Suicide and Mental Health in Virginia: 2003-2007 Marc Leslie Virginia Violent Death Reporting System Office of the Chief Medical Examiner Virginia Department

Suicide and Mental Health in Suicide and Mental Health in Virginia: 2003-2007Virginia: 2003-2007

Marc LeslieMarc LeslieVirginia Violent Death Reporting SystemVirginia Violent Death Reporting SystemOffice of the Chief Medical ExaminerOffice of the Chief Medical ExaminerVirginia Department of HealthVirginia Department of Health

Presentation for Department of Mental Health, Mental Retardation Presentation for Department of Mental Health, Mental Retardation and Substance Abuse Services Management Teamand Substance Abuse Services Management TeamJune 22, 2009June 22, 2009

22

Outline of PresentationOutline of Presentation

Overview of the National Violent Death Reporting Overview of the National Violent Death Reporting System (NVDRS) and the Virginia Violent Death System (NVDRS) and the Virginia Violent Death Reporting System (VVDRS)Reporting System (VVDRS)

Suicide in Virginia: 2003-2007Suicide in Virginia: 2003-2007

Suicide and mental health problems in Virginia: Suicide and mental health problems in Virginia: 2003-20072003-2007

Additional detail on suicide victims with mental Additional detail on suicide victims with mental health problems: 2007health problems: 2007

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Overview of NVDRS/VVDRSOverview of NVDRS/VVDRS

Surveillance project funded by the Centers for Disease Surveillance project funded by the Centers for Disease Control and Prevention (CDC) in 17 statesControl and Prevention (CDC) in 17 states

Collects data on all suicide, homicide, legal intervention, Collects data on all suicide, homicide, legal intervention, undetermined cause/manner, unintentional firearm injury, and undetermined cause/manner, unintentional firearm injury, and terrorism deathsterrorism deaths

Abstracted into standardized databaseAbstracted into standardized database

VVDRS began in late 2003VVDRS began in late 2003

Located in the Office of the Chief Medical Examiner (OCME) Located in the Office of the Chief Medical Examiner (OCME) which has legal authority over relevant caseswhich has legal authority over relevant cases

Information primarily from OCME, Vital Records, law Information primarily from OCME, Vital Records, law enforcement, and Department of Forensic Sciencesenforcement, and Department of Forensic Sciences

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Primary Data ElementsPrimary Data Elements Demographics (e.g., age, race, sex, education)Demographics (e.g., age, race, sex, education)

Residential information of victim (e.g., address)Residential information of victim (e.g., address)

Address of injury and type of location where injuredAddress of injury and type of location where injured

Date and time of injuryDate and time of injury

Method of fatal injury (e.g., firearm)Method of fatal injury (e.g., firearm)

Cause and manner of deathCause and manner of death

Toxicological findingsToxicological findings

CircumstancesCircumstances

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CircumstancesCircumstances Why victim committed suicideWhy victim committed suicide

Life stressors/events present at time of fatal injuryLife stressors/events present at time of fatal injury

Reported primarily from OCME and law enforcement Reported primarily from OCME and law enforcement investigationsinvestigations

Multiple criteria; different for each circumstanceMultiple criteria; different for each circumstance

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Collecting Data about Mental Health ProblemsCollecting Data about Mental Health Problems Evidence in death investigation record that victim had a Evidence in death investigation record that victim had a

mental health problemmental health problem

Diagnosis is abstracted when death is investigated by a Diagnosis is abstracted when death is investigated by a medical doctor, or when there is evidence that victim medical doctor, or when there is evidence that victim received treatmentreceived treatment

Mental health treatment records are occasionally Mental health treatment records are occasionally available, but not regularlyavailable, but not regularly

Treatment labeled as “current” (within two months of Treatment labeled as “current” (within two months of injury) or “noncurrent” (over two months prior to injury)injury) or “noncurrent” (over two months prior to injury)

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Overview of All Suicides: 2003-2007Overview of All Suicides: 2003-2007 4,216 suicides4,216 suicides

Rate of 11.2 (more than twice the homicide rate)Rate of 11.2 (more than twice the homicide rate)

Most victims male (76.9%) and White (86.7%)Most victims male (76.9%) and White (86.7%)

Median age of 46Median age of 46

Firearm (57.0%), Hanging/Suffocation (18.9%), and Poison Firearm (57.0%), Hanging/Suffocation (18.9%), and Poison (18.1%) most common methods(18.1%) most common methods

Rural areas have lower numbers, but higher ratesRural areas have lower numbers, but higher rates

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Widowed males: 60.8Widowed males: 60.8

LENOWISCO Planning District: 20.8LENOWISCO Planning District: 20.8

Males: 17.5Males: 17.5

State average: 11.2State average: 11.2

Widowed females: 6.1Widowed females: 6.1

Hispanics: 4.9Hispanics: 4.9

Suicide risk (rate per 100,000) varies by race, sex, age, Suicide risk (rate per 100,000) varies by race, sex, age, education, marital status, residence, and other factors:education, marital status, residence, and other factors:

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Suicide Risk by Selected Features

Hig

h S

choo

l Edu

catio

n, 2

2.4

LEN

OW

ISC

O P

lann

ing

Dis

trict

, 20.

8

Age

s 85

and

old

er, 1

8.5

Mal

e, 1

7.5

Whi

te, 1

3.0

Wid

owed

fem

ale,

6.1

Bla

ck, 6

.0

Fem

ale,

5.1

His

pani

c, 4

.9

Wid

owed

mal

e, 6

0.8

Ave

rage

, 11.

2

Edu

catio

n be

yond

Hig

h S

choo

l, 9.

6N

orth

ern

Virg

inia

Reg

iona

l P

lann

ing

Dis

trict

, 7.6

0

10

20

30

40

50

60

70

Feature

Rat

e pe

r 100

,000

1010


Suicide Rate by Age Group

6.8

11.7 12.414.4

16.6

14.1 14.8

18.3 18.5

1.20

2

4

6

8

10

12

14

16

18

20

Age Group

Ra

te p

er

10

0,0

00

1111


Males and females differ notably on many features:Males and females differ notably on many features: Age influences risk, but in different ways for males (risk Age influences risk, but in different ways for males (risk

increases with age) and females (risk rises, then decreases increases with age) and females (risk rises, then decreases with age)with age)

Method of fatal injury different for males (1.8 times more Method of fatal injury different for males (1.8 times more frequent use of firearms than females) and females (3.4 times frequent use of firearms than females) and females (3.4 times more frequent use of poison than males)more frequent use of poison than males)

Marital status has major impact on males, but not on females Marital status has major impact on males, but not on females (except for divorced females)(except for divorced females)

Circumstances (46.5% of males have a mental health Circumstances (46.5% of males have a mental health problem, compared to 70.9% of females)problem, compared to 70.9% of females)

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Suicide and Mental Health Problems Suicide and Mental Health Problems in Virginia: 2003-2007in Virginia: 2003-2007

This presentation focuses on persons who: This presentation focuses on persons who: Died between 2003 and 2007Died between 2003 and 2007

Manner of death is suicide (completed suicides only)Manner of death is suicide (completed suicides only)

Were residents of Virginia at time of injury or deathWere residents of Virginia at time of injury or death

Were noted as having a mental health problem (Were noted as having a mental health problem (nn = 2,128) = 2,128)

Had at least one circumstance known, but were not noted Had at least one circumstance known, but were not noted as having a mental health problem (as having a mental health problem (nn = 1,948) = 1,948)

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Percentage of Selected Attributes With and Without Mental Health Problems

73.4

70.9

62.2

59.1

53.9

52.2

48.3

46.5

42.9

40.4

38.9

19.2

26.6

29.1

37.8

40.9

46.1

47.8

51.7

53.5

57.1

59.6

61.1

80.8

0%10%20%30%40%50%60%70%80%90%

100%

Per

cent

age

Mental Health Problem No Mental Health Problem

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Percentage of Age Groups With and Without a Mental Health Problem

41.7

40.9 51

.5

55.7

58.9

58.5

47.0

40.6

35.1

65.5

58.3

59.1 48

.5

44.3

41.1

41.5

53.0

59.4

64.9

34.5

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85 andolder

Pe

rcen

tage

Mental Health Problem No Mental Health Problem

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Methods of fatal injury:Methods of fatal injury: Firearm (46.7%)Firearm (46.7%)

Poison (25.8%)Poison (25.8%)

Hanging/Suffocation (20.3%)Hanging/Suffocation (20.3%)

Fall (2.2%)Fall (2.2%)

Drowning (1.9%)Drowning (1.9%)

Sharp Instrument (1.8%)Sharp Instrument (1.8%)

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Poisoning suicide (Poisoning suicide (n n = 548 victims) – use of at least one:= 548 victims) – use of at least one: Prescription medication (79.6%)Prescription medication (79.6%)

Over-the-Counter medication (17.0%)Over-the-Counter medication (17.0%)

Alcohol (13.5%)Alcohol (13.5%)

Carbon Monoxide (10.6%)Carbon Monoxide (10.6%)

Street drug (5.7%)Street drug (5.7%)

Opiate (40.7%)Opiate (40.7%)

Antidepressant (40.1%)Antidepressant (40.1%)

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Specific poisons (Specific poisons (n n = 548 victims)= 548 victims) Amitriptyline/Nortriptyline (10.8%)Amitriptyline/Nortriptyline (10.8%)

Citalopram (10.8%)Citalopram (10.8%)

Oxycodone (10.6%)Oxycodone (10.6%)

Methadone (10.2%)Methadone (10.2%)

Quetiapine (9.5%)Quetiapine (9.5%)

Hydrocodone (8.9%)Hydrocodone (8.9%)

Diphenhydramine (8.8%)Diphenhydramine (8.8%)

Acetaminophen (8.2%)Acetaminophen (8.2%)

Alprazolam (6.9%)Alprazolam (6.9%)

Morphine (6.8%)Morphine (6.8%)

Propoxyphene (6.2%)Propoxyphene (6.2%)

Fluoxetine (6.0%)Fluoxetine (6.0%)

Bupropion (5.1%)Bupropion (5.1%)

Cocaine (4.9%)Cocaine (4.9%)

1818


Diagnoses and treatment:Diagnoses and treatment: Depression (74.6%)Depression (74.6%)

Bipolar (13.7%)Bipolar (13.7%)

Anxiety Disorder (8.8%)Anxiety Disorder (8.8%)

Schizophrenia (4.7%)Schizophrenia (4.7%)

Current mental health treatment (74.7%)Current mental health treatment (74.7%)

Noncurrent mental health treatment (7.7%)Noncurrent mental health treatment (7.7%)

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Combination of Mental Health Problems, Problems with Alcohol, and Problems with Other Substances

Mental Health Problem, 71.3%

Mental Health Problem, Other

Substance Problem, 9.6%

Mental Health, Alcohol, and Other

Substance Problems, 6.0%

Mental Health Problem, Alcohol Problem, 13.1%

2020


Other Noteable Circumstances for Suicide Victims with Mental Health Problems (Percentage)

Recent criminal legal problems, 7.5

Financial problems, 10.2

Job problems, 11.2

Physical health problems, 20.4

Intimate partner problems, 28.1

Crisis in past two weeks, 28.4

Current depressed mood, 40.6

0 5 10 15 20 25 30 35 40 45

Pe

rce

nta

ge

2121


Other CircumstancesOther Circumstances

Warnings of suicide:Warnings of suicide: Disclosed intent to commit suicide (31.9%)Disclosed intent to commit suicide (31.9%)

History of suicide attempts (30.5%)History of suicide attempts (30.5%)

Combined disclosed intent to commit suicide and/or history of Combined disclosed intent to commit suicide and/or history of suicide attempts (51.6%)suicide attempts (51.6%)

This means that over half of suicide victims with a mental This means that over half of suicide victims with a mental health problem were known to be or to have been suicidal.health problem were known to be or to have been suicidal.

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Suicide and Mental Health Problems in Virginia: Suicide and Mental Health Problems in Virginia: State-Added Data from 2007State-Added Data from 2007

OverviewOverview Variables created, defined, and collected by VVDRSVariables created, defined, and collected by VVDRS

Standards may differ from the CDCStandards may differ from the CDC

Arose from inability to capture details and nuancesArose from inability to capture details and nuances

Over 90 new elementsOver 90 new elements

First year of completed data: calendar year 2007First year of completed data: calendar year 2007

Currently working on calendar year 2008Currently working on calendar year 2008

Additional information about 346 (71.6%) suicide victims with a Additional information about 346 (71.6%) suicide victims with a mental health problemmental health problem

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General Suicide CircumstancesGeneral Suicide Circumstances Crisis in past 24 hours (19.7%, or 61.0% of those with a Crisis in past 24 hours (19.7%, or 61.0% of those with a

crisis in past two weeks)crisis in past two weeks)

Took prescribed pain medication, past two months (16.4%)Took prescribed pain medication, past two months (16.4%)

Sleeping too little (15.1%) or too much (0.4%)Sleeping too little (15.1%) or too much (0.4%)

Unusual behavior, past two weeks (5.4%)Unusual behavior, past two weeks (5.4%)

Family history of suicide (4.1%)Family history of suicide (4.1%)

Loved ones not surprised by suicide (2.9%)Loved ones not surprised by suicide (2.9%)

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Disclosed Intent to Commit SuicideDisclosed Intent to Commit Suicide

Disclosed intent to:Disclosed intent to: Family members (35.1%)Family members (35.1%)

Intimate partners (current/former) (32.1%)Intimate partners (current/former) (32.1%)

Friends/acquaintances (18.3%)Friends/acquaintances (18.3%)

Mental health professionals (6.9%)Mental health professionals (6.9%)

Medical personnel (4.6%)Medical personnel (4.6%)

Corrections Officers/other corrections staff (2.3%)Corrections Officers/other corrections staff (2.3%)

2525



Reactions to disclosed intent:Reactions to disclosed intent: Action taken to prevent suicide (34.4%)Action taken to prevent suicide (34.4%)

Threats not taken seriously (11.5%)Threats not taken seriously (11.5%)

Threats taken seriously, no action taken to prevent Threats taken seriously, no action taken to prevent suicide (1.5%)suicide (1.5%)

2626



Actions taken by loved ones to prevent suicide (Actions taken by loved ones to prevent suicide (n n = 45):= 45): Sought some form of mental health treatment (including Sought some form of mental health treatment (including

hospitalization) (28.9%)hospitalization) (28.9%)

Limited access to firearms (20.0%) or ammunition (2.2%)Limited access to firearms (20.0%) or ammunition (2.2%)

Checked on victim (17.8%)Checked on victim (17.8%)

Tried to persuade victim to not commit suicide(15.6%)Tried to persuade victim to not commit suicide(15.6%)

Called 911/law enforcement (13.3%)Called 911/law enforcement (13.3%)

Monitored victim (6.7%)Monitored victim (6.7%)

2727


Past 24 hours (21.2%)Past 24 hours (21.2%)

25 hours – 7 days (27.3%)25 hours – 7 days (27.3%)

8 – 14 days (9.1%)8 – 14 days (9.1%)

15 – 31 days (6.1%)15 – 31 days (6.1%)

32 days – 6 months (15.2%)32 days – 6 months (15.2%)

7 – 12 months (6.1%)7 – 12 months (6.1%)

1 year – 2 years (6.1%)1 year – 2 years (6.1%)

Over 2 years (9.1%)Over 2 years (9.1%)


Time between Time between firstfirst disclosure of intent and completed disclosure of intent and completed suicide (suicide (n n = 33):= 33):

2828


Mental Health ProblemsMental Health Problems

General issues:General issues: Ever given a TDO/ECO (5.2%)Ever given a TDO/ECO (5.2%)

Mental health records classify victim as not a threat to Mental health records classify victim as not a threat to self or others/not suicidal (2.5%)self or others/not suicidal (2.5%)

Hopeless about resolving/dealing with mental health Hopeless about resolving/dealing with mental health problems (2.1%)problems (2.1%)

2929



Type of mental health professional seen, Type of mental health professional seen, past two monthspast two months:: Psychiatrist (23.4%)Psychiatrist (23.4%)

Primary care physician (7.0%)Primary care physician (7.0%)

Medical doctor (type not specified) (2.7%)Medical doctor (type not specified) (2.7%)

Psychologist (0.6%)Psychologist (0.6%)

3030



Type of mental health professional seen Type of mental health professional seen everever:: Psychiatrist (32.1%)Psychiatrist (32.1%)

Primary care physician (5.4%)Primary care physician (5.4%)

Medical doctor (type not specified) (3.3%)Medical doctor (type not specified) (3.3%)

Psychologist (0.6%)Psychologist (0.6%)

3131


8 – 14 days (0.2%)8 – 14 days (0.2%)

15 – 31 days (0.6%)15 – 31 days (0.6%)


7 – 12 months (0.4%)7 – 12 months (0.4%)




Time between Time between firstfirst visit to a mental health professional and visit to a mental health professional and completed suicide:completed suicide:

3232


Past 24 hours (2.3%)Past 24 hours (2.3%)

25 hours – 7 days (5.4%)25 hours – 7 days (5.4%)

8 – 14 days (2.5%)8 – 14 days (2.5%)

15 – 31 days (3.9%)15 – 31 days (3.9%)


7 – 12 months (0.8%)7 – 12 months (0.8%)




Time between Time between lastlast visit to a mental health professional and visit to a mental health professional and completed suicidecompleted suicide

3333


Usage of Mental Health Medications for Suicide Victims with a Current Mental Health Problem

Ever, But Not in Past 31 Days,

12.4%

Past 31 Days, 48.7%

Never /Unknown, 38.9%


3434

Questions, Data RequestsQuestions, Data Requests

Marc LeslieMarc Leslie

VVDRS CoordinatorVVDRS Coordinator

Address: 737 N. 5Address: 737 N. 5thth Street Street

Suite 301Suite 301

Richmond, VA 23219Richmond, VA 23219

Phone: 804-205-3855Phone: 804-205-3855

E-mail: [email protected]: [email protected]

Documents

Suicide and Mental Health in Virginia: 2003-2007 Marc Leslie Virginia Violent Death Reporting System Office of the Chief Medical Examiner Virginia Department