epidemiology of self-directed violence

The epidemiology of self-directed violence

Alex E. CrosbyDivision of Violence Prevention

Centers for Disease Control and Prevention

Feb 2015

National Center for Injury Prevention and Control

Division of Violence Prevention/Etiology and Surveillance Branch

"The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry.”

Why is suicidal behavior a public health issue?

• Morbidity and mortality• 10th leading cause of death in 2013 accounted for over 41,000

deaths• Estimated 483,586 emergency dept visits for self-inflicted injury in

2012 (NEISS)• Health consequences in many areas

• Physical, mental, behavioral, reproductive, sexual transmitted diseases

• Potential for impact by public health• Focus on prevention• Science base• Stresses multi-disciplinary approach

• Mission of public health includes this issue “ … to reduce the amount of disease, premature death, and disease-

producing discomfort and disability in the population.”

J. Last, Dictionary of Epidemiology 1988

Leading causes of death – United States, 2013

Rank Cause Number of deaths1 Heart Disease 611,1052 Malignant Neoplasms 584,8813 Chronic Lower Respiratory

Ds149,205

4 Unintentional Injuries 130,5575 Cerebrovascular Ds 128,9786 Alzheimer’s Disease 84,7677 Diabetes mellitus 75,5788 Influenza and pneumonia 56,9799 Nephritis 47,11210 Suicide 41,14911 Septicemia 38,156

Source: CDC vital statistics

Leading causes of death for selected age groups – United

States, 2013Rank 10-14 years 15-19 years 20-29 years 30-39 years 40-49 years 50-59 years1 Unintentional

InjuriesUnintentional



InjuriesMalignantNeoplasms

MalignantNeoplasms

2 MalignantNeoplasms

Suicide Suicide Suicide Heart Disease

Heart Disease

3 Suicide Homicide Homicide MalignantNeoplasms

UnintentionalInjuries

UnintentionalInjuries

4 CongenitalMalformations

MalignantNeoplasms

MalignantNeoplasms

Heart Disease

Suicide LiverDisease

5 Homicide Heart Disease

Heart Disease

Homicide LiverDisease

ChronicLower

Respiratory Ds 6 Heart

DiseaseCongenital

Malformations

DiabetesMellitus

Liver Disease DiabetesMellitus

DiabetesMellitus

7 ChronicLower

Respiratory Ds

Influenza and Pneumonia

CongenitalMalformation

s

DiabetesMellitus

Cerebro-Vascular

Suicide

8 Influenza and Pneumonia

ChronicLower

Respiratory Ds

HIV Cerebro-Vascular

Homicide Cerebro-Vascular


Leading causes of death by ethnicity – United States, 2013

Source: CDC Vital Statistics

Rank White Black

American Indian/AN Asian Latino

1 Heart Disease Heart Disease Heart Disease Malignant Neoplasms

Malignant Neoplasms

2 Malignant Neoplasms

Malignant Neoplasms

Malignant Neoplasms

Heart Disease Heart Disease

3Chronic Low Respiratory

CerebroVascular

Unintentional Injuries

Cerebrovascular


4 Unintentional Injuries

Diabetes Mellitus

Diabetes Mellitus


Cerebrovascular

5 Cerebrovascular


Liver Disease Diabetes Mellitus

Diabetes Mellitus

6 Alzheimer’s Disease

Chronic Low Respiratory


Influenza and pneumonia

Liver Disease

7 Diabetes Mellitus

Nephritis CerebroVascular



8 Influenza and pneumonia

Homicide Suicide Alzheimer’s Disease

Alzheimer’s Disease

9 Suicide Septicemia Influenza and pneumonia

Nephritis Influenza and pneumonia

0

5

10

15

20

25

30

Year

Rat

e pe

r 100

,000

pop

ulat

ion

MaleFemaleTotal


Suicide among all persons by sex -- United States,

1933-2013

Suicide rates among persons aged15-19 years -- United States, 1956-

2013

0

2

4

6

8

10

12

14

16

18

20

1956

1959

1962

1965

1968

1971

1974

1977

1980

1983

1986

1989

1992

1995

1998

2001

2004

2007

2010

2013

Year

Rat

e pe

r 100

,000

po

pula

tion

Male

Total

Female


0

500

1000

1500

2000

2500

3000

3500

4000

4500

0-4 ^5-9

^10-1

4

^15-1

9

^20-2

4

^25-2

9

^30-3

4

^35-3

9

^40-4

4

^45-4

9

^50-5

4

^55-5

9

^60-6

4

^65-6

9

^70-7

4

^75-7

9

^80-8

4^8

5+

Age Group

Num

ber o

f dea

ths

0

3

6

9

12

15

18

21

Rat

e pe

r 100

,000

pop

ulat

ion

RateNumber


Suicides and suicide rates among all persons -- United

States, 2013

0

10

20

30

40

50

Age Group in years

Rat

e pe

r 100

,000

pop

ulat

ion

MalesFemales

Suicide rates among all persons by age and sex--

United States, 2013


Suicide by method – United States, 2013

Firearms51.4%

Suffocation24.5%

Poisoning16.1%

Fall2.4%

Other5.7%


Age-adjusted suicide rates among all persons by state -- United States,

2013 (U.S. avg 12.6)

Rates per 100,000 population5.8 to 11.611.7 to 12.512.6 to 15.615.7 to 23.7

Source: Centers for Disease Control and Prevention (CDC) vital statistics

Wash., D.C.

0

5

10

15

20

25

30

35

40

Age Group in years

Rat

e pe

r 100

,000

pop

ulat

ion

Eur-Amer NonLatino

Afr-Amer NonLatino

Native American Non-Latino

Asian-PI Non-Latino

Latino

Suicide rates by ethnicity and age group -- United States, 2009-2013

Source: CDC Vital Statistics

Burden of injury

Hospitalizations

Emergency Dept visits

Events reported on surveys

Unreported events

Deaths

Public Health Burden of suicidal behavior -- United

States, 2012

*Source: CDC’s National Vital Statistics System¶Source: Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS)§ Source: CDC’s National Electronic Injury Surveillance System – All Injury Program

Number and ratio of persons affected by suicidal thoughts and behavior among adults aged ≥18 years

— United States, 2012

*Source: CDC’s National Vital Statistics System,†Source: Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS) § Source: Source: CDC’s National Electronic Injury Surveillance System-All Injury Program ¶ Source: SAMHSA’s National Survey on Drug Use and Health** Source: SAMHSA’s National Survey on Drug Use and Health Number in parentheses represent the ratio of deaths to other categories

Deaths*

Hospitalizations †

Emergency Department visits§

Suicide attempts ¶

Seriously considered suicide**

39,426 (1)

129,205 (3.3)

405,000 (10.3)

1,129,000 (32.7)

9,031,000 (229.1)

0

50

100

150

200

250

300

350

400

450

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64 65

+

Age Group in years

Rat

e pe

r 100

,000

pop

ulat

ion

MalesFemales

Self-inflicted injury among all persons by age and sex--United

States, 2013

Source: CDC WISQARS NEISS

Suicidal ideation and behavior among high school students by

category and sex* -- United States, 2013

0

5

10

15

20

25

Seriously considersuicide

Suicide plan Attempted suicide^ Suicide attempt withmedical

Category

Perc

enta

ge o

f all

stud

ents

FemaleMaleTotal

Source: CDC Youth Risk Behavior Survey* During the 12 months preceding the survey^One or more times

Percentage of high school students who report suicidal behavior* by

sex – U.S., 1990-2013

0

24

6

8

1012

14

Year

Perc

enta

ge o

f all

stud

ents

Source: Youth Risk Behavior Surveillance System*At least one attempt during the 12 months preceding the survey

Female

Male

Total

Resources and internet-based Statistics

• National Center for Injury Prevention and Control • Division of Violence Prevention• www.cdc.gov/ncipc

• www.cdc.gov/ncipc/wisqars/default.htm

• Injury mortality and leading cause of death statistics available by:• Intent, Method• Year• State• Demographics

• Age, Sex, Race • Injury morbidity

• Hospital emergency dept events• Natl Violent Death reporting System

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Thank you

National Center for Injury Prevention and Control

Division of Violence Prevention

www.cdc.gov/injury; 770-488-4410

http://www.cdc.gov/injury

epidemiology of self-directed violence

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