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Katie Fowler, Asha Ivey, Sharyn Parks-Brown, Alex E. Crosby

Epidemiological assistance addressing youth suicidal behavior in s outhern and central Delaware, Spring 2012. Katie Fowler, Asha Ivey, Sharyn Parks-Brown, Alex E. Crosby Centers for Disease Control and Prevention 23 July 2012. National Center for Injury Prevention and Control.

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Katie Fowler, Asha Ivey, Sharyn Parks-Brown, Alex E. Crosby

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  1. Epidemiological assistance addressing youth suicidal behavior in southern and central Delaware, Spring 2012 Katie Fowler, Asha Ivey, Sharyn Parks-Brown, Alex E. Crosby Centers for Disease Control and Prevention 23 July 2012 National Center for Injury Prevention and Control Division of Violence Prevention “The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry.”

  2. Objectives of the Meeting • Review Background & Methods • Review Preliminary Findings • Qualitative • Quantitative • Preliminary Recommendations

  3. Between January and March, 2012, seven middle school and high school age adolescents, and two young adults who were recent high school graduates died by suicide within a 25-mile radius in central and southern Delaware. Four of these deaths were among students from the same high school: High school A in Kent County, Delaware. From 2000-2009 the average annual number of deaths by suicide among persons aged 12-21 years was seven. Discussions initiated between agencies, invitation to CDC extended April 2012 Background

  4. Characterize the fatal and non-fatal suicidal behaviors among youth occurring between January and March, 2012, in Kent County and Sussex County, Delaware Describe trends in fatal and non-fatal suicidal behaviors over the past 4 years (2008 - 2012) among youth in Kent County and Sussex County, Delaware Identify, where possible, victim, family and community risk and protective factors; and Identify relevant prevention strategies for youth suicide Objectives

  5. Fatal and nonfatal behavior (suicides & suicide attempts) occurring among persons aged 12-21 years in Kent or Sussex County between 1 Jan 2012 - 4 May 2012. Case definition

  6. Review of existing data Fatal Office of Chief Med Examiner Law enforcement Nonfatal Medical records Hospitalization (inpatient) Hospital Emer Dept Surveys YRBS School climate Discussions with members of youth-serving organizations School personnel Crisis workers Methods

  7. Number of fatal and nonfatal suicide-related events by week – Southern and Central Delaware, Jan 2012 – May 2012 (N = 117)

  8. Suicide fatalities by age – central and southern Delaware, Jan-May 2012 Source: Delaware Office of Chief Med Examiner

  9. Suicide fatalities by sex – central and southern Delaware, Jan-May 2012 Source: Delaware Office of Chief Med Examiner

  10. Suicide fatalities by method – central and southern Delaware, Jan-May 2012 Source: Delaware Office of Chief Med Examiner

  11. Nonfatal suicide attempts by age– central and southern Delaware, Jan-May 2012

  12. Nonfatal suicide attempts by sex– central and southern Delaware, Jan-May 2012

  13. Nonfatal suicide attempt methods– central and southern Delaware, Jan-May 2012

  14. Suicidal ideation and behavior among high school students by category and sex* --US and Delaware, 2011 Source: CDC Youth Risk Behavior Survey* During the 12 months preceding the survey^One or more times

  15. Ever bullied on school property among high school students by category and sex* -- U.S and Delaware, 2011 Source: CDC Youth Risk Behavior Survey* During the 12 months preceding the survey

  16. Suicidal behavior risk and protective factors Societal Community • Inappropriate access to lethal means • Geography (Rural) • Cultural Values Peer/Family Individual • Spirituality • Incarceration • Social isolation vs. support • Family history of interpersonal or self-directed violence • Exposure to violence • Victimization • Age • Sex • Mental Illness • Substance misuse • Stressful life events • Prior suicide attempt(s)

  17. Awareness of threats or bullying within school perpetrated by students --Delaware, 2009-2011 Source: Delaware School Climate Survey

  18. Circumstances among suicide decedents -- Delaware, 2012 Source: Office of Chief Medical Examiner and Delaware State Police

  19. Compounding of circumstances among completed suicides (n=11) -- Delaware, 2012 • Median number of circumstances per decedent: 3 • Mode number of circumstances per decedent: 4 • Range: 2 – 7 different circumstances per decedent Source: Office of Chief Medical Examiner and Delaware State Police

  20. Top barriers to accessing mental health services and preventing suicides • Limited activities for youth outside of school • Limited mental health resources; long wait lists • Lack of transportation to appointments and activities • Lack of parent/community education (mental health, substance use, suicide prevention, parenting skills) • Resistance to seeking mental health treatment (parents and kids) • Inappropriate access to firearms • Limited student education on substance use, mental health, and suicide • Limited ongoing staff training specific to substance use, mental health, crisis response, available resources

  21. Periodic mental health (including suicidal behavior) awareness training for persons in youth-serving organizations Develop partnerships to help address needs of youth Data gathering and monitoring – e.g., health dept, hospitals, medical examiner Youth programs – education, faith-based organizations, community-based organizations Review proven suicide prevention strategies for youth Recommendations

  22. Continue data gathering and cleaning Interviews with school staff - completed Finalize hospital in-patient and emergency department data Contact with Delaware Attorney General Crisis center call volume Analysis of case-control Develop comprehensive trip report (short term) and focused detailed report (long term) Identify relevant prevention strategies for youth suicide based on local factors Next steps

  23. Delaware DPH Delaware OCME Bay Health Medical Center Division of Prevention and Behavioral Health Services Delaware State Police Univ of Delaware Beebee Medical Center Nanticoke Hospital Rockford Medical Center Dover Behavioral Health School Districts A and B administrators and staff State Department of Education Acknowledgements

  24. Thank You For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: http://www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Injury Prevention and Control Division of Violence Prevention

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