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Suicide in the Northern Health Planning Region, 2003-2008. Marc E. Leslie Coordinator, Virginia Violent Death Reporting System Office of the Chief Medical Examiner, Virginia Department of Health The Northern Health Planning Region Suicide Prevention Summit June 6, 2011 Annandale, VA. - PowerPoint PPT Presentation
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Suicide in the Northern Health Planning Region, 2003-2008
Marc E. LeslieCoordinator, Virginia Violent Death Reporting SystemOffice of the Chief Medical Examiner, Virginia Department of Health
The Northern Health Planning Region Suicide Prevention Summit June 6, 2011Annandale, VA
Map of the Northern Health Planning Region (HPR)
2
Fairfax
Loudoun
Prince William
Arlington
Alexandria
Manassas
Fairfax City
Falls Church
Manassas Park
3
Pop Quiz
In the Northern Health Planning Region:
1. Average number of suicides per year? (Hint: average of 41 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 Northern HPR, 2003-2008
Overview of the Problem
5
Suicide in the Northern HPR, 2003-2008
Average 2003 2004 2005 2006 2007 20080
20
40
60
80
100
120
140
160
180
200
159138 132
170160 166
188Number of Suicides by Year
Year
Nu
mb
er
of
Su
icid
es
6
Suicide in the Northern HPR, 2003-2008
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
7.8 7.1 6.78.4 7.8 8.0
8.9
11.3 10.8 11.0 11.3 11.4 11.2 12.0
Suicide Rate by Year
Northern HPR Virginia
Year
Su
icid
e R
ate
Pe
r 1
00
,00
0
7
Suicide in the Northern HPR, 2003-2008
Suicide vs. Homicide (2003-2008)
• 954 suicides; rate of 7.8
• 245 homicides; rate of 2.0
• Suicide about 4 times more common than homicide
8
Suicide in the Northern HPR, 2003-2008
Average 2003 2004 2005 2006 2007 20080
200
400
600
800
1000
1200
1400
1,007 1,033 984857
9391,074
1,156
Number of Non-Fatal Suicide Attempts by Year
Year
Nu
mb
er
of
Su
icid
e A
tte
mp
ts
9
Suicide in the Northern HPR, 2003-2008
Total 2003 2004 2005 2006 2007 20080.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
49.6 53.1 49.842.3 45.7
51.8 54.9
62.3 60.0 61.1 58.2 59.066.4 69.2
Non-Fatal Suicide Attempt Rate by Year
Northern HPR Virginia
Year
No
n-F
ata
l Su
icid
e R
ate
Pe
r 1
00
,00
0
10
Suicide in the Northern HPR, 2003-2008
Who is at Risk?
11
Suicide in the Northern HPR, 2003-2008
Selected Demographic Elements
Gender
Race
Age
12
Suicide in the Northern HPR, 2003-2008
Race and Gender
• Male (73%, rate of 11.5)
• White (82%, rate of 8.5)
• White males (60%, rate of 12.4), White females (22%, rate of 4.6), Black males (7%, rate of 9.2), and Asian males (6%, rate of 8.0)
(remember, overall rate for Northern HPR is 7.8)
13
Suicide in the Northern HPR, 2003-2008
Age
• Median age is 44
• Ages 45-54 most common age group (21%)
• Highest rates for those ages 65-74 (11.7), 75-84 (17.5), and 85 and over (14.3)
14
Suicide in the Northern HPR, 2003-2008
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
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
Suicide Rate by Age Group
Northern HPR Virginia
Age Group
Su
icid
e R
ate
Pe
r 1
00
,00
0
15
Suicide in the Northern HPR, 2003-2008
Race and Gender: Non-Fatal Attempts
• Most commonly by females (65%, rate of 64.0)
• Whites still most common and highest risk; risk levels rises for all races
• Gap between White and Black suicide rates narrows
16
Suicide in the Northern HPR, 2003-2008
Total Male Female0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
7.8 11.5 4.3
49.635.0
64.0
Fatal and Non-Fatal Suicide Rates by Gender
Fatal Non-Fatal
Gender
Ra
te P
er
10
0,0
00
17
Suicide in the Northern HPR, 2003-2008
Age: Non-Fatal Attempts
• Median age is 30
• Non-fatal risk is greater than fatal suicide risk for all age groups, except ages 75-84
• 28 times rate increase for those ages 15-19 (from 5.5 to 152.3)
• In general, non-fatal attempt rate decreases with age
18
Suicide in the Northern HPR, 2003-2008
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
20.0
40.0
60.0
80.0
100.0
120.0
140.0
160.0Non-Fatal and Fatal Suicide Rate by Age Group
Non-Fatal Fatal
Age Group
Ra
te P
er
10
0,0
00
Ages 75-84: only age group with fatal rate
greater than non-fatal rate
19
Suicide in the Northern HPR, 2003-2008
Veterans
20
Suicide in the Northern HPR, 2003-2008
Veterans
• 20% of all suicide victims (18 years and older)
• 27% of males; 4% of females
• Unknown if veterans served in combat, but can generally tell if they are currently in the military
21
Suicide in the Northern HPR, 2003-2008
Veterans
• Male veterans older than male non-veterans (median ages of 58 and 41, respectively)
• Median age suggests that those who are combat veterans generally not in the most recent conflicts
• 70% of males ages 65 and over are veterans compared to 18% of males ages 18-64
22
Suicide in the Northern HPR, 2003-2008
Method of Fatal Injury
23
Suicide in the Northern 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 91% of suicides
• Most poisons are prescribed medications, primarily mental health medications and pain medications
24
Suicide in the Northern HPR, 2003-2008
Total Males Females0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
39.9 46.3
23.0
27.428.0
25.7
23.8 16.5
43.3
Selected Methods by Gender
Poison
Hanging/Suffocation
Firearm
Gender
Pe
rce
nta
ge
Usi
ng
Me
tho
d
25
Suicide in the Northern HPR, 2003-2008
Method of Fatal Injury: Non-Fatal Attempts
• Most common method for non-fatal attempts is poison (76%)
• Poison use is defining method difference between fatal and non-fatal attempts
26
Suicide in the Northern HPR, 2003-2008
Geography
27
Suicide in the Northern HPR, 2003-2008
Geography
• Northern HPR has 9 localities (4 counties and 5 cities)
• 2 of these localities (22%) have a suicide rate exceeding the rate for Virginia (11.3)
• In general smaller locality = lower number and higher rate
28
Suicide in the Northern HPR, 2003-2008
# Rate
Highest Suicide Rates
Falls Church 8 12.3
Manassas 27 12.3
Alexandria 68 8.4
Arlington 97 8.2
Prince William 164 7.8
# Rate
Lowest Suicide Rates
Fairfax City 9 6.6
Loudoun 111 7.1
Manassas Park 5 7.3
Fairfax County 465 7.7
29
Suicide in the Northern HPR, 2003-2008
Fairfax
Loudoun
Prince William
Arlington
Alexandria
Manassas
Fairfax City
Falls Church
Manassas Park
Rate per 100,000
7
8
12
30
Suicide in the Northern HPR, 2003-2008
Fairfax
Loudoun
Prince William
Arlington
Alexandria
Manassas
Fairfax City
Falls Church
Manassas Park
Rate per 100,000
6.6 - 11.3
11.4 - 12.3
31
Suicide in the Northern HPR, 2003-2008
Selected Circumstances
32
Suicide in the Northern HPR, 2003-2008
Most Common Circumstances
• Mental health problem (62%)
• Crisis in past two weeks (33%)
• Intimate partner problem (32%)
• Problem with alcohol and/or other substances (25%)
• Physical health problem (22%)
33
Suicide in the Northern HPR, 2003-2008
Circumstances: Mental Health
• Females (73%) more than males (58%)
• Most prevalent in ages 45-54 and 55-64 (70% of each)
• 50% or more for every age group ages 20-24 and up
• 82% 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 Northern HPR, 2003-2008
Circumstances: Crisis in Past 2 Weeks
• 33% of all persons; no real gender difference
• Most crises (67%) occurred in the past 24 hours*
• Indicator of reactive suicides
• 40% or more for all age groups up through 25-34
*2007-2008 data
35
Suicide in the Northern HPR, 2003-2008
Circumstances: Intimate Partner Problems
• 32% having problems with current/former intimate partner at time of suicide
• 30% of males, 35% of females
• 56% also having a crisis in the past 2 weeks
• Shows volatility of intimate partner conflict
36
Suicide in the Northern HPR, 2003-2008
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
37
Suicide in the Northern HPR, 2003-2008
Circumstances: Alcohol and Other Substance Problems
• 25% of all persons
• 30% or more of ages 25-34, 35-44, and 45-54
• 43% of those with alcohol problems had elevated levels of alcohol in their system at death (compared to 12% of those without alcohol problems)
38
Suicide in the Northern HPR, 2003-2008
Circumstances: Physical Health Problems
• 22% of all suicide victims; 21% of males, 24% of females
• Median age of 59 compared to 41 for those without a physical health problem
• 53% or more of those ages 65 and older
39
Suicide in the Northern 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 Northern HPR, 2003-2008
Circumstances: Warning Signs
• 52% disclosed intent and/or had prior attempts
• Most commonly disclosed to intimate partners (51%), family (42%), friends/acquaintances (12%), and mental health professionals (6%)*
• Disclosing intent similar for males (38%) and females (37%)
• Prior attempts more common for females (36%) than for males (21%)
*2007-2008 data
41
Suicide in the Northern HPR, 2007-2008
Actions Taken to Prevent Suicide*
• Sought/encouraged mental health treatment (24%)
• Called 911/law enforcement (16%)
• Checked in on victim (16%)
• Limited access to firearms/ammunition (16%)
• Tried to persuade victim to not commit suicide (11%)
*2007-2008 data (entire slide)
42
Suicide in the Northern HPR, 2007-2008
Efforts to Limit Access to Firearms and/or Ammunition*
• 9 persons had friends or family members who restricted access to firearms or ammunition
• Includes 3 persons not known to disclose intent, but loved ones acted out of concern
• Variety of techniques used to restrict (hiding, removing)
• Of these persons, 7 (78%) used a firearm as method of fatal injury
*2007-2008 data (entire slide)
43
Suicide in the Northern HPR, 2003-2008
In the fatal suicide, those with prior attempts used less lethal methods than those without prior attempts
Firearm45%
Poison20%
Hanging/Suffocation
26%
Other10%
No Prior Suicide Attempts
Firearm25%
Poison37%
Hanging/Suffocation
33%
Other6%
Prior Suicide Attempts
44
Suicide in the Northern HPR, 2007-2008
Other Warning Signs of Suicide*
• Taking prescribed pain medication (17%)
• Sleeping too little (12%)
• Unusual behavior, past two weeks (4%)
• Family/friends expected suicide (3%)
• Family history of suicide (3%)
*2007-2008 data (entire slide)
45
Suicide in the Northern HPR, 2003-2008
Conclusions
• Suicide rates are highest among Whites, males, and older adults
• A firearm is the most common method of fatal injury
• The majority of suicide victims have a mental health problem, and most of these persons were being treated
46
Suicide in the Northern HPR, 2003-2008
Conclusions
• 52% 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
• Northern Virginia suicides look different than the rest of the state
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
48
Appendix: Additional Information and Complete Tables
49
Suicide in the Northern HPR, 2003-2008
Information Slide
Demographics
Gender 51
Race 51
Ethnicity 51
Race/Gender 52
Age Group 53
Veterans
Male Age Group/Veteran 56
Method of Fatal Injury
Complete List of Methods 57
Selected Methods by Age 58
Categories of Poison 59
Most Common Poisons 60
Information Slide
Circumstances
Relationship Problems 62
Life Stressors 62
Alcohol/Other Substances 63
Mental Health 64-65
Warning Signs of Suicide 66
Disclosed Intent 67
Actions to Prevent Suicide 68-69
Prior Suicide Attempts 70
Other Warning Signs 71
Index: Fatal Suicide
50
Suicide in the Northern HPR, 2003-2008
Information Slide
Non-Fatal Suicide
Gender 54
Race 54
Ethnicity 54
Age Group 55
Method of Fatal Injury
Complete List of Methods 61
Index: Non-Fatal Suicide
51
Suicide in the Northern HPR, 2003-2008
# % Rate
Gender
Male 693 72.6 11.5
Female 261 27.4 4.3
Race
White 778 81.6 8.5
Black 84 8.8 5.7
Asian 91 9.5 5.9
Native American 1 0.1 2.0
Ethnicity
Hispanic 66 6.9 3.9
TOTAL 954 100.0 7.8
52
Suicide in the Northern HPR, 2003-2008
# % Rate
Selected Race/Gender
White male 568 59.5 12.4
White female 210 22.0 4.6
Black male 66 6.9 9.2
Asian male 59 6.2 8.0
Asian female 32 3.4 4.1
Black female 18 1.9 2.3
53
Suicide in the Northern HPR, 2003-2008
# % Rate
Age Group
10-14 8 0.8 1.0
15-19 41 4.3 5.5
20-24 73 7.7 10.2
25-34 180 18.9 10.2
35-44 196 20.5 9.2
45-54 204 21.4 10.8
55-64 114 11.9 8.5
65-74 69 7.2 11.7
75-84 53 5.6 17.5
85 and older 16 1.7 14.3
TOTAL 954 100.0 7.8
Highest risk: 75-84
Largest percentage of victims: ages 45-54
54
Non-Fatal Suicide Attempts in the Northern HPR, 2003-2008
# % Rate
Gender
Male 2,117 35.0 35.0
Female 3,925 65.0 64.0
Unknown 1 <0.1 -
Race
White 3,873 64.1 42.5
Black 553 9.2 37.3
Asian 310 5.1 20.3
Native American 5 0.1 9.8
Other 561 9.3 -
Unknown 741 12.3 -
Ethnicity
Hispanic 481 8.0 28.2
TOTAL 6,043 100.0 49.6
55
Non-Fatal Suicide Attempts in the Northern HPR, 2003-2008
# % Rate
Age Group
5-9 5 0.1 0.6
10-14 232 3.8 28.4
15-19 1,125 18.6 152.3
20-24 904 15.0 126.6
25-34 1,289 21.3 73.3
35-44 1,148 19.0 54.0
45-54 881 14.6 46.7
55-64 303 5.0 22.5
65-74 82 1.4 13.9
75-84 43 0.7 14.2
85 and older 27 0.4 24.1
Unknown 4 0.1 -
TOTAL 6,043 100.0 49.6
Largest percentage: ages 25-34
Greatest risk: ages 15-19
56
Suicide in the Northern HPR, 2003-2008
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%
26
.5
11
.8
6.5
14
.0
15
.6 23
.8
27
.5
57
.1
85
.7
75
.0
73
.5
88
.2
93
.5
86
.0
84
.4 76
.2
72
.5
42
.9
14
.3
25
.0
Male Age Group and Veteran Status
Non-Veteran
Veteran
Age Group
Pe
rce
nta
ge
Wh
o a
re V
ete
ran
s
57
Suicide in the Northern HPR, 2003-2008
# %
Method of Fatal Injury
Firearm 381 39.9
Hanging/Suffocation 261 27.4
Poison 227 23.8
Fall 41 4.3
Sharp Instrument 30 3.1
Drowning 12 1.3
Motor Vehicle 8 0.8
Other Transport Vehicle 6 0.6
Fire or Burn 2 0.2
Other 2 0.2
91% of all suicides
58
Suicide in the Northern HPR, 2003-2008
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
Suicide in the Northern HPR, 2003-2008
# %
General Category of Poison
Prescription Medication 162 71.4
Over-the-Counter Medication 65 28.6
Alcohol 39 17.2
Carbon Monoxide 30 13.2
Street Drugs 12 5.3
Other 12 5.3
Percentages are based on the number of poisoning suicides (n = 227).
60
Suicide in the Northern HPR, 2003-2008# %
Most Common Poisons
Oxycodone* 39 17.2
Diphenhydramine 37 16.3
Methadone* 30 13.2
Acetaminophen 24 10.6
Hydrocodone* 24 10.6
Alprazolam** 23 10.1
Morphine* 21 9.3
Diazepam** 18 7.9
Citalopram** 16 7.0
Quetiapine** 15 6.6
Fluoxetine** 15 6.6
Bupropion** 15 6.6
Percentages based on the number of poisoning suicides (n = 227). Poisons used by 15 or more persons are listed.
*Commonly prescribed for pain management
** Commonly prescribed for mental health treatment
61
Non-Fatal Suicide Attemptsin the Northern HPR, 2003-2008
# %
Method of Fatal Injury
Poison 4,582 75.8
Sharp Instrument 1,106 18.3
Fall 56 0.9
Hanging/Suffocation 51 0.8
Firearm 38 0.6
Fire or Burn 28 0.5
Motor Vehicle 10 0.2
Hot Object/Substance 5 0.1
Drowning 1 <0.1
Other 125 2.1
Unspecified 41 0.7
62
Suicide in the Northern HPR, 2003-2008
# %
Relationship Characteristics
Intimate Partner Problem 294 31.5
Non-intimate Relationship Problem 94 10.1
Life Stressor Characteristics
Crisis within Two Weeks of Suicide* 312 33.4
Physical Health Problem 205 22.0
Job Problem 137 14.7
Financial Problem 123 13.2
Recent Criminal Legal Problem 91 9.8
Death/Suicide of Family/Friend 53 5.7
Perpetrator of Interpersonal Violence 38 4.1
Percentages are based on the number of suicides with at least one known circumstance (n = 933).
* Of these, 67% had a crisis in past 24 hours (2007-2008 data)
63
Suicide in the Northern HPR, 2003-2008
# %
Substance Use Characteristics
Problem with Alcohol/Other Substances 237 25.4
Problem with Alcohol 119 12.8
Problem with Other Substances 73 7.8
Problem with Alcohol and Other Substances 45 4.8
Percentages are based on the number of suicides with at least one known circumstance (n = 933).
64
Suicide in the Northern HPR, 2003-2008
# %
Mental Health Problems
Current Mental Health Problem 576 61.7
Diagnosis: Depression 436 46.7
Diagnosis: Bipolar 93 10.0
Diagnosis: Anxiety Disorder 69 7.4
Diagnosis: Schizophrenia 26 2.8
Mental Health Treatment 471 50.5
Current Mental Health Treatment 398 42.7
Noncurrent Mental Health Treatment 73 7.8
Percentages are based on the number of suicides with at least one known circumstance (n = 933). Diagnoses are not exclusive, but represent the most common diagnoses.
65
Suicide in the Northern HPR, 2007-2008
# %
Use of Prescribed Mental Health Medications
Used in Past 31 Days and/or Prior 164 71.0
Used in Past 31 Days 132 57.1
Used, But Not in Past 31 Days 32 13.9
Unknown/Never Used 67 29.0
Percentages are based on the number of victims with a mental health problem (n = 231). Data are from 2007-2008.
66
Suicide in the Northern HPR, 2003-2008
# %
Warning Signs of Suicide
Disclosed Intent/History of Attempts 487 52.2
Disclosed Intent to Commit Suicide 353 37.8
History of Suicide Attempts 233 25.0
Percentages are based on the number of suicides with at least one known circumstance (n = 933).
67
Suicide in the Northern HPR, 2007-2008
# %
Person to Whom Victim Disclosed Intent
Intimate Partner (Current/Former) 48 51.1
Family Members 39 41.5
Friends/Acquaintances 11 11.7
Mental Health Professional 6 6.4
Medical Personnel 3 3.2
Percentages are based on the number of victims who disclosed intent and where this information is known (n = 94). Data are from 2007-2008.
68
Suicide in the Northern HPR, 2007-2008
# %
Type of Action Taken to Prevent Suicide
Sought Mental Health Treatment 9 24.3
Called 911/Law Enforcement 6 16.2
Checked on Victim 6 16.2
Limited Access to Firearms and/or Ammunition 6 16.2
Tried to Persuade Victim 4 10.8
Monitored Victim 2 5.4
Percentages are based on the number of suicides where someone took action to prevent the suicide (n = 37). Data are from 2007-2008.
Some victims had family, friends, or others who reacted to the disclosed intent and tried to prevent the suicide
69
Suicide in the Northern HPR, 2007-2008
# %
How Firearm Access was Restricted
Removed; all firearms 3 33.3
Removed; victim purchased another firearm 2 22.2
Hidden (not locked) 1 11.1
Removed; gave back later 1 11.1
Removed; victim had a hidden firearm 1 11.1
Removed; victim took back by force 1 11.1
Percentages are based on the number of victims where it was known how firearm access was restricted (n = 9). Data are from 2007-2008.
70
Suicide in the Northern HPR, 2007-2008
# %
Number of Prior Suicide Attempts
One 63 62.4
Two 24 23.8
Three 5 5.0
Four or more 2 2.0
Multiple, unspecified 7 6.9
Percentages are based on the number of victims with a known number of prior attempts (n = 101). Data are from 2007-2008.
71
Suicide in the Northern HPR, 2007-2008
# %
Other Warning Signs
Took Prescribed Pain Medication, Past Two Months 59 17.1
Sleep Problems 42 12.1
Sleeping Too Little 41 11.8
Sleeping Too Much 1 0.3
Unusual Behavior, Past Two Weeks 15 4.3
Did Not Want to be a Burden 14 4.0
Family/Friends Expected Suicide 11 3.2
Family History of Suicide 9 2.6
Percentages are based on the number of suicides with at least one known circumstance (n = 346). Data are from 2007-2008.