SUICIDE
Presented 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
Intentional
injury directed
at self
Intentional
injury directed
at others
Fatal
Non Fatal
Suicide
completors
Suicide
attemptors
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
Injury-Related Deaths in the
U.S.
160,000
144,374
140,000
120,000
97,900
100,000
80,000
46,180
60,000
29,056
40,000
17,124
20,000
0
All INJ
Unintent
Homicide
Age Adjusted Rates, 2000 CDC
Suicide
Total
Intentional
Spectrum of Suicide
2000
1800
1600
1400
1200
1000
800
600
400
200
0
?
750,000 Attempts
30,000 Deaths
Contemplators
Attemptors
2000 Age-Adjusted Rates, CDC
Completors
Suicide Rates Vary Globally
Source: World Health Organization (WHO)
Suicide Rates Vary by Region in the U.S.
Rural Rates are
Higher than
Metropolitan Rates
Source: CDC
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
Death Rates High Across Ages
Death
Rate
20
18
16
14
12
10
8
6
4
2
0
Age l0- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 85+
14
19
24
29
34
39
44
49
2000 CDC Data
54
59
64 85+
Death Rates per 100,000 population
Mechanism of Suicide Deaths Both
Genders, All Ages
#3
Poisoning
17%
1%
1%
#1
Firearms
#2
56%
21%
Suffocation
2%
2%
2001 CDC Data
Firearm
Cut/pierce
Fall
Suffocation
MVC
Poisoning
Fire/burn
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
Male Gender
Suicide Deaths & Attempts
250
200
150
100
em
Male Attempt
Male Death
50
0
l0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 6585+
Age-Adjusted Rates per 100,000
Population, 2000 CDC Data
Female Gender
Suicide Deaths and Attempts
350
300
250
200
Female Attempt
Female Death
150
100
50
0
l014
15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 6519 24 29 34 39 44 49 54 59 64 85+
Age-Adjusted Rates per 100,000
Population, 2000 CDC Data
Suicide Deaths Plus Suicide Attempts
By Gender and Age
350
300
250
Total Rates Differ Little By
Gender
200
Total Male
Total Female
150
100
50
0
l0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 6585+
Age-Adjusted Rates per 100,000
Population, 2000 CDC Data
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
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
Barnes LS, Suicide and LifeThreatening Behavior, 2001
Suicide’s Impact On
Trauma 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
15% Intentional
13%
2%
Unintentional
Unintentional
Directed at Others
Directed at Self
85%
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)
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
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