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The Burden of Suicide Among Youth in North Carolina
Child Fatality Task Force – Intentional Death Prevention CommitteeDecember 8th, 2014
Data Sources: Suicide and Self-Inflicted Injury
• North Carolina Violent Death Reporting System (NC-VDRS)• Death Certificate• Law Enforcement Incident Reports• Medical Examiner Reports
• Hospital Discharge
• Emergency Department Admissions • NC-DETECT
• N.C. Youth Risk Behavior Survey (YRBS)
• Web-based Injury Statistics Query and Reporting System (WISQARS)
Source: NC State Center for Health Statistics; Analysis by Injury Epidemiology and Surveillance Unit
Leading Causes of Injury Deaths: N.C. Residents 2013
* Unintentional Other and Unintentional Unspecified are two separate categories. Other comprises several smaller defined causes of death, while Unspecified refers to unintentional deaths that were not categorized due to coding challenges.
Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2012Analysis by Injury Epidemiology and Surveillance UnitaUnintentional Other and Unintentional Unspecified are two separate categories. Other comprises several smaller defined causes of death, while Unspecified refers to unintentional deaths that were not categorized due to coding challenges.
Source: NC-VDRS, 2004-2012; N.C. State Center for Health Statistics, Vital Statistics-Hospitalizations, 2004-2012; NC DETECT, 2008-2012Analysis by Injury Epidemiology and Surveillance Unit
Suicide and Self-Inflicted Injury: N.C. Residents 2004-2012
0
30
60
90
120
150
180
210
240
Crud
e Ra
te p
er 1
00,0
00
Age (Years)
Suicide Death Rate
Hospitalization Rate
ED Visit Rate
Suicide and Self-Inflicted Injury among Youth ages 10 to 17 in North Carolina
Source: NC-VDRS, 2004-2012; N.C. State Center for Health Statistics, Vital Statistics-Hospitalizations, 2004-2012; NC DETECT, 2008-2012Analysis by Injury Epidemiology and Surveillance Unit
Suicide and Self-Inflicted Injury: N.C. Residents ages 10-17, 2004-2012
2.6 3.0 2.7 2.9 2.3 3.6 2.3 2.3 3.4
54.0 50.0 49.6 56.147.6
62.557.1
67.9 67.9
107.2
132.5
115.2123.5
139.5
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
160.0
2004 2005 2006 2007 2008 2009 2010 2011 2012
Crud
e Ra
te p
er 1
00,0
00
Suicide Death Rate Hospitalization Rate ED Visit Rate
Source: NC-VDRS, 2004-2012; N.C. State Center for Health Statistics, Vital Statistics-Hospitalizations, 2004-2012; NC DETECT, 2008-2012Analysis by Injury Epidemiology and Surveillance Unit
4.0
32.8
80.4
1.5
82.7
169.0
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
160.0
180.0
Suicide Rate Hospitalization Rate ED Visit Rate
Crud
e Ra
te p
er 1
00,0
00
MaleFemale
Suicide and Self-Inflicted Injury: N.C. Residents ages 10-17, 2004-2012
Source: NC-VDRS, 2004-2012; N.C. State Center for Health Statistics, Vital Statistics-Hospitalizations, 2004-2012; NC DETECT, 2008-2012Analysis by Injury Epidemiology and Surveillance Unit
Suicide and Self-Inflicted Injury: N.C. Residents ages 10-17, 2004-2012
1.3
27.5
59.2
5.2
106.0
230.6
0.0
50.0
100.0
150.0
200.0
250.0
Suicide Rate Hosptialization Rate ED Visit Rate
Crud
e Ra
te p
er 1
00,0
00
Age (years)
Ages 10-14Ages 15-17
Source: NC-VDRS, 2004-2012Analysis by Injury Epidemiology and Surveillance Unit
Suicide : N.C. Residents ages 10-17, 2004-2012
79.1%
18.4%
1.2% 1.2%
WhiteBlackAmerican IndianAsian
Source: NC-VDRS, 2004-2012Analysis by Injury Epidemiology and Surveillance Unit
Suicides by County of Residence: N.C. Residents ages 10-17, 2004-2012
Source: NC-N.C. State Center for Health Statistics, Vital Statistics-Hospitalizations, 2004-2012; NC DETECT, 2008-2012Analysis by Injury Epidemiology and Surveillance Unit
Self-Inflicted Injury : N.C. Residents ages 10-17, 2004-2012
79.1%18.4%
1.2%0.5%
12.0%
Self-Inflicted Injury Hospitalizations
Poisoning
Cut/pierce
Suffocation
Firearm
Other/Unspecified
58.6%30.0%
1.2%0.3%
9.9%
Self-Inflicted Injury ED Visits
Source: N.C. YRBS, 2013
Suicidal Behavior: N.C. High School Students, 2013
11.6%
21.7%
10.9%
15.8%
5.5% 5.2%
0%
10%
20%
30%
Male Female
Seriously consideredattempting suicide during thelast 12 months
Made a plan for suicideattempt during the last 12months
Made a suicide attempt thatresulted in an injury needingtreatment by a medicalprofessional during the last 12months
Source: N.C. YRBS, 2013
Suicidal Behavior: N.C. High School Students, 2013
14.3%
40.2%
10.6%
38.0%
4.8%
12.3%
0%
10%
20%
30%
40%
50%
Heterosexual Gay, Lesbian, orBisexual
Seriously consideredattempting suicide duringpast 12 months
Made a plan for suicideattempt during past 12months
Made a suicide attemptduring past 12 months thatresulted in an injuryneeding treatment by amedical professional
Source: WISQARS, 2004-2012Analysis by Injury Epidemiology and Surveillance Unit
Suicide: Youth ages 10-17, 2004-2012
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
2004 2005 2006 2007 2008 2009 2010 2011 2012
Crud
e Ra
te p
er 1
00,0
00
United States North Carolina
Source: NC-VDRS, 2004-2012Analysis by Injury Epidemiology and Surveillance Unit
Suicide: N.C. Residents, 2004-2012
2.0
11.2
21.7 22.125.1
28.024.5
27.4
34.7
49.4
0.62.9 4.0 6.1 8.4
10.98.0
5.4 3.33.3
0.0
10.0
20.0
30.0
40.0
50.0
60.0
10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Crud
e Ra
te p
er 1
00,0
00
Male Female
NC Child Fatality Prevention SystemChild Fatality Task Force
Local Child Fatality Prevention Teams Children and Youth Branch Confidential county-level reviews
Non-maltreatment deaths Make recommendations for local and state changes
Community Child Protection Teams Division of Social Services Confidential county-level reviews
Active maltreatment cases or maltreatment deaths Make recommendations for local and state changes
Child Fatality Review Teams Division of Social Services Confidential state-level reviews of select cases
CPS involvement within 12 months of death Suspicion that death was due to abuse or neglect
NC Child Fatality Prevention SystemNC Child Fatality Prevention Team
Reviews deaths of children 17 years old and under
Deaths must be certified by the Medical Examiner system:Homicides, suicides, accidents, poisoningsTrauma, disaster, violenceUnknown, unnatural or suspicious circumstances In police custody, jail or prison In state-operated mental health facilitiesPotential public health hazards During surgical or anesthetic proceduresSudden and not reasonably related to previously-known diseaseWithout medical attendance
Provides assistance and consultation to local teams
Provides aggregate data reports to the public and other agencies/organizations upon request
DataReview ≈ 500 cases/year approximately 12 months
after the date of death
Public sources of information OCME Vital Records Department of Corrections Department of Motor Vehicles
Confidential sources of information Division of Social Services records Law enforcement investigation reports Hospital/ED/pediatric/mental health records Team findings and discussions
Goal is to obtain the most complete picture of a child’s life as it pertains to his/her death
Youth Suicide in NC by Yearn=247
24
28 2730
21
35
23 24
35
0
5
10
15
20
25
30
35
40
2004 2005 2006 2007 2008 2009 2010 2011 2012
Num
ber
of S
uici
des
2
73
172
0
20
40
60
80
100
120
140
160
180
200
5 - 9 yrs 10 - 14 yrs 15 - 17 yrs
Num
ber
of S
uici
des
Youth Suicide in NC by Age
Youth Suicide in NC by Year & Age Group
97
9 9
5
7
3
11
15
15
21
18
21
16
28
20
13
20
0
5
10
15
20
25
30
2004 2005 2006 2007 2008 2009 2010 2011 2012
Num
ber
of S
uici
des
14 yo & under 15-17 yo
Youth Suicide in NC by Age & Sex
0
10
20
30
40
50
60
70
6 7 8 9 10 11 12 13 14 15 16 17
Num
ber
of S
uici
des
Age (in years)
Male Female
Youth Suicide in NC by Year & Sex
20
17
22
25
15
27
1617
25
4
11
5 5 68 7 7
10
0
5
10
15
20
25
30
2004 2005 2006 2007 2008 2009 2010 2011 2012
Num
ber
of S
uici
desMale Female
Youth Suicide in NC by Means
47.8%
42.9%
6.9%
1.2% 1.2%
ASPHYXIA
GUN
TOXIN
MOTOR VEHICLE
FALL or JUMP /DROWNING / OTHER
Youth Suicide in NC by Means & Sex
66.7%20.6%
9.5%
3.2%
41.3%
50.5%
6.0% 1.6% 0.5%ASPHYXIA
GUN
TOXIN
MOTORVEHICLE
FALL or JUMP /DROWNING /OTHER
Female Male
Youth Suicide in NC: Looking Back
Child Protective ServicesAt least 32% of children who committed suicide between
2004 and 2012 had some type of prior contact with CPS
Mental Health At least 20% of children had a documented mental illness
at some point in their lifetime60% were receiving treatment at time of death 15% were not receiving treatment at time of deathTreatment status unknown for remaining 25%
An additional 12% of children were characterized as depressed by friends and/or family members in the weeks or months leading up to their death
Youth Suicide in NC: Looking Back
History11% of children had attempted suicide at least once before
Circumstances of interest 18% of children reported recent relationship problems
(e.g., friend, family member, boyfriend/girlfriend)
11% of children had issues in the school environment (e.g., academics, behavior, victim/perpetrator of bullying)
A suicide note was recovered in only 12% of cases
Case Examples
Youth Suicide in NC: Looking Ahead
Preliminary data
2013: 41 suicides
2014: 40 suicides as of 12/4/2014
Suicide case review session - update
Elyssa Trani, MSNC Child Fatality Prevention Team
Office of the Chief Medical Examinerelyssa.trani@dhhs.nc.gov
Anna Austin, MPHInjury and Violence Prevention Branch
NC Division of Public Healthanna.austin@dhhs.nc.gov
Contact Information
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