Suicide in Dane County: Scope of the Problem Charles R. Vear, MPH - PowerPoint PPT Presentation

Suicide in Dane County: Scope of the Problem Charles R. Vear, MPH Wisconsin Department of Health Services Hannah Flanagan, LMFT Journey Mental Health Center September 26–27, 2019 Division of Public Health

Presentation Overview Wiscons nsin n and Dane ne County unty suicide data ta 1. 1. • Suicide by demographics • Suicide by methods • Toxicology of suicide decedents • Risk factors Jour urne ney Ment ntal Health h Cente nter 2. 2. • Current interventions • Suicide risk assessments • Strategies and approaches to improving comfort discussing suicide risk with patients Questi tions 3. 3. 2

Analytic Notes

Analytic Notes Data ata in th this r s report w was o as obtai btained f from m death ath c certificate tes, c coroner an and  medic ical l examin miner r reports ts, and l law e enforceme ment r t reports ts. Vital records: includes only Wisconsin residents • Wisconsin Violent Death Reporting Systems: includes only • Wisconsin residents who died by suicide in Wisconsin  All a All age-ad adju juste ted r rate ates u s use se U U.S. stan standard p population in 2000 f 2000 for ag age- adju ad just stme ment. 4

Wisconsin and Dane County Suicide Data Demographics

Suicide in 2018 Wisconsin residents died by by su suicide in 2018 2018 886 886 (5 (5% d % dec ecrease from 2017) Dane county residents died by by su suicide in 2018 2018 74 74 (6% i increa ease e from 2017) Data S Source rce: : Vital Records death certificate data, 2018. 6

Suicide rate among Dane residents increased by 35% , 2000–2017. 20.0 per 15. 15.3 ate p N= 918 918 rate 10. 10.9 15.0 suicide r N= 588 588 000 14. 14.0 100,00 10.0 sted su N= 47, 47,16 168 100, 10.4 10. 12.3 12. Wisconsin N= 29, 29,31 312 N= 70 70 adjust U.S. 5.0 8. 8.9 Age-ad Dane N= 38 38 Ag 0.0 2000 2017 Year Ye Data S Source rce: : Vital Records death certificate data, 2000-2017. Mortality data from the National Vital Statistics System (NVSS), 2000-2017. 7

Dane had a significantly lower rate of suicide when compared with the state, 2013–2017. Age-adju Ag just sted su suicide r rate ates s per 100, 100,00 000 Significantly higher rate Higher than state rate Lower than state rate Significantly lower rate No rate calculated (<10 suicides) Source ce: : Vital Records death certificate data, 2013–2017 8

The majority of suicides were male , 2013–2017. 22% 22% 28% 28% Wisconsin Dane N= 4,284 N= 338 72% 72% 78% 78% Male Female Male Female Source ce: : Vital Records death certificate data, 2013-2017 9

Suicide rate was highest among ages 45–54 , 2013–2017. 30.0 Wisconsin Dane 25.5 per 25.0 ate p 22.3 suicide rate 20.0 000 100,00 15.0 specific su 100, 10.0 Age-sp 5.0 Ag 0.0 10-14 15-17 18-24 25-34 35-44 45-54 55-64 65-74 75+ Ag Age in in years Source ce: : Vital Records death certificate data, 2013-2017 10 10

Suicide rate was highest among whites , 2013–2017. 20 Wisconsin Dane per Wisconsin ate p 15.3 14.7 rate 15 13.5 suicide r 000 100,00 sted su 10 100, 6.5 adjust 5.9 5.2 4.6 5 Age-ad Ag 0 0 White AI/AN Asian Black Source ce: : Vital Records death certificate data, 2013-2017. 11 11

Suicide rate was highest among non-Hispanics , 2013–2017. Wisconsin Dane 20 per ate p 14.9 rate 15 12.9 suicide r 000 100,00 sted su 10 100, 6.5 adjust 5.7 5 Age-ad Ag 0 Non-Hispanic Hispanic Source ce: : Vital Records death certificate data, 2013-2017. 12 12

Wisconsin and Dane County Suicide Data Method of Suicide

Firearm was the most commonly used method of suicide , 2013–2017. Other Other Firearm 8% 10% Firearm Wisconsin 49% Wisconsin 42% Dane Poisoning Poisoning 16% 18% Dane Wisconsin Dane Suffocation 27% Suffocation 30% No Note: : Other category includes drowning, motor vehicle, fire, and other. Suffocation includes hanging, strangulation, and suffocation. Source ce: : Wisconsin Violent Death Reporting System, 2013-2017. 14 14

Males were more likely to use firearms or suffocation and females were more likely to use poisoning as method of suicide in Dane, 2013–2017. Firear arm Suffocati ocation on Poisoni ning ng 8% 8% 31% 31% 34% 34% N = 138 N = 99 N = 58 66% 66% 69% 69% 92% 92% Male Female Male Female Male Female Note: : Suffocation includes hanging, strangulation, and suffocation. Source ce: : Wisconsin Violent Death Reporting System, 2013-2017. 15 15

Suffocation was the most common method of suicide for those 15 to 17 . Firearm was the most common method of suicide for those 18 and older in Dane, 2013–2017. 80% 70% ides 67% of suicid 59% 60% 51% nt of 43% 38% 40% 35% Percent 34% 20% 0% 15-17 18-24 25-34 35-44 45-54 55-64 65-74 75+ Ag Age in in years Firearm Suffocation Poisoning Source ce: : Wisconsin Violent Death Reporting System, 2013-2017. 16 16

Wisconsin and Dane County Suicide Data Toxicology

Toxicology Definitions Dete tected su substa bstances are those that have been detected in toxicology testing. This can be an indication of the victim’s state of mind during the incident. Detected substances can be at levels that do not cause toxicity and may not have contributed to the cause of death. Detected substances are included for all suicide methods (for instance, poisoning, firearm, and suffocation). 18 18

Toxicology Definitions Su Substance ces d determ rmined by by coroner/me medic ical l examin miner to contri ribute to death ath are those that reached toxic levels and impacted organ function resulting in death. Substances determined to contribute to death are only included for poisoning suicides. 19 19

Alcohol and antidepressants were the 2 most commonly detected substances among suicide deaths, 2014–2017. 40% Wisconsin Dane of suicides 30% ercent of s 20% 10% Per 0% Source ce: : Wisconsin Violent Death Reporting System, 2014-2017. 20 20

Alcohol was the most commonly detected substance among firearm suicides. Antidepressants were the most commonly detected substance among poisoning and suffocation suicides in Dane, 2014–2017. 80% 65% ides 60% of suicid 43% 35% ercent of 40% 34% 33% 33% 26% 18% 18% 15% 15% 20% Per 8% 0% Firearm Suffocation Poisoning Alcohol Antidepressant Benzodiazepine Opioid Source ce: : Wisconsin Violent Death Reporting System, 2014-2017. 21 21

Opioids and antidepressants were the most common substances to contribute to death among poisoning suicides, 2014–2017. Wisconsin Dane 60% 53% ides g suicid 50% 38% 38% 40% 36% poisoning 35% 28% 30% of p 20% cent o 10% Perce 0% Opioid Antidepressant Benzodiazepine Source ce: : Wisconsin Violent Death Reporting System, 2014-2017. 22 22

Substance Group Definitions  Prescription : medication prescribed by a doctor such as oxycodone or Ambien.  Over the counter (OTC): medications available without prescription such as Advil or Zyrtec.  Gas : poisons that can be inhaled such as carbon monoxide or propane.  Legal : substances available legally such as alcohol or nicotine.  Illegal : substances not available legally or by prescription such as heroin or cocaine.  Other poison: substances not intended for human consumption such as household cleaners (not including gas). 23 23

Prescription medications were the most common substance group determined to contribute to death among poisoning suicides, 2014–2017. 100% 90% ides Wisconsin g suicid 80% 72% Dane 60% poisoning 40% 29% 26% 23% 19% 16% 20% 12% 10% 8% of p 3% 2% cent o 0% Perce Source: Wisconsin Violent Death Reporting System, 2014-2017. 24 24

Wisconsin and Dane County Suicide Data Risk Factors

Social Ecological Model Indiv ivid idual: l: biological and personal history that increases the likelihood of becoming a victim or perpetrator of violence. Relatio tionship ip: close or significant relationships that may increase the risk of experiencing violence as a victim or perpetrator. Communi nity: settings, such as schools, workplaces, and neighborhoods, in which social relationships occur and the characteristics of these associated with becoming victims or perpetrators of violence. 26 26

Individual 27 27

Less than half of those who died by suicide left a suicide note, disclosed their intent, or had a history of suicide attempts , 2013–2017. 50% 47% Wisconsin Dane rcumstances 42% 40% 34% 30% 28% of circu 30% 23% 20% rtion o Proport 10% 0% Left a suicide note Disclosed suicidal Had a history of intent suicide attempts Source ce: : Wisconsin Violent Death Reporting System, 2013-2017. 28 28

Females who died by suicide were more likely to have a reported history of suicide attempts, disclosed suicide intent, or left a suicide note in Dane, 2013–2017. Male Female 57% rcumstances 60% 56% 50% 43% 37% 40% of circu 27% 30% 25% rtion o 20% Proport 10% 0% Left a suicide note Disclosed suicidal Had a history of intent suicide attempts Source ce: : Wisconsin Violent Death Reporting System, 2013-2017. 29 29