1. SUICIDE Presented by The American College of Surgeons Committee on Trauma Subcommittee on Injury Prevention and Control

2. The Language of Suicidology Contemplator – thoughts of self harm intended to end own life. Attemptor – acts on thoughts and injures self. Completor – ends own life. Survivor – close personal relationship with a completor.

3. Classifying Intentional Injuries FatalNon Fatal Intentional injury directed at self Suicide completors Suicide attemptors Intentional injury directed at others HomicideAssault

4. Magnitude of Problem Over 30,000 deaths annually in the U.S., over 1 million worldwide 25 times as many people attempt suicide 63% of intentional deaths 1.7 times as many deaths as homicide #3 cause of death in 1 st 4 decades of life 2001 CDC Data

5. Age Adjusted Rates, 2000 CDC Injury-Related Deaths in the U.S. 29,056 17,124 97,900 46,180 144,374

6. 2000 Age-Adjusted Rates, CDC Spectrum of Suicide ? 30,000 Deaths 750,000 Attempts

7. Source: World Health Organization (WHO) Suicide Rates Vary Globally

8. Source: CDC Suicide Rates Vary by Region in the U.S. Rural Rates are Higher than Metropolitan Rates

9. Demographics Males 4 x more likely to die than females Native American, Caucasian highest rates In youth, less racial or ethnic variation Elderly at high risk 2001 CDC Data

10. 2000 CDC Data Death Rates High Across Ages Age Death Rate Death Rates per 100,000 population

11. Mechanism of Suicide Deaths Both Genders, All Ages 2001 CDC Data Firearms Suffocation Poisoning #1 #2 #3

12. Gender Differences Males use firearms more than females Suffocation used by males more than females Poisoning used by females more than males Males attempts more likely to result in death

13. Age-Adjusted Rates per 100,000 Population, 2000 CDC Data Male Gender Suicide Deaths & Attempts

14. Age-Adjusted Rates per 100,000 Population, 2000 CDC Data Female Gender Suicide Deaths and Attempts

15. Age-Adjusted Rates per 100,000 Population, 2000 CDC Data Suicide Deaths Plus Suicide Attempts By Gender and Age Total Rates Differ Little By Gender

16. Summary Demographics Male death rate > Female Native American > White > African American > Hispanics Suicide is 3 rd most common cause of death 10-34, 4 th 35-44, 5 th 45-54. Adolescent suicide represents fastest growing segment of suicide attempts. Rates for 65+ are greatest

17. Risk Factors

18. Depression and Hopelessness: Major Risk Factors 1 of 16 people with depression commit suicide 2/3 of people who commit suicide are depressed, higher for adolescents Depression plus alcohol increases risk Hopelessness, anxiety increases risk American Association of Suicidology

19. Other Risk Factors Family member committed suicide (survivor) Childhood trauma, especially abuse Intimate Partner Violence Divorce Recent move, especially for adolescents Firearms Alcohol Education Chemical – low levels of serotonin

20. Adolescents and Young Adults High rate of depression, hopelessness Impulsivity, Alcohol Use important Recent move of household a risk factor Many seek help from family/friends. –Need community-based training for prevention –Need to remove the stigma of suicide Suicide and Life-Threatening Behavior. 2001;32S

21. Barnes LS, Suicide and Life- Threatening Behavior, 2001 Help-Seeking Behavior Adults: Medical community often contacted prior to attempt Adolescents: Few have recent medical contact Often seek help from family or friends Less than 10% use Hotlines

22. Suicides Impact On Trauma Centers National Trauma Data Bank

23. National Trauma Data Bank (NTDB) Voluntary reporting by trauma centers to central database maintained by the American College of Surgeons. Suicide identified by E-codes.

24. Intentionality of Trauma Patients in NTDB Produced by: Suicide Prevention and Research Center, University of Nevada School of Medicine Data Source: National Trauma Data Bank (NTDB), American College of Surgeons, (n= 265,441) Unintentional 15% Intentional

25. Suicide in Trauma Centers 2% of all admissions 77% male, average age 40 years 80% are penetrating injuries 24% mortality (higher than other types of trauma) 75% require OR or are admitted to ICU

26. Suicide in Trauma Centers Many have known mental health problems Longer hospital and ICU stays than other injuries Few are discharged to psychiatric facility

27. Trauma Patients at Future Risk of Suicide

28. Traumatic Brain Injury Patients Traumatic Brain Injury patients are at risk of subsequent suicide attempts* –35% hopeless –23% suicidal ideation –17% have attempted suicide Higher risk with substance abuse Repeated suicide attempts * Simpson G Psychol Med 2002; 32(4):687-97.

29. Other Trauma Patients Depression in other patients following trauma? Those with ongoing somatic complaints have higher incidence of depression. Associated with ongoing alcohol use?

30. Interventions Treat depression –SSRIs, others Individual cognitive therapy decreases repeat attempts Group Therapy Family Counseling Physician Speaking with patient and family may make a difference

31. Recommendations Suggestions for Trauma Centers

32. Recommendations Participate in NTDB –National, regional, state suicide burden to Trauma Centers Suicide Education –Surgery Residents –Trauma Fellows –Practicing Surgeons –Primary Care Physicians –Other medical personnel –Medical Students

33. Recommendations Develop A Suicide Prevention Plan for your Community. –Demographics –Identify hospital and community resources –Educate medical staff –Injury Prevention – partner with community groups –Rural locations

34. Resources www.cdc.gov www.suicidology.org www.sprc.org www.surgeongeneral.org www.aas.org www.afsp.org Reducing Suicide: A National Imperative. 2002. Institute of Medicine. National Academy of Sciences