ACTION ALLIANCE FOR SUICIDE PREVENTION APRIL 3, 2018

ACTION ALLIANCE FOR SUICIDE PREVENTION APRIL 3, 2018

ACTION ALLIANCE FOR SUICIDE PREVENTION APRIL 3, 2018 Mamadou Ndiaye, Epidemiologist WA State DOH | 2 people desire death when two fundamental needs are frustrated to the point of extinction; namely, the need to belong with or connect to others, and the need to feel effective with or to influence others..." - T. Joiner, 2005 (Why People Die by Suicide) WA State DOH | 3 Data Sources Death certificates Comprehensive Hospital Abstracting System (CHARS) National Violent Death Reporting System o 2015 data o 9 counties King, Pierce, Snohomish, Kitsap, Thurston, Whatcom, Skagit, Mason, Cowlitz ** Data reporting based on WA residents WA State DOH | 4 A g e -A d ju s t e d R a t e p e r 1 0 0 ,0 0 0 Measure & Background Results WA 1.2.A.g: Reduce suicide death rate from the rate of 15.6 per 100,000 in 2015 to

14.0 per 100,000 in 2020 18 16 15.0 14 12.9 n=857 13.0 14.0 13.3 15.6 14.0 n=1247 * n=112 14.9 3 16.5

14.6 13.8 13.4 12 Results WA Goal 2020: 14.0 per 100,000 10 8 WA Goal USA 6 4 2 0 2007 2008 2009 * 2017 Data Preliminary as of April 2,

2018 2010 2011 2012 2013 WA State DOH | 5 2014 2015 2016 Source: DOH death certificates Geography 2012-2016 Washington State Suicide Mortality (State Age-Adjusted Rate = 14.9 per 100,000. ^=fewer than 10 deaths) WA State DOH | 7 Source: DOH death certificates Change in Number of Suicides by County

Percent Change (2007-2011 vs 2012-2016) 80% 67% 70% 60% 50% 40% 40% 30% 16% 16% 18% 13% 14% 11% 9% 20% 18% 10% 2% 0% -5% -10% -40%

2% -2% -14% -20% -30% 22% 23% 29% 30% 27% 28% 29% -23% -29% Note: Only counties with more than 30 deaths are included. WA State DOH | 8 Source: DOH death certificates 2016 Crude Rate per 100,000 Geography

Urban Core Suburban Large Rural Town Small Town/Isolated Rural Number of Deaths 14.6 18.1 13.9 20 WA State DOH | 9 Population 784 96 57 171 5,387,606 530,901 411,219 853,952 Source: DOH death certificates

Race A g e - A d ju s t e d R a t e p e r 1 0 0 , 0 0 0 Suicide Rate by Race/Ethnicity (2012-2016) 30 26.6 25 20 16.9 15 11.6 9.6 10 9.1 7.4 6.5 5 0

n=120 AIAN AIAN: American Indian and Alaskan Native Multi: Multiracial NHOPI: Native Hawaiian/Other Pacific Islander n=455 White 2 n=12 Multi 2 n=25 NHOPI WA State DOH | 11 n=11 Black 9 n=20 Asian 7 n=25

Hispanic 1 Source: DOH death certificates A g e - A d ju s t e d R a t e p e r 1 0 0 , 0 0 0 Suicide Rate by Race/Ethnicity WA and US (2012-2016) 30 26.6 WA 25 USA 20 18.9 16.9 16.4 15 10

9.1 7.92 5.8 6.3 6.5 6.2 5 0 n=120 AIAN AIAN: American Indian and Alaskan Native Multi: Multiracial Asian/PI: Asian or Pacific Islander n=455 White 2 n=11Black 9 WA State DOH | 12

n=25 Asian/PI 6 n=25 Hispanic 1 Source: DOH death certificates Change in Suicide Rate by Race/Ethnicity (2007-2011 vs 2012-2016) 30 2007-2011 2012-2016 AI/AN-NH: 26.6 25 20 AI/AN-NH: 19.9 White-NH: 16.9 15

White-NH: 15.1 NHOPI-NH: 10.4 10 5 NHOPI-NH: 9.6 Black-NH: 9.1 Asian-NH: 7.4 Hispanic: 6.5 Black-NH: 7.8 Asian-NH: 6.3 Hispanic: 5.3 0 AIAN: American Indian and Alaskan Native Multi: Multiracial NHOPI: Native Hawaiian/Other Pacific Islander WA State DOH | 13 Source: DOH death certificates Age and Sex Suicide Rate (Number) by Age and Sex

Rate per 100,000 (2012-2016) 70 Male Femal e 60 50 40 30 20 10 0 10-14 15-24 25-34 35-44 45-54 55-64

WA State DOH |15 65-74 75-84 85+ Source: DOH death certificates Rates (Number) of Hospitalization for Intentional Self-Harm by Age and Sex Rate per 100,000 (2012-2016) Male 120 Female 100 80 60 40

20 0 <10 10-14 15-24 25-34 35-44 45-54 WA State DOH |16 55-64 65-74 75-84 85+ Source: Comprehensive Hospital Abstract Reporting System (CHARS) Method

Definitions Firearm: Intentional self-harm by handguns, rifle, shotgun, larger and unspecified firearm discharge. o ICD-10 codes: X72 to X74 Suffocation: Intentional self-harm by suffocation, hanging, strangulation. o ICD-10 code: X70 Poisoning: Intentional self-harm by prescription, non-prescription and illicit drugs, alcohol, organic solvents, gases/vapors, pesticides and other chemicals and noxious substances. o ICD-10 codes: X60 to X69 WA State DOH | 18 Methods of Suicide (2012-2016, 2017*) 60% Percent 50% 48.0% 20122016 2017* 50.6%

40% 28.5% 30% 24.4% 18.6% 20% 12.6% 10% 3.3% 0% * 2017 Preliminary Numbers Firearm Suffocation Poisoning WA State DOH |19 3.4%

Falls 5.7% 5.0% Other Source: DOH death certificates Methods of Suicide- By Sex Percent of Suicides (2012-2016) 60% 54.1% Male 50% Female 40% 30% 37.7% 28.2%

24.5% 24.3% 20% 12.6% 10% 0% Firearm n=223 n=363 3 Poisoning n=521 n=485 Suffocation n=101 n=312 0 3.0% 4.1% 2.3% 1.8% 1.0% 2.0% 2.5% 1.8%

Fall/Jump n=124 n=53 Cut/Pierce n=96 n=23 Drowning n=42 n=26 Other n=102 n=23 WA State DOH |20 Source: DOH death certificates Selected Population: Youth Suicide Rate in Washington Ages 10-24 years old 2012-2016 WA State DOH | 22 Youth Suicide Rates (Ages 10-17 and 18-24 years Rate per 100,000

old) WA State compared to US 20.0 18.7 n=125 18.0 16.3 16.0 15.0 n=91 13.8 14.0 14.8 16.0 15.2 15.5 16.0 13.1

WA_10 to 17 12.0 WA_18 to 24 USA_10 to 17 10.0 7.8 8.0 6.0 n=37 5.1 4.0 3.5 2.8 2.7 2008 2009 USA_18 to 24

4.3 4.1 5.2 4.7 1.9 2.0 n=14 0.0 2007 2010 2011 2012 2013 WA State DOH | 23 2014

2015 2016 Source: DOH death certificates Suicide Methods used among Youth (ages 10-24 years old) (2012-2016) 60% Age 10-17 51.8% Age 18-24 Percent 50% 46.7% 40% 37.7% 32.9% 30%

20% 9.6% 10% 5.8% 5.5% 2.6% 0% Suffocation Firearm Poisoning WA State DOH | 24 Falls 5.3% 2.1% Others Source: DOH death certificates NVDRS Findings among Youth Suicides (ages 12-17 years old)

(2015) (N=30 in 9 counties) Problems mentioned C-ME / LE Family Relationships 13 Suicide Thought History 13 School problem History of treatment for mental illness/substance abuse 7 Diagnosed mental health problem 5 NVDRS: National Violent Death Reporting System C-ME/LE: Coroner-Medical Examiner and Law Enforcement.

WA State DOH | 25 5 Selected Population: Men in the Middle Years (MIMY) WA and US Rate of Suicide among MIMY Rate per 100,000 (ages 35-64 years old) 35 n=36 30 0 27.0 WA MIMY n=41 rate 32.2 28.1 27.4 28.3 29.5

29.9 28.8 8 29.7 28.1 26.6 USA MIMY rate 25 20 15 State rate 10 5 0 2007

2008 2009 2010 2011 2012 WA State DOH | 27 2013 2014 2015 2016 Source: DOH death certificates Suicide Methods Used among MIMY (35-64 years old) (2012-2016) 60% Percent

50% 50.1% 40% 30% 24.0% 20% 16.0% 10% 0% Firearm Suffocation Poisoning 3.4% 2.9% 3.5% Cut/Pierce

Falls Others WA State DOH | 28 Source: DOH death certificates Selected Population: Older Adults Rate of Suicide among Older Adults Rate per 100,000 (ages 65 years and older) 25 23.5 21.8 n=269 20 17.8 n=330 15.6 15

WA_65 to 74 10 WA_75+ USA_65 to 74 5 USA_75+ 0 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013 2012-2014 2013-2015 Source: DOH death certificates WA State DOH | 30

2014-2016 Trends of Top Methods Used among Older Adults (65 years and older) (2012-2016) 70% 64% Percent 60% 50% 40% 30% 20% 20% 10% 10% 0% Firearm Poisoning Suffocation

2% 2% 3% Falls Cut/Pierce Other Source: DOH death certificates WA State DOH | 31 NVDRS Findings among Older Adults (ages 55 years and older) (2015) Problems mentioned (N=227 in 9 counties) C-ME / LE Physical health problem

117 Suicide thought history 65 Diagnosed mental health problem 60 History of treatment for mental illness/substance abuse 46 Alcohol problem 28 Financial problem 27 Current treatment for mental illness/substance abuse 27 NVDRS: National Violent Death Reporting System C-ME/LE: Coroner-Medical Examiner and Law Enforcement.

WA State DOH | 32 Selected Population: American Indian and Alaska Natives (AI/AN) A g e -A d ju s t e d R a t e p e r 1 0 0 ,0 0 0 Rate of Suicide among AI/AN in Washington State and USA WA AI/AN rate 30 USA AI/AN rate 25 26.6 n=120 19.9 20 n=88 State rate

15 10 5 0 2007-2011 2008-2012 2009-2013 2010-2014 WA State DOH | 34 2011-2015 2012-2016 Source: DOH death certificates Rate and Number of Suicides among AI/AN By Age Rate per 100,000 (2012-2016) Among AI/AN 60

50 40 30 20 10 0 1-14 15-24 25-44 WA State DOH | 35 45-64 65+ Source: DOH death certificates Suicide Method Use among AI/AN (2012-2016) Among AI/AN 50%

Percent 45% 43.3% 40% 35.0% 35% 30% 25% 20% 15% 4.2% 5% 0% 9.2% 8.3% 10% Firearm Suffocation

Poisoning WA State DOH | 36 Cut/Pierce Other Source: DOH death certificates Selected Population: Veterans Overview In 2016, the VA estimates a total of 567,000 veterans in Washington state. Department of Defense reports 64,171 active duty military and reserve members. From 2012 to 2016, 1,165 veterans* died by suicide. o This accounts for 21.5 % of all WA suicides. o 36.7 % of veterans were ages 55 to 74. o 240 veterans died by suicide in 2016 (crude rate**: 38.0 per 100,000) * Veterans includes active service members, reserve members, and veterans. ** Rate based on veterans. WA WA State State DOH DOH || 38

38 NVDRS Findings among Military (2015) (N=142 in 9 counties) Problems mentioned C-ME / LE Physical health problem 48 Intimate partner problem 37 Suicide thought history 36 Diagnosed mental health problem History of treatment for mental illness/substance abuse 31 NVDRS: National Violent Death Reporting System Military includes active duty, reserve and veterans.

C-ME/LE: Coroner-Medical Examiner and Law Enforcement. WA State DOH | 39 24 Selected Population: Occupation Overview Collaboration with WA Labor and Industries (LNI), the National Institute for Occupational Safety and Health, WA Department of Healths Center for Health Statistics, and the National Violent Death Reporting System (NVDRS) for classification Data sources for Occupation o Death certificates o LNI o NVDRS Activities in WA o Construction Industry Alliance for Suicide Prevention o Enterprise Suicide Prevention Workgroup o 2SHB 2671 Improving behavioral health in the agriculture industry WA WA State State DOH DOH || 41 41 NVDRS Findings among Homeless

(2015) (N=43 in 9 counties) Problems mentioned C-ME / LE History of treatment for mental illness/substance abuse 14 Suicide thought history 10 Eviction or loss of home 9 Alcohol problem 8 Intimate partner problem 7 NVDRS: National Violent Death Reporting System

C-ME/LE: Coroner-Medical Examiner and Law Enforcement. WA State DOH | 42 Preliminary 2017 Data 2017 Overview 1,247 suicides (age-adjusted rate=16.5 per 100,000) in 2017 compared to 1,123 (age-adjusted rate=14.9 per 100,000) in 2016. There is a +2.5% average annual percent change of suicide from 2006 through 2017. When comparing 2016 and 2017, most of the increases are seen in: o suicides by firearm and suffocation o youth and older age groups (65+ years old) * 2017 Data Preliminary as of April 2, 2018 WA WA State State DOH DOH || 44 44 Research Suicides Among American Indian/Alaska Natives National Violent Death Reportin g System, 18 States, 20032014 Characteristics of and Precipitating Circumstances Surrounding Suicide Among Persons Aged 101

7 Years Utah, 20112015 Preventing Suicide among Men in the Middle Years: Recommendations for Suicide P revention Programs Suicide Means among Decedents Aged 50+ Years, 20052014: Trends and Associat ions with Sociodemographic and Precipitating Factors Department of Defense Suicide Event Report (DoDSER) Annual reports Suicide Trends Among and Within Urbanization Levels by Sex, Race/Ethnicity, Age Group, and Mechanism of Death United States, 20012015 Sexual Orientation Discordance and Nonfatal Suicidal Behaviors in U.S. High School Students WA State DOH | 45 Contributing Staff Conrad Otterness, Epidemiologist Neetha Mony, State Suicide Prevention Plan Program Manager Therese Hansen, Manager, Injury & Violence Prevention Ambyr Travis, UW Public Health Intern WA State DOH | 46

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