An Overview of Texas Suicide John Hellsten, PhD Environmental & Injury Epidemiology and Toxicology Unit Texas Department of State Health Services DSHS Grand Rounds Austin, TX; November 9, 2011

What is suicide? Suicide is death due to an injury which was intentionally inflicted upon the decedent by him/her self. Reported on death certificates by Medical Examiners and Justices of the Peace

2007 Ranking by State United States 34,598 11.5 # deaths rate per 100,000 population United States 34,598 11.5 New Mexico 401 20.4 (3) Oklahoma 531 14.7 (13) Arkansas 402 14.2 (17) Louisiana 522 12.2 (28) Texas 2,433 10.2 (41)

Demographic Patterns 2007 AGE US TX 10-14 15-19 20-24 25-34 35-44 180 0.9 12 0.7 15-19 1,481 6.9 134 7.7 20-24 2,659 12.7 219 12.5 25-34 5,278 13.1 424 12.1 35-44 6,722 15.6 471 13.8 45-54 7,778 17.7 524 16.2 55-64 5,069 15.5 329 14.5 65-74 2,444 12.6 149 11.7 75+ 2,977 16.0 171 15.3 SEX US TX Male 27,269 18.4 1,932 17.2 Female 7,329 4.7 501 4.3 Total 34,598 11.3 2,433 10.5 Data retrieved from WISQARS, CDC. Age-adjusted rates/100,000 RACE/ ETHNICITY US TX White 28,897 13.5 1,827 15.0 Black 1,916 5.1 116 4.4 Hispanic 2,465 6.0 434 Other 1,248 6.7 49 4.3 Suicide statistics are often skewed/driven by particular demographics: SEX - M:F rate is ~4:1; Females account for only 20% of suicide deaths. RACE – Whites account for 75 and 83% respectively of suicide deaths in Texas y US – somewhat less racial disparity in TX AGE – suicide DEATHS rare among young, however not to say suicidal behavior (ideation, attempts) is not exhibited at young ages Bimodal distribution with rates highest among elderly y among middle ages (prevention emphasis is usually on youth).

Suicide Across the Life-Span Texas deaths per 100,000 Bimodal distribution – peaks at 45-54 y 75+ (~16.0/100000); double the 15-19 rate (8.9) How different would this look if each indiv age was charted? Source: TX DSHS, Center for Health Statistics;2005-2007

Suicide Across the Life-Span Females deaths per 100,000 Rates stay lower/flatter in the younger ages than males – doesn’t increase so quickly until mid 20s Source: TX DSHS, Center for Health Statistics;2005-2007

Texas Suicide Deaths Across the Life-Span by Race/Ethnicity deaths per 100,000 Whites African Americans Hispanics

Texas Suicide Mortality 1931-2010* deaths per 100,000 1931-1940 : 12.3 to 12.1 Large decline during WWII : low at 6.8 in ’43, risen to 8.3 in ’45, nearly a 33% drop during the war. 1950-1970 :relatively stable till late 60s; 9.1 in ’50, 8.7 in’60, 9.0 in ’66. Next 20 years (’66 to ’85) increase to 13.7 in ’85, a 52% increase! From ’90 (12.7) to ’99 (10.0) a 21% decline to rates we havent seen since 60s Since 2000, nearly 9% increase in 1950 1960 1970 1980 1990 2000 2010* Thanks to TDH Injury Epidemiology & Surveillance Program, 2001. *2010 data have not been finalized and are subject to change

Trends in Suicide Deaths US & Texas Age-adjusted rates per 100,000 US Texas

Recent Changes Texas, 2007 to 2010* AGE 2007 2010* 10-14 12 0.7 21 1.2 15-19 134 7.7 138 7.4 20-24 219 12.5 249 13.0 25-34 424 12.1 475 12.4 35-44 471 13.8 511 14.1 45-54 524 16.2 615 17.9 55-64 329 14.5 432 16.9 65-74 149 11.7 201 13.9 75+ 171 15.3 212 18.8 SEX 2007 2010* Male 1,932 17.2 2,267 18.6 Female 501 4.3 590 4.6 Total 2,433 10.5 2,857 11.6 Source: DSHS Center for Health Statistics. Age-adjusted rates/100,000 RACE/ ETHNICITY 2007 2010* White 1,827 15.0 2,104 17.0 Black 116 4.4 165 5.9 Hispanic 434 6.0 539 5.8 Other 49 4.3 4.2

Trends in Texas Suicide Deaths by Sex Age-adjusted rates per 100,000 Male Female ~10% increase for both from 2007-2010

Trends in Texas Suicide Deaths Females Age-adjusted rates per 100,000 ~10% increase for both from 2007-2010

Texas Suicide Deaths by Race/Ethnicity Age-adjusted rates per 100,000 White Hispanic African-American Source: TX DSHS, Center for Health Statistics

Suicide Methods Source: TX DSHS, Center for Health Statistics, 2005-2007

Texas Suicide Deaths by Mechanism Males Source: TX DSHS, Center for Health Statistics, 2004-2006

Texas Suicide Deaths by Mechanism Females

Metropolitan Suicide 2007-2009 deaths per 100,000 Texas Source: DSHS, Center for Health Statistics

Non-fatal Attempts 0.5% of US adult population attempted suicide during 2008-2009; Texas estimate is 0.6% of population (109,000 people). MMWR October 21, 2011 / 60(SS13);1-22 $71,738,300 in medical costs for 2003 Texas hospitalizations for self-inflicted injuries. Children's Safety Network Economics and Data Analysis Resource Center & West Virginia University Injury Control Research Center $343,832,600 in total costs (medical, quality of life, work-loss)

Youth Risk Behavior Survey Texas, 2011 Felt sad or hopeless (at least 2 weeks in a row) - 29.2% Seriously considered attempting - 15.8% Made a plan – 13.2% Attempted 1 or more times – 10.8% Injury requiring medical treatment – 3.5% Jennifer Haussler Garing 512/776-2564 jennifer.garing@dshs.state.tx.us

Suicide Attempt Requiring Medical Treatment Youth Risk Behavior Survey, Texas %