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The Suicide Spectrum in Delaware County. Fredric N. Hellman, M.D., M.B.A. Chief Medical Examiner, Delaware County, PA. Role of the Medical Examiner. Identification: presumptive vs confirmatory Estimation of Time of Death Documentation of Injuries/Pathology Collection of Trace Evidence

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The suicide spectrum in delaware county

The Suicide Spectrum in Delaware County

Fredric N. Hellman, M.D., M.B.A.

Chief Medical Examiner, Delaware County, PA


Role of the medical examiner
Role of the Medical Examiner

  • Identification: presumptive vs confirmatory

  • Estimation of Time of Death

  • Documentation of Injuries/Pathology

  • Collection of Trace Evidence

  • Determination of Cause & Manner of Death


Manner of death
Manner of Death

  • A classification of the way in which the cause of death came about, with special reference to social relationships and personal causation

  • Categories:

    • Natural

    • Accident

    • Suicide

    • Homicide

    • Undetermined


The medical examiner s role in potential suicide investigation
The Medical Examiner’s Role in Potential Suicide Investigation

  • The medical examiner is responsible for the investigation of any unexplained, unexpected, mysterious or violent death

  • In the case of potential suicide, the ME must attempt to ascertain, to a reasonable degree of medical certainty, both intent towards self-destruction and a subsequent lethal act


The medical examiner you
The Medical Examiner & You Investigation

  • Suicide has been a serious health problem for many years, but has only recently acquired the attention that it merits

  • Every year, approximately 30,000 individuals die by suicide in the U.S., and one million die worldwide

  • More than 650,000 people annually receive emergency treatment after a suicide attempt in this country

  • Suicide is the third-leading COD amongst American youth, being #11 for Americans across all ages


National suicide rates
National Suicide Rates Investigation

  • While having remained fairly stable through time among this country’s general population (12.1/100,000 (1976); 10.8/100,000 (1996)), substantial shifts in suicide rates have been observed amongst various age, gender, & ethnic groups


National suicide rates1
National Suicide Rates Investigation

  • While females are more likely than males to attempt suicide, males are 4X as likely to be successful

  • White males/females accounted for over 90% of suicides in 1997, with white males alone responsible for 72%

  • Firearm-related deaths accounted for 58% of all suicides in 1997


Suicide regional variation
Suicide-Regional Variation Investigation

  • Suicide rates have varied by geographic region, being consistently higher in the Western states

    • Reasons are unclear, but may reflect regional differences in certain demographic variables (Suicide rates are known to be higher for the elderly, for white males, & for certain racial/ethnic groups)


Suicide regional variation1
Suicide-Regional Variation Investigation

  • From 1990-1994, 154,444 persons were reported to complete suicide in the U.S.

    • Northeast: 23,734 (15%)-8.6/100,000

    • Midwest: 34,492 (22%)-10.9/100,000

    • West: 38,709 (25%)-14.1/100,000

    • South: 57,509 (37%)-13.1/100,000

    • Total U.S. adjusted suicide rate during this period-11.8/100,000


Suicide regional variation2
Suicide-Regional Variation Investigation

  • Reasons other than for possible regional differences in certain demographics:

    • Suicide rates are higher in communities with deficient social integration & unstable social environments

    • Limited economic opportunity with increased unemployment as well as residential instability may also contribute to an elevated suicide rate


More suicide statistics
More Suicide Statistics Investigation

  • Suicide rates are inversely related to level of education

  • The incidence of suicide is also significantly lower among married individuals than among those who are single, separated, divorced or widowed


Suicide among youth
Suicide Among Youth Investigation

  • The Problem: Rates of reported suicides among adolescents & young adults have nearly tripled between 1952 & 1996

    • 1950: 4.5/100,000

    • 1990: 13.5/100,000


Suicide among youth1
Suicide Among Youth Investigation

  • Suicide is now the 4th leading cause of death amongst children aged 10-14 years

  • Suicide is the 3rd leading cause of death amongst adolescents aged 13-24 years, exceeded only by unintentional injury & homicide


Suicide among youth2
Suicide Among Youth Investigation

  • Risk Factors include:

    • Family history of suicide

    • Impulsive/aggressive behavior

    • Social isolation

    • Prior suicide attempt(s)

    • Easier access to alcohol, illicit drugs & lethal suicide methods


Suicide ideation attempts among youth
Suicide Ideation/Attempts Among Youth Investigation

  • While suicide represents the 3rd leading cause of death among U.S teens, many more seriously consider suicide w/o attempting or attempt w/o completing the act


Suicide ideation attempts among youth1
Suicide Ideation/Attempts Among Youth Investigation

  • 1999: 20% of all H.S. students acknowledged having seriously considered or attempted suicide during the prior year

    • 8% actually attempted suicide

    • Less than 3% reported an injurious episode necessitating medical attention


The suicide profile delaware county
The Suicide Profile- InvestigationDelaware County

  • Suicide rates & associated demographic data were tracked from 1990-2006

  • Deaths due to suicide during this period: 933, with 904 initiated within Delaware Co.

  • Per annum range: 45-69, with a median=55 & a mean=56 deaths

  • Based upon a county population=547,651, the 1990 suicide rate per 100,000 individuals=10.4


The suicide profile delaware county1
The Suicide Profile- Investigation Delaware County

  • Utilizing the Delaware Valley Regional Planning Commission est. population in 2000(549,070):

    -DELCO suicide rate(2006)=10.1


The suicide profile delaware county2
The Suicide Profile- InvestigationDelaware County

  • By gender & race, suicide was successfully completed by 210 females (22.5%) & 723 males (77.5%). All but 116 such acts were completed by Caucasians (88%), with the vast majority of suicides being completed by Caucasian males (71%).


The suicide profile delaware county3
The Suicide Profile- InvestigationDelaware County

  • Suicide rate by race(1990/1998):

    • White-8.4/7.2

    • Black-4.9/7.2

    • Asian-0/0

    • Hispanic-16.7/0


Suicide at the extremes delaware county
Suicide at the Extremes-Delaware County Investigation

  • Between 1990-2006, 61 individuals (6.5%) between the ages of 16-20 years completed suicide, with 153 additional suicides (16.4%) among those aged 21-30 years

  • At the opposing end of the age spectrum, 221 persons 61 years of age or older (18.8%) completed suicide during this period of time


Delaware county suicide rate 1990 2006
Delaware InvestigationCounty Suicide Rate (1990-2006)


Delaware county demographics
Delaware County Demographics Investigation

  • A total of 65 boroughs, townships and communities comprised the study distribution of completed suicides within the county during the period 1990-2006.

    • Two communities were without completed suicides during this timeframe (Corcordville, Lester)

    • Eight communities outside of the county contributed 29 suicides during this period (inciting act versus location of pronouncement of death)

    • Adjusted Delaware County suicide rate (1990-2006): 9.8


Delaware county demographics1
Delaware County Demographics Investigation

  • Community population range (2000 census data):

    • Largest population: Upper Darby (81,529)

    • Smallest population: Ruttledge (852)

  • Per capita income (PCI) range:

    • Highest PCI: Rose Valley ($54.2K)

      • Suicide rate/100,000: 11.3

    • Lowest PCI: Chester City ($13.1K)

      • Suicide rate/100,000: 12.1

    • Mean PCI: $25.0K


Delaware county household demographics
Delaware County Household Demographics Investigation

  • Married couples (104,911) versus single-parent households (26,542): 4.0:1

    • Highest ratio: Thornbury (16.1:1), with PCI = $22.0K

      • Suicide rate/100,000: 10.1

    • Lowest ratio: Chester City (0.8:1), with PCI = $13.1K

      • Suicide rate/100,000: 12.1


Delaware county household demographics1
Delaware County Household Demographics Investigation

  • Households of those 65+ years & alone: 5,792 M and 18,057 F

    • Highest % per total community population: Edgemont (7.3%)

      • Suicide rate/100,000: 20.1

    • Lowest % per total community population: Bethel (1.1%)

      • Suicide rate/100,000: 7.6

    • Average %: 4.5%

      • Suicide rate/100,000: 9.8


Delaware county demographics educational level
Delaware County Demographics Educational Level Investigation

  • Delaware County residents with educational attainment of bachelor’s degree or above: 109,670 out of 355,174 residents 25+ years of age (30.0%)

    • Community with highest % of residents with educational attainment of bachelor’s degree or above: Swarthmore (2,618/3,395 (77.1%))

      • Suicide rate-13.3

    • Community with lowest % of residents with educational attainment of bachelor’s degree or above: Chester City (1,804/21,174 (0.85%))

      • Suicide Rate-12.1


Community suicide rate demographics
Community Suicide Rate Demographics Investigation

  • Communities with suicide rates of 14.1/100,000 or greater: 14/65

    • Range: 14.1-48.1/100,000

    • Mean: 21.9/100,000

  • Communities with suicide rates of 7.0/100,00 or less: 11/65

    • Range: 4.2-7.0/100,000

    • Mean: 5.8/100,000


Community suicide rate demographics1
Community Suicide Rate Demographics Investigation

  • Communities with suicide rates of 14.1/100,000 or greater:

    • PCI: $21.9K

    • Married : Single parent households: 3.6:1

    • Households of 65+ years & alone: 4.85%

    • Educational attainment of bachelor’s degree or above: 18.4%


Community suicide rate demographics2

Communities with suicide rates of 7.0/100,000 or less: Investigation

PCI: $29.4K

Married : Single Parent household: 7.1:1

Households of 65+ years & alone: 4.35%

Educational attainment of bachelor’s degree & above: 40.6%

Community Suicide Rate Demographics


Suicide risk factors
Suicide Risk Factors Investigation

Suicide rates are higher in communities with deficient social integration & unstable social environments

Limited economic opportunity with increased unemployment as well as residential instability may also contribute to an elevated suicide rate


Suicide associations
Suicide Associations Investigation

  • Suicide rates are inversely related to level of education

  • The incidence of suicide is also significantly lower among married individuals than among those who are single, separated, divorced or widowed


Suicide associations1
Suicide Associations Investigation

  • Suicide rates are known to be higher for the elderly, for white males, & for certain racial/ethnic groups


Suicide among youth3
Suicide Among Youth Investigation

  • Risk Factors include:

    • Family history of suicide

    • Impulsive/aggressive behavior

    • Social isolation

    • Prior suicide attempt(s)

    • Easier access to alcohol, illicit drugs & lethal suicide methods


Suicide among the elderly
Suicide Among the Elderly Investigation

  • Risk factors include:

    • Widowhood

    • Serious medical illness, with associated anxieties

    • Social isolation

    • Depression

    • Alcoholism & prescription drug abuse

    • Financial constraints


The surgeon general s call to action
The Surgeon General’s Call To Action Investigation

  • The public health approach:

    • Define the problem

    • Identify the causes & protective factors

    • Develop & test interventions

    • Implement interventions