisoning suicides (n = 178).

60

Suicide in the Eastern HPR, 2003-2008# %

Most Common Poisons

Citalopram* 21 11.8

Amitriptyline* 18 10.1

Oxycodone** 18 10.1

Hydrocodone** 17 9.6

Alprazolam* 14 7.9

Quetiapine* 14 7.9

Diphenhydramine 13 7.3

Cocaine 13 7.3

Bupropion* 12 6.7

Methadone** 11 6.2

Diazepam* 10 5.6

Zolpidem 10 5.6

Percentages based on the number of poisoning suicides (n = 178). Poisons used by 10 or more persons are listed.

* Commonly prescribed for mental health treatment

** Commonly prescribed for pain management

61

Non-Fatal Suicide Attemptsin the Eastern HPR, 2003-2008

# %


Poison 3,770 83.9

Sharp Instrument 439 9.8

Firearm 84 1.9

Hanging/Suffocation 27 0.6

Fire or Burn 12 0.3

Fall 9 0.2

Motor Vehicle 6 0.1

Drowning 3 0.1

Hot Object/Substance 3 0.1

Other 116 2.6

Unspecified 22 0.5

62


# Rate

Accomack 17 7.3

Chesapeake 116 8.9

Essex 8 12.6

Franklin City 4 7.7

Gloucester 43 18.9

Hampton 86 9.8

Isle of Wight 14 6.9

James City 44 12.6

King and Queen 10 24.5

King William 12 13.3

Number and Rate (per 100,000) of Suicides by Locality of Residence

63


# Rate

Lancaster 11 15.7

Mathews 6 10.9

Middlesex 9 14.3

Newport News 95 8.8

Norfolk 161 11.4

Northampton 9 11.2

Northumberland 13 16.9

Poquoson 8 11.3

Portsmouth 65 10.8

Number and Rate (per 100,000) of Suicides by Locality of Residence (continued)

64


# Rate

Richmond County 12 22.0

Southampton 12 11.3

Suffolk 40 8.4

Virginia Beach 284 10.8

Westmoreland 19 18.4

Williamsburg 11 15.4

York 34 9.2

Eastern HPR 1,143 10.6

Virginia 5,146 11.3

Number and Rate (per 100,000) of Suicides by Locality of Residence (continued)

65


# %

Relationship Characteristics

Intimate Partner Problem 377 34.1

Non-intimate Relationship Problem 66 6.0

Life Stressor Characteristics

Crisis within Two Weeks of Suicide* 372 33.7

Physical Health Problem 194 17.6

Recent Criminal Legal Problem 143 12.9

Job Problem 118 10.7

Financial Problem 89 8.1

Perpetrator of Interpersonal Violence 72 6.5

Death/Suicide of Family/Friend 53 4.8

Percentages are based on the number of suicides with at least one known circumstance (n = 1,105).

* Of these, 73% had a crisis in past 24 hours (2007-2008 data)

66


# %

Substance Use Characteristics

Problem with Alcohol/Other Substances 288 26.1

Problem with Alcohol 140 12.7

Problem with Other Substances 88 8.0

Problem with Alcohol and Other Substances 60 5.4


67


# %

Mental Health Problems

Current Mental Health Problem 557 50.4

Diagnosis: Depression 440 39.8

Diagnosis: Bipolar 84 7.6

Diagnosis: Anxiety Disorder 60 5.4

Diagnosis: Schizophrenia 32 2.9

Mental Health Treatment 460 41.6

Current Mental Health Treatment 434 39.3

Noncurrent Mental Health Treatment 26 2.4

Percentages are based on the number of suicides with at least one known circumstance (n = 1,105). Diagnoses are not exclusive, but represent the most common diagnoses.

68


# %

Use of Prescribed Mental Health Medications

Used in Past 31 Days and/or Prior 112 56.3

Used in Past 31 Days 89 44.7

Used, But Not in Past 31 Days 23 11.6

Unknown/Never Used 87 43.7

Percentages are based on the number of victims with a mental health problem (n = 199). Data are from 2007-2008.

69


# %

Warning Signs of Suicide

Disclosed Intent/History of Attempts 458 41.4

Disclosed Intent to Commit Suicide 340 30.8

History of Suicide Attempts 213 19.3


70


# %

Person to Whom Victim Disclosed Intent

Family Members 26 54.2

Intimate Partner (Current/Former) 17 35.4

Friends/Acquaintances 8 16.7

Medical Personnel 2 4.2

Mental Health Professional 2 4.2

Percentages are based on the number of victims who disclosed intent and where this information is known (n = 48). Data are from 2007-2008.

71


# %

Type of Action Taken to Prevent Suicide

Sought Mental Health Treatment 7 35.0

Tried to Persuade Victim 5 25.0

Called 911/Law Enforcement 5 25.0

Checked on Victim 1 5.0

Percentages are based on the number of suicides where someone took action to prevent the suicide (n = 20). 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


# %

Number of Prior Suicide Attempts

One 31 49.2

Two 7 11.1

Three 3 4.8

Four or more 3 4.8

Multiple, unspecified 19 30.2

Percentages are based on the number of victims with a known number of prior attempts (n = 63). Data are from 2007-2008.

73


# %

Other Warning Signs

Sleep Problems 40 10.3

Sleeping Too Little 39 10.1

Sleeping Too Much 1 0.3

Took Prescribed Pain Medication, Past Two Months 40 10.3

Unusual Behavior, Past Two Weeks 14 3.6

Family History of Suicide 8 2.1

Did Not Want to be a Burden 7 1.8

Family/Friends Expected Suicide 4 1.0

Percentages are based on the number of suicides with at least one known circumstance (n = 388). Data are from 2007-2008.

suicide in the eastern health planning region, 2003-2008

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suicides rate

homicides rate

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overall rate

males ages