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1/4/2018 - - PDF document

1/4/2018


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1/4/2018 1

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Who is this?

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Carson Spencer 1969-2004

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Goals

  • Identify new trends in suicide death data
  • Describe model of suicide risk
  • List components of public health approach
  • 10 Things to Think About

10

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Age-adjusted suicide rates 2014 (U.S. avg 13.0/100K)

10.6-13.0 7.7-10.5 13.1-16.9 17.0-23.8 Source: CDC vital statistics Rate per 100,000

2015 State Ranking/No. (Rate)

  • 1. Alaska 201 (27)
  • 2. Wyoming157 (27)
  • 3. Montana 272 (26)
  • 4. New Mexico 500 (24)
  • 5. Idaho 359 (22)
  • 6. Utah 630 21.0
  • 7. Oklahoma 790 (20)
  • 7. South Dakota 173 (20)
  • 9. Colorado1,093 (20)
  • 10. Arkansas 577 (19)
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≥18 years United States, 2013

*Source: CDC’s National Vital Statistics System,

†Source: Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project - Nationwide Inpatient Sample

(HCUP-NIS)

§ Source: Source: CDC’s National Electronic Injury Surveillance System-All Injury Program ¶ Source: SAMHSA’s National Survey on Drug Use and Health

** Source: SAMHSA’s National Survey on Drug Use and Health Number in parentheses represent the ratio of deaths to other categories

39,894 Deaths

118,740 Hospitalizations

405,300 ER visits

1,312,00 Suicide attempts

9,292,000 Seriously considered suicide

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Suicide Death by method – United States, 2014

Firearms 49.9% Suffocation 26.7% Cut/pierce 1.7% Poisoning 15.9% Fall 2.3% Other 3.5%

Firearms Suffocation Cut/pierce Poisoning Fall Other Source: CDC vital statistics

Firearm 1% Overdose 83% Ligature/Suffocation 1% Sharp 11% Other 4%

Firearm Overdose Ligature/Suffocation Sharp Other

Suicide Attempt Method

Model of Suicide Risk

Perceived Burdensomeness Thwarted Belongingness Acquired Capacity for Suicide Desire for suicide High risk for suicide death or serious attempt

Thomas Joiner’s model of suicide risk, 2006

@sspencerthomas

Words Make Worlds

Say this Instead of this

Died of Suicide Committed Suicide Suicide Death Successful Attempt Suicide Attempt Unsuccessful Attempt Person Living with Suicidal Thoughts

  • r Behavior

Suicide Ideator or Attempter Suicide Completed Suicide

(Describe the Behavior)

Manipulative, Cry for Help, Suicidal Gesture Working with Dealing with Suicidal Person

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Upstream approaches

Goals: Build Protective Factors Prevent Problems

midstream

Goals: Early Identification Link to care

Downstream

Goals: Manage crises Restore functioning

Strategic Suicide Prevention

“Making Suicide Prevention a Health and Safety Priority”

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Source: Knox, K, et al., Risk of Suicide and related adverse outcomes after exposure to a suicide programme in the US Air Force: cohort study. British Medical Journal, December 13, 2003.

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Table 3: Comparison of the effects of risk for suicide and related adverse outcomes in the USAF population prior to implementation of the program (1990-1996) and after implementation of the program (1996-2002). Outcome Relative Risk (RR) and 95% CI Risk Reduction (1- RR) Excess Risk (RR-1) Suicide .67 [.5702, .8017] ↓ 33%

  • Homicide

.48 [.3260, .7357] ↓ 51% Accidental Death .82 [.7328, .9311] ↓ 18%

  • Severe Family Violence

.46 [.4335, .5090] ↓ 54%

  • Moderate Family

Violence .70 [.6900, .7272] ↓ 30%

  • Mild Family Violence

1.18 [1.1636, 1.2040]

  • ↑ 18%

Results

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#5 Provide State of the Art Intervention

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1/4/2018 9

  • Collaborative therapeutic stance (Jobes – CAMS)
  • Trauma and Suicide Prevention (Bryan)
  • Practical Art of Suicide Assessment (Shea)
  • Assessing & Managing Suicide Risk (AMSR – SPRC)
  • Recognizing and Responding to Suicide Risk (AAS)
  • DBT (Linehan)
  • Importance of follow up (“caring letters” study)
  • Helping the Suicidal Person (Freedenthal)

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#6 Reduce Access to Lethal Means

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Lethal Method Reduced Substitution Attempter uses another

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those methods are less lethal. Delay Attempt delayed as attempter seeks access. Fewer attempts prove fatal Suicidal crisis passes for many * The acute period in which someone will attempt is often short. * 89-95% of attempters do not go on to die by suicide. Overall Suicide Rate Drops driven by drop in suicides by restricted method.

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#8 Effective and Safe Suicide Grief and Trauma Response

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McInosh, John (2010, April 22). Therapists as Survivors of Client Suicide: . AAS Conference 2010

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