Suicide in the Central Health Planning Region, 2003-2008 Marc E. Leslie Coordinator, Virginia Violent Death Reporting System Office of the Chief Medical

Suicide in the Central Health Planning Region, 2003-2008Marc E. LeslieCoordinator, Virginia Violent Death Reporting SystemOffice of the Chief Medical Examiner, Virginia Department of Health

Presented by Stephanie GoodmanInjury Data and Evaluation CoordinatorOffice of Family Health Services, Virginia Department of Health

The Central Health Planning Region Suicide Prevention Summit June 1, 2011Chesterfield County, VA

Map of the Central Health Planning Region (HPR)

2

Halifax

Sussex

Surry

Brunswick

Mecklenburg

Charlotte

Dinwiddie

Lunenburg

Nottoway

Greensville

Prince Edward

Hanover

Amelia

Buckingham

Chesterfield

Henrico

Goochland

PowhatanCumberland New Kent

Prince George

Charles City

Richmond City

Petersburg

Hopewell

Emporia

Colonial Heights

3

Pop Quiz

In the Central Health Planning Region:

1. Average number of suicides per year? (Hint: average of 133 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 Central HPR, 2003-2008

Overview of the Problem

5


Average 2003 2004 2005 2006 2007 20080

20

40

60

80

100

120

140

160

180

148139 141 146

167

139156

Number of Suicides by Year

Year

Nu

mb

er

of

Su

icid

es

6


Total 2003 2004 2005 2006 2007 20080.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

11.4 11.1 11.1 11.312.8

10.511.7

11.3 10.8 11.0 11.3 11.4 11.2 12.0

Suicide Rate by Year

Central HPR Virginia

Year

Su

icid

e R

ate

Pe

r 1

00

,00

0

7


Suicide vs. Homicide (2003-2008)

• 888 suicides; rate of 11.4

• 799 homicides; rate of 10.3

• Suicide slightly more common than homicide

8


Average 2003 2004 2005 2006 2007 20080

200

400

600

800

1000

1200

1400

1,096968 1,002 1,064 1,055

1,197 1,288

Number of Non-Fatal Suicide Attempts by Year

Year

Nu

mb

er

of

Su

icid

e A

tte

mp

ts

9


Total 2003 2004 2005 2006 2007 20080.0

20.0

40.0

60.0

80.0

100.0

120.0

84.777.1 79.0 82.7 81.0

90.796.8

62.3 60.0 61.1 58.2 59.066.4 69.2

Non-Fatal Suicide Attempt Rate by Year


Year

No

n-F

ata

l Su

icid

e R

ate

Pe

r 1

00

,00

0

10


Who is at Risk?

11


Selected Demographic Elements

Gender

Race

Age

12


Race and Gender

• Male (77%, rate of 18.0)

• White (80%, rate of 14.3)

• White males (61%, rate of 21.9), White females (19%, rate of 6.8), and Black males (15%, rate of 10.6) are 95% of all suicide victims

(remember, overall rate for Central HPR is 11.4)

13


Age

• Median age is 46

• Ages 45-54 most common age group (23%) and second highest rate (17.1)

• Highest rate for those 85 and over (17.7)

14


Total

10-1

415

-19

20-2

425

-34

35-4

445

-54

55-6

465

-74

75-8

4

85 a

nd o

lder

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

Suicide Rate by Age Group


Age Group

Su

icid

e R

ate

Pe

r 1

00

,00

0

15


Race and Gender: Non-Fatal Attempts

• Most commonly by females (61%, rate of 100.9)

• Whites still most common and highest risk; but Black risk level rises notably (from rate of 6.3 to 69.6)

16


Total Male Female0.0

20.0

40.0

60.0

80.0

100.0

120.0

11.4 18.0 5.2

84.767.6

100.9

Fatal and Non-Fatal Suicide Rates by Gender

Fatal Non-Fatal

Gender

Ra

te P

er

10

0,0

00

17


Age: Non-Fatal Attempts

• Median age is 33

• Risk increases for all age groups except 85 and over

• 21 times increase for those ages 15-19

• In general, non-fatal attempt rate decreases with age

18


Total 5-

910

-14

15-1

920

-24

25-3

435

-44

45-5

455

-64

65-7

475

-84

85 a

nd o

lder

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0Non-Fatal and Fatal Suicide Rate by Age Group

Non-Fatal Fatal

Age Group

Ra

te P

er

10

0,0

00

At ages 85 and older, the fatal rate surpasses

the non-fatal rate

19


Veterans

20


Veterans

• 22% of all suicide victims (18 years and older)

• 21% of males; 1% of all 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 44, respectively)

• Median age suggests that those who are combat veterans generally not in the most recent conflicts

• 61% of males ages 65 and over are veterans compared to 20% of males ages 18-64

22


Method of Fatal Injury

23



• 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 94% of suicides

• Most poisons are prescribed medications, primarily mental health medications and pain medications

24


Total Males Females0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

61.0 67.7

39.1

17.318.2

14.5

15.3 8.8

36.7

Selected Methods by Gender

Poison

Hanging/Suffocation

Firearm

Gender

Pe

rce

nta

ge

Usi

ng

Me

tho

d

25


Method of Fatal Injury: Non-Fatal Attempts

• Most common method for non-fatal attempts is poison (78%)

• Poison use is defining method difference between fatal and non-fatal attempts

26


Geography

27


Geography

• Central HPR has 27 localities (22 counties and 5 cities)

• 12 of these localities (44%) have a suicide rate exceeding the rate for Virginia (11.3)

• In general smaller locality = lower number and higher rate

28


# Rate

Five Highest Suicide Rates

Amelia 14 18.9

New Kent 18 18.3

Mecklenburg 35 18.0

Emporia 6 17.7

Prince George 34 15.9

# Rate

Five Lowest Suicide Rates

Surry 2 4.7

Greensville 4 5.8

Charles City 3 7.0

Cumberland 4 7.1

Hopewell 11 8.1

29


Halifax

Sussex

Surry

Hanover

Brunswick

Mecklenburg

Charlotte

Amelia

Dinwiddie

Buckingham

Lunenburg

Chesterfield

Nottoway

Henrico

Greensville

Goochland

Powhatan

Prince Edward

New Kent

Prince George

Charles City

CumberlandRichmond City

Petersburg

Hopewell

Emporia

Colonial Heights

Rate per 100,000

5 - 8

9 - 11

12 - 15

16 - 19

30


Halifax

Sussex

Surry

Hanover

Brunswick

Mecklenburg

Charlotte

Amelia

Dinwiddie

Buckingham

Lunenburg

Chesterfield

Nottoway

Henrico

Greensville

Goochland

Powhatan

Prince Edward

New Kent

Prince George

Charles City

CumberlandRichmond City

Petersburg

Hopewell

Emporia

Colonial Heights

Rate per 100,000

4.7 - 11.3

11.4 - 18.9

31


Selected Circumstances

32


Most Common Circumstances

• Mental health problem (57%)

• Crisis in past two weeks (39%)

• Intimate partner problem (36%)

• Problem with alcohol and/or other substances (25%)

• Physical health problem (21%)

33


Circumstances: Mental Health

• Females (75%) more than males (51%)

• Most prevalent in ages 55-64 (70%); 33% or more of every age group

• 87% 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

• 39% of all persons; 43% of males, 24% of females

• Most crises (72%) occurred in the past 24 hours*

• Indicator of reactive suicides

• 50% or more for age groups 15-19, 20-24, and 25-34

*2007-2008 data

35


Circumstances: Intimate Partner Problems

• 36% having problems with current/former intimate partner at time of suicide

• 39% of males, 29% of females

• 64% also having a recent life crisis

• Shows volatility of intimate partner conflict

36


Total

10-1

415

-19

20-2

425

-34

35-4

445

-54

55-6

465

-74

75-8

4

85 a

nd o

lder

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0Intimate Partner Problems and Crisis by Age Group

Intimate Partner Problem Crisis in Past 2 Weeks

Age Group

Pe

rce

nta

ge

with

Cir

cum

sta

nce

37


Circumstances: Alcohol and Other Substance Problems

• 25% of all persons

• Peaks at ages 35-44 (34%) and 45-54 (33%)

• 47% of those with alcohol problems had elevated levels of alcohol in their system (compared to 13% of those without alcohol problems)

38


Circumstances: Physical Health Problems

• 21% of all suicide victims; 19% of males, 26% of females

• Median age of 58 compared to 44 for those without a physical health problem

• 45% 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

• 50% disclosed intent and/or had prior attempts

• Most commonly disclosed to intimate partners (53%), family (34%), or friends/acquaintances (18%)*

*2007-2008 data

41


Actions Taken to Prevent Suicide*

• Sought/encouraged mental health treatment (38%)

• Limited access to firearms/ammunition (27%)

• Tried to persuade victim to not commit suicide (18%)

• Called 911/law enforcement (12%)

• Checked in on victim (12%)

*2007-2008 data (entire slide)

42


Efforts to Limit Access to Firearms and/or Ammunition*

• 16 persons had friends or family members who restricted access to firearms or ammunition

• Includes 7 persons not known to disclose intent, but loved ones acted out of concern

• Variety of techniques used to restrict (hiding, removing, disassembling)

• Of these persons, 15 (94%) used a firearm to commit suicide


43


In the fatal suicide, those with prior attempts used less lethal methods than those without prior attempts

Firearm67%

Poison12%

Hanging/Suffocation

16%

Other5%

No Prior Suicide Attempts

Firearm37%

Poison28%

Hanging/Suffocation

23%

Other11%

Prior Suicide Attempts

44


Other Warning Signs of Suicide*

• Sleeping too little (17%)

• Taking prescribed pain medication (16%)

• Unusual behavior, past two weeks (8%)

• Family history of suicide (5%)

• Family/friends expected suicide (4%)


45


Conclusions

• Suicide rates are highest among Whites, males, and middle-aged and older adults

• Most suicides involve use of a firearm to inflict fatal injury

• The majority of suicide victims have a mental health problem, and most of these persons were being treated

46


Conclusions

• 50% 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

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 Slide

Demographics

Gender 51

Race 51

Ethnicity 51

Race/Gender 52

Age Group 53

Veterans

Male Age Group/Veteran 56


Complete List of Methods 57

Selected Methods by Age 58

Categories of Poison 59

Most Common Poisons 60

Information Slide

Locality-Specific

Number/Rate by Locality 62-64

Circumstances

Relationship Problems 65

Life Stressors 65

Alcohol/Other Substances 66

Mental Health 67-68

Warning Signs of Suicide 69

Disclosed Intent 70

Actions to Prevent Suicide 71-72

Prior Suicide Attempts 73

Other Warning Signs 74

Index: Fatal Suicide

50


Information Slide

Non-Fatal Suicide

Gender 54

Race 54

Ethnicity 54

Age Group 55


Complete List of Methods 61

Index: Non-Fatal Suicide

51


# % Rate

Gender

Male 681 76.7 18.0

Female 207 23.3 5.2

Race

White 712 80.2 14.3

Black 161 18.1 6.3

Asian 9 1.0 4.8

Native American 3 0.3 9.7

Other 3 0.3 -

Ethnicity

Hispanic 14 1.6 5.6

TOTAL 888 100.0 11.4

52


# % Rate

Selected Race/Gender

White male 540 60.8 21.9

Black male 130 14.6 10.6

White female 172 19.4 6.8

Black female 31 3.5 2.3

The White male suicide rate is more than twice the rate for Black males, 3.2 times the rate for White females, and almost 10 times the rate for Black females.

53


# % Rate

Age Group

10-14 9 1.0 1.7

15-19 41 4.6 7.4

20-24 75 8.4 13.9

25-34 108 12.2 10.5

35-44 172 19.4 14.6

45-54 201 22.6 17.1

55-64 138 15.5 16.3

65-74 77 8.7 15.8

75-84 45 5.1 13.7

85 and older 22 2.5 17.7

TOTAL 888 100.0 11.4

Highest risk: ages 85 and older

Largest percentage of victims: ages 45-54

54

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

# % Rate

Gender

Male 2,566 39.0 67.6

Female 4,007 61.0 100.9

Unknown 1 <0.1 -

Race

White 4,446 67.6 89.0

Black 1,773 27.0 69.6

Asian 45 0.7 24.0

Native American 5 0.1 16.2

Other 215 3.3 -

Unknown 90 1.4 -

Ethnicity

Hispanic 142 2.2 57.0

TOTAL 6,574 100.0 84.7

55

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

# % Rate

Age Group

5-9 6 0.1 1.2

10-14 242 3.7 46.2

15-19 882 13.4 158.9

20-24 866 13.2 160.1

25-34 1,451 22.1 140.8

35-44 1,573 23.9 133.7

45-54 1,056 16.1 89.9

55-64 348 5.3 41.2

65-74 85 1.3 17.4

75-84 52 0.8 15.8

85 and older 12 0.2 9.6

Unknown 1 <0.1 -

TOTAL 6,574 100.0 84.7

Largest percentage: ages 35-44

Greatest risk: ages 20-24

56


Total

18-1

920

-24

25-3

435

-44

45-5

455

-64

65-7

475

-84

85 a

nd o

lder

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

27

.5

0.0 1

3.6

11

.3 20

.0

21

.5 34

.6 46

.7

80

.0

68

.4

72

.5

10

0.0 86

.4

88

.8 80

.0

78

.5 65

.4 53

.3

20

.0

31

.6

Male Age Group and Veteran Status

Non-Veteran

Veteran

Age Group

Pe

rce

nta

ge

Wh

o a

re V

ete

ran

s

57


# %


Firearm 542 61.0

Hanging/Suffocation 154 17.3

Poison 136 15.3

Fall 22 2.5

Drowning 13 1.5

Motor Vehicle 8 0.9

Sharp Instrument 8 0.9

Fire or Burn 6 0.7

Other 1 0.1

94% of all suicides

58


Total

10-1

415

-19

20-2

425

-34

35-4

445

-54

55-6

465

-74

75-8

4

85 a

nd o

lder

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0Selected Methods of Injury by Age

Poison

Hanging/Suffocation

Firearm

Age Group

Pe

rce

nta

ge

Usi

ng

Me

tho

d

59


# %

General Category of Poison

Prescription Medication 97 71.3

Carbon Monoxide 21 15.4

Over-the-Counter Medication 21 15.4

Alcohol 7 5.1

Street Drugs 5 3.7

Other 6 4.4

Percentages are based on the number of poisoning suicides (n = 136).

60

Suicide in the Central HPR, 2003-2008# %

Most Common Poisons

Amitriptyline* 17 12.5

Methadone** 12 8.8

Propoxyphene** 12 8.8

Morphine** 11 8.1

Diphenhydramine 10 7.4

Acetaminophen 10 7.4

Quetiapine* 9 6.6

Citalopram* 9 6.6

Alprazolam* 8 5.9

Oxycodone** 7 5.1

Bupropion* 7 5.1

Percentages based on the number of poisoning suicides (n = 136). Poisons used by 7 or more persons are listed.

* Commonly prescribed for mental health treatment

** Commonly prescribed for pain management

61

Non-Fatal Suicide Attemptsin the Central HPR, 2003-2008

# %


Poison 5,144 78.2

Sharp Instrument 1,067 16.2

Firearm 56 0.9

Hanging/Suffocation 35 0.5

Fall 29 0.4

Fire or Burn 23 0.3

Motor Vehicle 13 0.2

Hot Object/Substance 3 <0.1

Drowning 1 <0.1

Other Natural/Environmental 1 <0.1

Other 145 2.2

Unspecified 57 0.9

62


# Rate

Amelia 14 18.9

Brunswick 13 12.1

Buckingham 13 13.6

Charles City 3 7.0

Charlotte 7 9.4

Chesterfield 185 10.6

Colonial Heights 10 9.5

Cumberland 4 7.1

Dinwiddie 22 14.4

Emporia 6 17.7

Number and Rate (per 100,000) of Suicides by Locality of Residence

63


# Rate

Goochland 15 12.7

Greensville 4 5.8

Halifax 27 12.5

Hanover 73 12.5

Henrico 185 10.9

Hopewell 11 8.1

Lunenburg 12 15.3

Mecklenburg 35 18.0

New Kent 18 18.3

Number and Rate (per 100,000) of Suicides by Locality of Residence (continued)

64


# Rate

Nottoway 9 9.6

Petersburg 18 9.2

Powhatan 18 11.2

Prince Edward 12 9.6

Prince George 34 15.9

Richmond City 130 11.1

Surry 2 4.7

Sussex 8 11.0

Central HPR 888 11.4

Virginia 5,146 11.3

Number and Rate (per 100,000) of Suicides by Locality of Residence (continued)

65


# %

Relationship Characteristics

Intimate Partner Problem 314 36.2

Non-intimate Relationship Problem 75 8.6

Life Stressor Characteristics

Crisis within Two Weeks of Suicide* 334 38.5

Physical Health Problem 181 20.9

Financial Problem 121 13.9

Recent Criminal Legal Problem 113 13.0

Job Problem 108 12.4

Death/Suicide of Family/Friend 71 8.2

Perpetrator of Interpersonal Violence 68 7.8

Percentages are based on the number of suicides with at least one known circumstance (n = 868).

* Of these, 72% had a crisis in past 24 hours (2007-2008 data)

66


# %

Substance Use Characteristics

Problem with Alcohol/Other Substances 219 25.2

Problem with Alcohol 89 10.3

Problem with Other Substances 80 9.2

Problem with Alcohol and Other Substances 50 5.8


67


# %

Mental Health Problems

Current Mental Health Problem 495 57.0

Diagnosis: Depression 385 44.4

Diagnosis: Bipolar 67 7.7

Diagnosis: Anxiety Disorder 59 6.8

Diagnosis: Schizophrenia 25 2.9

Mental Health Treatment 429 49.4

Current Mental Health Treatment 385 44.4

Noncurrent Mental Health Treatment 44 5.1

Percentages are based on the number of suicides with at least one known circumstance (n = 868). Diagnoses are not exclusive, but represent the most common diagnoses.

68


# %

Use of Prescribed Mental Health Medications

Used in Past 31 Days and/or Prior 125 70.6

Used in Past 31 Days 109 61.6

Used, But Not in Past 31 Days 16 9.0

Unknown/Never Used 52 29.4

Percentages are based on the number of victims with a mental health problem (n = 177). Data are from 2007-2008.

69


# %

Warning Signs of Suicide

Disclosed Intent/History of Attempts 435 50.1

Disclosed Intent to Commit Suicide 339 39.1

History of Suicide Attempts 190 21.9


70


# %

Person to Whom Victim Disclosed Intent

Intimate Partner (Current/Former) 41 53.2

Family Members 26 33.8

Friends/Acquaintances 14 18.2

Mental Health Professional 5 6.5

Medical Personnel 3 3.9

Percentages are based on the number of victims who disclosed intent and where this information is known (n = 77). Data are from 2007-2008.

71


# %

Type of Action Taken to Prevent Suicide

Sought Mental Health Treatment 13 38.2

Limited Access to Firearms and/or Ammunition 9 26.5

Tried to Persuade Victim 6 17.6

Called 911/Law Enforcement 4 11.8

Checked on Victim 4 11.8

Monitored Victim 2 5.9

Percentages are based on the number of suicides where someone took action to prevent the suicide (n = 34). Data are from 2007-2008.

Some victims had family, friends, or others who reacted to the disclosed intent and tried to prevent the suicide

72


# %

How Firearm Access was Restricted

Removed; all firearms 6 42.9

Hidden (not locked) 3 21.4

Involuntary mental health commitment 1 7.1

Removed; all but one firearm 1 7.1

Removed; gave back later 1 7.1

Removed; locked away 1 7.1

Removed; victim purchased a new firearm 1 7.1

Percentages are based on the number of victims where it was known how firearm access was restricted (n = 14). Data are from 2007-2008.

73


# %

Number of Prior Suicide Attempts

One 34 61.8

Two 6 10.9

Three 3 5.5

Four or more 1 1.8

Multiple, unspecified 11 20.0

Percentages are based on the number of victims with a known number of prior attempts (n = 55). Data are from 2007-2008.

74


# %

Other Warning Signs

Sleep Problems 51 17.6

Sleeping Too Little 49 17.0

Sleeping Too Much 2 0.7

Took Prescribed Pain Medication, Past Two Months 45 15.6

Unusual Behavior, Past Two Weeks 23 8.0

Family History of Suicide 15 5.2

Did Not Want to be a Burden 10 3.5

Family/Friends Expected Suicide 10 3.5

Percentages are based on the number of suicides with at least one known circumstance (n = 289). Data are from 2007-2008.

Documents

Suicide in the Central Health Planning Region, 2003-2008 Marc E. Leslie Coordinator, Virginia Violent Death Reporting System Office of the Chief Medical