Suicide in North Carolina and the Nation Intentional Death Prevention Committee Child Fatality Task Force Injury Epidemiology and Surveillance Unit October 10, 2011
Today s Agenda Overview US and NC NC-Violent Death Reporting System (NC- VDRS) Hospitalization and ED data YRBS data Q&A
Overview
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.
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* 20 19 18 17 16 15 14 13 12 11 10 12.8 12.2 North Carolina Figure 5: Age-Adjusted Suicide Rate for Ages 10 or Older in North Carolina and the United States Over Time* 14.0 13.9 13.7 12.2 13.1 13.9 13.4 12.5 12.7 12.5 12.8 12.7 United States 14.3 12.8 13.7 13.1 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year
Age-Adjusted Suicide Rate per 100,000 persons Age-Adjusted Suicide Rate for Ages 10-17 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* 5 4 3 2 3.83 3.32 3.2 3.08 2.09 2.9 3.07 2.49 2.47 3.06 3.02 2.72 2.62 2.79 2.48 2.5 1 0 2000 2001 2002 2003 2004 2005 2006 2007 Year
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)
North Carolina Violent Death Reporting System (NC-VDRS)
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.
Currently Funded NVDRS States, 2010
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 2004-2009. Data for 2010 & 2011 will be forthcoming.
Key Findings
1200 Suicide Deaths by Year: NC-VDRS, 2004-2008 1150 1148 1100 1107 1085 1050 1000 1017 1009 950 900 2004 2005 2006 2007 2008
Suicide Deaths by Year: NC-VDRS, 2004-2008 1200 10 to 17 Ages 18+ 1081 1057 1126 1000 993 981 800 600 400 200 0 24 28 26 28 22 2004 2005 2006 2007 2008
Per 100,000 persons Suicide Rates by Sex and Age Group: NC-VDRS, 2004-2008 60.0 50.0 Female Rate Male Rate 50.3 40.0 37.8 30.0 20.0 22.3 21.5 25.6 26.4 23.5 26.9 10.0 0.0 10.9 10.1 9.1 7.6 5.7 5.4 3.9 4.3 3.0 3.4 1.8 0.5 10 to 14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 >84
Percentage of Suicide by Sex: NC-VDRS, 2004-2008 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 10-17 76% white/23% black 45% firearm/46% hanging
Suicide Circumstances: Mental Health & Substance Abuse, NC-VDRS: 2004-2008 Current Mental Health Problem 32.91 51.85 Current Mental Health Treatment 30.38 44.44 Current Depressed Mood 27.85 44.44 Alcohol Problem 0 2.53 Males (N=79) Other Substance Problem Ages 10-17 7.59 0 Females (N=27) Circumstances are known for 81% males & 87% females 0 10 20 30 40 50 60
Suicide Circumstances: Interpersonal, NC-VDRS: 2004-2008 Intimate Partner Problem 21.52 33.33 Other Relationship Problem 29.63 37.97 Other death of Family/Friend past 5yrs 0 5.06 Victim of IPV past month 0 3.7 Perpetrator of IPV past month 3.7 7.59 Males (N=79) Suicide of Family/Friend in past 5yrs Ages 10-17 1.27 0 Females (N=27) Circumstances are known for 81% males & 87% females 0 5 10 15 20 25 30 35 40
Suicide Circumstances: Life Stressors, NC-VDRS: 2004-2008 Crisis during the previous 2 weeks 48.15 58.23 Physical Health problem 3.8 7.41 Job problem 0 1.27 Recent criminal legal problem 0 10.13 Ages 10-17 School Problem 7.41 Males (N=79) 12.66 Females (N=27) Circumstances are known for 81% males & 87% females 0 10 20 30 40 50 60 70
Suicide Circumstances: Suicide Event, NC-VDRS: 2004-2008 History of suicide attempts 10.13 33.33 Disclosed intent to commit suicide 11.39 22.22 Males (N=79) Left a suicide note 21.52 Females (N=27) 37.04 Ages 10-17 Circumstances are known for 81% males & 87% females 0 5 10 15 20 25 30 35 40
Suicide Attempts Hosp and ED Map of Suicide Rates for Ages 10 or Older by North Carolina County of Residence (2004-2008)
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.
Hospitalizations and ED Visits
Rate per 100,000 persons Suicide Attempts Hospitalization Rates, 2004-2008 160 Male Hospitalization Rate Female Hospitalization Rate 140 120 100 80 60 40 20 0 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85 + Age Group (Years)
Rate per 100,000 persons Suicide Attempts ED Visit Rates, 2006-2008 Male Emergency Visit Rate Female Emergency Visit Rate 300 250 200 150 100 50 0 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85 + Age Group (Years)
NC Youth Risk Behavior Survey
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, 2009 25 20 15 10 16.1 13.2 11.3 10.19.9 9.7 10.3 9.9 8.6 Co nsidered suicide M ade a suicide plan 5 0 Total Female Male Attempted suicide
Economic Impact
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
Estimated Hospitalization Charges for Self-Inflicted Injuries for Ages 10-17 in North Carolina by Year Year Number of Hospitalizations with Charge Data Average Charges Median Charges Total Charges 2004 504 $7,022 $4,885 $3,539,557 2005 472 $7,053 $5,182 $3,329,171 2006 474 $7,632 $6,062 $3,617,652 2007 543 $8,689 $6,728 $4,718,496 2008 462 $8,494 $6,718 $3,924,531 2009 607 $8,992 $7,143 $5,458,325 TOTAL 3,062 $8,029 $6,259 $24,587,735
Resources & Reports
An average day in NC 3 suicides 18 hospitalizations 25 ED visits??? unattended
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)
Questions? Scott Proescholdbell North Carolina Violent Death Reporting System Injury and Violence Prevention Branch Chronic Disease and Injury Section NC Division of Public Health 919-707-5425 www.injuryfreenc.ncdhhs.gov