How Epidemiologists Think About Suicide Roger B. Trent, Ph.D. EPIC Branch California Department of Health Services

Public Health Surveillance Surveillance--standard data collected consistently over years covering entire populations Contrasted with “studies” over a limited time to test a hypothesis Emphasis on medical rather than psychological aspects

Data on Deaths, Including Suicide From standard death certificates used everywhere in the U.S. Designed to describe all deaths, so not designed for looking at suicide in particular (e.g., nothing on alcohol, prior attempts)

Hospitalization Data In many states, every hospital stay is recorded, so “self-destructive” injuries can be identified “Severity” = not fatal, but serious enough to require admission as an in-patient

The Injury Pyramid for Suicide Fatal (death certificates) Hospitalized (discharge records) Out-patient & untreated (self-reports in surveys)

Suicide Rates by Age & Sex, California 1998

Attempted Suicide Rates by Age & Sex, California 1998

Fatal Methods Used

Nonfatal Methods Used

Method Affects Lethality

Some Unanswered Questions Prevention vary by age? Prevention vary by gender? Strength of intent a factor in method choice? Availability a factor in method choice?

Conclusions Public Health: Illuminate the patterns Put in context with other health issues Identify groups at risk in the population Surveillance +Hypothesis testing studies +Clinical experience Basis for policy