Slide 1 - Welcome to the American College of Surgeons

Document Sample
Slide 1 - Welcome to the American College of Surgeons Powered By Docstoc
					             SUICIDE
               Presented by
      The American College of Surgeons
           Committee on Trauma
Subcommittee on Injury Prevention and Control
  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.
Classifying Intentional Injuries

                  Fatal        Non Fatal


Intentional       Suicide      Suicide
injury directed   completors   attemptors
at self
Intentional       Homicide     Assault
injury directed
at others
       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 1st 4 decades of life

 2001 CDC Data
   Injury-Related Deaths in the
               U.S.
160,000   144,374
140,000
120,000             97,900
100,000
 80,000                                                         46,180
 60,000
                                                    29,056
 40,000                        17,124
 20,000
     0
          All INJ   Unintent     Homicide            Suicide      Total
                     Age Adjusted Rates, 2000 CDC              Intentional
       Spectrum of Suicide
2000
1800
1600
1400
1200
1000
 800
       ?        750,000 Attempts

 600                                            30,000 Deaths
 400
 200
   0
       Contemplators          Attemptors           Completors

                 2000 Age-Adjusted Rates, CDC
Suicide Rates Vary Globally




               Source: World Health Organization (WHO)
Suicide Rates Vary by Region in the U.S.




                  Rural Rates are
                  Higher than
                  Metropolitan Rates

                       Source: CDC
                 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
Death Rates High Across Ages
Death
Rate
 20
 18
 16
 14
 12
 10
  8
  6
  4
  2
  0
Age l0- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 85+
      14   19   24   29   34   39    44    49    54    59     64 85+

                               2000 CDC Data    Death Rates per 100,000 population
      Mechanism of Suicide Deaths Both
             Genders, All Ages
          #3
         Poisoning       1%
               17%


                                                     Firearm
              1%
                                                     Cut/pierce
                                          #1         Fall
                                          Firearms   Suffocation
                                                     MVC
 #2      21%
                                          56%
                                                     Poisoning
Suffocation                                          Fire/burn


                   2%
                    2%
                          2001 CDC Data
         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
                 Male Gender
          Suicide Deaths & Attempts
250


200


150
                                                                    Male Attempt
100                                     em                          Male Death

50


 0
      l0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-
                                                                        85+

                              Age-Adjusted Rates per 100,000
                                Population, 2000 CDC Data
              Female Gender
        Suicide Deaths and Attempts
350
300
250
200
150                                                     Female Attempt
                                                        Female Death
100
50
  0
      l0-   15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65-
      14    19 24 29 34 39 44 49 54 59 64 85+
                       Age-Adjusted Rates per 100,000
                         Population, 2000 CDC Data
          Suicide Deaths Plus Suicide Attempts
                   By Gender and Age
350

300

250
                             Total Rates Differ Little By
                             Gender
200
                                                                     Total Male
150
                                                                     Total Female
100

 50

  0
      l0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-
                                                                        85+
                               Age-Adjusted Rates per 100,000
                                 Population, 2000 CDC Data
     Summary Demographics
• Male death rate > Female
• Native American > White > African
  American > Hispanics
• Suicide is 3rd most common cause of
  death 10-34, 4th 35-44, 5th 45-54.
• Adolescent suicide represents fastest
  growing segment of suicide attempts.
• Rates for 65+ are greatest
Risk Factors
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
            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
    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
       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


                  Barnes LS, Suicide and Life-
                  Threatening Behavior, 2001
Suicide’s Impact On
 Trauma Centers


National Trauma Data Bank
     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.
Intentionality of Trauma Patients in
                NTDB

                                                                           15% Intentional


                                                          13%
                                                                               Unintentional
                                                            2%                 Directed at Others
                                                                               Directed at Self
Unintentional
              85%




    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)
    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
    Suicide in Trauma Centers
• Many have known mental health problems

• Longer hospital and ICU stays than other
  injuries

• Few are discharged to psychiatric facility
Trauma Patients at Future Risk
         of Suicide
 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.
      Other Trauma Patients

• Depression in other patients following
  trauma?

• Those with ongoing somatic complaints
  have higher incidence of depression.

• Associated with ongoing alcohol use?
             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
   Recommendations

Suggestions for Trauma Centers
            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
         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
                  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

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:6
posted:2/10/2010
language:English
pages:34