Suicide Prevention FY 2014 Background Document Preventing Suicide Saves Lives The Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control (CDC Injury Center) focuses on the primary prevention of suicidal behavior While suicide is often thought of as an individual problem, it impacts families, communities, and society in general The long-term goal of the CDC Injury Center work in suicide prevention is to prevent suicidal behavior by reducing risk factors and increasing factors promoting resilience at the individual, family, community, and societal levels Public Health Problem Suicide is a serious public health problem, which can have lasting harmful effects on individuals, families, and communities Family and friends of people who die by suicide may feel shock, anger, guilt, and depression Suicide also affects the health of the community, and the medical costs and lost wages associated with suicide take an economic toll on communities • • • • • In 2010, there were more than 38,000 suicides in the United States Approximately every 15 minutes, an individual dies by suicide In 2010, suicide was the second leading cause of death among young adults aged 20 to 29, and was the 10th leading cause of death for Americans Suicides are on the rise, up 10% since 2006 More than million adults reported making a suicide attempt in the past year Suicides and self-inflicted injuries cost society approximately $41.2 billion a year in medical and work loss costs combined Strategies that Work CDC Injury Center’s suicide prevention efforts are focused on supporting surveillance and research activities Effective prevention strategies are needed to promote awareness of suicide and encourage a commitment to social change The following are some effective prevention strategies promoting awareness of suicide and encouraging behavior change: Community-wide Education Promising population-based programs target the entire community (e.g school, tribe, workplaces) through activities raising awareness, educate about suicide’s risk and protective factors, encourage help-seeking, promote tolerance, decrease stigma, and teach positive life and coping skills Reduced Access to Lethal Means Promising strategies are focused on reducing access to lethal means One example is to require new packaging of potentially lethal over the counter substances (e.g pain relievers) Another example would be to install barriers on bridges Reducing access to lethal means during periods of crisis can make it more likely that the person will delay or survive a suicide attempt Comprehensive Community-based Programs The U.S Air Force (USAF) and Natural Helpers suicide prevention programs, in which the CDC Injury Center participated, are examples of successful multi-faceted programs Both included strategies to engage the broader community around prevention with key messages and activities and also included specific programmatic activities for subgroups at high risk for suicidal behavior The multi-component nature of these programs allows them to address both persons at low risk and at high risk for suicidal behavior Federal Partnerships to Understand and Prevent Suicide The CDC Injury Center partners extensively with other federal agencies to understand and prevent suicide Examples of these collaborations include: Substance Abuse and Mental Health Services Administration (SAMHSA) The CDC Injury Center funded enhanced evaluations of the work of three SAMHSA’s funded Garrett Lee Smith grantees SAMHSA’s Garrett Lee Smith grants provide funding for state, territory, and tribal community grants, and college campus grants for suicide prevention efforts As a result of these Enhanced Evaluations, the CDC Injury Center created a series of actionable knowledge briefs to help integrate research into suicide prevention efforts in local communities The partnership with SAMHSA also yielded a number of tools providing suicide prevention practitioners with user-friendly, actionable support for (1) implementing early identification and referral data tracking systems in schools, (2) identifying, implementing, adapting, and evaluating gatekeeper training programs, and (3) providing tribal families and leaders with concrete messages and examples on how to increase protective factors and reduce risk factors for youth suicide Additionally, in 2011, the CDC Injury Center and SAMHSA collaborated on a study of non-fatal suicidal behavior in the United States based on data from the National Survey on Drug Use and Health The results, which were published in the October 2011 Morbidity and Mortality Weekly Report (MMWR), revealed approximately 8.3 million adults (3.7% of the adult population) had suicidal thoughts, 2.2 million adults (1.0% of the adult population) made suicide plans, and one million adults (0.5% of the adult population) made a suicide attempt in the past year Suicidal thoughts, suicide planning, and suicide attempts were significantly higher among young adults aged 18 to 29 years compared to those over 30 Suicidal thoughts, but not suicide planning or attempts, were significantly higher among females than males This was the first report to also present state-level data on suicidal thoughts and behavior Veteran’s Health Administration The CDC Injury Center is actively engaged with colleagues from the Veteran’s Health Administration to access and analyze data on suicide and self-directed violence and has provided technical assistance on various suicide prevention efforts in the military For example, CDC Injury Center staff served on the U.S Air Force’s Integrated Product team which developed the successful Air Force Suicide Prevention Program (AFSPP) The AFSPP’s foci are: reducing the number and rate of active duty Air Force suicides; advocating a community approach to suicide prevention; providing assistance and guidance to organizations and individuals administering various components of the AFSPP; and identifying factors contributing to the incidence of suicide and developing a response to reduce the impact of such factors U.S Surgeon General The CDC Injury Center collaborated with the U.S Surgeon General and SAMHSA on the development of the 2012 National Strategy for Suicide Prevention, a call to action intended to guide suicide prevention in the U.S over the next decade The National Strategy includes 13 goals and 60 objectives reflecting advances in suicide prevention knowledge, research, and practice, as well as broader changes in society and health care delivery creating new opportunities for suicide prevention Department of Defense (DoD) & Department of Veteran’s Affairs (VA) The CDC Injury Center participates on a collaborative between DoD and the VA to ensure system-wide consistency related to suicide risk-reduction policy initiatives, and suicide surveillance metrics As part of this partnership, the CDC Injury Center has completed the first phase of a project demonstrating the ability of linking the DoD Suicide Event Report with the National Violent Death Reporting System (NVDRS) The purpose in linking these data is to provide information that can be used to tailor military and veteran suicide prevention strategies This collaborative project is expected to result in a number of activities and products, including: Ongoing comprehensive surveillance on suicides among current/former military personnel Additional analyses and reports using data from both systems to describe fatal and non-fatal suicidal behavior and contributing factors among active duty U.S Army personnel The first report created from this linked database has been published and findings suggest focusing military suicide prevention efforts on intimate partner relationships, increasing coping skills to handle job-related problems, increasing access to mental health or substance abuse treatment, and providing support for soldiers currently in treatment Suicide Prevention In Action CDC’s Injury Center has led or participated in a number of activities to promote suicide prevention by tracking trends and conducting research to understand this problem Surveillance CDC Injury Center’s NVDRS is a state-based surveillance system, which pools information about the “who, when, where and how” of data on violent deaths, unintentional firearm injury deaths, and deaths of undetermined intent to better understand the “why.” Currently, 18 states capture this critical data allowing us to link records on violent deaths occurring in the same incident to help identify risk factors for suicide, homicide, multiple homicide events, and homicides followed by the suicide of the perpetrator; provide timely preliminary information on violent deaths; describe in detail the circumstances contributing to a violent death such as job loss, physical and mental health problems, family and other stressors Research CDC’s Injury Center has conducted important studies including: Examining the Influence of Connectedness on Self-Directed Violence in Adolescence “Connectedness” is the degree to which an individual or group is closely interrelated or shares resources with other individuals or groups The results of this study showed connectedness to family, school and adults at school were all associated with lower risk of non-suicidal self-harm, suicidal ideation, suicide plans, and non-fatal suicidal behavior The study found that family connectedness was most strongly and consistently associated with lower risk Examining the Relationship Between Business Cycles and Suicide _ Findings from this study show suicide rates rise in economic recessions and fall during expansions; people in prime working ages (25 to 64 years old) are more vulnerable to suicide during recessions than others The findings underscore the need for additional suicide prevention measures when the economy falters Identifying and Disseminating Effective Interventions CDC’s Injury Center is funding and evaluating two interventions, LET’s CONNECT and The Senior Connection, to promote and strengthen individual, family, and community connectedness, a key protective factor of interest in suicide prevention LET’s CONNECT links adolescents who are at-risk for suicidal behavior with peer and community mentors The Senior Connection seeks to link socially disconnected seniors with a peer support network Outcomes of these randomized controlled trials (expected in 2015) will inform the practice of suicide prevention in two vulnerable populations, adolescents and older adults Suicide Prevention Successes States have been successful in using findings from NVDRS to improve suicide prevention efforts, such as: Oregon In Oregon, the rate of suicide among those over age 65 was three times the rate for those aged 10 to 24 NVDRS allowed Oregon to learn many details about the circumstances of older adult suicides, which informed prevention Almost 50% of men and 60% of women above age 65 who died by suicide in Oregon were reported to have a depressed mood before death However, only a small proportion of these depressed people – 14% of the men and 29% of the women – were under treatment for their depression, suggesting screening and treatment for depression might have saved lives In response, Oregon developed a state Older Adult Suicide Prevention Plan that recommended primary care be better integrated with mental health services so suicidal behavior and ideation is recognized and older adults receive appropriate treatment South Carolina The State of South Carolina, in partnership with the South Carolina Mental Health Association, used the South Carolina NVDRS data to describe the problem of youth suicide, identify target communities, and successfully apply to SAMHSA for a suicide prevention grant The grant provided evidenced-based gatekeeper training to schools, institutions of higher education, local offices of public welfare and juvenile justice, pediatricians’ offices, faith-based and community organizations, and to foster and adoptive parents Currently, South Carolina’s NVDRS data is being used to assess and update South Carolina’s suicide prevention plan Utah In Utah, NVDRS data enabled the statewide task force to identify trends and risk factors for prescription drug-related suicides As a result, a number of prevention strategies are currently underway including training on prescribing practices and better access for medical providers to a controlled substance database Rhode Island Rhode Island NVDRS data identified the importance of creating suicide prevention programs targeting 35 to 54 year olds Although a substantial percent of suicides in Rhode Island were found to be among this age group, most suicide prevention efforts did not target them These data, along with suicide attempt data, was presented to the Rhode Island Injury Community Planning Group’s Suicide Prevention Subcommittee Responding to this information, the subcommittee recently launched new prevention efforts targeting working-age adults New Jersey New Jersey NVDRS suicide data has been used to help task forces plan responses to youth and police suicides In addition, the data has recently supported suicide prevention efforts by the Governor’s Council raising awareness and reducing stigma about mental health problems New Mexico New Mexico NVDRS suicide data is currently supporting the writing of a comprehensive state suicide prevention plan The suicide prevention plan will be a requirement for the combined New Mexico Substance Abuse Prevention and Treatment and Community Mental Health Block Grant application to SAMHSA Investigating Military Suicide Deaths A number of NVDRS states are using data to investigate military suicide deaths: New Jersey is using NVDRS data to create a description of suicides among current or former military personnel in the state, which will be used to inform prevention efforts Colorado is utilizing NVDRS data to work with the Denver VA Medical Center to improve understanding of suicides among current or former military personnel in the state Kentucky’s NVDRS data was used in a recently funded National Institutes of Health (NIH) grant entitled “Suicide Bereavement in Military and their Families” Future Goals CDC seeks to expand its efforts to prevent suicide by: • Expanding NVDRS to all 50 states and D.C to better understand the problem of suicide and using these data to inform state and local suicide prevention efforts • Expanding resources and support for fatal and non-fatal surveillance systems for self-directed violence including suicidal thought and behavior The resources would allow for collection of data at the national, state, and local levels, which leads to more relevant information for decisionmaking • • Developing a deeper understanding of how promoting and strengthening connectedness may impact suicidal behavior Developing and determining the efficacy and effectiveness of strategies to prevent suicidal behavior and expanding the number of prevention strategies ... of suicide prevention in two vulnerable populations, adolescents and older adults Suicide Prevention Successes States have been successful in using findings from NVDRS to improve suicide prevention. .. for Suicide Prevention, a call to action intended to guide suicide prevention in the U.S over the next decade The National Strategy includes 13 goals and 60 objectives reflecting advances in suicide. .. successful Air Force Suicide Prevention Program (AFSPP) The AFSPP’s foci are: reducing the number and rate of active duty Air Force suicides; advocating a community approach to suicide prevention;