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
Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009
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
Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 1988 - 2010
Overall Suicide Rate by Year, San Diego County, 1988 - 2010
02468
10121416
Rat
e pe
r 100
,000
Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 1988 - 2009
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%
Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009
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
Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009
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
Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009
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
Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009
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
YRBS
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
Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2001 - 2010
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
Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009
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
Source: County of San Diego HHSA, Public Health Services Emergency Medical Services, Medical Examiner’s Database, 2000 - 2009
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]