Suicide: A National, Preventable Public Health Problem

1. Suicide: A National, Preventable Public Health Problem “The mind is its own place, and in itself can make a heaven of hell, a hell of heaven” – John Milton Randall Stevens, M.D. 9th Annual Indiana Rural Public Health Policy Forum January 18, 2011

2. Not a New Phenomenon (centuries old) • Honorable in some cultures • Immoral, a crime for others • Robs families, communities and societies around the world of thousands each year. • In US alone, suicide: • Kills more than 32,000/year • Costs $11.8 billion in lost income Suicide Sources: CDC 2007 & Goldsmith et al 2002 9th Annual Indiana Rural Public Health Policy Forum

3. Source: National Center for Health Statistics, 2007 Death Rates for Suicide by Sex, 1950-2004 9th Annual Indiana Rural Public Health Policy Forum

4. For 15-24 Age Group • 3rd Leading cause of death (13% of all deaths) • 4-6 times more likely for males than females • For every suicide committed in the US: there are 100-200 attempted suicides • For 25-34 Age Group • 2nd Leading cause of death (after unintentional injuries) Facts about Suicide Sources: CDC 2006 & Arias et al 2003 9th Annual Indiana Rural Public Health Policy Forum

5. Source: National Center for Health Statistics Suicide Rates by Age Group and Sex 9th Annual Indiana Rural Public Health Policy Forum

6. For people aged 65+ • 14.3/100,000 die by suicide. • National average: 10.9/100,000 • Americans aged 75+ • Rate of suicide is three times higher than average • Non-Hispanic white men aged 85+ • Have an even higher rate with 17.8 suicide deaths per 100,000 • Elderly people who die by suicide are often divorced or widowed and suffer from a physical illness. More Facts about Suicide Sources: CDC 2006 & Mental Health America, 2008 9th Annual Indiana Rural Public Health Policy Forum

7. Source: National Center for Health Statistics Age-adjusted Suicide Rates by State 9th Annual Indiana Rural Public Health Policy Forum

8. NSSP: unveiled in 2001 • A catalyst for social change with the power to transform attitudes, policies, and services • 11 goals and 68 measurable objectives: • public and private sector involvement • reduce harmful after-effects on family/community • Framework for action and a guide for development of services and programs. • Example: Institute of Medicine’s 2002 workshops • Landmark report: “Reducing Suicide: A National Imperative” National Strategy for Suicide Prevention: Goals & Objectives for Action 9th Annual Indiana Rural Public Health Policy Forum

9. Substance Abuse a growing risk factor • Important area of suicide prevention • NSSP Goals 3, 7, and 8 highlight this role: • Reduce the stigma of being a consumer of mental health, substance abuse & suicide prevention services. • Need for effective suicide prevention-related clinical and professional practices by health care providers, including those involved in substance abuse treatment. • Increase access to and community linkages with mental health and substance abuse services. Substance Abuse & Suicide 9th Annual Indiana Rural Public Health Policy Forum

10. Depression & Mood Disorders • Alcohol & Drug Abuse • Associated with a risk 6.2 times greater than average risk of suicide attempts Most Frequent Risk Factors Sources: IOM, 2002 & Molnar et al, 2001 9th Annual Indiana Rural Public Health Policy Forum

11. A skillful doctor cures illness when there is no sign of disease, and thus the disease never comes. Liu An, second century Chinese philosopher 9th Annual Indiana Rural Public Health Policy Forum

12. Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders and certain personality disorders • Alcohol and other substance use disorders • Hopelessness • Impulsiveness and/or aggressiveness • History of trauma or abuse • Major physical illness • Previous suicide attempt • Family history of suicide Biopsychosocial Risk Factors Source: Suicide Prevention Resource Center, 2008 9th Annual Indiana Rural Public Health Policy Forum

13. Lack of social support; sense of isolation • Stigma of help-seeking behavior • Barriers to accessing health care, especially mental health care and substance abuse treatment • Certain cultural and religious beliefs (for instance, the belief that suicide is a noble resolution of a personal dilemma) • Exposure to (including through the media) and influence of others who have died by suicide Sociocultural Risk Factors Source: Suicide Prevention Resource Center, 2008 9th Annual Indiana Rural Public Health Policy Forum

14. Job or financial loss • Relational or social loss • Easy access to lethal means • Local clusters of suicide with a contagious influence Environmental Risk Factors Source: Suicide Prevention Resource Center, 2008 9th Annual Indiana Rural Public Health Policy Forum

15. What can you do?