suicide in the northern health planning region, 2003-2008

Suicide in the Northern Health Planning Region, 2003-2008Marc 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


Average 2003 2004 2005 2006 2007 20080

20406080

100120140160180200

159138 132

170 160 166188

Number of Suicides by Year

Year

Num

ber o

f Sui

cide

s

6


Total 2003 2004 2005 2006 2007 20080.02.04.06.08.0

10.012.014.016.018.020.0

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

Sui

cide

Rat

e P

er 1

00,0

00

7


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


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

Num

ber o

f Sui

cide

Atte

mpt

s

9


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


Year

Non

-Fat

al S

uici

de R

ate

Per

100

,000

10


Who is at Risk?

11


Selected Demographic Elements

Gender

Race

Age

12


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


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


Total

10-14

15-19

20-24

25-34

35-44

45-54

55-64

65-74

75-84

85 an

d olde

r0.02.04.06.08.0

10.012.014.016.018.020.0

Suicide Rate by Age Group


Age Group

Sui

cide

Rat

e P

er 1

00,0

00

15


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


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

Rat

e P

er 1

00,0

00

17


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


Total

5-910

-1415

-1920

-2425

-3435

-4445

-5455

-6465

-7475

-84

85 an

d olde

r0.0

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

Rat

e P

er 1

00,0

00

Ages 75-84: only age group with fatal rate

greater than non-fatal rate

19


Veterans

20


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


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


Method of Fatal Injury

23


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


Total Males Females0.0

10.020.030.040.050.060.070.080.090.0

100.0

39.9 46.323.0

27.428.0

25.7

23.8 16.543.3

Selected Methods by Gender

PoisonHanging/SuffocationFirearm

Gender

Per

cent

age

Usi

ng M

etho

d

25


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


Geography

27


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


# 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


Fairfax

Loudoun

Prince William

Arlington

Alexandria

Manassas

Fairfax City

Falls Church

Manassas Park

Rate per 100,0007

8

12

30


Fairfax

Loudoun

Prince William

Arlington

Alexandria

Manassas

Fairfax City

Falls Church

Manassas Park

Rate per 100,0006.6 - 11.3

11.4 - 12.3

31


Selected Circumstances

32


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


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


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


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


Total

10-14

15-19

20-24

25-34

35-44

45-54

55-64

65-74

75-84

85 an

d olde

r0.0

10.020.030.040.050.060.070.080.090.0

100.0Intimate Partner Problems and Crisis by Age Group

Intimate Partner Problem Crisis in Past 2 Weeks

Age Group

Per

cent

age

with

Circ

umst

ance

37


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


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


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


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


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


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


43


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


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%)


45


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


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

[email protected]

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


Information SlideDemographicsGender 51Race 51Ethnicity 51Race/Gender 52Age Group 53VeteransMale Age Group/Veteran 56Method of Fatal InjuryComplete List of Methods 57Selected Methods by Age 58Categories of Poison 59Most Common Poisons 60

Information SlideCircumstancesRelationship Problems 62Life Stressors 62Alcohol/Other Substances 63Mental Health 64-65Warning Signs of Suicide 66Disclosed Intent 67Actions to Prevent Suicide 68-69Prior Suicide Attempts 70Other Warning Signs 71

Index: Fatal Suicide

50


Information SlideNon-Fatal SuicideGender 54Race 54Ethnicity 54Age Group 55Method of Fatal InjuryComplete List of Methods 61

Index: Non-Fatal Suicide

51


# % RateGenderMale 693 72.6 11.5Female 261 27.4 4.3RaceWhite 778 81.6 8.5Black 84 8.8 5.7Asian 91 9.5 5.9Native American 1 0.1 2.0EthnicityHispanic 66 6.9 3.9TOTAL 954 100.0 7.8

52


# % RateSelected Race/GenderWhite male 568 59.5 12.4White female 210 22.0 4.6Black male 66 6.9 9.2Asian male 59 6.2 8.0Asian female 32 3.4 4.1Black female 18 1.9 2.3

53


# % RateAge Group10-14 8 0.8 1.015-19 41 4.3 5.520-24 73 7.7 10.225-34 180 18.9 10.235-44 196 20.5 9.245-54 204 21.4 10.855-64 114 11.9 8.565-74 69 7.2 11.775-84 53 5.6 17.585 and older 16 1.7 14.3TOTAL 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

# % RateGenderMale 2,117 35.0 35.0Female 3,925 65.0 64.0Unknown 1 <0.1 -RaceWhite 3,873 64.1 42.5Black 553 9.2 37.3Asian 310 5.1 20.3Native American 5 0.1 9.8Other 561 9.3 -Unknown 741 12.3 -EthnicityHispanic 481 8.0 28.2TOTAL 6,043 100.0 49.6

55

Non-Fatal Suicide Attempts in the Northern HPR, 2003-2008

# % RateAge Group5-9 5 0.1 0.610-14 232 3.8 28.415-19 1,125 18.6 152.320-24 904 15.0 126.625-34 1,289 21.3 73.335-44 1,148 19.0 54.045-54 881 14.6 46.755-64 303 5.0 22.565-74 82 1.4 13.975-84 43 0.7 14.285 and older 27 0.4 24.1Unknown 4 0.1 -TOTAL 6,043 100.0 49.6

Largest percentage: ages 25-34

Greatest risk: ages 15-19

56


Total

18-19

20-24

25-34

35-44

45-54

55-64

65-74

75-84

85 an

d olde

r0%

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-VeteranVeteran

Age Group

Per

cent

age

Who

are

Vet

eran

s

57


# %Method of Fatal InjuryFirearm 381 39.9Hanging/Suffocation 261 27.4Poison 227 23.8Fall 41 4.3Sharp Instrument 30 3.1Drowning 12 1.3Motor Vehicle 8 0.8Other Transport Vehicle 6 0.6Fire or Burn 2 0.2Other 2 0.2

91% of all suicides

58


Total

10-14

15-19

20-24

25-34

35-44

45-54

55-64

65-74

75-84

85 an

d olde

r0.0

10.020.030.040.050.060.070.080.090.0

100.0Selected Methods of Injury by Age

PoisonHanging/SuffocationFirearm

Age Group

Per

cent

age

Usi

ng M

etho

d

59


# %General Category of PoisonPrescription Medication 162 71.4Over-the-Counter Medication 65 28.6Alcohol 39 17.2Carbon Monoxide 30 13.2Street Drugs 12 5.3Other 12 5.3

Percentages are based on the number of poisoning suicides (n = 227).

60

Suicide in the Northern HPR, 2003-2008# %

Most Common PoisonsOxycodone* 39 17.2Diphenhydramine 37 16.3Methadone* 30 13.2Acetaminophen 24 10.6Hydrocodone* 24 10.6Alprazolam** 23 10.1Morphine* 21 9.3Diazepam** 18 7.9Citalopram** 16 7.0Quetiapine** 15 6.6Fluoxetine** 15 6.6Bupropion** 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 InjuryPoison 4,582 75.8Sharp Instrument 1,106 18.3Fall 56 0.9Hanging/Suffocation 51 0.8Firearm 38 0.6Fire or Burn 28 0.5Motor Vehicle 10 0.2Hot Object/Substance 5 0.1Drowning 1 <0.1Other 125 2.1Unspecified 41 0.7

62

Suicide in the Northern HPR, 2003-2008# %

Relationship CharacteristicsIntimate Partner Problem 294 31.5Non-intimate Relationship Problem 94 10.1Life Stressor CharacteristicsCrisis within Two Weeks of Suicide* 312 33.4Physical Health Problem 205 22.0Job Problem 137 14.7Financial Problem 123 13.2Recent Criminal Legal Problem 91 9.8Death/Suicide of Family/Friend 53 5.7Perpetrator 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


# %Substance Use CharacteristicsProblem with Alcohol/Other Substances 237 25.4

Problem with Alcohol 119 12.8Problem with Other Substances 73 7.8Problem 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


# %Mental Health ProblemsCurrent Mental Health Problem 576 61.7Diagnosis: Depression 436 46.7Diagnosis: Bipolar 93 10.0Diagnosis: Anxiety Disorder 69 7.4Diagnosis: Schizophrenia 26 2.8Mental 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


# %Use of Prescribed Mental Health MedicationsUsed in Past 31 Days and/or Prior 164 71.0

Used in Past 31 Days 132 57.1Used, 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


# %Warning Signs of SuicideDisclosed 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


# %Person to Whom Victim Disclosed IntentIntimate Partner (Current/Former) 48 51.1Family Members 39 41.5Friends/Acquaintances 11 11.7Mental Health Professional 6 6.4Medical 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


# %Type of Action Taken to Prevent SuicideSought Mental Health Treatment 9 24.3Called 911/Law Enforcement 6 16.2Checked on Victim 6 16.2Limited Access to Firearms and/or Ammunition 6 16.2Tried to Persuade Victim 4 10.8Monitored 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


# %How Firearm Access was RestrictedRemoved; all firearms 3 33.3Removed; victim purchased another firearm 2 22.2Hidden (not locked) 1 11.1Removed; gave back later 1 11.1Removed; victim had a hidden firearm 1 11.1Removed; 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


# %Number of Prior Suicide AttemptsOne 63 62.4Two 24 23.8Three 5 5.0Four or more 2 2.0Multiple, 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


# %Other Warning SignsTook Prescribed Pain Medication, Past Two Months 59 17.1Sleep Problems 42 12.1 Sleeping Too Little 41 11.8 Sleeping Too Much 1 0.3Unusual Behavior, Past Two Weeks 15 4.3Did Not Want to be a Burden 14 4.0Family/Friends Expected Suicide 11 3.2Family 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.

suicide in the northern health planning region, 2003-2008

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percentage of suicide

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