Improving surveillance of intimate partner violence (IPV): A collaboration between the North Carolina Violent Death Reporting System and domestic violence prevention organizations

Unemployment-Related Suicides in North Carolina, 2004-2010

Annie Hirsch, MPHNorth Carolina Division of Public Health

CSTE Annual ConferenceJune 11, 2013

1Objectives

Identify characteristics of unemployment-related suicide decedentsDetermine if unemployment-related suicide rate increased along with unemployment rateExamine differences between unemployment-related suicides and all other suicides

2BackgroundNorth Carolina Violent Death Reporting System (NC-VDRS) Statewide surveillance system Collects data on all violent deaths that occur in North CarolinaMulti-source; captures circumstances that contributed to each death

One of the precipitating circumstances captured by the NC-VDRS is job problem

3North Carolina Unemployment Rate

Data source: Bureau of Labor StatisticsN.C. unemployment rate increased sharply in recent years, peaking at 11.4% in early 2010

4Hypothesis

Unemployment is one of many factors that can contribute to suicideWe hypothesized that the rate of unemployment-related suicides would increase during the economic recession

5Methods

Descriptive studyNC-VDRS used to identify all suicides from 2004-2010 among N.C. residents for which job problem was a precipitating circumstance

6Methods, Continued

Details about job problem abstracted from medical examiner and law enforcement narratives to identify suicides related to unemploymentIndustry in which decedent usually worked identified from death certificate dataDemographic information and frequency of precipitating circumstances calculated using SAS 9.3

7Case Selection

Circumstance information availableN = 7,118No job problem reportedN = 6,543Job problem reportedN = 575Problem related to job loss/ unemploymentN = 397Problem related to current jobN = 178No circumstance information availableN = 584All suicides of N.C. residents, 2004-2010N = 7,702

8Results

Objective 1: Identify characteristics of unemployment-related suicide decedents

9Demographic Characteristics

From 2004-2010, the NC-VDRS identified 397 suicides for which unemployment was a precipitating circumstance85% of decedents were male 90% were white Ranged in age from 19 to 72

10Age Distribution of Persons who Died inUnemployment-Related Suicides, 2004-2010

11Employment Information

For 61% of decedents, a job loss was a precipitating factor in their death, while the inability to find a job was a factor for 19%

12Employment Information

The most common industries in which the decedents usually worked before becoming unemployed were construction (13%) and manufacturing (12%)

13Circumstance Information

Many decedents had other contributing circumstances in addition to unemployment:

14

Example Narratives for Unemployment-Related SuicidesJob loss + breakup/divorceThe victim had recently lost his job and was currently depressed over the job loss and a breakup with a girlfriend. (Male, Age 21) The victim was reportedly depressed because he had lost his job several months before. His wife then left him after he lost his job and moved in with her parents. (Male, Age 53)

1515

Example Narratives for Unemployment-Related Suicides, ContinuedJob loss + breakup/divorce + home loss/evictionThe victim was currently separating from his wife, who had taken their daughter to another state. In the past year, he had lost his business, lost his home, and his mother died. (Male, Age 37) The victim had recently been divorced, lost his job, and was about to be evicted from his home. (Male, Age 49)

1616

Example Narratives for Unemployment-Related Suicides, ContinuedJob loss + health problemVictims depression increased after losing her job and health insurance. She was very concerned due to major physical health problems that required frequent medical visits and medication. (Female, Age 40)

1717

Urban vs. Rural County of ResidenceYear

Rate among residents of Urban counties (ages 18+)Rate among residents of Rural counties (ages 18+)20040.770.6020050.620.6020060.810.8320070.560.7920080.770.9520091.170.9420101.270.78Total0.860.79

Higher rate per 100,000 among residents of urban counties (counties with at least 250 residents per square mile)1818

Rate of Unemployment-Related Suicides by Economic Development Regions North Carolina, 2004-2010

Statewide unemployment-related suicide rate was 8.4 deaths per million residents ages 19+

1919Results, Continued

Objective 2. Determine if the rate of unemployment-related suicides increased along with the unemployment rate

20North Carolina Unemployment Rate

Data source: Bureau of Labor StatisticsN.C. unemployment rate increased sharply in recent years, peaking at 11.4% in early 2010

21Unemployment-related Suicides by Year

YearNumber of suicides for which unemployment was a contributing factorPercent of total suicides200445 4.4%200540 4.0%200655 5.0%200745 4.1%200859 5.1%200976 6.6%201077 6.5% Unemployment contributed to 6.5% of suicides in 2010, up from 4.4% in 2004

22Number of Unemployed Suicide Decedents and Number of Unemployment-related Suicides by Year

23Suicide Rate and Unemployment-related Suicide Rate by Year

24Results, Continued

Objective 3: Examine differences between unemployment-related suicides and all other suicides

25Characteristics of N.C. Residents Who Died By Suicide, 2004-2010

Suicides related to unemployment (N = 397)All other suicides(N = 7,305)Sex85% male77% maleRace/Ethnicity90% white,98% non-Hispanic89% white97% non-HispanicVeteran status14% were veterans20% were veteransMarital status42% married31% never married25% divorced3% widowed44% married28% never married21% divorced7% widowedWeapon used60% firearm25% hanging13% poisoning59% firearm17% hanging19% poisoning

26Mental Health History for N.C. Residents Who Died By Suicide, 2004-2010

Suicides related to unemployment (N = 397)All other suicides w/ circumstance info available (N = 6,721)Current depressed mood72%43%Current mental health problem46%45%Current treatment for mental illness42%41%History of suicide attempts16%17%Disclosed intent to commit suicide27%24%

27Summary

Majority of unemployment-related suicide decedents were white, middle-aged males with multiple contributing circumstancesRate of unemployment-related suicides increased slightly during economic recessionUnemployment-related suicide decedents more likely to be male and have current depressed mood and less likely to be veterans, but otherwise did not differ significantly from all other suicide decedents

28Discussion

Why did unemployment-related suicide rate increase only slightly as unemployment rate rose dramatically? Possible explanations:Unemployment became more socially acceptable during recessionTime delay (greater increase will be seen in 2011)Other ideas?

29Suicide Prevention Resources

SPRC has produced new information sheets to help managers and co-workers recognize and respond to people who may be at risk for suicideInformation sheets include lists of relevant resource materials and organizationswww.sprc.org/basics/roles-suicide-prevention

30

Suicide Prevention Resources

31

Co-authors from N.C. Division of Public Health:Scott ProescholdbellTammy NorwoodJane Ann MillerSherry Lehman

CDC/CSTE Applied Epidemiology Fellowship

Acknowledgments

32Questions?

Annie HirschNorth Carolina Division of Public Healthannie.hirsch@dhhs.nc.gov(919) 707-5902

33