SUICIDE Presented by The American College of Surgeons Committee on Trauma Subcommittee on Injury Prevention and Control
Mar 27, 2015
SUICIDEPresented by
The American College of Surgeons
Committee on Trauma
Subcommittee on Injury Prevention and Control
The Language of Suicidology
• Contemplator – thoughts of self harm intended to end own life.
• Attemptor – acts on thoughts and injures self.
• Completor – ends own life.• Survivor – close personal relationship with
a completor.
Classifying Intentional Injuries
Fatal Non Fatal
Intentional injury directed at self
Suicide
completors
Suicide
attemptors
Intentional injury directed at others
Homicide Assault
Magnitude of Problem
• Over 30,000 deaths annually in the U.S., over 1 million worldwide
• 25 times as many people attempt suicide
• 63% of intentional deaths
• 1.7 times as many deaths as homicide
• #3 cause of death in 1st 4 decades of life
2001 CDC Data
Age Adjusted Rates, 2000 CDC
Injury-Related Deaths in the U.S.
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
All INJ Unintent Homicide Suicide TotalIntentional
29,05617,124
97,900
46,180
144,374
2000 Age-Adjusted Rates, CDC
Spectrum of Suicide
0
200400
600
800
10001200
1400
1600
18002000
Contemplators Attemptors Completors
?30,000 Deaths
750,000 Attempts
Source: World Health Organization (WHO)
Suicide Rates Vary Globally
Source: CDC
Suicide Rates Vary by Region in the U.S.
Rural Rates are Higher than Metropolitan Rates
Demographics
• Males 4 x more likely to die than females
• Native American, Caucasian highest rates
• In youth, less racial or ethnic variation
• Elderly at high risk
2001 CDC Data
2000 CDC Data
Death Rates High Across Ages
02468
101214161820
l0-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-85+
85+Age
Death Rate
Death Rates per 100,000 population
Mechanism of Suicide Deaths Both Genders, All Ages
56%
2%2%
21%
1%
17%
1%
Firearm
Cut/pierce
Fall
Suffocation
MVC
Poisoning
Fire/burn
2001 CDC Data
Firearms
Suffocation
Poisoning
#1
#2
#3
Gender Differences
• Males use firearms more than females
• Suffocation used by males more than females
• Poisoning used by females more than males
• Males attempts more likely to result in death
Age-Adjusted Rates per 100,000 Population, 2000 CDC Data
Male GenderSuicide Deaths & Attempts
0
50
100
150
200
250
l0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-85+
Male AttemptMale Deathem
Age-Adjusted Rates per 100,000 Population, 2000 CDC Data
Female GenderSuicide Deaths and Attempts
0
50
100
150
200
250
300
350
l0-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-85+
Female AttemptFemale Death
Age-Adjusted Rates per 100,000 Population, 2000 CDC Data
Suicide Deaths Plus Suicide AttemptsBy Gender and Age
0
50
100
150
200
250
300
350
l0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-85+
Total MaleTotal Female
Total Rates Differ Little By Gender
Summary Demographics
• Male death rate > Female• Native American > White > African
American > Hispanics• Suicide is 3rd most common cause of
death 10-34, 4th 35-44, 5th 45-54.• Adolescent suicide represents fastest
growing segment of suicide attempts.• Rates for 65+ are greatest
Risk Factors
Depression and Hopelessness:Major Risk Factors
• 1 of 16 people with depression commit suicide
• 2/3 of people who commit suicide are depressed, higher for adolescents
• Depression plus alcohol increases risk
• Hopelessness, anxiety increases risk
American Association of Suicidology
Other Risk Factors
• Family member committed suicide (survivor)• Childhood trauma, especially abuse• Intimate Partner Violence• Divorce• Recent move, especially for adolescents• Firearms• Alcohol• Education• Chemical – low levels of serotonin
Adolescents and Young Adults
• High rate of depression, hopelessness• Impulsivity, Alcohol Use important• Recent move of household a risk factor• Many seek help from family/friends.
– Need community-based training for prevention– Need to remove the stigma of suicide
Suicide and Life-Threatening Behavior. 2001;32S
Barnes LS, Suicide and Life-Threatening Behavior, 2001
Help-Seeking Behavior
Adults: • Medical community often contacted prior to
attempt
Adolescents: • Few have recent medical contact• Often seek help from family or friends• Less than 10% use Hotlines
Suicide’s Impact OnTrauma Centers
National Trauma Data Bank
National Trauma Data Bank (NTDB)
• Voluntary reporting by trauma centers to central database maintained by the American College of Surgeons.
• Suicide identified by E-codes.
Intentionality of Trauma Patients in NTDB
85%
13%
2%
Unintentional
Directed at Others
Directed at Self
Produced by: Suicide Prevention and Research Center, University of Nevada School of MedicineData Source: National Trauma Data Bank (NTDB™), American College of Surgeons , (n= 265,441)
Unintentional
15% Intentional
Suicide in Trauma Centers
• 2% of all admissions
• 77% male, average age 40 years
• 80% are penetrating injuries
• 24% mortality (higher than other types of trauma)
• 75% require OR or are admitted to ICU
Suicide in Trauma Centers
• Many have known mental health problems
• Longer hospital and ICU stays than other injuries
• Few are discharged to psychiatric facility
Trauma Patients at Future Risk of Suicide
Traumatic Brain Injury Patients
• Traumatic Brain Injury patients are at risk of subsequent suicide attempts* – 35% hopeless– 23% suicidal ideation– 17% have attempted suicide
• Higher risk with substance abuse• Repeated suicide attempts
* Simpson G Psychol Med 2002; 32(4):687-97.
Other Trauma Patients
• Depression in other patients following trauma?
• Those with ongoing somatic complaints have higher incidence of depression.
• Associated with ongoing alcohol use?
Interventions
• Treat depression– SSRIs, others
• Individual cognitive therapy decreases repeat attempts
• Group Therapy• Family Counseling
• Physician Speaking with patient and family may make a difference
Recommendations
Suggestions for Trauma Centers
Recommendations
• Participate in NTDB– National, regional, state suicide burden to Trauma
Centers
• Suicide Education– Surgery Residents– Trauma Fellows– Practicing Surgeons– Primary Care Physicians – Other medical personnel– Medical Students
Recommendations
• Develop A Suicide Prevention Plan for your Community.– Demographics– Identify hospital and community resources– Educate medical staff– Injury Prevention – partner with community
groups– Rural locations
Resources
• www.cdc.gov• www.suicidology.org• www.sprc.org• www.surgeongeneral.org• www.aas.org• www.afsp.org• Reducing Suicide: A National Imperative. 2002.
Institute of Medicine. National Academy of Sciences