Suicide in San Diego County

1. Suicide in San Diego County County of San Diego Health and Human Services Agency Public Health Services

3. 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

4. Suicide Rate by California County, 1999- 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

5. Number of Suicides by Age and GenderSan Diego County, 2000 - 2009 70% 25 to 64 years 52% of population 11% 15 to 24 years 17% of population 19% 65+ 11% of population Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009

6. Suicide Rates by Age and GenderSan Diego County, 2000 - 2009 Highest rates in oldest males Female suicide rate peaks at 45-54 years Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009

7. Overall Suicide Rate by Age Group and Year, San Diego County, 1988 - 2010 Age distribution starting to change Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 1988 - 2010

8. Overall Suicide Rate by Year, San Diego County, 1988 - 2010 1988 – 1992 average 13.5/100,000 2005 – 2009 average 11.1/100,000 18% Decline Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 1988 - 2009

9. Suicide Methods: Both Sexes, All Ages, 2000 - 2009 Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009

10. Suicide Rates by Method, 5-Year Periods, 1990 - 2009 Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009

11. Suicide Rates by Method, 1990 - 2009 Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009

12. Suicide Rates by Race/Ethnicity: San Diego County, 2000 - 2009 Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009

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

14. YRBS

15. Transitional Age Youth (TAY) Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2001 - 2010

16. Suicide Rates by Marital Status: Age 25 – 64 Years, 2000 - 2009 Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009

17. Suicide Rates by Marital Status: Age 65 Years and Older, 2000 - 2009 Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009

19. Toxicology: Percent Positive by Substance and Sex, 2000 - 2007 Source: County of San Diego HHSA, Public Health Services, Emergency Medical Services, Medical Examiner Database, 2000 – 2007

20. 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

21. 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

22. 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

23. 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

24. 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

25. Conclusions: High Risk • Economy? Some evidence • Solitude • Mental Health • Depression • PTSD • Physical Health • Pain • Cancer • Substance Abuse • Access to Lethal Means

26. Conclusions: Protective Factors • Social Support • Marriage/Family • Work • Church • Access to Care

27. Contact Information Alan M. Smith, PhD, MPH County of San Diego, HHSA, Emergency Medical Services (619) 285-6429 Alan.Smith@sdcounty.ca.gov