Suicide in North Carolina and the Nation

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1 Suicide in North Carolina and the Nation Intentional Death Prevention Committee Child Fatality Task Force Injury Epidemiology and Surveillance Unit October 10, 2011

2 Today s Agenda Overview US and NC NC-Violent Death Reporting System (NC- VDRS) Hospitalization and ED data YRBS data Q&A

3 Overview

4 Overview Suicide is a significant public health problem for all states. Agencies need to understand the precipitating circumstances for prevention. NC-Violent Death Reporting System (NC- VDRS) is a multi-source system that attempts to provide a full picture of violent deaths including suicides.

5

6 Age-Adjusted Suicide Rate per 100,000 persons Age-Adjusted Suicide Rate for Ages 10 or Older in North Carolina and the United States Over Time* North Carolina Figure 5: Age-Adjusted Suicide Rate for Ages 10 or Older in North Carolina and the United States Over Time* United States Year

7

8 Age-Adjusted Suicide Rate per 100,000 persons Age-Adjusted Suicide Rate for Ages in North Carolina and the United States Over Time* 6 North Carolina United States Figure 5: Age-Adjusted Suicide Rate for Ages 10 or Older in North Carolina and the United States Over Time* Year

9 Suicides are Only the Tip of the Iceberg 1,160* Deaths 6,571* Hospitalizations 9,655* ED Visits For every death 5.6 hospitalized 8.3 ED visits???,??? EMS???,??? Outpatient Visits?,???,??? Medically Unattended Injury (home, work, school) INJURY ICEBERG * 2010 provisional death file, 2009 for hospitalization discharge and 2010 for NC DETECT (Emergency Department visits)

10 North Carolina Violent Death Reporting System (NC-VDRS)

11 What is the National Violent Death Reporting System (NVDRS)? 1. Population-based, public health reporting system on deaths from violence managed by the CDC Funding through competitive application Ultimate goal to fund 50 states and territories 2. Data are collected by states and sent to CDC Data on homicides, suicides, and deaths from unintentional firearm, legal intervention and undetermined intent obtained from multiple sources Personal identifiers are removed 3. Provides timely and detailed data on incidents where someone is killed by violence, including victims, suspects, weapons, circumstances and their inter-relationships.

12 Currently Funded NVDRS States, 2010

13 Introduction to NC-VDRS NC-VDRS was funded in 2003 and since 2004 has been working with the NC State Center for Health Statistics, Office of the Chief Medical Examiner and local law enforcement agencies to collect data on all deaths from violence that occur in North Carolina. From inception, NC-VDRS indentified and consulted with many stakeholders working on violence prevention at the state level. NC-VDRS has complete data for Data for 2010 & 2011 will be forthcoming.

14 Key Findings

15 1200 Suicide Deaths by Year: NC-VDRS,

16 Suicide Deaths by Year: NC-VDRS, to 17 Ages

17 Per 100,000 persons Suicide Rates by Sex and Age Group: NC-VDRS, Female Rate Male Rate to >84

18 Percentage of Suicide by Sex: NC-VDRS, Females-23.2% Males-76.8% Females-24.2% Males-75.8% Suicide deaths = 5,366 All ages (10+) 90% white/9% black; 59% firearm/19% poisoning 16% hanging Suicide deaths = 128 Ages % white/23% black 45% firearm/46% hanging

19 Suicide Circumstances: Mental Health & Substance Abuse, NC-VDRS: Current Mental Health Problem Current Mental Health Treatment Current Depressed Mood Alcohol Problem Males (N=79) Other Substance Problem Ages Females (N=27) Circumstances are known for 81% males & 87% females

20 Suicide Circumstances: Interpersonal, NC-VDRS: Intimate Partner Problem Other Relationship Problem Other death of Family/Friend past 5yrs Victim of IPV past month Perpetrator of IPV past month Males (N=79) Suicide of Family/Friend in past 5yrs Ages Females (N=27) Circumstances are known for 81% males & 87% females

21 Suicide Circumstances: Life Stressors, NC-VDRS: Crisis during the previous 2 weeks Physical Health problem Job problem Recent criminal legal problem Ages School Problem 7.41 Males (N=79) Females (N=27) Circumstances are known for 81% males & 87% females

22 Suicide Circumstances: Suicide Event, NC-VDRS: History of suicide attempts Disclosed intent to commit suicide Males (N=79) Left a suicide note Females (N=27) Ages Circumstances are known for 81% males & 87% females

23 Suicide Attempts Hosp and ED Map of Suicide Rates for Ages 10 or Older by North Carolina County of Residence ( )

24 Narratives EXAMPLE 1: Victim was a 14 year old female who threatened to hang herself if her siblings told their mother about a boy she had met. The siblings did not consider this a real threat since she had threatened to commit suicide several times before. After the mother went to bed the siblings found the Victim hanging. The Victim's brother cut her down, hid the weapon, and covered the Victim with a blanket. The mother found the Victim's body the next morning. EXAMPLE 2: Victim was a 15 year old male who was found hanging from the upper rung of his bunk bed by a belt which was placed around his neck. Victim's father reported a teacher had come by for a parent teacher conference because Victim had gotten bad grades. Victim was placed on punishment and was very upset he had disappointed his father. Victim's father went outside to smoke and when he returned he found Victim. Victim was taken to a local hospital where he later died.

25 Hospitalizations and ED Visits

26 Rate per 100,000 persons Suicide Attempts Hospitalization Rates, Male Hospitalization Rate Female Hospitalization Rate Age Group (Years)

27 Rate per 100,000 persons Suicide Attempts ED Visit Rates, Male Emergency Visit Rate Female Emergency Visit Rate Age Group (Years)

28 NC Youth Risk Behavior Survey

29 Percentage Percentage of N.C. high school students w ho considered suicide, made a suicide plan, or attem pted suicide, by gender: N.C. YRBS, Co nsidered suicide M ade a suicide plan 5 0 Total Female Male Attempted suicide

30 Economic Impact

31 Suicide- Estimated Lifetime Cost (2005 dollars) Medical Costs Work Loss Cost Combined Costs US (all ages) $99,733,000 $26,631,195,000 $26,730,929,000 US (10-17) $5,516,000 $1,246,994 $1,276,203,000 NC (all ages) $3,443,000 $794,339,000 $797,781,000 NC (10-17) $74,000 $31,780,000 $31,854,000 Source: CDC WISQARS, 2011

32 Estimated Hospitalization Charges for Self-Inflicted Injuries for Ages in North Carolina by Year Year Number of Hospitalizations with Charge Data Average Charges Median Charges Total Charges $7,022 $4,885 $3,539, $7,053 $5,182 $3,329, $7,632 $6,062 $3,617, $8,689 $6,728 $4,718, $8,494 $6,718 $3,924, $8,992 $7,143 $5,458,325 TOTAL 3,062 $8,029 $6,259 $24,587,735

33 Resources & Reports

34

35

36

37 An average day in NC 3 suicides 18 hospitalizations 25 ED visits??? unattended

38 NC Acknowledgements NC IVPB, DPH NC-VDRS Susan Autry Jessica Fine Tammy Norwood NC-VDRS Support Felicia Adams Katherine Harmon NC-VDRS Advisory Board Members NC Office of the Chief Medical Examiner NC State Center for Health Statistics Local Law Enforcement Agencies NC State Bureau of Investigations (SBI)

39 Questions? Scott Proescholdbell North Carolina Violent Death Reporting System Injury and Violence Prevention Branch Chronic Disease and Injury Section NC Division of Public Health

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