Assessment, Treatment & Management of Suicide Daniel W. Clark, Ph.D. Clinical Psychologist 360.349.1698 drdan@criticalconcepts.org

Note Most of these statistical slides are from DOH’s epidemiologist Dr. Jennifer Sabel in 2015. I’ve added a couple extras at the end. If you have any questions, please feel free to ask. ATMS 2016 temp

Suicide Deaths in Washington Jennifer Sabel

Suicide Trends, 1990-2014 Washington State Department of Health If we look at suicide trends over time in Washington, rates have ranged between 12 and 15 per 100,000. A trend analysis shows rates gradually declined through 2006 to 12 per 100,000 and have started increasing again since 2006 back to 15 per 100,000 in 2014. Historically, states in the western region, including the Rocky Mountain region, of the US have had higher rates of suicide compared to the rest of the country. Note: Basically when we age-adjust a rate we are adjusting the rate to what it would be if there was a standard population distribution. This is important to do because people of different ages are more or less likely to engage in healthy or unhealthy behaviors.   Adjusting rates for differences in age distributions helps us to understand whether there are differences among groups independent of their age structures. Age-adjustment also allows us to compare rates in the same population over a period of time during which the population structure might have changed. It is also important for comparing rates in different geographic locations that might have populations with different age structures (i.e. more older folks and less younger folks). Source: Washington State Department of Health, Death Certificates Washington State Department of Health

Leading Cause of Suicide, 2014 The leading cause or methods of suicide deaths in Washington is firearms. Just over half of suicides are committed with a firearm. The next most common methods were hanging – suffocation and poisoning.

Suicide Age and Gender, 2012-2014 Suicide deaths are dominated by males, accounting for 77% of suicide deaths in this time period. For males, the rates increase with age, and men ages 75 and older had the highest suicide rates while men ages 45–64 had the highest number of suicides. Source: Washington State Department of Health, Death Certificates Washington State Department of Health

Suicide Trends by Age Group 1990-2014 This slide shows the trends over time by age group. These rates combine males and females. For 45-64 year olds has been increasing over time this entire time period, with a faster increase occurring since 2000. For 65 years old and older has steadily declined over time. 25-44 year old trend decreased during the late 1990’s through the mid 2000’s, and has increased since that time. 10-24 year old trend decreased during the late 1990’s, and has increased since that time. Source: Washington State Department of Health, Death Certificate Data Washington State Department of Health

Suicide Race and Ethnicity, 2012-2014 # of deaths 72 2686 68 116 130 American Indian, Alaska Natives have the highest rate of suicide followed by whites. Despite American Indian and Alaska Natives having the highest rate, they also have the fewest number of deaths – because they make up a small portion of the state’s population. Source: Washington State Department of Health, Death Certificates 2014 population data by race are estimated. Washington State Department of Health

Number of Suicides By County of Residence, 2010-2014 12 51 14 389 22 4 9 19 35 43 162 18 54 117 68 45 64 15 1,253 520 97 148 94 30 690 72 60 57 27 Clallam Jefferson Grays Harbor Pacific Whatcom Skagit Snohomish King Pierce Lewis Mason Cowlitz Thurston Clark Skamania Klickitat Yakima Kittitas Chelan Douglas Grant Okanogan Ferry Stevens Pend Oreille Spokane Lincoln Adams Whitman Franklin Benton Walla Walla Columbia Garfield Asotin Wahkiakum San Juan Kitsap 17 80 355 7 199 179 Like I showed you with the race and ethnicity chart, the rate can be relatively high even though it represents a small number of deaths. For example Asotin has a high suicide rate even with 22 suicides over a 5 year time period. Conversely, King County had the lowest suicide rates during this time period, the most suicides occurred in King County. This is due to the fact that King County has about 30% of the state’s population. These maps are all by which county was where the person lived. Source: Washington State Department of Health, Death Certificates Washington State Department of Health

Suicide Rates By County of Residence, 2010-2014 Island Rate=16 Clallam Rate=22 Jefferson Rate=15 Grays Harbor Rate=20 Pacific Rate=23 Whatcom Rate=14 Skagit Snohomish King Rate=12 Pierce Rate=17 Lewis Mason Cowlitz Thurston Clark Skamania Rate=33 Klickitat Yakima Kittitas Rate=18 Chelan Douglas Rate=10 Grant Okanogan Ferry Stevens Rate=25 Pend Oreille Spokane Lincoln Adams Whitman Rate=11 Franklin Benton Rate=13 Walla Walla Columbia Garfield Asotin Rate=19 Wahkiakum San Juan Kitsap This slide looks suicide rates by county, using 5 years of data combined. King County had the lowest suicide rates during 2010-2014, which was significantly lower than the state rate. Clallam, Grays Harbor, Pacific, Pierce, Skamania and Stevens had the highest suicide rates. These rates were significantly higher than the state rate. Even with 5 years of data, there are 9 counties had fewer than 20 suicides, and so these aren’t included because the rates can fluctuate widely with so few deaths. These maps are all by which county was where the person lived. Significantly lower rate No rate – fewer than 15 deaths Lower than state rate Higher than state rate Significantly higher rate State Rate = 14 Source: Washington State Department of Health, Death Certificates Washington State Department of Health

Suicide & Armed Forces Participation 2012-2014 Death certificate: Was the decedent ever in the U.S. Armed Forces? U.S. Armed Forces Participation Military (veteran or active duty) Civilian # of suicides % of suicides 700 22 2,417 78 We know from reports from the military and veterans affairs that both veterans and those who are currently in the military are at higher risk of suicide. There is a question on the death certificate that asks if the decedent was ever in the Armed Forces. With the data that we have available, we can’t calculate risk because of a lack of the total population in our state who are either veterans or currently serving in the military. We can look at the percentage of those who committed suicide that participated in the armed forces. Overall, about 22% of those who died of suicide had participated in the armed forces. However, among those 65 years old and older this percentage is 56%. (While veterans make up about 26% of 65+ population). Veterans make up about 9% of the WA population. The most recent data I could find for active duty population is from 2002, and about 4% of WA’s population was active duty. If this is the case, then approximately 13% of the population have or are currently serving in the armed forces. If this is accurate, then those serving in armed forces would have almost twice the risk of suicide compared to those that haven’t. Note: Those who are currently serving here in Washington would be captured in these statistics, but those stationed here in Washington, but deployed overseas would not be captured. About 13% of WA’s population is either currently serving or has served in U.S. Armed Forces Source: Washington State Department of Health, Death Certificates Washington State Department of Health

Summary of High Risk Groups for Suicide in WA Males 45 years old and older In non-urban areas American Indian/Alaska Natives and Whites Higher poverty & lower educational attainment areas Participation in the armed forces In summary, there are a number of groups that are at higher risk of dying from suicide than others in our state. Males, particularly those 45 years old and older. Those in rural areas. There are a number of counties that have a higher rate. Both American Indian and Alaska Natives and White residents have higher rates. Those in census tracts with higher poverty and lower percentages of people that have graduated college. Participation in the armed forces also appears to be a risk factor, although I didn’t have a great source for the population who is currently serving in the armed forces in our state. Washington State Department of Health

ATMS 2016 AFSP website

Suicide by region ATMS 2016 AAS website, 2015

ATMS 2016

Military Suicide 1996-2013 ATMS 2016

Completion Characteristics Male 93% White/Caucasian 74% Age: 17-24 40% Rank: E1-E4 50% Method: Firearm 65% Sought help 61% Issue: Relationships 41% ATMS 2016 DoDSER 2012

Army Suicide 2012 ATMS 2016

Suicide Demographics Gender Female:male ratio is 3:1 for attempted suicide Female:male ratio is 1:4 for completed suicide ATMS 2016

Suicide Rates