Mining the National Violent Death Reporting System (NVDRS): - - PowerPoint PPT Presentation

New Risk Factors for Suicide: Mining the National Violent Death Reporting System (NVDRS): Analysis of 30,000 Suicides

• Dr. Steven Stack *

Dept of Psychiatry & Dept. of Criminology, Wayne State University Paper presented at the annual meetings of the Midwest Injury Prevention Association, Ann Arbor, MI

Monday, Sept 30, 10:30-Noon, Great Lakes Room, Central, Palmer Commons

Session: C. Violence: How Data Informs Prevention.

*email: aa1051@wayne.edu

{MIPA.NVDRS.091213c}

Background with NVDR: (a) Book (2011) testing the artistic

construction hypothesis, do 1400 suicides in films reflect patterns in suicides in the real (NVDRS) world? (b) Study (2011) using the narratives in NVDRS to locate 71 Russian roulette (RR) suicide to test the link between ethnic minority status & RR

• suicides. One of first academics to gain access to the Nat'l database.

A search through Medline found 41 articles using the NVDRS for a variety of purposes

• Develop understanding of suicide for a

group of interest(e.g. suicide among pregnant women) for prevention (Gold et al., 2012)

• Locate trends, areas, & demographic

groups high in suicide in a state for prevention & program evaluation purposes (Powell, et al., 2006).

Present paper: Uses the NVDRS to locate new/neglected social predictors of suicide

• Social Disorders vs. Mental Disorders. Since Durkheim’s (1897) Suicide,

there has been on ongoing debate on the causes of suicide: is suicide primarily a individual/psychiatric problem or a social problem.

• Social Disorders. Social aspects of suicide include strains in groups such

as work, and family – unemployment & divorce are examples.

• Mental Disorders. Psychiatric problems including major depression,

substance abuse, dysthymia, & schizophrenia have dominated suicide

• studies. Disorders such as depression have received far more attention

as contributing factors to suicide than social strains.

• Table 1 illustrates the number of suicide articles carried by psychiatry

journals and sociology journals (a discipline most apt to publish articles stressing social factors related to suicide) from 1980-2013. (MEDLINE, accessed 9-12—13).

• NVDRS can be used to draw more attention to the social causes of

suicide and to suggest strategies for prevention.

Neglect of Social Causes of Suicide: Articles Published in Psychiatry vs. Sociology Journals, 1980-2013 (source: Medline, accessed 9-12-13)

NVDRS: Present Analysis

• Reviews full NVDRS restricted data on 30,593 suicides, NVDRS 2003-
• 2006. Data are from up to 17 states in the NVDRS network.
• The version of the NVDRS we received from CDC included the rich

qualitative investigator/police reports or narratives.

• Took about ten months to get dual human subjects approvals & to

transform & merge the 4 CDC data files into an SPSS readable file.

• Assesses the prevalence of major categories of selected social strains

and their subtypes in the NVDRS. Strains include:

– Economic Factors, Legal problems, Intimate Partner Problems.

• NVDRS & related data suggest new varieties of social strain:
• Economic including demotions, indebtedness
• Legal, including automobile accidents
• Suggests suicide prevention efforts might be expanded from such

modalities as media guidelines/school based programs to also include courts and the workplace.

JOB PROBLEMS & SUICIDE

• The NVDRS main codes contain this category. It

includes: tensions with a coworker, poor performance reviews, increased pressure, unemployment, having trouble finding a job, lay

• ffs, &fear of layoffs.
• Incidence of Job Problems in the NVDRS:

Number of Suicide with problem Percent of Suicides with Problem

Job Problems 3,049 10.0%

Previous Research on Job Problems: MEDLINE Search, 1980-2113

Job Problem Number of Articles in Medline with subject=suicide

Unemployment 571 Job demotions Under-employment 1 (Australia) Work strains Co worker Work pressure Poor performance review {Comparison (Depression)} 7,806 Most of the NVDRS sub categories of job problems are relatively new. The NVDRS narratives could be reviewed to further breakdown which subcategories are most/least frequent & to explore their co morbidities with other social &psychiatric factors.

DETROIT SUICIDE PROJECT & Work Problems: Selected Case Studies

• Case 1. Mrs. Smith was notified of a demotion by her supervisor

at work. At 5PM she drove home and suicided by Carbon Monoxide poisoning in her garage.

• Case 2. After months of disputes with a colleague at a steak
• house. 2 workers engaged in a vicious knife fight. Shortly

thereafter one suicided when faced with assault charges.

• Case 3. A sexist male worker in an auto plant had a long term

conflict with his female foreman. When she put him on unpaid leave, he suicided (Stack & Wasserman, 2008).

• Elsewhere, using the NMFBS, persons who were demoted in the

12 months before their death were 6.1 times more apt to die through suicide than employed persons (Stack, 2009).

• Stack, S. & Wasserman, I. (2007). Economic strain and suicide risk: A qualitative analysis. Suicide & Life Threatening Behavior. 37, 103-
• 112. Stack, S. (2009). The suicide of Ajax: A note on occupational strain as a neglected factor in suicidology. Pp.49-53 in Stack, S & Lester,
• D. (eds.). Suicide & the creative arts. New York: Nova Science.

FINANCIAL PROBLEMS & SUICIDE

• NVDRS main codes contain this category. It

includes: bankruptcy, overwhelming debts, foreclosure of a home or business, a gambling problem with mounting debts,& a husband and wife arguing about money.

• Incidence of Financial Problems in the NVDRS:

Number of Suicide with problem Percent of Suicides with Problem

Financial Problems 3,044 9.9%

Previous Research on Financial Problems: MEDLINE Search, 1980-2013

Job Problem

Number of Articles in Medline with subject=suicide Indebtedness 7 Eviction or foreclosure 1 bankruptcy 4 (OR=7.1, India) {Comparison (Depression Problem)} 7,806 {Comparison (Alcohol Problem)} 2,817 Most of the NVDRS sub categories of financial strain Are relatively new. The NVDRS narratives could be reviewed to further breakdown which subcategories are most/least

• frequent. & to explore their social/psychiatric contexts or comorbidities

DETROIT SUICIDE PROJECT & Financial Problems: Selected Case Studies

• Case 1. Mrs. Jones was under a court order to pay

back taxes in full or she would be imprisoned for defiance of a court order. The day before her hearing, not having the money, she suicided.

• Case 2-10. Evictions. 8 of 9 persons with no where

to go, suicided the night before their evictions.

• Stack, S. & Wasserman, I. (2007). Economic strain and suicide risk: A qualitative analysis. Suicide &

Life Threatening Behavior. 37, 103-112.

SOCIAL STRAIN: Legal Problems

• Criminal legal problems include impending arrest, police pursuit ,

impending court date. Specifics can include: awaiting a criminal court date for a drunk driving charge, arrested for possession of cocaine, committed suicide while incarcerated.

• Civil/Other Legal Issues. Examples include involvement in a heated

court case involving child custody, child protective services recently removed a child from the victim’s home, being sued by a former business partner.

• Incidence of Recent Legal Problems in the NVDRS:

Number of Suicide with problem Percent of Suicides with Problem Criminal Legal Problems 2,845 9.3% Civil/other legal problems 1,010 3.3%

Previous Research on Legal Problems: MEDLINE Search, 1980-2013

Legal Problem Number of Articles in Medline with subject= suicide “legal problems” ‘criminal litigation” “court cases” “civil courts” Criminal arrests 4 Crime victimization 54 Crime perpetrators 28 courts Hits not relevant- on assisted suicide & related legal changes {Comparison (Depression Problem)} (7806)

Legal Problems & Suicide Risk: Pioneering Study, 1 county

Legal Problem Suicides (255) w problem Controls (510) w Problem Odds Ratio Domestic Violence 5.1% 2.2% 2.4* Misdemeanors 12.9% 4.7% 3.0* All Criminal Cases 18.0% 8.2% 2.5* Motor Vehicle Accidents 5.1% 1.6% 3.0* All traffic Cases 17.6% 10.4% 1.9* Foreclosures 5.1% 1.8% 3.0* Multiple Civil Cases 3.1% 0.4% 8.2* * p< .05 Cook, T. & Davis, M. (2012). Assessing legal strains & risk of suicide. Suicide & Life Threatening Behavior, 42,495-506.

Intimate Partner Problems(IPP) & SUICIDE

• IPP can include situations such as the victim goes to his old house shoots his

estranged wife and then shoots himself, victim was engaged in a bitter custody dispute with her ex husband, (c )the victim reports that she & her husband had been arguing and she spent the night at her mother’s. (d) a mother forbid her 14 year old daughter from talking to a 19 year old male she had met online& the victim & her boyfriend broke up.

• Incidence of IPP Problems in the NVDRS:

Number of Suicides with problem Percent of Suicides with Problem Intimate Partner Problems 8,260 27.0%

Previous Research on Intimate Partner Problems: MEDLINE Search, 1980-2013

Intimate Partner Problems Number of Articles in Medline with subject=suicide Divorce 311 Adultery 2 separation marital homicide-suicide 4 (Depression Problem) 7,806 (Schizophrenia) 1,837 Some of the NVDRS sub categories of IPP are already the subject of substantial research, but not as much as mental disorders. Some such as extra marital affairs & sexual jealousy, noted in qualitative work in the UK, are neglected. NVDRS narratives could be reviewed to further breakdown which subcategories are mort/least

• frequent. & to explore their social/psychiatric contexts.

Mining the NVDRS Narratives: Example:

Informing the Prevention of Russian Roulette Suicides

• Research on uncommon forms of suicide & suicide prevention can be stymied due

to lack of enough local cases to analyze.

• The NVDRS , with over 30,000 cases of suicide, can be utilized to provide rich

descriptive data, including qualitative narratives, on specific modalities of

• suicide. In some cases it is much easier to obtain information using the NVDRS

than to tediously extract data from large numbers of case files from a local medical examiner’s office.

• An example is the epidemiology of Russian Roulette. The NVDRS was used to

generate the largest sample of RR cases to test a hypothesis that RR is apparently a more acceptable means to suicide for racial minorities (who generally have a low official suicide rate, but a higher incidence of suicide by cop, victim precipitated homicide & some other forms of life threatening behavior).

Russian Roulette (RR): The Detroit Suicide Project vs. the NVDRS

• Stack & Wasserman(2008) spent scores of hours reading

1,412 files at the Wayne County Medical Examiner’s Office and found 15 cases of RR.

• Wasserman & Stack (2011) in less than one hour found 71

Cases of Russian Roulette suicides in the NVDRS (2003- 2006) . An excel based search for the words “Russian Roulette” (& related phrases) was done on the narratives found in the NVDRS.

• Being a machine readable file, the NVDRS can save

researchers enormous amounts of time.

• Stack & Wasserman (2008) Social & Racial correlates of Russian roulette. Suicide & Life

Threatening Behavior, 38, 436-441. Wasserman & Stack (2011). Race, urban context & Russian roulette: Findings from the national violent death reporting system, 2003-2006. Suicide & Life Threatening Behavior, 41,33-40.

CONCLUSION

• NVDRS is an underutilized resource for understanding suicide.
• Understanding the social sources of suicidality is fundamental to its prevention.
• Many major social variable sets/constructs in the NVDRS (e.g., legal problems,

financial problems-indebtedness, bankruptcy) suggest new departures for research & prevention.

• Work is needed to delve into the rich narratives from suicide investigators found

in the NVDRS. This will allow for the discovery of themes within variable sets.

• For example, what kind of job problem- demotions, problems with co-workers,

fear of lay offs is most common and what categories of people are at the highest risk for these job problems.

• For example, under the category “legal strains” what subcategories such as

automobile accidents or misdemeanors are most important and what are the psychiatric/social co-morbidities associated with each?

• Preliminary answers to these important questions can be extracted from the

NVDRS, but will require considerable work to locate cases, read each narrative, and code data in the rich narratives.

END

Further reading on the NVDRS: this book analyzes the

extent to which suicides in the movies accurately represent suicides in the real world. It uses the NVDRS to measure the nature

• f real world suicides. NVDRS

suicides are compared to 1,400 film portrayals of suicide.

Available on amazon.com.