Suicide among adolescents aged 10-14 in the United States Sally C. Curtin, M.A. Margaret Warner, Ph.D. National Center for Health Statistics Webinar – Injury Control Research Center for Suicide Prevention University of Rochester School of Medicine and the Education Development Center February 8, 2017 National Center for Health Statistics Division of Vital Statistics

Two recent NCHS/CDC publications that include youth suicide Curtin S, Warner M, Hedegaard H. Increase in suicide in the United States, 1999–2014. NCHS data brief, no 241. Hyattsville, MD: National Center for Health Statistics. 2016. https://www.cdc.gov/nchs/products/databriefs/db241.htm QuickStats: Death Rates for Motor Vehicle Traffic Injury, Suicide, and Homicide Among Children and Adolescents aged 10–14 Years — United States, 1999–2014. MMWR Morb Mortal Wkly Rep 2016;65:1203. DOI: http://dx.doi.org/10.15585/mmwr.mm6543a8

Methods Mortality data from the National Vital Statistics System Information from death certificates from 50 States and DC Demographic information on age, race, and ethnicity Underlying cause of death information as classified by the International Classification of Diseases (ICD), 10th revision (Suicide= *U03, X60-X84, Y87.0) For 1968-1998, earlier revisions of the ICD are used but suicide deaths are comparable across revisions Measures Rates of suicide for 10-14 year olds per 100,000 population for 2000-2015 Trends analyzed and average annual percent change calculated with Joinpoint regression software (version 4.2.0.1, 2015) from the National Cancer Institute

Suicide rates for youth aged 10-14: United States, 1968-2015 20th century 21st century NOTE: Suicides are identified with International Classification of Diseases (ICD), 8th revision codes E950-E959 for 1968-1978; ICD, 9th revision codes E950-E959 for 1979-1998; and ICD, 10th revision codes U03, X60-X84, Y87.0 for 1999-2015. SOURCE: NCHS, National Vital Statistics System, mortality.

Suicide rates for youth aged 10-14: United States, 2000-2015 More than 400 deaths in both 2014 and 2015, up from 180 deaths in 2007, the recent low point SOURCE: NCHS, National Vital Statistics System, mortality.

Suicide and MVT death rates for youth aged 10-14: United States, 2000-2015 NOTE:s MVT = Motor vehicle traffic injuries. Motor vehicle traffic injuries are identified with International Classification of Disease, 10th Revision (ICD-10) codes V02-V04[.1,.9],V09.2,V12-V14[.3-.9],V19[.4-.6],V20-V28[.3-.9],V29-V79[.4-.9], V80[.3-.5],V81.1,V82.1,V83- V86[.0-.3],V87[.0-.8],V89.2). All motor vehicle traffic injuries are unintended. SOURCE: NCHS, National Vital Statistics System, mortality.

MMWR November 4, 2016

Suicide by single years of age for youth aged 10-14: United States, 2015 76% 24% SOURCE: NCHS, National Vital Statistics System, mortality.

Suicide rates for youth aged 10-14: United States, 2000-2015 * Average annual percentage change was statistically significant at p<0.05. NOTE: Regression lines were generated using the Joinpoint Regression Program, National Cancer Institute. SOURCE: NCHS, National Vital Statistics System, mortality.

Suicide rates for youth aged 10-14, by sex: United States, 2000-2015 8.7%* -6.6%* 7.7%* * Average annual percentage change was statistically significant at p<0.05. NOTE: Regression lines were generated using the Joinpoint Regression Program, National Cancer Institute. SOURCE: NCHS, National Vital Statistics System, mortality.

Suicide rates for females, by age: United States, 2000 and 2015 * The difference in rates between 2000 and 2015 was significant (p< 0.05). SOURCE: NCHS, National Vital Statistics System, mortality.

Suicide rates for males, by age: United States, 2000 and 2015 * The difference in rates between 2000 and 2015 was significant (p<0.05). SOURCE: NCHS, National Vital Statistics System, mortality.

Percent distribution of suicide deaths by means by sex for youth aged 10-14: United States, 2015 3 9 9 63 Suicide methods are identified with ICD–10 codes X72–X74 for firearm and X70 for suffocation. All other includes: Cut/Pierce; Drowning; Falls; Poisoning; Other specified, classifiable Injury; Other specified, not elsewhere classified Injury; and Unspecified Injury. SOURCE: NCHS, National Vital Statistics System, mortality.

Suicide by leading means for youth aged 10-14: United States, 2000-2015 * Average annual percentage change was statistically significant at p<0.05. NOTE: Regression lines were generated using the Joinpoint Regression Program, National Cancer Institute. SOURCE: NCHS, National Vital Statistics System, mortality.

Suicide by leading means for male youth aged 10-14: United States, 2000-2015 5.1%* -5.5%* 14.1%* -7.8%* * Average annual percentage change was statistically significant at p<0.05. NOTE: Regression lines were generated using the Joinpoint Regression Program, National Cancer Institute. SOURCE: NCHS, National Vital Statistics System, mortality.

8.0* 3-yr 3-yr * Average annual percentage change was statistically significant at p<0.05. NOTE: Regression lines were generated using the Joinpoint Regression Program. National Cancer Institute. SOURCE: NCHS, National Vital Statistics System, mortality.

Summary Suicide rates for 10-14 year olds in the United States are at almost 50-year highs Rate in 2014-2015 is similar to the rate for deaths from motor vehicle traffic injuries Rates for females tripled between 2000 and 2015 (steady increase) Rates for males declined from 2000-2007 and then doubled between 2007 and 2015 Suffocation is the leading suicide means for 10-14 year olds; rates have increased steadily for females Suicides by firearm declined from 2000 to 2008 but since 2008, have increased

Limitations Some of the increase may be due to increases in reporting, especially among children aged 10-12 Potential for variation in how ambiguous cases are classified drug overdose “choking game” However, the increase is consistent with other, related information …  

Final thought Completed suicides are just one piece of a larger public health issue among youth in the United States Recent tripling between 2009 and 2013 of non-fatal self-harm episodes (cutting and piercings) requiring ED visits in youth aged 10-14 Bell TM, Qiao N, Jenkins PC, Siedlecki CB, Fecher AM. Trends in Emergency Department Visits for Nonfatal Violence-Related Injuries Among Adolescents in the United States, 2009-2013. Journal of Adolescent Health, 58, 573-575. 2016. Statistically significant increase between 2008 and 2013 in the rate of 12-17 year olds who have had a major depressive episode in the last 12 months National Center for Health Statistics. Chapter 28: Mental Health and Mental Disorders. Healthy People 2020 Midcourse Review. Hyattsville, MD. 2016.

Thank you! Contact: SCurtin@cdc.gov Acknowledgment: We would like to thank our NCHS colleague Dr. Holly Hedegaard for her thoughtful and thorough review of this presentation. We would also like to thank all of the people who work behind the scenes on the vital statistics data; who make The National Vital Statistics System what it is: the oldest and most successful example of inter-governmental data sharing in Public Health. Thank you! Contact: SCurtin@cdc.gov