the burden of suicide among youth in north carolina · suicide and self-inflicted injury: n.c....

The Burden of Suicide Among Youth in North Carolina

Child Fatality Task Force – Intentional Death Prevention CommitteeDecember 8th, 2014

Data Sources: Suicide and Self-Inflicted Injury

• North Carolina Violent Death Reporting System (NC-VDRS)• Death Certificate• Law Enforcement Incident Reports• Medical Examiner Reports

• Hospital Discharge

• Emergency Department Admissions • NC-DETECT

• N.C. Youth Risk Behavior Survey (YRBS)

• Web-based Injury Statistics Query and Reporting System (WISQARS)

Source: NC State Center for Health Statistics; Analysis by Injury Epidemiology and Surveillance Unit

Leading Causes of Injury Deaths: N.C. Residents 2013

* Unintentional Other and Unintentional Unspecified are two separate categories. Other comprises several smaller defined causes of death, while Unspecified refers to unintentional deaths that were not categorized due to coding challenges.

Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2012Analysis by Injury Epidemiology and Surveillance UnitaUnintentional Other and Unintentional Unspecified are two separate categories. Other comprises several smaller defined causes of death, while Unspecified refers to unintentional deaths that were not categorized due to coding challenges.

Source: NC-VDRS, 2004-2012; N.C. State Center for Health Statistics, Vital Statistics-Hospitalizations, 2004-2012; NC DETECT, 2008-2012Analysis by Injury Epidemiology and Surveillance Unit

Suicide and Self-Inflicted Injury: N.C. Residents 2004-2012

0

30

60

90

120

150

180

210

240

Crud

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00,0

00

Age (Years)

Suicide Death Rate

Hospitalization Rate

ED Visit Rate

Suicide and Self-Inflicted Injury among Youth ages 10 to 17 in North Carolina


Suicide and Self-Inflicted Injury: N.C. Residents ages 10-17, 2004-2012

2.6 3.0 2.7 2.9 2.3 3.6 2.3 2.3 3.4

54.0 50.0 49.6 56.147.6

62.557.1

67.9 67.9

107.2

132.5

115.2123.5

139.5

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

2004 2005 2006 2007 2008 2009 2010 2011 2012

Crud

e Ra

te p

er 1

00,0

00

Suicide Death Rate Hospitalization Rate ED Visit Rate


4.0

32.8

80.4

1.5

82.7

169.0

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

Suicide Rate Hospitalization Rate ED Visit Rate

Crud

e Ra

te p

er 1

00,0

00

MaleFemale




1.3

27.5

59.2

5.2

106.0

230.6

0.0

50.0

100.0

150.0

200.0

250.0

Suicide Rate Hosptialization Rate ED Visit Rate

Crud

e Ra

te p

er 1

00,0

00

Age (years)

Ages 10-14Ages 15-17

Source: NC-VDRS, 2004-2012Analysis by Injury Epidemiology and Surveillance Unit

Suicide : N.C. Residents ages 10-17, 2004-2012

79.1%

18.4%

1.2% 1.2%

WhiteBlackAmerican IndianAsian


Suicides by County of Residence: N.C. Residents ages 10-17, 2004-2012

Source: NC-N.C. State Center for Health Statistics, Vital Statistics-Hospitalizations, 2004-2012; NC DETECT, 2008-2012Analysis by Injury Epidemiology and Surveillance Unit

Self-Inflicted Injury : N.C. Residents ages 10-17, 2004-2012

79.1%18.4%

1.2%0.5%

12.0%

Self-Inflicted Injury Hospitalizations

Poisoning

Cut/pierce

Suffocation

Firearm

Other/Unspecified

58.6%30.0%

1.2%0.3%

9.9%

Self-Inflicted Injury ED Visits

Source: N.C. YRBS, 2013

Suicidal Behavior: N.C. High School Students, 2013

11.6%

21.7%

10.9%

15.8%

5.5% 5.2%

0%

10%

20%

30%

Male Female

Seriously consideredattempting suicide during thelast 12 months

Made a plan for suicideattempt during the last 12months

Made a suicide attempt thatresulted in an injury needingtreatment by a medicalprofessional during the last 12months

Source: N.C. YRBS, 2013

Suicidal Behavior: N.C. High School Students, 2013

14.3%

40.2%

10.6%

38.0%

4.8%

12.3%

0%

10%

20%

30%

40%

50%

Heterosexual Gay, Lesbian, orBisexual

Seriously consideredattempting suicide duringpast 12 months

Made a plan for suicideattempt during past 12months

Made a suicide attemptduring past 12 months thatresulted in an injuryneeding treatment by amedical professional

Source: WISQARS, 2004-2012Analysis by Injury Epidemiology and Surveillance Unit

Suicide: Youth ages 10-17, 2004-2012

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

2004 2005 2006 2007 2008 2009 2010 2011 2012

Crud

e Ra

te p

er 1

00,0

00

United States North Carolina


Suicide: N.C. Residents, 2004-2012

2.0

11.2

21.7 22.125.1

28.024.5

27.4

34.7

49.4

0.62.9 4.0 6.1 8.4

10.98.0

5.4 3.33.3

0.0

10.0

20.0

30.0

40.0

50.0

60.0

10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Crud

e Ra

te p

er 1

00,0

00

Male Female

NC Child Fatality Prevention SystemChild Fatality Task Force

Local Child Fatality Prevention Teams Children and Youth Branch Confidential county-level reviews

Non-maltreatment deaths Make recommendations for local and state changes

Community Child Protection Teams Division of Social Services Confidential county-level reviews

Active maltreatment cases or maltreatment deaths Make recommendations for local and state changes

Child Fatality Review Teams Division of Social Services Confidential state-level reviews of select cases

CPS involvement within 12 months of death Suspicion that death was due to abuse or neglect

NC Child Fatality Prevention SystemNC Child Fatality Prevention Team

Reviews deaths of children 17 years old and under

Deaths must be certified by the Medical Examiner system:Homicides, suicides, accidents, poisoningsTrauma, disaster, violenceUnknown, unnatural or suspicious circumstances In police custody, jail or prison In state-operated mental health facilitiesPotential public health hazards During surgical or anesthetic proceduresSudden and not reasonably related to previously-known diseaseWithout medical attendance

Provides assistance and consultation to local teams

Provides aggregate data reports to the public and other agencies/organizations upon request

DataReview ≈ 500 cases/year approximately 12 months

after the date of death

Public sources of information OCME Vital Records Department of Corrections Department of Motor Vehicles

Confidential sources of information Division of Social Services records Law enforcement investigation reports Hospital/ED/pediatric/mental health records Team findings and discussions

Goal is to obtain the most complete picture of a child’s life as it pertains to his/her death

Youth Suicide in NC by Yearn=247

24

28 2730

21

35

23 24

35

0

5

10

15

20

25

30

35

40

2004 2005 2006 2007 2008 2009 2010 2011 2012

Num

ber

of S

uici

des

2

73

172

0

20

40

60

80

100

120

140

160

180

200

5 - 9 yrs 10 - 14 yrs 15 - 17 yrs

Num

ber

of S

uici

des

Youth Suicide in NC by Age

Youth Suicide in NC by Year & Age Group

97

9 9

5

7

3

11

15

15

21

18

21

16

28

20

13

20

0

5

10

15

20

25

30

2004 2005 2006 2007 2008 2009 2010 2011 2012

Num

ber

of S

uici

des

14 yo & under 15-17 yo

Youth Suicide in NC by Age & Sex

0

10

20

30

40

50

60

70

6 7 8 9 10 11 12 13 14 15 16 17

Num

ber

of S

uici

des

Age (in years)

Male Female

Youth Suicide in NC by Year & Sex

20

17

22

25

15

27

1617

25

4

11

5 5 68 7 7

10

0

5

10

15

20

25

30

2004 2005 2006 2007 2008 2009 2010 2011 2012

Num

ber

of S

uici

desMale Female

Youth Suicide in NC by Means

47.8%

42.9%

6.9%

1.2% 1.2%

ASPHYXIA

GUN

TOXIN

MOTOR VEHICLE

FALL or JUMP /DROWNING / OTHER

Youth Suicide in NC by Means & Sex

66.7%20.6%

9.5%

3.2%

41.3%

50.5%

6.0% 1.6% 0.5%ASPHYXIA

GUN

TOXIN

MOTORVEHICLE

FALL or JUMP /DROWNING /OTHER

Female Male

Youth Suicide in NC: Looking Back

Child Protective ServicesAt least 32% of children who committed suicide between

2004 and 2012 had some type of prior contact with CPS

Mental Health At least 20% of children had a documented mental illness

at some point in their lifetime60% were receiving treatment at time of death 15% were not receiving treatment at time of deathTreatment status unknown for remaining 25%

An additional 12% of children were characterized as depressed by friends and/or family members in the weeks or months leading up to their death

Youth Suicide in NC: Looking Back

History11% of children had attempted suicide at least once before

Circumstances of interest 18% of children reported recent relationship problems

(e.g., friend, family member, boyfriend/girlfriend)

11% of children had issues in the school environment (e.g., academics, behavior, victim/perpetrator of bullying)

A suicide note was recovered in only 12% of cases

Case Examples

Youth Suicide in NC: Looking Ahead

Preliminary data

2013: 41 suicides

2014: 40 suicides as of 12/4/2014

Suicide case review session - update

Elyssa Trani, MSNC Child Fatality Prevention Team

Office of the Chief Medical [email protected]

Anna Austin, MPHInjury and Violence Prevention Branch

NC Division of Public [email protected]

Contact Information

mailto:[email protected]

mailto:[email protected]

the burden of suicide among youth in north carolina · suicide and self-inflicted injury: n.c....

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