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SUICIDE

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SUICIDE

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    2. 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.

    3. Classifying Intentional Injuries

    4. 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 The CDC maintains a database of suicide data for each state in the U.S. In 2001, there were over 30,000 deaths due to suicide. There were more than 1.7 times as many deaths from suicide than from homicide. Males are four times as likely to die from their suicide attempt, while females overall are more likely to attempt suicide. 57% of suicides deaths use firearms.The CDC maintains a database of suicide data for each state in the U.S. In 2001, there were over 30,000 deaths due to suicide. There were more than 1.7 times as many deaths from suicide than from homicide. Males are four times as likely to die from their suicide attempt, while females overall are more likely to attempt suicide. 57% of suicides deaths use firearms.

    5. Age Adjusted Rates, 2000 CDC Injury-Related Deaths in the U.S.

    6. 2000 Age-Adjusted Rates, CDC Spectrum of Suicide

    7. Worldwide, Eastern Europe, the Soviet Republic and China have rates that exceed those of the U.S. Canada and Australia and portions of western Europe are roughly equivalent to the USWorldwide, Eastern Europe, the Soviet Republic and China have rates that exceed those of the U.S. Canada and Australia and portions of western Europe are roughly equivalent to the US

    8. Examining suicide death rates in the U.S., the red states on this map have the highest suicide rates and are, with the exception of Florida, largely Western States Blue states have the next highest death rates from suicide, followed by grey, and the white states have the lowest suicide rates; Generally, rural areas have higher suicide rates than Metropolitan areas.Examining suicide death rates in the U.S., the red states on this map have the highest suicide rates and are, with the exception of Florida, largely Western States Blue states have the next highest death rates from suicide, followed by grey, and the white states have the lowest suicide rates; Generally, rural areas have higher suicide rates than Metropolitan areas.

    9. 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 The CDC maintains a database of suicide data for each state in the U.S. In 2001, there were over 30,000 deaths due to suicide. There were more than 1.7 times as many deaths from suicide than from homicide. Males are four times as likely to die from their suicide attempt, while females overall are more likely to attempt suicide. 57% of suicides deaths use firearms.The CDC maintains a database of suicide data for each state in the U.S. In 2001, there were over 30,000 deaths due to suicide. There were more than 1.7 times as many deaths from suicide than from homicide. Males are four times as likely to die from their suicide attempt, while females overall are more likely to attempt suicide. 57% of suicides deaths use firearms.

    10. 2000 CDC Data Death Rates High Across Ages Actual death rates per 100,000 population change remain quite high throughout life and in fact increase in the geriatric population. Actual death rates per 100,000 population change remain quite high throughout life and in fact increase in the geriatric population.

    11. Mechanism of Suicide Deaths Both Genders, All Ages

    12. 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

    13. Age-Adjusted Rates per 100,000 Population, 2000 CDC Data Male Gender Suicide Deaths & Attempts However, if we examine attempts separately from deaths, we see that the proportion of attempts, shown in light yellow compared with suicide deaths is large, especially in the younger years. However the proportion of deaths to attempts increases significantly with age. We can see that although the rates per 100,000 of suicide deaths is high, the number of attempts is staggering. There are over 23,000 male deaths per yearHowever, if we examine attempts separately from deaths, we see that the proportion of attempts, shown in light yellow compared with suicide deaths is large, especially in the younger years. However the proportion of deaths to attempts increases significantly with age. We can see that although the rates per 100,000 of suicide deaths is high, the number of attempts is staggering. There are over 23,000 male deaths per year

    14. Age-Adjusted Rates per 100,000 Population, 2000 CDC Data Female Gender Suicide Deaths and Attempts Switching to females, we can see that females have a much lower death rate than do males, but it important to remember that there are 5,800 deaths per yearSwitching to females, we can see that females have a much lower death rate than do males, but it important to remember that there are 5,800 deaths per year

    15. Age-Adjusted Rates per 100,000 Population, 2000 CDC Data Suicide Deaths Plus Suicide Attempts By Gender and Age If we look at total attempts, lethal and non-lethal, we see that the total rate for males and females differs little, and in fact there are some categories where females exceed malesIf we look at total attempts, lethal and non-lethal, we see that the total rate for males and females differs little, and in fact there are some categories where females exceed males

    16. 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

    17. Risk Factors

    18. 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

    19. 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

    20. 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 A surprising result was that even if situations that looked like “impulsive” suicide attempts, the majority of adolescents and young adults had in fact sought help prior to their attempt. More sought help from family and friends than for all “professionals” combined.A surprising result was that even if situations that looked like “impulsive” suicide attempts, the majority of adolescents and young adults had in fact sought help prior to their attempt. More sought help from family and friends than for all “professionals” combined.

    21. 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

    22. Suicide’s Impact On Trauma Centers National Trauma Data Bank

    23. 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.

    24. Intentionality of Trauma Patients in NTDB The data I am presenting is based upon a preliminary analysis of NTDB data, after permission was obtained from the NTDB. An analysis of an even larger number of patients in the NTDB will be presented at the Western Trauma Meeting next month. If we look at intentionality, 15% of patients in the NTDB represent intentional injuries, and only 2% represent injury to self.The data I am presenting is based upon a preliminary analysis of NTDB data, after permission was obtained from the NTDB. An analysis of an even larger number of patients in the NTDB will be presented at the Western Trauma Meeting next month. If we look at intentionality, 15% of patients in the NTDB represent intentional injuries, and only 2% represent injury to self.

    25. 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

    26. Suicide in Trauma Centers Many have known mental health problems Longer hospital and ICU stays than other injuries Few are discharged to psychiatric facility

    27. Trauma Patients at Future Risk of Suicide

    28. 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 Move to Risk factors specific to trauma patients.Move to Risk factors specific to trauma patients.

    29. Other Trauma Patients Depression in other patients following trauma? Those with ongoing somatic complaints have higher incidence of depression. Associated with ongoing alcohol use? Move to Risk factors specific to trauma patients.Move to Risk factors specific to trauma patients.

    30. 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

    31. Recommendations Suggestions for Trauma Centers

    32. 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

    33. 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

    34. 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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