Source: CDC. Suicide Rates Vary by Region in the U.S. ..

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SUICIDE
Presented by The American College of
Surgeons Committee on Trauma Subcommittee on
Injury Prevention and Control
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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.

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Classifying Intentional Injuries
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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
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Injury-Related Deaths in the U.S.
144,374
97,900
46,180
29,056
17,124
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Spectrum of Suicide
?
750,000 Attempts
30,000 Deaths
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Suicide Rates Vary Globally
Source World Health Organization (WHO)
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Suicide Rates Vary by Region in the U.S.
Rural Rates are Higher than Metropolitan Rates
Source CDC
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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
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Death Rates High Across Ages
Death Rate
Age
Death Rates per 100,000 population
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Mechanism of Suicide Deaths Both Genders, All Ages
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Poisoning
1
Firearms
2
Suffocation
2001 CDC Data
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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

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Male GenderSuicide Deaths Attempts
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Female GenderSuicide Deaths and Attempts
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Suicide Deaths Plus Suicide AttemptsBy Gender
and Age
Total Rates Differ Little By Gender
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Summary Demographics

• Male death rate gt Female
• Native American gt White gt African American gt
  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

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Risk Factors

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Depression and HopelessnessMajor 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
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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

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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. 200132S
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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

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Suicides Impact OnTrauma Centers

• National Trauma Data Bank

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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.

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Intentionality of Trauma Patients in NTDB
15 Intentional
Unintentional
Produced by Suicide Prevention and Research
Center, University of Nevada School of
Medicine Data Source National Trauma Data Bank
(NTDB), American College of Surgeons , (n
265,441)
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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

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Suicide in Trauma Centers

• Many have known mental health problems
• Longer hospital and ICU stays than other injuries
• Few are discharged to psychiatric facility

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Trauma Patients at Future Risk of Suicide
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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.
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Other Trauma Patients

• Depression in other patients following trauma?
• Those with ongoing somatic complaints have higher
  incidence of depression.
• Associated with ongoing alcohol use?

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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

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Recommendations

• Suggestions for Trauma Centers

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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

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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

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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