EDC Learning. Making the Case for a Comprehensive Approach to Suicide Preven9on and Injury Preven9on

Transcription

1 Making the Case for a Comprehensive Approach to Suicide Preven9on and Injury Preven9on A New Focus on Commonali1es Instead of Differences Jerry Reed, PhD, MSW August 4, 2016

2 The River

3 Injury Defined An act that damages or hurts Injury Inten1onal (Violence) Uninten1onal

4 A Typology of Violence Source: World Health Organiza1on

5 Commonali9es among Different Types of Injury Mechanisms Falls Fire and heat Firearm Motor vehicle Struck by / against Water SeUngs Medical Outcome Uninten1onal Interpersonal Violence Self- Directed Violence

6 Suicide by Means, U.S., 2014 Suffoca9on 27% Other 2% Cut Pierce 2% Drowning 1% Fall 2% Firearm 50% Poisoning 16% Source: CDC WISQARS Fatal Reports, 2014

7 Scope of the Problem

8 5 Leading Causes of Death, U.S., 2014 Source: CDC WISQARS Fatal Report, 2014

9 Deaths Are Not the Whole Picture Deaths 199,756 Hospitaliza9ons 2,521,244 Emergency Department Visits 26,997,976 Source: CDC WISQARS Fatal and Non- Fatal Reports, 2014, All Ages, All Injuries

10 Burden by Intent Suicide Deaths 42,773 ED Visits 121,362 Hospitaliza9ons 214,805 Homicide Deaths 15,809 Hospitaliza9ons 130,785 Uninten9onal Deaths 136,053 Hospitaliza9ons 2,170,947 ED Visits 25,474,794 ED Visits 1,328,758 Source: CDC WISQARS Fatal and Non- Fatal Reports, 2014, All Ages, All Injuries

11 5 Leading Causes of Injury Deaths, U.S., 2014 Source: CDC WISQARS Fatal Reports, 2014

12 5 Leading Causes of Injury Hospitaliza9ons, U.S., 2014 Source: CDC WISQARS Non- Fatal Reports, 2014

13 5 Leading Causes of Injury ED Visits, U.S., 2014 Source: CDC WISQARS Non- Fatal Reports, 2014

14 Leading Causes of Injury, U.S., 2014 Falls Interpersonal Violence Motor Vehicle Crashes Poisoning Suicide and Self- Harm

15 Data Sources Uninten9onal Motor Vehicle Crashes Uninten9onal Falls Suicide and Self- Harm Interpersonal Violence Uninten9onal Poisoning Vital Sta1s1cs X X X X X Hospital Discharge Data Emergency Department Data X X X X X X X X X X Child Welfare Reports X X Violent Death Repor1ng Systems X X X Poison Control Centers X X

16 Iden9fying Risk and Protec9ve Factors

17 Socio- Ecological Model Society Community Policies Culture Social Norms SeUngs or ins1tu1ons in which social rela1onships take place Rela1onship Individual Interac1on between two or more people Personal Characteris1cs Behavior Biological Factors Experience

18 Risk Factors Uninten9onal Motor Vehicle Crashes Uninten9onal Falls Suicide and Self- Harm Interpersonal Violence Uninten9onal Poisoning Neighborhood Poverty X X X X High Alcohol Outlet Density X X X X Poor Behavioral Control / Impulsiveness X X X X Substance Use X X X X X Social Isola1on X X Poor Parent- Child Rela1onships X X Sources: World Health Organiza1on; CDC, Connec1ng the Dots: An Overview of the Links Among Mul1ple Forms of Violence

19 Protec1ve Factors Uninten9onal Motor Vehicle Crashes Uninten9onal Falls Suicide and Self- Harm Interpersonal Violence Uninten9onal Poisoning Associa1on with Prosocial Peers X X X Access to Mental Health and Substance Abuse Services Community Support / Connected- ness Connectedness with a Caring Adult X X X X X X X X X X X X X Source: CDC, Connec1ng the Dots: An Overview of the Links Among Mul1ple Forms of Violence

20 Injuries as Risk Factors Trauma9c Brain Injury In9mate Partner Violence Suicide Risk

21 Trauma9c Brain Injury & Suicide

22 Trauma9c Brain Injury Defined A blow or jolt to the head or a penetrating head injury that disrupts the function of the brain

23 Trauma Defined Psychological Trauma: a deeply distressing or disturbing experience. An experience that produces psychological injury or pain. Physical Trauma: Also known as "injury", is a physiological wound caused by an external source. It can also be described as "a physical wound or injury, such as a fracture or blow".

24 TBI as a Risk Factor for Suicide Trauma1c brain injury is associated with substan1ally elevated risks of premature mortality, par1cularly for suicide, injuries, and assaults, even ader adjustment for sociodemographic and familial factors. Fazel 2014 The risk for commiung suicide is two to four 1mes greater for individuals with TBI than for the general popula1on. Even mild brain injury increases risk. Center for Substance Abuse Treatment 2010

25 TBI and Suicide: Co- Occurring Risk Factors Substance Abuse Can lead to TBI Oden co- occurs with suicidality Can be a symptom of sustaining a TBI When a psychiatric disorder or SUD cooccurs with TBI, the risk for attempted or completed suicide is further increased. Center for Substance Abuse Treatment 2010

26 TBI and Suicide: Co- Occurring Risk Factors Experiences with Violence In1mate Partner Violence Child Maltreatment Veterans

27 In9mate Partner Violence & Suicide

28 In9mate Partner Violence & Suicide Not a One Way Street Suicide Risk In9mate Partner Violence

29 Naviga9ng Cultures Percep1ons of Perpetrators Screening Crisis Lines: Training & Role of Responder Times of High Risk Follow Up

30 Preven9on Strategies

31 Injury Trends Fatal Injuries by Cause, Ages Falls Suicide Homicide Motor Vehicle Poisoning Source: CDC WISQARS Fatal Reports, 2014, Ages <1-19

32 Injury Trends Fatal Injuries by Cause, Ages Falls Suicide Homicide Motor Vehicle Poisoning Source: CDC WISQARS Fatal Reports. 2014, Ages 20-64

33 Injury Trends Fatal Injuries by Cause, Ages Falls Suicide Homicide Motor Vehicle Poisoning Source: CDC WISQARS Fatal Reports. 2014, Age 65+

34 Preven9on Strategies Parent Educa9on School- Wide Interven9ons and Supports Distribu9on & Use of Safety Devices Home Visi9ng Homicide X X X Suicide X X X X Motor Vehicle Crashes X X X X Falls X X X X Uninten1onal Poisoning X X

35 Parent Educa9on Interpersonal Violence Suicide Motor Vehicle Falls Poisoning Triple P Posi1ve Paren1ng Program hnp:// en/home/ Parent- Child Interac1on Therapy Training in non- violent problem solving skills Coping skills Triple P Posi1ve Paren1ng Program hnp:// en/home/ Incredible Years hnp://incredibleyears.com/ Strengthening Families Program hnp:// Counseling on Access to Lethal Means (CALM) Project hnp://legacy.nreppadmin.net/viewinterven1on.aspx?id=15 Safety seat educa1on that is provided by physicians and other health care professionals in clinical seungs Proper installa1on and use of safety seats and booster seats through hands- on educa1on Parent involvement in teen driving through knowledge of Graduated Driver Licensing regula1ons (Parents Are the Key to Safe Teen Drivers - - A campaign from the CDC) Parent/teen driving agreements that address Graduated Driver Licensing requirements An1cipatory guidance from physicians about falls and trauma1c brain injuries Social norms campaigns, such as the Children Can t Fly Program hnp:// An1cipatory guidance from physicians about safe storage of medica1ons out of reach of children and prompt and appropriate disposal of unused or expired medica1ons to prevent misuse by children and adolescents Children s Safety Network

36 School- Wide Interven9ons & Supports Interpersonal Violence Suicide Motor Vehicle Falls Preschool programs, such as state pre- K and Head Start Social and emo1onal learning programs, such as the Good Behavior Game ( hnp://legacy.nreppadmin.net/viewinterven1on.aspx?id=201) and Coaching Boys into Men (hnp:// School- Wide Posi1ve Behavioral Interven1ons and Supports (PBIS) (hnps://pbis.org) Good Behavior Game (hnp://legacy.nreppadmin.net/viewinterven1on.aspx?id=201) Sources of Strength (hnp://legacy.nreppadmin.net/viewinterven1on.aspx?id=248) Linking Educa1on and Awareness of Depression and Suicide (LEADS) for Youth Curriculum Coping and Support Training (CAST) ( hnp:// programs/cast- coping- and- support- training) Peer- to- peer educator programs, such as: Teens in the Driver s Seat (hnp:// updates/eupdate- 9.html#) Impact Teen Drivers (hnp://impacneendrivers.org/ Champion Schools Program (hnp:// schools) Return to Play Guidelines & Coach Training ( hnp:// Children s Safety Network

37 Distribu9on & Use of Safety Devices Suicide Cabinet locks and gun locks (Reducing a Suicidal Person s Access to Lethal Means of Suicide: A Research Agenda ( hnp:// Motor Vehicle Free or reduced cost child safety seats and booster seats combined with proper installa1on and use of these seats (Na1onal Child Safety Seat Distribu1on Program Evalua1on Assesses Training, NHTSA, hnp:// +Safety+Seat+Distribu1on+Program+Evalua1on+Assesses+Training) Falls Installa1on of stair guards Installa1on of window guards Use of bicycle helmets Safe playground design, especially installa1on of protec1ve surfaces and removal of especially dangerous equipment Children s Safety Network

38 Home Visi9ng Interpersonal Violence Suicide Nurse- Family Partnership (hnp:// CDC s Essen1als for Childhood: Steps to Create Safe, Stable, and Nurturing Rela1onships and Environments for All Children ( hnp:// Conduct psychosocial screening Provide guidance on reducing access to lethal means Motor Vehicle Falls Poisoning Educa1on, distribu1on, and installa1on of child safety seats and booster seats Educa1on about the importance of consistent use of seat belts by older children and teens Use of home safety checklist to iden1fy and remove fall hazards (American College of Preventa1ve Medicine Childhood Injury Risk Assessment Tool hnp:// Safe storage of household chemical products to keep them out of the reach of children Safe storage of medica1ons out of reach of children and prompt and appropriate disposal of unused or expired medica1ons to prevent misuse by children and adolescents Children s Safety Network

39 Future Direc9ons

40 Moving to a Comprehensive Approach Collect and analyze data to iden1fy geographic areas, seungs, and popula1ons at increased risk of injuries and suicide Work across programs, departments, agencies, and disciplines to reduce and eliminate silos Build coali1ons and networks that understand the commonali1es among different types of injuries

41 Moving to a Comprehensive Approach Iden1fy cross- cuung risk and protec1ve factors Screen for and address mul1ple risk factors Strengthen mul1ple protec1ve factors Implement and scale up cross- cuung preven1on strategies

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46 References Alaska Mental Health Trust Authority (2007) Alaska Suicide Follow-back Study Final Report: Alcaraz. Charlie (2014) Traumatic Brain Injury (TBI): The Substance Abuse Connection Pima Prevention Partnership: Presentation to the TBI CoP June 4 th, Belanger HG, Curtiss G, Demery JA, Lebowitz BK, Vanderploeg RD. Factors moderating neuropsychological outcomes following mild traumatic brain injury: a meta-analysis. J Int Neuropsychol Soc. 2005;3: Brenner, Lisa A. PhD, ABPP; Ignacio, Rosalinda V. MS; Blow, Frederic C. PhD Suicide and Traumatic Brain Injury Among Individuals Seeking Veterans Health Administration Services Journal of Head Trauma Rehabilitation: July/August Volume 26 - Issue 4 - p doi: /HTR.0b013e31821fdb6e Center for Substance Abuse Treatment. (2010). Treating Clients With Traumatic Brain Injury. Substance Abuse Treatment Advisory, Volume 9, Issue 2. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2005) [2016, June 28]. Available from URL: Children s Safety Network. (2016). Evidence-Based Strategies and Readings for Child Safety CoIIN. Waltham, MA: Education Development Center, Inc. Fazel S, Wolf A, Pillas D, Lichtenstein P, Långström N. Suicide, Fatal Injuries, and Other Causes of Premature Mortality in Patients With Traumatic Brain Injury: A 41-Year Swedish Population Study. JAMA Psychiatry. 2014;71(3): doi: /jamapsychiatry Iverson, Grant L, (2013) Chronic traumatic encephalopathy and risk of suicide in former athletes Br J Sports Med bjsports published Online First: 31 October 2013doi: /bjsports

47 References Klonoff PS, Lage GA (1995) Suicide in patients with traumatic brain injury: risk and prevention. J Head Trauma Rehabil 10: Kuipers, P. & Lancaster, A. (2000). Developing a suicide prevention strategy based on the perspectives of people with brain injuries. The Journal of Head Trauma Rehabilitation, 15, (6): Leon-Carrion J (1997) An approach to the treatment of affective disorders and suicide tendencies after TBI. in Neuropsychological rehabilitation: fundamentals, innovation and directions. ed León-Carrión J (GR/St Lucie Press, Delray Beach, FL), pp M. V. Morton, P. Wehman (1995) Psychosocial and emotional sequelae of individuals with traumatic brain injury: a literature review and recommendations Brain Injury 9:1, Mazaux, Jean-Michel; Masson, Francoise; Levin, Harvey S.; Alaoui, Patrice; Maurette, Pierre et al. (1997) Long-term neuropsychological outcome and loss of social autonomy after traumatic brain injury Archives of Physical Medicine and Rehabilitation vol. 78 (12) p Ownsworth TL, Oei TP (1998) Depression after traumatic brain injury: conceptualization and treatment considerations. Brain Inj 12: Persinger MA (1994) Sense of a presence and suicidal ideation following traumatic brain injury: indications of right-hemispheric intrusions from neuropsychological profiles. Psychol Rep 75: Silver, J.M., Kramer, R., Greenwald, S., Weissman, M. (2001). The association between head injuries and psychiatric disorders: findings from the New Haven NIMH Epidemiological Catchment Area Study. Brain Injury, 15 (11): Simpson G. and Tate, R. (2005). Clinical Features of Suicide Attempts After Traumatic Brain Injury. The Journal of Nervous and Mental Disease, 13, 10, Simpson, G. & Tate, R. (2002). Suicidality after traumatic brain injury: demographic, injury and clinical correlates. Psychological Medicine, 32,

48 References Tate R, Simpson G, Flanagan S, et al. (2000) Completed suicide after traumatic brain injury. J Head Trauma Rehabil 12:16 28 Teasdale TW, Engberg AW (2000) Disability pensions in relation to traumatic brain injury: a population study. Brain Inj 14: Teasdale, T. W. & Engberg, A. W. (2001). Suicide after traumatic brain injury: A population study. The Journal of Neurology, Neurosurgery and Psychiatry, 71, (4): Wilkins, N., Tsao, B., Hertz, M. Davis, R., Klevens, J. (2014). Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Oakland, CA: Prevention Institute. World Health Organization. (2002). World Report on Violence and Health: Summary. Geneva. A Typology of Violence, Pg. 5.

49 Contact Informa9on Jerry Reed, PhD, MSW Educa1on Development Center (202)