SUICIDE Presented by The American College of Surgeons Committee on Trauma Subcommittee on Injury...

SUICIDEPresented by

The American College of Surgeons

Committee on Trauma

Subcommittee on Injury Prevention and Control

The Language of Suicidology

• Contemplator – thoughts of self harm intended to end own life.

• Attemptor – acts on thoughts and injures self.

• Completor – ends own life.• Survivor – close personal relationship with

a completor.

Classifying Intentional Injuries

Fatal Non Fatal

Intentional injury directed at self

Suicide

completors

Suicide

attemptors

Intentional injury directed at others

Homicide Assault

Magnitude of Problem

• Over 30,000 deaths annually in the U.S., over 1 million worldwide

• 25 times as many people attempt suicide

• 63% of intentional deaths

• 1.7 times as many deaths as homicide

• #3 cause of death in 1st 4 decades of life

2001 CDC Data

Age Adjusted Rates, 2000 CDC

Injury-Related Deaths in the U.S.

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

All INJ Unintent Homicide Suicide TotalIntentional

29,05617,124

97,900

46,180

144,374

2000 Age-Adjusted Rates, CDC

Spectrum of Suicide

0

200400

600

800

10001200

1400

1600

18002000

Contemplators Attemptors Completors

?30,000 Deaths

750,000 Attempts

Source: World Health Organization (WHO)

Suicide Rates Vary Globally

Source: CDC

Suicide Rates Vary by Region in the U.S.

Rural Rates are Higher than Metropolitan Rates

Demographics

• Males 4 x more likely to die than females

• Native American, Caucasian highest rates

• In youth, less racial or ethnic variation

• Elderly at high risk

2001 CDC Data

2000 CDC Data

Death Rates High Across Ages

02468

101214161820

l0-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-85+

85+Age

Death Rate

Death Rates per 100,000 population

Mechanism of Suicide Deaths Both Genders, All Ages

56%

2%2%

21%

1%

17%

1%

Firearm

Cut/pierce

Fall

Suffocation

MVC

Poisoning

Fire/burn

2001 CDC Data

Firearms

Suffocation

Poisoning

#1

#2

#3

Gender Differences

• Males use firearms more than females

• Suffocation used by males more than females

• Poisoning used by females more than males

• Males attempts more likely to result in death

Age-Adjusted Rates per 100,000 Population, 2000 CDC Data

Male GenderSuicide Deaths & Attempts

0

50

100

150

200

250

l0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-85+

Male AttemptMale Deathem

Age-Adjusted Rates per 100,000 Population, 2000 CDC Data

Female GenderSuicide Deaths and Attempts

0

50

100

150

200

250

300

350

l0-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-85+

Female AttemptFemale Death

Age-Adjusted Rates per 100,000 Population, 2000 CDC Data

Suicide Deaths Plus Suicide AttemptsBy Gender and Age

0

50

100

150

200

250

300

350

l0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-85+

Total MaleTotal Female

Total Rates Differ Little By Gender

Summary Demographics

• Male death rate > Female• Native American > White > African

American > Hispanics• Suicide is 3rd most common cause of

death 10-34, 4th 35-44, 5th 45-54.• Adolescent suicide represents fastest

growing segment of suicide attempts.• Rates for 65+ are greatest

Risk Factors

Depression and Hopelessness:Major Risk Factors

• 1 of 16 people with depression commit suicide

• 2/3 of people who commit suicide are depressed, higher for adolescents

• Depression plus alcohol increases risk

• Hopelessness, anxiety increases risk

American Association of Suicidology

Other Risk Factors

• Family member committed suicide (survivor)• Childhood trauma, especially abuse• Intimate Partner Violence• Divorce• Recent move, especially for adolescents• Firearms• Alcohol• Education• Chemical – low levels of serotonin

Adolescents and Young Adults

• High rate of depression, hopelessness• Impulsivity, Alcohol Use important• Recent move of household a risk factor• Many seek help from family/friends.

– Need community-based training for prevention– Need to remove the stigma of suicide

Suicide and Life-Threatening Behavior. 2001;32S

Barnes LS, Suicide and Life-Threatening Behavior, 2001

Help-Seeking Behavior

Adults: • Medical community often contacted prior to

attempt

Adolescents: • Few have recent medical contact• Often seek help from family or friends• Less than 10% use Hotlines

Suicide’s Impact OnTrauma Centers

National Trauma Data Bank

National Trauma Data Bank (NTDB)

• Voluntary reporting by trauma centers to central database maintained by the American College of Surgeons.

• Suicide identified by E-codes.

Intentionality of Trauma Patients in NTDB

85%

13%

2%

Unintentional

Directed at Others

Directed at Self

Produced by: Suicide Prevention and Research Center, University of Nevada School of MedicineData Source: National Trauma Data Bank (NTDB™), American College of Surgeons , (n= 265,441)

Unintentional

15% Intentional

Suicide in Trauma Centers

• 2% of all admissions

• 77% male, average age 40 years

• 80% are penetrating injuries

• 24% mortality (higher than other types of trauma)

• 75% require OR or are admitted to ICU

Suicide in Trauma Centers

• Many have known mental health problems

• Longer hospital and ICU stays than other injuries

• Few are discharged to psychiatric facility

Trauma Patients at Future Risk of Suicide

Traumatic Brain Injury Patients

• Traumatic Brain Injury patients are at risk of subsequent suicide attempts* – 35% hopeless– 23% suicidal ideation– 17% have attempted suicide

• Higher risk with substance abuse• Repeated suicide attempts

* Simpson G Psychol Med 2002; 32(4):687-97.

Other Trauma Patients

• Depression in other patients following trauma?

• Those with ongoing somatic complaints have higher incidence of depression.

• Associated with ongoing alcohol use?

Interventions

• Treat depression– SSRIs, others

• Individual cognitive therapy decreases repeat attempts

• Group Therapy• Family Counseling

• Physician Speaking with patient and family may make a difference

Recommendations

Suggestions for Trauma Centers

Recommendations

• Participate in NTDB– National, regional, state suicide burden to Trauma

Centers

• Suicide Education– Surgery Residents– Trauma Fellows– Practicing Surgeons– Primary Care Physicians – Other medical personnel– Medical Students

Recommendations

• Develop A Suicide Prevention Plan for your Community.– Demographics– Identify hospital and community resources– Educate medical staff– Injury Prevention – partner with community

groups– Rural locations

Resources

• www.cdc.gov• www.suicidology.org• www.sprc.org• www.surgeongeneral.org• www.aas.org• www.afsp.org• Reducing Suicide: A National Imperative. 2002.

Institute of Medicine. National Academy of Sciences