Evaluation of Maryland Youth Suicide (12
(12 ­­ 24 years), 2003
24 years), 2003 ­­ 2004 Maryland Department of Health and Mental Hygiene Center for Maternal and Child Health AND Johns Hopkins Bloomberg School of Public Health Public Health Applications for Student Experience Kimberly Rosendorf [email protected] Preceptor: Dr. William Adih [email protected] May 12, 2006
May 12, 2006 Public Health Problem n n
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Suicide is the third leading cause of death among adolescents and young adults ages 15
adolescents and young adults ages 15 ­­ 24 years. The overall rate of suicide among youth has declined slowly since 1992. However, rates remain unacceptably high. In Maryland, in 2003
In Maryland, in 2003 ­­ 2004, youth under 25 years accounted for 16.3% of the population and 21% of all suicides. Suicide is responsible for personal and economic loss to communities and societies worldwide. In addition, the conditions that result in suicide or suicide attempts reduce one
attempts reduce one ’’ s quality of life. Suicide is generally a complication of a psychiatric disorder, but this disorder is often not the lone cause and it may result from additional risk factors. The three leading risk factor categories for adolescent suicide include mood disorders, substance abuse problems, and behavior disorders
problems, and behavior disorders NVDRS: 17 Participating States
NVDRS: 17 Participating States NVDRS: How it Works Occurrence of a Death Death Certificate Request for Data ME/Coroner Police Crime Lab ME/Coroner Reports State Health Department or Other State Health Agencies CDC State Database Dissemination of State Data National Database Police Reports Crime Lab Reports Other Federal Agencies (e.g. Bureau of Justice Statistics; Office of the Surgeon General; Bureau of Alcohol, Tobacco, and Firearms; FBI) Dissemination of National Data Website Annual Reports Research
Demographics (N=133) %
% Gender Male Female 84.2 15.8 Age 12­ 19 12 ­19 20­ 24 20 ­24 37.6 62.4 Race African American Asian White Other Race 24.8 3.0 70.7 1.5 County Urban Rural 74.4 25.6 Suicide by Age: Comparison to National Statistics 16.0 14.1 14.0 11.5 12.0 12.1 10.0 7.3 8.0 5.0 6.0 4.0 2.0 6.5 2.2 2.0 1.7 0.0 <15 yrs (12­ 14 yrs) 15­19 yrs 20­24 yrs MD in state (2003­2004) * MD (2003, WISQARS) ** US (2003, WISQARS) *MD resident suicides committed in MD ** Web­based Injury Statistics Query and Reporting System: http://w w w .cdc.gov/ncipc/w isq ars/ contains data on all MD resident suicides including those committed outside the state and national statistics
Suicide by Gender: Comparison to National Statistics 16.0 14.0 12.0 MD in state (2003­2004) * 13.4 12.8 MD (2003, WISQARS) ** 10.9 US (2003, WISQARS) 10.0 8.0 6.0 4.0 2.1 2.5 2.5 2.0 0.0 Males, 12­24 yrs Females, 12­24 yrs *MD resident suicides committed in MD ** Web­based Injury Statistics Query and Reporting System: http://w w w .cdc.gov/ncipc/w isq ars/ contains data on all MD resident suicides including those committed outside the state and national statistics
Suicide by Race: Comparison to National Statistics 10.0 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 MD in state (2003­2004) * 8.8 8.2 MD (2003, WISQARS) ** 7.7 US (2003, WISQARS) 5.9 5.7 5.0 Whites, 12­24 yrs Blacks, 12­24 yrs *MD resident suicides committed in MD ** Web­based Injury Statistics Query and Reporting System: http://w w w .cdc.gov/ncipc/w isq ars/ contains data on all MD resident suicides including those committed outside the state and national statistics
Suicide Rate by County, 12­24 years, Maryland 2003­2004 Allegany Wicomico Calvert Carroll How ard Frederick Prince George's Baltimore Harford Baltimore city Montgomery Anne Arundel 0.0 43.3 39.2 34.4 21.5 14.9 14.7 13.1 11.7 11.4 9.8 9.3 8.8 10.0 20.0 30.0 40.0 50.0 Rate per 100,000 Note: Rates are shown for only the counties with 5 or more suicides. Other counties with suicides during these years and the indicated number include: Cecil (4), Charles (4), Washington (3), Queen Anne’s (2), and St. Mary’s (1).
Selected Characteristics of Suicide Victims, 12­ 24 years, Maryland, 2003­2004 Current Mental Health Problem Depressed Mood Intimate Partner Problem Crisis in Past 2 w eeks Other Substance Problem Recent Criminal Legal Problem Other Relationship Problem Alcohol Problem School Problem Perpetrator of Interpersonal Violence Financial Problem Family Death in Past 5 Years Suicide of Friend or Family in Past 5 Years Physical Health Problem Victim of Interpersonal Violence 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 Percent
Suicide Intent and History of Prior Suicide Attempts, 12­24 years, Maryland, 2003­2004 30.0 28.3 23.3 25.0 20.8 Percent
20.0 15.0 10.0 5.0 0.0 Disclosed Intent to Commit Suicide suicide note History of Suicide Attempts D
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Mental Health and Mood Problems Among Suicide Victims, 12­24 years, Maryland, 2003­2004 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 31.7 31.7 3.3 3.3 2.5 1.7 0.8 0.8 Treatment for Mental Health Problems, 12­24 years, Maryland, 2003­2004 45.0 40.0 39.2 35.0 30.0 Percent
30.0 25.0 20.0 12.8 15.0 10.0 5.0 0.0 Ever Treated for Mental Illness Current Treatment for Mental Illness Tested Positive for Antidepressants Substance Use and Abuse Among Suicide Victims, 12­24 years, Maryland, 2003­2004 40.0 35.8 35.0 Percent
30.0 24.6 25.0 23.3 20.0 15.0 13.3 10.0 5.0 0.0 Alcohol Problem Tested Positive Other Substance Tested Positive for Alcohol Problem for Other Drugs Relationship and Interpersonal Problems Among Suicide Victims, 12­24 years, Maryland, 2003­2004 35.0 31.7 30.0 Percent
25.0 20.0 15.0 15.0 10.0 5.0 5.0 0.8 0.0 Intimate Partner Other Relationship Problem Problem Perpetrator of Interpersonal Violence Victim of Interpersonal Violence Traumatic Life Events Among Suicide Victims, 12­24 years, Maryland, 2003­2004 35.0 30.0 30.0 Percent
25.0 20.0 15.0 10.0 4.2 5.0 1.7 0.0 Crisis in Past 2 weeks Family Death in Past 5 Years Suicide of Friend or Family in Past 5 Years Other Problems among Suicide Victims, 12­24 years, Maryland, 2003­2004 14.0 13.3 12.0 Percent
10.0 8.0 5.8 6.0 5.0 4.2 4.0 1.7 2.0 0.0 Recent Criminal Legal Problem School Problem Financial Problem Job problem Physical Health Problem Methods of Suicide, 12­24 years, Maryland, 2003­2004 50.0 46.2 39.4 30.0 20.0 3.8 0.8 0.8 Fall Sharp Instrument Motor Vehicle Hanging, strangulation, suffocation 0.0 Poisoning 9.1 10.0 Firearm Percent
40.0 Significant Associations by Gender Proportion % (N) P­ Value P ­Value Difference in Proportions † Difference in Proportions † (%) Gender Female Male 55.00 (11) 17.00 (17) 0.0002 38.00 (14.99, 61.01) History of Gender Suicide Attempts Female Male 40.00 (8) 17.00 (17) 0.021 23.00 (0.3, 45.7) Gender Female Male 4.76 (1) 54.05 (60) 0.0000* 0.0000 * ­49.29 ( ­62.29, 62.29, ­ ­36.30) 36.30) ­ 49.29 (­ Gender Female Male 61.90 (13) 35.14 (39) 0.021 26.77 (4.18, 49.36) Suicide Note Firearm Hanging, Strangulation, Suffocation *Fisher’s exact used where observed cell count < 5 and expected cell count > 5 †† By normal approximation
Significant Associations by Age Proportion % (N) P­ Value Difference in Proportions † P ­Value Difference in Proportions † (%) Alcohol Problem Age 20­ 24 20 ­24 12­ 19 12 ­19 18.92 (14) 4.35 (2) 0.027 * 0.027 * Tested Positive for Alcohol Age 20­ 24 20 ­24 12­ 19 12 ­19 37.70 (23) 8.16 (4) 0.0003* 29.54 (15.16, 43.92) 14.57 (3.88, 25.27) *Fisher’s exact used where observed cell count < 5 and expected cell count > 5 †† By normal approximation
Significant Relationships by Residence Proportion P­ Value P ­Value % (N) Difference in Proportions † (%) Difference in Proportions †(%) County Rural Urban 25.93 (7) 9.89 (9) 0.033 16.04 (­ 33.67, 1.60) 16.04 ( ­33.67, 1.60) Other Substance Problem County Rural Urban 40.74 (11) 16.48 (15) 0.008 24.26 (4.22, 44.30) Tested Positive for Alcohol County Rural Urban 42.31 (11) 19.51 (16) 0.019 22.80 (1.96, 43.63) Alcohol Problem †† By normal approximation
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Describing the problem, understanding the risk factors, and prot
Describing the problem, understanding the risk factors, and prot ective factors are essential in effective preventive efforts. Promote overall mental health among children by reducing early r
Promote overall mental health among children by reducing early r isk factors for depression, substance abuse, and aggressive behaviors and bu
for depression, substance abuse, and aggressive behaviors and bu ilding resiliency. Detect youth most likely to be at risk through screening for dep
Detect youth most likely to be at risk through screening for dep ression, substance abuse, and suicide ideation and refer them for treatme
substance abuse, and suicide ideation and refer them for treatme nt. Limit young people
Limit young people ’’ s access to lethal weapons (e.g., guns and medications). Use caution in media and school
Use caution in media and school ­­ based suicide education programs so as not to normalize or glamorize suicide.
to normalize or glamorize suicide. Acknowledgements n n William Adih
Adih , MD, DrPH
DrPH * n n Maureen Edwards, MD, MPH* n n George Thorpe, MD** *Center for Maternal and Child Health, DHMH **Center for Preventive Health Services, DHMH
**Center for Preventive Health Services, DHMH