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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