In Focus: Suicides Deaths Cape Cod and the Islands 2000 to Prepared by Christine Clements Stein, MPH, PhD Rasneet Sandhu

Transcription

1 In Focus: Suicides Deaths Cape Cod and the Islands 2000 to 2009 Prepared by Christine Clements Stein, MPH, PhD Rasneet Sandhu November 2012

2 For immediate assistance if you or someone you know is in crisis please call the National Suicide Prevention Lifeline at or call the Department of Mental Health Cape & Islands Crisis Hotline at

3 Introduction This summary provides general facts about suicide and data on suicide deaths specific to residents of Cape Cod (Barnstable County), Martha s Vineyard (Duke s County) and Nantucket from 2000 to We also provide a focused discussion about suicide in three high risk populations: youth and young adults, middle-aged men, and older adults. Unless otherwise noted, the state and regional data are from the Massachusetts Registry of Vital Records and Statistics, extracted using the custom report feature of the Massachusetts Community Health Information Profile (MassCHIP). National data are from the Centers for Disease Control and Prevention (CDC). 2 A note on case counts Consistent with the CDC rule for reporting fatal injury data at the state and county level, we have suppressed any count of suicide deaths fewer than 10 for data 2008 onwards and any data inclusive of The CDC rule aims to protect inadvertent disclosure of individuals who have died from a fatal injury. 3 As the reader will note, we have grouped annual suicide death counts for Cape Cod and the Islands as the yearly count for the islands of Martha s Vineyard and Nantucket is consistently fewer than 10 cases. All cases are those of Cape and Islands residents regardless of where the death occurred. Of note, because of an exchange agreement among states, the death of a Massachusetts resident in another state is reported to and captured by the Massachusetts Registry of Vital Records and Statistics. A note on death rates The suicide death rate is the number of occurrences per 100,000 persons. This allows us to compare a region or population group to itself over time and to others. When reporting suicide death rates for populations as a whole, we have used age-adjusted rates to take into consideration differences in age distribution from one population to another. A difference in the suicide death rate between two populations is not significant alone. To note statistically significant differences we have evaluated the 95% confidence interval around each rate. The range of values in a confidence interval will include the true value of the rate 95% of the time. When two confidence intervals overlap, there is not a statistically significant difference between the rates. 4 We advise monitoring notable differences in rates even if not statistically significant. In keeping with the CDC rule regarding occurrences fewer than 10, and because of the wide confidence intervals for proportions and rates for small counts, we have suppressed death rates per 100,000 persons when the occurrences are fewer than 10. Additionally, rates for occurrences fewer than 20 should be interpreted cautiously, again because of the wide confidence interval for the results. A note on determining a death to be suicide Common questions are who determines a death to be suicide and what criteria are used, these generally arise from concern for under-reporting suicide deaths. Although some deaths may be ruled an undetermined cause, the process for concluding the cause of all deaths particularly injury-related deaths is systematic and rigorous. A good reference for details is the Massachusetts Department of Public Health Report, Massachusetts Deaths P age

4 General Facts About Suicide These facts are drawn from several sources, including CDC, the American Association of Suicidology (ASA), and the Massachusetts Department of Public Health (MDPH). Suicide is a major public health concern. In 2009, suicide was the 10 th leading cause of death in the United States and Massachusetts and the third leading cause of death for adolescents and young adults. In 2009, there were nearly 37,000 suicide deaths in the United States and 531 in Massachusetts. Males are four times as likely to die by suicide as females, but females are three times as likely to attempt suicide. Suicide occurs across ethnic, economic, social and age boundaries. Factors associated with suicide death are many and complex and differ for each person and by factors such as age and sex. According to the MDPH report on Violent Deaths in Massachusetts , the following are common circumstances of suicide deaths: 66 percent had a current depressed mood and/or current mental health problem at the time of death 7 28 percent were experiencing an alcohol or other substance abuse problem 26 percent were experiencing an intimate partner problem 15 percent had a job problem 35 percent left a suicide note 31 percent disclosed their suicidal intent Suicide is preventable. Most suicidal people give warning signals of their suicidal intentions and talking about suicide does not cause someone to become suicidal. A number of Cape Cod and the Islands organizations and coalitions are engaged in suicide prevention activities, including raising awareness about mental health and substance abuse concerns, trainings for professionals and others to learn how to talk with someone who may be at risk for suicide and to refer them for help, and building healthy and resilient communities. 8 I. Suicide Deaths in Total Cape Cod and the Islands Suicide Deaths 249 residents of Cape Cod & the Islands died by suicide from 2000 to 2009 The 249 suicide deaths for the ten-year period 2000 to 2009 comprised 222 residents of Cape Cod, 16 residents of Martha s Vineyard, and 11 residents of Nantucket. As shown in Figure 1, in 2009 alone, there were 30 suicide deaths, which is significant as reflected below in the discussion about suicide death rates. Regardless of statistics, each suicide is traumatic and can have far-reaching consequences for family, friends, and even strangers. 9 Approximately six family members and close friends 2 P age

5 survive the person who dies by suicide, with more survivors extending from that circle such as co-workers, neighbors and fellow students of young people. 10 The loss is often shocking, painful and unexpected and the grief can be intense, complex, and long term. Survivors themselves are at higher risk for suicide. Number of Suicide Deaths Figure 1: Suicide Death Count Cape Cod & Islands (N=249) Cape & Islands II. Suicide Death Rate The suicide death rate for Cape Cod & the Islands is now 1.6 times the Massachusetts rate As shown in Figure 2, for Cape Cod and the Islands: The 2009 age adjusted suicide death rate is 11.9 per 100,000 persons contrasted with 7.7 per 100,000 for Massachusetts and this statistically significant. Massachusetts has one of the lowest suicide death rates in the nation, number 48 of 51, including the District of Columbia. 11 Of note, the 2009 age adjusted suicide death rate for Cape Cod and the Islands is similar to the national rate. The doubling of the age adjusted suicide death rate from 6.2 per 100,000 persons in 2000 to 11.9 per 100,000 in 2009 is notable; however, it is not statistically significant P age

6 Figure 2: Age-Adjusted Suicide Death Rates Age-Adjusted Rate per 100, Year National Massachusetts Cape & Islands III. Suicide Deaths by Demographic Factors In this section, we focus on the most recent five years of available data 2005 to 2009 to provide recent information while ensuring enough cases are available to avoid groupings that are fewer than ten. During the 2005 to 2009 five-year period, there were 141 Cape Cod and Islands suicide deaths comprising 125 Cape Cod residents and 16 residents of Martha s Vineyard and Nantucket. A. Differences by Sex The Cape Cod & Islands ratio of suicide deaths is 4 male to 1 female Figure 3: Suicide Deaths by Sex Cape Cod & Islands 2005 to 2009 (N=141) Female 18% Male 82% The Cape Cod and Islands 4:1 ratio of male to female suicide deaths is consistent with Massachusetts and national norms. Of note, females are three times more likely to attempt suicide than males. 4 P age

7 B. Differences by Age More than half of Cape Cod & the Islands suicide deaths are people ages 40 to 59 years Figure 4: Suicide Deaths by Age Cape Cod & Islands (N=141) 70 yrs and older yrs 8% 11% yrs 12% yrs 16% yrs 23% yrs 30% Note: Although not a grouping of ten years, the ages 25 to 39 years are combined because of the relatively small count in that age span and to avoid percentages from fewer than 10 cases. Table 1 provides additional details on the percentage of suicide deaths by age group for Cape Cod and the Island contrasted with Massachusetts. Table 1: Suicide Deaths by Age: Cape Cod & Islands and Massachusetts, 2005 to 2009 Age in years Cape Cod & Islands MA N % % Under age <1% % 9.9% % 24.3% % 25.1% % 22.2% % 8.6% 70 and older % 9.4% Total % 100% Figure 5 shows the age specific suicide rates per 100,000 persons, which allow us to compare Cape Cod and the Islands with Massachusetts as a whole. Of note: Persons 40 to 59 years are at highest risk for death by suicide. The higher suicide death rate for the 15 to 24 year-old age group for Cape Cod and the Islands compared with Massachusetts is statistically significant (11.9 contrasted with 5.4 per 100,000). 5 P age

8 The higher suicide death rate for the 40 to 49 year-old age group for Cape Cod and the Islands compared with Massachusetts is statistically significant (21.2 contrasted with 11.9 per 100,000). Age Specific Rate per 100, Figure 5: Age-Specific Rates Cape Cod & Islands Contrasted with Massachusetts & plus Age Group MA Cape & Islands Note: Although not a grouping of ten years, 25 to 39 years are combined because of the relatively small count in that age span. C. Differences by Sex and Gender Whereas the number of occurrences of female suicide deaths is so small, we do not report the number and rate for female versus male suicide deaths. In summary, the rate for female deaths for each age group is very low and similar to that for Massachusetts as a whole. We discuss male suicide death rates on page 7. IV. Focus On Youth and Young Adults The suicide death rate Cape Cod and the Islands young people ages 15 to 24 years is significant at more than twice the Massachusetts rate Sixteen young people from Cape Cod and the Islands age 15 to 24 years took his or her life between 2005 and The five-year age specific rate of 11.9 per 100,000 persons compared with 5.4 per 100,000 for Massachusetts is statistically significant. Resulting from concern about this age group, Cape Cod and the Islands is one of three regions that have received funds from MDPH to run a Youth Suicide Prevention Project. The Community Health Center of Cape Cod in Mashpee houses this region s project. Besides the suicide death rate for young people, there is concern for the high rate of thinking about suicide and attempting suicide for the age group 15 to 19 years. The indicator for this is the Massachusetts Youth Risk Behavioral Survey (YRBS) administered by MDPH and the Department of Elementary and Secondary every two years in a representative sample of high schools across the state. 13 The YRBS survey design allows for generalization of results to high school students as a whole. 6 P age

9 With reference to 2011 Massachusetts YRBS data presented in Table 2, 13 percent of high school students had serious thoughts of suicide in the past year 14 and seven percent attempted suicide. Generalizing these percentages to the 9,857 Cape Cod and Islands public high school students in the 2011/2012 school year 15, in the past year in our region: Approximately 1,300 high school students had serious thoughts of suicide. Approximately 700 students attempted suicide. Approximately 300 students needed medical attention resulting from a suicide attempt. The highest risk group is lesbian, gay, bisexual (LGB) students who were 7 percent of responding students in the 2011 YRBS. Approximately seven times as many LGB high school students reported attempting suicide contrasted to other students. Of note, the percentage of LGB students indicating that they have attempted suicide has steadily increased since 2005 and jumped from 24.7% in 2009 to 34.1% in Table 2: Massachusetts 2011 YRBS (High School Students) In the past year Overall LGB Other Students Had serious thoughts of suicide 13% Not available Not available Attempted suicide 7% 34.1% 4.6% Required medical attention as a result of a suicide attempt 2% 8.3% 1.7% V. Focus On Middle-Aged Men The suicide death rate for Cape Cod & the Islands middle-aged men is particularly concerning As discussed before, male suicide deaths accounted for 82 percent of the total deaths (N=115) for the period 2005 to The suicide death rate for Cape Cod and the Islands males is concerning across age groups, as it is for Massachusetts as a whole. Middle-aged men are particularly high risk. As shown in Figure 6, the highest risk group for Cape Cod and the Islands is males age 40 to 49 years followed by males age years. The 2005 to 2009 suicide death rate for Cape Cod and the Islands males aged 40 to 59 years was 34.2 per 100,000 persons compared with per 100,000 for Massachusetts. At almost twice that of the state rate, the difference is statistically significant. 7 P age

10 Figure 6: Age-Specific Rate For Males by Age Cape Cod & Islands Compared with Massachusetts (N=33) 32.9 (N=28) Cape and Islands MA 30 Rate per 100, (N=15) 18.7 (N=20) 21.0 (N=19) plus Age in Years Note: Although not groupings of ten years, 25 to 39 years, and 60 years and older, are reported because of the relatively small count in these age spans. Following a grouping of male suicides mostly middle-aged men in the town of Falmouth in 2010, the Suicide Prevention Coalition of Cape Cod and the Islands enhanced its efforts to increase awareness of factors that can contribute to suicide in middle-aged men, such as depression, substance abuse, job loss, disruption in a relationship and other factors. The aim is to increase the likelihood men will seek help. VI. Focus On Older Adults From 2005 to 2009, 28 deaths of Cape Cod and the Islands residents aged 60 years and older were determined to be from suicide. The region s five-year suicide death rate for this age group was 8.1 per 100,000 persons and similar to the state rate of 7.4 per 100,000 persons. According to national statistics, men age 85 years and older are of highest concern for suicide risk. Although the suicide death rate for people 60 years and older is relatively low, protecting mental health of older adults is important, as a number of factors can contribute to experiencing depression and loneliness that have a lower occurrence in other age groups. Examples are significant illness or death of a spouse or other loved one, personal illness and/or disability, isolation from family and friends who do not live in the region and physical isolation because of lack of transport. The Suicide Prevention Coalition of Cape Cod and the Islands recently published a pamphlet regarding depression and suicide specifically for older adults P age

11 Endnotes 1 The most recent data released by the Massachusetts Department of Public Health (MDPH) from the Registry of Vital Records and Statistics are We will update this summary following official release of 2010 data. 2 For more information regarding data sources, contact Christine Clements Stein, Senior Project Manager, Barnstable County Department of Human Services, cstein@barnstablecounty.org or or (TTY) 3 The Centers for Disease Control and Prevention (CDC) has implemented new rules on reporting counts fewer than 10 for state and county data for years 2008 onward or when these years are combined with other years to avoid inadvertent disclosure of cases. 4 For further explanation of confidence intervals see Suicides and Self-Inflicted Injuries in Massachusetts: Data Summary 2011, page See Massachusetts Deaths 2008, pages15 and , 6 MDPH is participating in CDC s National Violent Death Reporting System to pool details from a range of reliable sources about the circumstances of violent deaths to guide intervention and prevention efforts. Massachusetts reports are available at and information on the national system can be found at 7 MDPH provided this statistic to us from the Massachusetts Violent Death Reporting System. The American Association of Suicidology Fact Sheet on Suicide and Depression also indicates that about 2/3 of people who complete suicide are depressed at the time of their death. For more information, see 8 The Suicide Prevention Coalition of Cape Cod and the Islands formed in 2009 to address concerns regarding the suicide rate for Barnstable County ( For more information about the coalition, other suicide prevention activities, and area trainings for professionals and others, contact Beth Albert, Director of Barnstable County Department of Human Services and Co-chair of the Suicide Prevention Coalition of Cape Cod and the Islands: balbert@barnstablecounty.org or or (TTY) 9 Quote of a co-chair of the Suicide Prevention Coalition of Cape Cod & Islands during a media interview. 10 American Association of Suicidology Survivor Fact Sheet: 11 Data source is CDC Fatal Injury Reports: 12 The lower and upper 95% confidence interval for the Cape and Islands suicide death rate of 6.2 per 100,000 persons in 2000 and 11.9 per 100,000 in 2009 overlap and hence the difference in rates is not statistically significant. Nevertheless, the change should not be dismissed. 13 Youth Risk Behavior Survey Report (2011): Some school districts decide to administer the YBRS or a similar survey themselves. Martha s Vineyard and Nantucket as well as several Cape Cod school districts have made this choice. For the purpose of this report, we used the statewide estimates to generalize to Cape Cod and the Islands high school students. 14 This is in contrast with 3.7 percent of the adult population having serious thoughts of suicide in the past year, according to the Centers for Disease Control and Prevention, Suicide Facts at a Glance, Data source is the Massachusetts Department of Elementary and Secondary Education. 16 For information on the brochure for older adults, contact Beth Albert, Director of Barnstable County Department of Human Services and Co-chair of the Suicide Prevention Coalition of Cape Cod and the Islands: balbert@barnstablecounty.org or or (TTY) 9 P age