SUICIDE IN NEW JERSEY NATIONAL SUICIDE PREVENTION WEEK EVENT DMHAS, New Jersey Department of Health Trenton War Memorial, Trenton, NJ September 13, 2018 New Jersey Violent Death Reporting System (NJVDRS) Center for Health Statistics and Informatics Bretta Jacquemin, MPH Principal Investigator 1
Suicide in New Jersey New Jersey has one of the lowest suicide rates in the nation, but like the rest of the country, has experienced a steady increase since 2000. Every day approximately 2 New Jersey residents die by suicide. In 2016, 689 New Jerseyans died by suicide, 7.2 per 100,000 (NJVDRS). Suicide is the 2 nd leading cause of death among those aged 10 14, 3 rd among those 15 24, and 4 th for those aged 25 34, 35 44, and 45 54. New Jersey Hospital Discharge Data System; CHS, Healthcare Quality and Informatics, New Jersey Department of Health (11/22/2016) 2
Suicide in New Jersey For every suicide 5.5 inpatient hospitalizations or emergency room discharges for non fatal suicide attempts and self inflicted injuries Consumption of substantial healthcare resources In 2015 1,837 ED visits Average $7,174 per visit. Treatment costs $13.1 million+ 2,550 hospitalizations for more serious self inflicted injuries Average LOS 5.2 days; Average $67,931 per stay. Annual total $173.2 million. 97% of ED visits and 99% of inpatients were discharged ALIVE. New Jersey Hospital Discharge Data System; CHS, Healthcare Quality and Informatics, New Jersey Department of Health (11/22/2016) 3
Overview of the NJVDRS New Jersey Violent Death Reporting System (NJVDRS) established at the Center for Health Statistics at the New Jersey Department of Health since 2002 The National Violent Death Reporting System has expanded and was announced as a NATIONAL PROGRAM earlier this year, collecting data from all 50 states, Puerto Rico, and Washington, DC 4
Overview of the NJVDRS Link data from different sources to create a single record, capturing all victims and suspects (if applicable) so they can be analyzed together NJDOH Office of Vital Statistics and Registry Office of the State Medical Examiner (OSME) Local Law Enforcement, New Jersey State Police, ROIC Child Fatality Review County Prosecutor s Offices Data abstractors code standardized circumstances and situational characteristics from these reports 5
Figure 1. Trends in suicide rates: United States & New Jersey, 2003 2016 US data from CDC/WISQARS; NJVDRS v.08082018, CHS NJDOH; Bridged race Estimates for population. Rates are calculated per 100,000 and age adjusted using the 2000 US Standard Population. Although NJ has one of the lowest, if not the lowest, suicide rates in the nation, the State still experienced a rise in suicide similar to what was seen nationally. 2015 saw the highest number and suicide rate since NJVDRS began (803; 8.5/100,000) before the decline in 2016 (689; 7.2/100,000). There does not appear to be a similar decline nationally. 6
Figure 2. Trends in suicide rates for youth and adults, New Jersey, 2003 2016 NJVDRS v.08082018, CHS NJDOH; Bridged race Estimates for population. Rates are calculated per 100,000 and age adjusted using the 2000 US Standard Population. Adults in this figure are persons age 25 years and over. Youth are persons age 10 24 years. Youth suicide and adult suicide have also generally followed the same pattern as seen nationally, and both experienced a drop in rates in 2016. 7
Figure 3. Trends in suicide rates by sex: United States & New Jersey, 2003 2016 US data CDC/WISQARS; NJVDRS v.08082018, CHS NJDOH; Bridged race Estimates for population. Rates are calculated per 100,000 and age adjusted using the 2000 US Standard Population. NJ Male suicide rates in 2016: up 4.5% from 2003, down 12.1% from 2015. NJ Female suicide rates in 2016: up 18.5% from 2003, down 22.0% from 2015. Males have generally higher suicide rates than females, and both are below the national level. Males and females in New Jersey also experienced a drop in rates in 2016, and nationally the female rate appears to have slightly decreased from 2015 to 2016. 8
Figure 4. Trends in suicide weapons, New Jersey, 2003 2016 NJVDRS v.08082018, CHS NJDOH; Bridged race Estimates for population. Rates are calculated per 100,000 and age adjusted using the 2000 US Standard Population. There were declines in rates among the major weapons used in suicide, although suicides by poisoning and hanging/strangling/suffocation appear to have had more of a decline than firearm suicides. 9
Figure 5. Suicide rates by age group, 2014 2016 NJVDRS v.08082018, CHS NJDOH; Bridged race Estimates for population. Rates are calculated per 100,000 age specific population. Male suicide rates are higher than female suicide rates in all age groups (more than double in among 10-24; nearly 3.5 times among 25-44; 3 times among 45-64; more than 5 times among 65+). 10
Suicide Circumstance Variables Crisis in past upcoming two weeks, plus details Current/past mental health problems and treatment Problems with substance abuse and/or alcohol abuse Other circumstances Physical health problems Intimate partner problems Suicide note, disclosure, previous attempts Financial job, school problems, current or impending homelessness Circumstance variables are based on information abstracted from the source reports. Many circumstances are global and can be endorsed for any violent death. Others are suicide or homicide-specific. 11
Situational Circumstances and Contact Points One quarter of adults who were experiencing a crisis had also disclosed their intent to die by suicide to someone else prior to action. 83% of all suicides from 2014 2016 have some situational circumstances known 29% were experiencing a crisis 25% in a depressed mood ; 41% current diagnosed mental health problem; 29% in either mental health or substance abuse treatment 16% contributing physical health problem 19% problem with a current or former intimate partner 14% substance abuse problem, 11% alcohol problem 12
Situational Circumstances and Contact Points Locations and settings as part of the risk Less than 1% were homeless; 4.3% were recently released from jail, hospital, or another institution 70% of suicides occurred at home, either the decedent s or someone else s 2.6% occurred in a hotel or motel, 3.2% in a motor vehicle, 4.4% in natural areas 13
Homicide Circumstance Variables Precipitated by another crime such as robbery, other assaults Jealousy, Lover s Triangle, Intimate Partner Violence Arguments over money, poverty Drug involvement, gang related, drive by Justifiable self defense, law enforcement involved deaths Hate crimes, mental ill suspects, random acts of violence Many circumstances are global, endorsed for any death 14
Figure 6. Trends in suicide weapons compared to Unintentional drug overdose, New Jersey, 2003 2016 NJVDRS v.08082018, CHS NJDOH and New Jersey Mortality Data for Unintentional drug overdose; Bridged race Estimates for population. Rates are calculated per 100,000 and age adjusted using the 2000 US Standard Population. In context of the drug overdose crisis in New Jersey. These deaths represent all drug overdose deaths- not just opioids, but especially in recent years, opioids are involved in 90-93% of all drug overdose deaths (ICD-10 X40-X44). 15
Map 1. County suicide and fatal drug overdose rates, 2014 2016 SUSSEX 17.2 WARREN 12.5 HUNTERDON 13.0 MORRIS 8.2 SALEM 13.4 WARREN 24.9 ESSEX 5.5 SOMERSET 6.7 MIDDLESEX 7.2 BURLINGTON 10.6 GLOUCESTER 8.6 CUMBERLAND 7.6 BERGEN 7.7 HUDSON 6.0 UNION 6.4 MERCER 6.3 CAMDEN 9.9 SUSSEX SUSSEX 18.9 14.8 PASSAIC 5.7 HUNTERDON 15.2 OCEAN 9.5 CAMDEN 30.2 CAPE MAY 11.8 6.5 8.2 8.3 10.6 10.7 17.2 SALEM 25.3 BURLINGTON 19.1 GLOUCESTER 28.1 CUMBERLAND 22.4 BERGEN 9.5 ESSEX 15.3 UNION 10.3 SOMERSET 11.1 MIDDLESEX 13.9 MERCER 13.7 MONMOUTH 8.7 5.5 6.4 ATLANTIC 12.6 MORRIS 11.8 PASSAIC 13.3 HUDSON 9.8 MONMOUTH 19.7 OCEAN 32.9 9.5 11.8 ATLANTIC 26.3 CAPE MAY 30.1 11.9 15.3 15.4 24.9 25.0 32.9 NJVDRS v.08082018, CHS NJDOH and New Jersey Mortality Data for Unintentional drug overdose; Bridged race Estimates for population. Rates are calculated per 100,000 and age adjusted using the 2000 US Standard Population. The general pattern of counties with higher suicide rates is similar to the pattern of counties with higher overdose rates (the speckled counties are the ones with the highest rate, and is substantially higher than the rest in that group). 16
Early Results from Enhanced Surveillance of Overdose in New Jersey (ESO NJ) Data collection for 2017 deaths is still being conducted, but what we know now: Ages of fatal overdoses range from 13 to 78+ 75% males 66% White non Hispanic, 19% Black non Hispanic, 12% Hispanic ESO NJ v.08082018, CHS NJDOH CHS has been funded to leverage the NJVDRS system, including existing collaborations and data sources, to conduct surveillance on overdose deaths. 17
Early Results from ESO NJ 7.8% known mental health problem, 10% history of mental health treatment Most common diagnoses were depression, bipolar disorder, anxiety, schizophrenia, PTSD, and other and unknown issues. 7% had a physical health problem 76% had existing substance abuse problems ESO NJ v.08082018, CHS NJDOH Circumstance data are abstracted using the same methodology as for suicides. 18
Early Results from ESO NJ Locations and settings as part of the risk 2.4% homeless; 4.3% were recently released from an institution such as a jail, hospital, or another institution 78% of fatal overdoses occurred at home, 63% at the decedent s home 5.6% occurred in a hotel/motel, 2% in a motor vehicle, 1.1% in jail or supervised residential facility ESO NJ v.08082018, CHS NJDOH 19
Contact Us Bretta Jacquemin, MPH New Jersey Violent Death Reporting System (NJVDRS) Enhanced Surveillance of Overdose in New Jersey (ESO NJ) Center for Health Statistics, a unit of Healthcare Quality and Informatics Population Health New Jersey Department of Health, Trenton, NJ Bretta.Jacquemin@doh.nj.gov Phone: 609 984 6797 http://www.state.nj.us/health/chs/njvdrs/ https://www.cdc.gov/violenceprevention/nvdrs/ The New Jersey Violent Death Reporting System is supported by Cooperative Agreement 5NU17CE002611 04 from the Centers for Disease Control and Prevention (CDC), NCIPC, Division of Violence Prevention. Enhanced Surveillance of Overdose Morbidity and Mortality in New Jersey is supported by Cooperative Agreement 5NU17CE924890 02 from the Centers for Disease Control and Prevention (CDC),NCIPC, Division of Unintentional Injury Prevention. 20
Philip D. Murphy Governor Sheila Y. Oliver Lt. Governor Shereef M. Elnahal, MD, MBA Commissioner 21