suicide in san diego county

Suicide in San Diego County

County of San DiegoHealth and Human Services Agency

Public Health Services

Age Groupof Victim 1 2 3 4 5

0-4 Drown Homicide Motor Vehicle Asphyxia Drug/Alcohol Overdose51 47 40 30 15

5-9 Motor Vehicle Drown Asphyxia Homicide Burn33 10 5 3 1

10-14 Motor Vehicle Suicide Homicide Drown Hang40 15 12 3 3

15-19 Motor Vehicle Homicide Suicide Drug/Alcohol Overdose Drown310 165 107 48 22

20-24 Motor Vehicle Suicide Homicide Drug/Alcohol Overdose Exposure497 249 204 144 21

25-34 Motor Vehicle Suicide Drug/Alcohol Overdose Homicide Drown501 473 470 248 45

35-44 Drug/Alcohol Overdose Suicide Motor Vehicle Homicide Fall849 611 448 192 57

45-54 Drug/Alcohol Overdose Suicide Motor Vehicle Fall Homicide1411 761 462 171 153

55-64 Drug/Alcohol Overdose Suicide Motor Vehicle Fall Homicide603 525 334 240 69

65-74 Fall Suicide Motor Vehicle Drug/Alcohol Overdose Medical/Therapeutic282 254 194 85 61

75-84 Fall Suicide Motor Vehicle Medical/Therapeutic Asphyxia742 246 208 53 44

85+ Fall Suicide Motor Vehicle Asphyxia Medical/Therapeutic1084 145 130 38 18

Total Drug/Alcohol Overdose Suicide Motor Vehicle Fall Homicide3656 3393 3210 2642 1245

Source: County of San Diego Health and Human Services Agency, Emergency Medical Services,Medical Examiner database, 2001 - 2010Note: Age detail not available for open or sealed cases.

Leading Causes of Non-Natural Death by Age Group of Victim,County of San Diego

2001 - 2010Rank of Cause of Death

Suicide Rate by State, 2007

Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2005. CDC WONDER On-line Database, compiled from Compressed Mortality File 1999-2005 Series 20 No. 2K, 2008. Accessed at http://wonder.cdc.gov/cmf-icd10.html on Mar 23, 2009 6:12:29 PM

DCNJNYCTMA

ILRI

MDHI

CANETXDEGAIA

MNMI

OHNHPAVA

TotalSCNCLASDIN

ALWI

WAFLTN

MOMEKSMSVTARNDOKID

KYORUTWVAZCONVMTWYNMAK

0 5 10 15 20 25

Rate per 100,000 (Age Adjusted)

Stat

e

California (#42)

U.S. Total

Suicide Rate by California County, 1999- 2007

San Benito Santa Clara Imperial Los Angeles Alameda San Mateo Orange Napa Merced Monterey San Joaquin Contra Costa Kings Yolo Fresno TotalTulare Solano Santa Barbara Ventura Stanislaus Riverside San Bernardino Sonoma San Francisco Placer Sutter San Diego Colusa Madera Kern Mono Sacramento Marin Santa Cruz San Luis ObispoEl Dorado Del Norte Nevada Mariposa Butte Modoc Tehama Glenn Amador Calaveras Inyo Mendocino Yuba Lassen Lake Humboldt Shasta Tuolumne Plumas Siskiyou

0 5 10 15 20 25

Chart Title

Rate per 100,000 (Age Adjusted)

Cou

nty

San Diego County (#30)

California Total

Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2005. CDC WONDER On-line Database, compiled from Compressed Mortality File 1999-2005 Series 20 No. 2K, 2008. Accessed at http://wonder.cdc.gov/cmf-icd10.html on Mar 23, 2009 6:12:29 PM

Number of Suicides by Age and GenderSan Diego County, 2000 - 2009

10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+0

100

200

300

400

500

600

700

800

10

89

203

374

482517

357

192 201

118

4 2041

112

166

222

120

56 5122

14

109

244

486

648

739

477

248 252

140

Male Female Total

Age Group

Num

ber o

f Sui

cide

s

Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009

70% 25 to 64 years52% of population

19% 65+11% of population

11% 15 to 24 years17% of population

Suicide Rates by Age and GenderSan Diego County, 2000 - 2009

10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ All Ages0

10

20

30

40

50

60

70

80

25.61

39.01

67.86

16.91

Male Female Total

Rat

e pe

r 100

,000

Highest rates in oldest males

Female suicide rate peaks at 45-54 years


Overall Suicide Rate by Age Group and Year, San Diego County, 1988 - 2010

1988 - 1992

1993-1997

1998-2002

2003 2004 2005 2006 2007 2008 2009 20100

5

10

15

20

25

30

35

40

15-24 25-44 45-64 65+ Total

Rat

e pe

r 100

,000

Age distribution starting to change


Overall Suicide Rate by Year, San Diego County, 1988 - 2010

02468

10121416

Rat

e pe

r 100

,000


1988 – 1992 average

13.5/100,0002005 – 2009

average

11.1/100,000

18% Decline

Suicide Methods: Both Sexes, All Ages, 2000 - 2009

OD/Poison21%

Hang/Asphyxia

22%Firearm40%

Jump 7%

Other10%


Suicide Rates by Method, 5-Year Periods, 1990 - 2009

1990 - 1994 1995 - 1999 2000 - 2004 2005 - 20090

1

2

3

4

5

6

7

8

Firearm; 6.92

Firearm; 4.2

Firearm OD/Poisoning Hang/Strangle/Suffocation Jump/Other

Ave

rage

Ann

ual R

ate

per 1

00,0

00

39% Decline in Firearm-Related Suicide Rate


Suicide Rates by Method, 1990 - 2009

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

0

1

2

3

4

5

6

7

8

Firearm/Explosive OD/Poisoning Hang/Strangle/Suffocation Jump from high place Non-firearm

Ave

rage

Ann

ual R

ate

per 1

00,0

00


Suicide Rates by Race/Ethnicity: San Diego County, 2000 - 2009

White Black Hispanic Asian/Other0

5

10

15

20

25

3025.6

10.78

5.838.618.53

2.751.44

3.02

17.12

6.99

3.635.71

Male Female Total

Race/Ethnicity

Rat

e pe

r 10

0,00

0


The Tip of the Iceberg

Emergency Department

Hospital Admissions

Deaths

0 500 1000 1500 2000 2500

2370

1524

377

Suicide/Self-Inflicted Injury, 2009

1 per day

4 per day

6.5 per day

Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 1988 – 2009California Department of Public Health, Safe and Active Communities Branchhttp://epicenter.cdph.ca.gov

Transitional Age Youth (TAY)

15 16 17 18 19 20 21 22 23 24 25-44 45-64 65+0

4

8

12

16

20

3.72.3

3.7

6.8 6.3 6.6

9.3 9.811.8

12.911.8

18.6 18.8

Suicide Rate by Age, 2001 - 2010

Age

Suic

ide

Rat

e pe

r 100

,000 Transitional Age Youth – 18 – 24 Years


Suicide Rates by Marital Status: Age 25 – 64 Years, 2000 - 2009

Single Married Divorced Widowed05

101520253035404550

35.4

10.8

45.248.4

14.7

4

15.7

8.6

27.2

7.4

28

16.2

Male Female Total

Marital Status

Rat

e pe

r 10

0,00

0


Suicide Rates by Marital Status: Age 65 Years and Older, 2000 - 2009

Single Married Divorced Widowed0

102030405060708090

78.2

19.4

78.3 77.8

9.44.6

10.8 7.4

44.5

12.7

34.7

20.9

Male Female Total

Marital Status

Rat

e pe

r 10

0,00

0


Figure 1.8: Toxicology Results for Alcohol and Drugs of Abuse by Gender, All Ages, 2004 - 2009

Toxicology Results: Males, All Ages

Negative39%

Drugs only28%

Alcohol + Drugs17%

Alcohol only16%

Toxicology Results: Females, All Ages

Drugs only37%

Negative29%

Alcohol + Drugs22%

Alcohol only12%

Source: County of San Diego Health and Human Services Agency, Emergency Medical Services, Medical Examiner Database, 2004 – 2009 Note: “Drugs of Abuse” includes methamphetamine, opiates, cocaine, cannabinoids, and benzodiazepines. This graph does not include antidepressants

N=436 N=1312

Toxicology: Percent Positive by Substance and Sex, 2000 - 2007

Alcohol

Metham

phetamine

Opiates

Cocaine m

etabolite

s

Cannab

inoids

Benzo

diazep

ines0%

5%

10%

15%

20%

25%

30%

35%

Male Female Total

Perc

ent T

este

d

Source: County of San Diego HHSA, Public Health Services, Emergency Medical Services, Medical Examiner Database, 2000 – 2007

Special Population: Lesbian, Gay, Bisexual, Transgender (LGBT)

• King, et al. meta-analysis– RR suicide attempts (vs hetero): 2.47

• Men: 4.28; Women: 1.82– RR depression: 2.03– RR alcohol/substance abuse: 1.51

• Mass. Dept. of PH– 31% of transgendered seriously considered

attempting suicide

LGBT

• No local data, but:• Mustanski, et al. (Am J Public Health. 2010;100:2426–

2432.)

– Study of 246 LGBT youth (16-20 yrs) in Chicago

– 31% lifetime suicide attempts– 7% 12 month suicide attempts– Comparable to YRBS in same area

Special Populations:Military/Veterans

• 10% of 15-24 year old male suicides• ~5% of 25-44 year old male suicides• PTSD and depression increased significantly

since Iraq invasion– Seal et al., AJPH, July, 2009

• Middle-aged and older male veterans not at increased risk of suicide– Miller et al., AJE, May, 2009

Special Populations:Incarcerated

• From 2000 – 2008 in San Diego County– 44 Deaths in custody

• About 10,000 prisoners in custody on any day• Rate: about 50/100,000

• Risk Factors– Psychiatric disorder– Substance abuse– Violence– Family suicide history

Conclusions

• Suicide is still a major public health issue– #2 cause of non-natural death in county

• Rates have been declining!– Down 18% over the past 20 years– Drops in almost every age group– Firearm suicide rates down 39%– BUT 45 – 64 year olds rates are still high

• Recent increases are a concern

Conclusions: High Risk• Economy? Some evidence• Solitude• Mental Health

– Depression– PTSD

• Physical Health– Pain– Cancer

• Substance Abuse• Access to Lethal Means

Conclusions: Protective Factors

• Social Support– Marriage/Family– Work– Church

• Access to Care

Contact Information

Alan M. Smith, PhD, MPH

County of San Diego, HHSA,Emergency Medical Services

(619) [email protected]

suicide in san diego county

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