how epidemiologists think about suicide roger b. trent, ph.d. epic branch california department of...
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How Epidemiologists Think About Suicide
Roger B. Trent, Ph.D.EPIC Branch
California Department of Health Services
Public Health Surveillance
• Surveillance--standard data collected consistently over years covering entire populations
• Contrasted with “studies” over a limited time to test a hypothesis
• Emphasis on medical rather than psychologicalaspects
Data on Deaths,Including Suicide
• From standard death certificates used everywhere in the U.S.
• Designed to describe all deaths, so not designed for looking at suicide in particular (e.g., nothing on alcohol, prior attempts)
Hospitalization Data
• In many states, every hospital stay is recorded, so “self-destructive” injuries can be identified
• “Severity” = not fatal, but serious enough to require admission as an in-patient
The Injury Pyramid for Suicide
Fatal (death certificates)
Hospitalized (discharge records)
Out-patient & untreated (self-reports in surveys)
Suicide Rates by Age & Sex, California 1998
0
20
40
60
80
'10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+
Male Female
Attempted Suicide Rates by Age & Sex, California 1998
0102030405060708090
100
'10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+
Male Female
Fatal Methods Used
Guns
Hanging Poison
Other
Nonfatal Methods Used
Poison
Cut/pierce
HangOther
Method Affects Lethality
Method Fatal Hosp. % Fatal
Gun 1,661 145 92
Hanging 692 203 77
Poison 544 12,338 4
Cut/pierce 58 2,219 3
Other 256 770 25
Some Unanswered Questions
• Prevention vary by age?
• Prevention vary by gender?
• Strength of intent a factor in method choice?
• Availability a factor in method choice?
Conclusions
• Public Health: Illuminate the patterns• Put in context with other health issues• Identify groups at risk in the population
Surveillance + Hypothesis testing studies+ Clinical experience
Basis for policy