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State of Alaska

Complete Health Indicator Report of Suicide Mortality Rate - Ages 15-24 (HA2020 Leading Health Indicator: 7A)

Definition

Rate of deaths resulting from the intentional use of force against oneself among those aged 15-24. Suicide mortality is defined as the number of deaths resulting from the intentional use of force against oneself per 100,000 population of that age group, in this case ages 15-24. The definition of suicide is "death arising from an act inflicted upon oneself with the intent to kill oneself." ICD-9 codes: E950-E959. ICD-10 codes: *U03, X60-X84, Y87.0.

Numerator

Number of deaths of ages 15-24 resulting from the intential use of force against oneself.

Denominator

Midyear resident population of 15-24 year olds for the same calendar year.

Data Interpretation Issues

Alaska populations are from the [http://laborstats.alaska.gov/pop/popest.htm Alaska Department of Labor and Workforce Development, Research and Analysis].

Why Is This Important?

The rate of suicide is increasing in America. Now the 10th leading cause of death, suicide claims more lives than traffic accidents and more than twice as many as homicides.^1^ The economic and human cost of suicidal behavior to individuals, families, communities, and society makes suicide a serious public health problem. Alaska had the second highest age-adjusted suicide rate in the nation in 2014 at 22.1, the most recent year for which national data are currently available.^2^ Suicide cost Alaska a total of $226,875,000 of combined lifetime medical and work lost cost in 2010, or an average of $1,383,382 per suicide death.^3^ The 15-24 age group had the highest rate of suicide mortality in Alaska at 36.4 per 100,000 and the largest number of deaths for the 10-year age cohorts for the 15-year average from 2000-2014.^4^ [[br]] [[br]] ---- {{class .SmallerFont 1. The Joint Commission. Detecting and treating suicide ideation in all settings. [https://www.jointcommission.org/sea_issue_56/]. Published February 24, 2016. Accessed October 11, 2016. 2. U.S. Centers for Disease Control and Prevention (CDC). Suicide mortality by state: 2014. St[http://www.cdc.gov/nchs/pressroom/sosmap/suicide-mortality/suicide.htm]. Accessed October 5, 2016. 3. American Foundation for Suicide Prevention. State fact sheets: suicide: Alaska 2016 facts & figures. [https://afsp.org/about-suicide/state-fact-sheets/#Alaska]. Accessed October 5, 2016. 4. Alaska Department of Health and Social Services. Health indicator report of suicide mortality rate - all ages. [http://ibis.dhss.alaska.gov/indicator/view/SuicDth.HA.html]. Accessed October 11, 2016. }}

Other Objectives

Healthy Alaskans 2020 Indicator 7.a: Reduce the suicide mortality rate of 15-24 year olds to 43.2 per 100,000 by 2020. '''Who is at risk for suicide?''' Much of what we know about the profile of individuals who have died by suicide and those who have attempted suicide comes from looking in the rearview mirror - at data compiled about suicide victims and attempts. Suicide may affect certain demographics - such as military veterans and men over age 45 - more than others. It's important to identify the risk factors, rather than membership in a group, when considering suicide risk. Paying attention to risk factors matters because patients may not disclose suicide ideation voluntarily. Risk factors for suicide include: * Mental or emotional disorders, particularly depression and bipolar disorder. Up to 90 percent of suicide victims suffer from a mental or emotional disorder at the time of death. * Previous suicide attempts or self-inflicted injury; the risk of suicide is twice as high (100 percent higher) than general suicide rates for one year following a suicide attempt and the higher risk continues beyond that. The risk is even higher the first few weeks immediately following a suicide attempt. * History of trauma or loss, such as abuse as a child, a family history of suicide, bereavement or economic loss. * Serious illness, or physical or chronic pain or impairment. * Alcohol and drug abuse. * Social isolation or a pattern/history of aggressive or antisocial behavior. * Discharge from inpatient psychiatric care, within the first year after and particularly within the first weeks and months after discharge. While some depressed patients who attempt or die by suicide after inpatient psychiatric hospitalization express suicide ideation before or during hospitalization, other depressed patients who have received inpatient psychiatric treatment develop suicide ideation after discharge. * Access to lethal means coupled with suicidal thoughts. However, there is no typical suicide victim. Most individuals having these risk factors do not attempt suicide, and others without these conditions sometimes do. Therefore, there is a danger in considering only individuals with certain conditions or experiences in certain settings as being at risk for suicide. It's imperative for everyone in all settings to better detect suicide ideation in others, and to take appropriate steps for their safety and/or refer these individuals to an appropriate provider for screening, risk assessment, and treatment.^1^[[br]] [[br]] ---- {{class .SmallerFont 1. The Joint Commission. Detecting and treating suicide ideation in all settings. [https://www.jointcommission.org/sea_issue_56/]. Published February 24, 2016. Accessed October 11, 2016. }}

How Are We Doing?

In 2014, the suicide mortality rate for Alaskan 15-24 year olds was 37.9 per 100,000. The suicide mortality rate for Alaska Native 15-24 year olds has been consistently higher than the average for all Alaskan youth. Male 15-24 year olds were 4 and a half times more likely to commit suicide than females of comparable age. Although the suicide rate for Alaskans aged 15-24 years at 37.9 per 100,000 was below the Healthy Alaskans 2020 goal of 43.2 per 100,000, significant disparities still exist to be addressed, for example the excessive death rates of Alaska Native youth and males in general. Suicide rates among Alaska Native people aged 15-24 years have declined significantly from levels of 141.2 per 100,000 in 1990 to 95.5 per 100,000 in 2013 (data from 2014 suppressed due to fewer than 20 deaths).

How Do We Compare With the U.S.?

Suicide mortality at 11.6 per 100,000 was only surpassed by unintentional injury mortality in 2014 for the 15-24 age group for the U.S. The 5,079 deaths represented 17.6% of the 28,791 deaths in this age group. The suicide mortality rate for all Alaskans 15-24 year olds at 37.9 per 100,000 is 2.25 times higher than the rate among 15-24 year olds nationally (11.6 per 100,000) in 2014.

What Is Being Done?

The Statewide Suicide Prevention Council [http://dhss.alaska.gov/suicideprevention/Pages/default.aspx ] advises the governor and legislature on issues relating to suicide. In collaboration with communities, faith-based organizations, and public-private entities, the Council works to improve the health and wellness of Alaskans by reducing suicide and its effect on individuals and communities.

Evidence-based Practices

Public health partners around the state are aligning work around these approaches adapted to Alaska's unique needs. Below are the strategies identified for enhancing mental health support systems. '''Strategy 1:''' [[br]]Create supportive environments that promote resilient, healthy, and empowered individuals, families, schools, and communities (universal prevention). '''Evidence Base:''' [[br]]The World Health Organization holds that "a supportive environment is of paramount importance for health. The two are interdependent and inseparable" (Sundsvall Statement on Supportive Environments for Health, 1991). Supportive environments can help protect people from risk factors for poor health, encourage participation in health care and health promotion, expand individuals' health competencies and self-reliance, and support person-centered health care. Stigma and attitudes about help-seeking (specifically seeking treatment or services for mental health conditions) are key barriers to promoting mental and emotional health and preventing mental illness. Creating communities that de-stigmatize depression and mental illness and encourage people to seek mental health services when needed can increase the number of people accessing services. '''Sources:''' [[br]]Segal DL, Coolidge FL, Mincic MS, O'Riley A. Beliefs about mental illness and willingness to seek help: a cross-sectional study. Aging Ment Health 2005;9(4):363-7. Reynders A, Kerkhof AJFM, Molenberghs G, Van Audenhove C. Attitudes and stigma in relation to help-seeking intentions for psychological problems in low and high suicide rate regions. Social Psychiatry and Psychiatric Epidemiology 2014;49(2): 231-9. '''Strategy 2:''' [[br]]Enhance clinical and community preventive services to ensure availability of timely treatment and support services (indicated prevention). '''Evidence Base:''' [[br]]Nearly half of individuals who die by suicide had a diagnosable mental health disorder. Timely access to appropriate mental health and substance use disorder treatment services as close to home as possible is essential to preventing suicide. Not all behavioral health professions provide or require suicide-specific education for licensure. Yet, outpatient and community behavioral health providers often provide services to individuals at risk of suicide and so are in a position to help prevent suicide. Evidence-based training that strengthens clinical competencies to address suicide risk and ideation can reduce suicide among people receiving behavioral health services. Primary and specialty health care providers also have a role to play in suicide prevention. Appropriate assessment and referral for services is needed in a variety of health care settings. Integrating behavioral health care with primary care can help ensure timely access to appropriate services, especially for patients experiencing mental health disorders. For example, the Community Preventive Services Task Force, DHHS recommends collaborative care for the management of depressive disorders. '''Sources:''' [[br]]National Research Council. Reducing Suicide: A National Imperative. Washington, DC: The National Academies Press, 2002. Recommendation from the Community Preventive Services Task Force for Use of Collaborative Care for the Management of Depressive Disorders[http://www.thecommunityguide.org/mentalhealth/CollabCare_Recommendation.pdf] '''Strategy 3:''' [[br]]Allocate resources to suicide prevention efforts proven effective through evidence based on surveillance, research, and evaluation. '''Evidence Base:''' [[br]]Prioritizing funding for evidence-based suicide prevention practices helps to ensure that limited public resources are used to the maximum benefit of communities. '''Source:''' [[br]] National Registry of Evidence Based Programs and Practices (NREPP) [http://www.nrepp.samhsa.gov]

Available Services

'''Alaska:''' [[br]]Careline Alaska [[br]][http://carelinealaska.com/] [[br]]Call anytime, toll-free: 1-877-266-4357 (HELP) SouthEast Alaska Regional Health Consortium (SEARHC) [[br]]1-877-294-0074 24/7 help line Identity, Inc. [[br]]907-258-4777 (ANC) GLBTQ help line [[br]]1-888-901-9876 (statewide) '''National:''' [[br]]National Suicide Prevention Hotline [[br]][http://www.suicidepreventionlifeline.org/] [[br]]Call 24/7: 1-800-273-8255 The Trevor Project [[br]][http://www.thetrevorproject.org] [[br]]1-866-488-7386 GLBTQ crisis hotline

Health Program Information

Casting the Net Upstream Goals^5^: [[br]]Goal 1. Alaskans accept responsibility for preventing suicide. [[br]]Goal 2. Alaskans effectively and appropriately respond to people at risk of suicide. [[br]]Goal 3. Alaskans communicate, cooperate, and coordinate suicide prevention efforts. [[br]]Goal 4. Alaskans have immediate access to the prevention, treatment, and recovery services they need. [[br]]Goal 5. Alaskans support survivors in healing. [[br]]Goal 6. Quality data and research is available and used for planning, implementation, and evaluation of suicide prevention efforts. The Joint Commission urges all health care organizations to develop clinical environment readiness by identifying, developing, and integrating comprehensive behavioral health, primary care, and community resources to assure continuity of care for individuals at risk for suicide. Many communities and health care organizations presently do not have adequate suicide prevention resources, leading to the low detection and treatment rate of those at risk. As a result, providers who do identify patients at risk for suicide often must interrupt their workflow and disrupt their schedule for the day to find treatment and assure safety for these patients.^1^ '''Detecting suicide ideation in non-acute or acute care setting''' 1. Review each patient's personal and family medical history for suicide risk factors. 2. Screen all patients for suicide ideation, using a brief, standardized, evidence-based screening tool. 3. Review screening questionnaires before the patient leaves the appointment or is discharged. '''Taking immediate action and safety planning''' 4. Take the following actions, using assessment results to inform the level of safety measures needed. '''Behavioral health treatment and discharge''' 5. Establish a collaborative, ongoing, and systematic assessment and treatment process with the patient involving the patient's other providers, family and friends as appropriate. 6. To improve outcomes for at-risk patients, develop treatment and discharge plans that directly target suicidality. '''Education and documentation''' 7. Educate all staff in patient care settings about how to identify and respond to patients with suicide ideation. 8. Document decisions regarding the care and referral of patients with suicide risk. [[br]] [[br]] ---- {{class .SmallerFont 1. The Joint Commission. Detecting and treating suicide ideation in all settings. [https://www.jointcommission.org/sea_issue_56/]. Published February 24, 2016. Accessed October 11, 2016. 5. Casting the net upstream: promoting wellness to prevent suicide. Alaska State Suicide Prevention Plan, 2012-2017. Annual Implementation Report 2014. [http://dhss.alaska.gov/SuicidePrevention/Documents/pdfs_sspc/CTN2014-Implementation.pdf]. Accessed October 11, 2016. }}


Related Indicators

Related Relevant Population Characteristics Indicators:


Related Health Care System Factors Indicators:


Related Risk Factors Indicators:


Related Health Status Outcomes Indicators:




Graphical Data Views

Suicide mortality rate per 100,000, ages 15-24, all Alaskans, Alaska Native people, and U.S., 1990-2020

::chart - missing::
confidence limits

Alaska ComparisonsYearSuicide mortality per 100,000 ages 15-24 (Crude Rate)Lower LimitUpper LimitNumer- atorDenom- inator
Record Count: 73
All Alaskans199053.137.169.24279,085
All Alaskans199148.833.364.33877,897
All Alaskans199244.529.859.23578,666
All Alaskans199350.334.566.13977,559
All Alaskans199455.238.571.94276,128
All Alaskans199538.524.552.52975,401
All Alaskans199645.430.360.43577,169
All Alaskans199729.117.240.92379,120
All Alaskans199853.837.969.74481,814
All Alaskans199928.517.140.02484,092
All Alaskans200053.338.368.44889,986
All Alaskans200125.915.636.32492,570
All Alaskans200233.521.945.03295,664
All Alaskans200333.522.144.93398,599
All Alaskans200441.228.853.742101,857
All Alaskans200526.716.836.628104,695
All Alaskans200637.225.748.740107,538
All Alaskans200730.420.040.733108,715
All Alaskans200838.927.250.742107,843
All Alaskans200933.522.644.436107,464
All Alaskans201046.033.158.949106,560
All Alaskans201134.022.945.136105,897
All Alaskans201234.223.045.336105,406
All Alaskans201341.429.053.843103,855
All Alaskans201437.926.049.939102,775
Alaska Native people1990141.2115.0167.32014,167
Alaska Native people1991**14,027
Alaska Native people1992**14,160
Alaska Native people1993151.4124.0178.82214,530
Alaska Native people1994166.4137.4195.32515,027
Alaska Native people1995**15,637
Alaska Native people1996123.899.0148.62016,158
Alaska Native people1997**16,814
Alaska Native people1998165.4137.6193.22917,533
Alaska Native people1999**18,219
Alaska Native people2000131.4107.7155.12418,265
Alaska Native people2001**18,600
Alaska Native people2002114.392.9135.72219,251
Alaska Native people2003114.493.3135.52320,098
Alaska Native people2004120.499.1141.72520,770
Alaska Native people2005**21,638
Alaska Native people2006103.083.8122.22322,332
Alaska Native people2007**22,555
Alaska Native people2008108.188.4127.72422,211
Alaska Native people2009103.484.2122.62322,243
Alaska Native people2010117.096.4137.52622,230
Alaska Native people201196.177.5114.82121,842
Alaska Native people2012102.282.9121.52221,519
Alaska Native people201395.576.7114.22020,952
Alaska Native people2014**20,659
U.S.200010.2
U.S.20019.9
U.S.20029.8
U.S.20039.6
U.S.200410.3
U.S.20059.9
U.S.20069.7
U.S.20079.6
U.S.20089.9
U.S.200910.0
U.S.201010.5
U.S.201111.0
U.S.201211.1
U.S.201311.1
U.S.201411.65,079
Healthy Alaskans Goal201343.2
Healthy Alaskans Goal201443.2
Healthy Alaskans Goal201543.2
Healthy Alaskans Goal201643.2
Healthy Alaskans Goal201743.2
Healthy Alaskans Goal201843.2
Healthy Alaskans Goal201943.2
Healthy Alaskans Goal202043.2

Data Notes

Rates for Alaska Native people for years 2001, 2005, 2007, and 2014 are based on fewer than 20 occurrences and are statistically unreliable. The values should be used with caution. Data provided by the [http://dhss.alaska.gov/dph/VitalStats/Pages/data/default.aspx Alaska Bureau of Vital Statistics (BVS)] in May 2016.   ** = Data not available due to fewer than 20 in the numerator. Alaska Native people refers to any mention of American Indian or Alaska Native heritage when enumerating racial and ethnic background. Individuals of multiple races incorporating American Indian/Alaska Native are moved into the Alaska Native group. When race and ethnicity are consider concurrently, Hispanic individuals with American Indian/Alaska Native heritage are combined into the Alaska Native (any mention) group and removed from the Hispanic class. The definition of the Alaska Native group is intended to conform to the eligibility requirements for access to Alaska Native Tribal Health Consortium.

Data Sources

  • [http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Alaska Bureau of Vital Statistics], Division of Public Health, Alaska Department of Health and Social Services
  • National Vital Statistics System, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention


Suicide mortality rate per 100,000, ages 15-24, by sex, all Alaskans and Alaska Native people, 2010-2014 (5-year average)

::chart - missing::

Alaska ComparisonsSuicide mortality per 100,000 ages 15-24 (Crude Rate)NoteNumer- ator
Record Count: 4
All AlaskansMales62.7175
All AlaskansFemales11.428
Alaska Native peopleMales158.887
Alaska Native peopleFemales30.5Statistically unreliable16

Data Notes

Rates for Alaska Native people for years 2001, 2005, 2007, and 2014 are based on fewer than 20 occurrences and are statistically unreliable. The values should be used with caution. Data provided by the [http://dhss.alaska.gov/dph/VitalStats/Pages/data/default.aspx Alaska Bureau of Vital Statistics (BVS)] in May 2016.   Rates based upon fewer than 20 occurrences are statistically unreliable and should be used with caution. Rates based upon fewer than 6 occurrences are not reported. Alaska Native people refers to any mention of American Indian or Alaska Native heritage when enumerating racial and ethnic background. Individuals of multiple races incorporating American Indian/Alaska Native are moved into the Alaska Native group. When race and ethnicity are consider concurrently, Hispanic individuals with American Indian/Alaska Native heritage are combined into the Alaska Native (any mention) group and removed from the Hispanic class. The definition of the Alaska Native group is intended to conform to the eligibility requirements for access to Alaska Native Tribal Health Consortium.

Data Source

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Alaska Bureau of Vital Statistics], Division of Public Health, Alaska Department of Health and Social Services

References and Community Resources

'''References:''' 1. The Joint Commission. Detecting and treating suicide ideation in all settings. [https://www.jointcommission.org/sea_issue_56/]. Published February 24, 2016. Accessed October 11, 2016. 2. U.S. Centers for Disease Control and Prevention (CDC). Suicide mortality by state: 2014. St[http://www.cdc.gov/nchs/pressroom/sosmap/suicide-mortality/suicide.htm]. Accessed October 5, 2016. 3. American Foundation for Suicide Prevention. State fact sheets: suicide: Alaska 2016 facts & figures. [https://afsp.org/about-suicide/state-fact-sheets/#Alaska]. Accessed October 5, 2016. 4. Alaska Department of Health and Social Services. Health indicator report of suicide mortality rate - all ages. [http://ibis.dhss.alaska.gov/indicator/view/SuicDth.HA.html]. Accessed October 11, 2016. 5. Casting the net upstream: promoting wellness to prevent suicide. Alaska State Suicide Prevention Plan, 2012-2017. Annual Implementation Report 2014. [http://dhss.alaska.gov/SuicidePrevention/Documents/pdfs_sspc/CTN2014-Implementation.pdf]. Accessed October 11, 2016. '''Resources:''' American Association of Suicidology [http://www.suicidology.org/] Centers for Disease Control and Prevention Suicide Fact Sheets [http://www.cdc.gov/ViolencePrevention/suicide/] National Institute of Mental Health - Suicide Prevention [http://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml] Statewide Suicide Prevention Council [http://dhss.alaska.gov/suicideprevention/Pages/default.aspx] Suicide Prevention Resource Center [http://www.sprc.org/] Substance Abuse and Mental Health Services Administration [http://www.samhsa.gov/prevention/suicide.aspx] '''Resources for clinicians''' Zero Suicide Toolkit [http://zerosuicide.sprc.org/toolkit], from the Suicide Prevention Resource Center and the National Action Alliance for Suicide Prevention ED-SAFE Materials [http://emnet-usa.org/ED-SAFE/materials.htm], from the Emergency Medicine Network Caring for Adult Patients with Suicide Risk [http://www.sprc.org/edguide] - A Consensus Guide for Emergency Departments, and Quick Guide for Clinicians [http://www.sprc.org/sites/default/files/EDGuide_quickversion.pdf], from the Suicide Prevention Resource Center Means Matter website [https://www.hsph.harvard.edu/means-matter/], from the Harvard T.H. Chan School of Public Health Mental Health Environment of Care Checklist [http://www.patientsafety.va.gov/professionals/onthejob/mentalhealth.asp] - For reviewing inpatient mental health units for environmental hazards, from the VA National Center for Patient Safety. QPR Institute [https://www.qprinstitute.com/] - Suicide prevention courses and training for professionals, institutions, and the public, on site or through a self-study program. SAFE-T Pocket Card for Clinicians [http://store.samhsa.gov/product/Suicide-Assessment-Five-Step-Evaluation-and-Triage-SAFE-T-Pocket-Card-for-Clinicians/SMA09-4432] - Five-step evaluation and triage for suicide assessment Suicide Prevention and the Clinical Workforce: Guidelines for Training [http://actionallianceforsuicideprevention.org/sites/actionallianceforsuicideprevention.org/files/Guidelines.pdf], from the Clinical Workforce Preparedness Task Force of the National Action Alliance for Suicide Prevention VA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide [http://www.healthquality.va.gov/guidelines/MH/srb/VADODCP_SuicideRisk_Full.pdf], from the Department of Veterans Affairs, Department of Defense, June 2013.

More Resources and Links

Alaska and national goals may be found at the following sites:

Alaska health promotion resources may be found at the following site:

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Maps of health indicators for various subdivisions of Alaska may be found at the following site:

Additional indicator data by state and county may be found on these Websites:

Medical literature can be queried at the PubMed website.

For an on-line medical dictionary, click on this Dictionary link.

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Page Content Updated On 11/29/2016, Published on 11/29/2016
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Content updated: Tue, 29 Nov 2016 11:35:10 AKST