Using Suicide Data for PreventionNovgorod Fall 2010 Institute

Lisa Wexler, PhD, MSW

Department of Public Health

University of Massachusetts Amherst

Overview• Significance of the Problem

– Global Rates per Country– United States, Alaska– Regional: Northwest Alaska

• Factors Associated with Suicidality in NW Alaska• How this data informs suicide prevention

programming on three levels.

Suicide is…

Social, cultural, biological, psychological, personal, etc…

Significance of the Problem

• Each year, approximately 900,000 lives are lost to suicide worldwide.

• Suicide represents 1.5% of the global burden of disease with nearly 20 million years of life lost through premature death.(Mann, Apter, Bertolote, Beautrais, Haas, Hegerl, et. al.,

2005)

Global Prevalence Distribution

• Eastern Europe has the highest annual suicide rates, where 10 countries report greater than 27 deaths per 100,000.

• Latin American and Muslim countries report the lowest rates of suicide with less than 6.5 per 100,000.– (Mann, Apter, Bertolote, Beautrais, Haas, Hegerl, et.

al., 2005)

Suicide Rates (per 100,000) by country, by gender

01020304050607080

GREECE

GUATEMALA

LITHUANIA

NORW

AY

PHILIP

PINES

RUSSIAN F

EDERATION

SWIT

ZERLA

ND

THAILAND

UNITED S

TATES O...

VENEZUELA

YUGOSLAVIA

ZIMBABW

E

Males

Females

--Statistics Reported by the World Health Organization

Age-Adjusted Suicide Rate in Each State per 100,000, 2004

Centers for Disease Control and Prevention, National Injury Mortality Data.

Alaska Suicide Rates by Ethnicity, Age

Indigenous Groups in Alaska

Allen, J., & Butler, J. EPIDEMIOLOGY OF SUICIDE IN ALASKA. Presentation at Behavioral and Mental Health Research in the Arctic Conference - June 2009

Allen, J., & Butler, J. EPIDEMIOLOGY OF SUICIDE IN ALASKA. Presentation at: Behavioral and Mental Health Research in the Arctic Conference - June 2009

Disparities in Suicide Rates

3. Suicidal(Tertiary Prevention)

1. Everyone (Primary

Prevention) 2. “At risk”(Secondary Prevention)

Levels of Prevention: Using data to shape prevention efforts

What do we know about Inupiaq suicidality (attempts and deaths)?

How can these understandings, patterns and issues contribute to suicide intervention efforts?

Tertiary-level Patterns and Issues:

What do we know about suicide in Northwest Alaska? (Wexler, Hill, Bertone-Johnson, & Fenaughty, 2008)

• Numbers: Attempts?

Deaths• Age/Gender• Method• Situational factors• Substance use• Counseling experience

Suicide Attempts by Age and Gender

0

5

10

15

20

25

30

Num

ber

of A

ttem

pts Males Females

Suicide Deaths by Age and Gender

0

2

4

6

8

10

Num

ber

of C

ompl

etio

ns

Age Group

Males Females

Who are at the greatest risk for suicide?

• Inupiat men between the ages of 15 and 34 are most likely to die by suicide.

• Young Inupiat people are most likely to exhibit suicidality.

Substance Abuse & Suicide Deaths

05

101520253035

<15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50>

N=213Substance Abuse Reported Substance Abuse Not Reported

Service History & Suicide

0

5

10

15

20

25

30

No history Counseling Crisis intervention

Retrospective Suicide StudyHill, Perkins & Wexler, 2007

Description of Factors Cases Controls

Visits per person 2.4/person 2.1/person

Reasons for visit 38% Injury 11% Injury

Alcohol Related Visits 19% of Visits 2% of Visits

Alcohol Related Injury Visits 41% of Injury Visits Ax related

0%

Emergency Room Visits 75% of Visits 56% of Visits

What do these data tell us that can inform tertiary prevention programming?

• Drinking alcohol increases a person’s suicide risk• Key risk factor: alcohol & injury (Emergency room)• Lethality of method matters• Informal systems of support are commonly used by

people who are suicidal.– Peers*, Family members, Pastor or other mentor

-- Sometimes (not often)…counselors

Medical staff in emergency room and village clinics should screen for suicide risk if a patient is seen for an alcohol-related injury.Mental Health workers and clinicians should educate close peers and family members of suicidal person about the risks of alcohol use and availability of guns.

Data-Driven Tertiary Prevention:

Secondary PreventionWhat kind of information will help shape programming targeted at young, indigenous people who are at higher risk for suicide in the region?

Community Members’Perceived Reasons for Suicide

(Wexler & Goodwin, 2006)

05

101520253035404550

Total Youth

Total Adult

What Could Adults in your Community Do to Help Prevent Suicide?

(Wexler & Goodwin, 2006)

020406080

100120

Adults

Youth

What is Important for Helping Kids Get Excited about their Future?

020406080

100

Adults

Youth

Adult-Youth Understandings (Wexler & Goodwin, 2006)

Young People:• Stress!

Prevention Approach:• Talking and spending

time with adults on an everyday basis.

More value placed on informal relationships.

Adults:• Boredom

Prevention Approach:• More organized

activities for youth.

More emphasis on programs for youth.

Differences but the same goal!

• Adults: “more programs”• Youth want adults to spend more time talking to

them.

*Young people want help figuring out how to get through everyday problems and planning their future. They want guidance from adults!

Informal: Adults reaching out to young people, talking to them about their lives regularly, and modeling healthy behavior and problem solving.

Formal: Youth programs that link young people with adults, public spaces for youth/community activities, and opportunities for meaningful engagement in a group.

Secondary Prevention:

What larger, community-level factors are contributing to suicide?

Research to understand the huge variance in suicide rates among indigenous communities.

Indigenous Communities with All of these “Cultural Continuity” factors had extremely low rates of suicide.

1. Self-government*2. Land Claims* 3. Education Services*4. Police and Fire Services 5. Health Services 6. Cultural Facilities (Chandler & Lalonde, 1998)�• �

Primary Suicide Prevention: Promoting Community-level Protective Factors

(Wexler, DiFluvio, Burke, 2009)

Providing young people with opportunities to participate and contribute.

Creating feelings of purpose (e.g. being a part of something bigger than oneself) through engagement.

Having role models to show them how to be “responsible” adults (pathways).

3. Tertiary Institute screening in village clinics and emergency room. Train medical staffMH counselors in local trends

1. Primary

Using Data to Inform Suicide Prevention on Three Levels in Northwest Alaska

2. Secondary Youth digital storytelling to focus on positives in their lives and share these with adults in the community.

Current community-empowerment model (SPSA) that is working with tribal leaders to reach out to youth and contribute to their communities.

Thank You!

Thanks to Maniilaq Association, NSF, SAMHSA, KTC, Aqqaluk Trust, and many community members from NW AK for contributing to this research.