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State of Alaska

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

The rate of suicide is increasing in America. Suicide rates have risen nearly 30% between 1999 and 2016.^1^ In 2016, suicide was the 10th leading cause of death.^2^ Suicide claims more lives than traffic accidents and more than twice the number of lives claimed by homicide.^3^ Leading methods of suicide are with discharge of firearms, suffocation, poisoning and falling.^4^ 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 2016, the most recent year for which national data are currently available.^5^ 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.^6^ Alaskans aged 15-24 years had the highest rate of suicide mortality in Alaska at 38.0 per 100,000 for the 15-year average from 2002-2016.^7^ [[br]] [[br]] ---- {{class .SmallerFont 1. Stone DM, Simon TR, Fowler KA, Kegler SR, et al. Vital signs: trends in state suicide rates - United States, 1999-2016 and circumstances contributing to suicide - 27 States, 2015. MMWR Centers for Disease Control and Prevention. June 8, 2018;67(22):617-624. [https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a1.htm?s_cid=mm6722al_x]. Accessed June 8, 2018. 2. Kochanek KD, Murphy SL, Xu J, Arias E. Mortality in the United States, 2016. NCHS Data Brief. December 2017;293:1-8. [https://www.cdc.gov/nchs/data/databriefs/db293.pdf]. Accessed June 14, 2018. 3. 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. 4. Shain B. Suicide and suicide attempts in adolescents. Pediatrics. American Academy of Pediatrics, Committee on Adolescence, Clinical Report. July 2016;138(1):e1-12. [http://pediatrics.aappublications.org/content/early/2016/06/24/peds.2016-1420]. Accessed August 28, 2018. 5. U.S. Centers for Disease Control and Prevention (CDC). Suicide mortality by state: 2016. [http://www.cdc.gov/nchs/pressroom/sosmap/suicide-mortality/suicide.htm]. Accessed October 1, 2018. 6. 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. 7. Alaska Department of Health and Social Services. Health indicator report of suicide mortality rate - all ages. [http://ibis.dhss.alaska.gov/indicator/complete_profile/SuicDth.html]. Accessed October 1, 2018. }}

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 Health Analytics and Vital Records Section (HAVRS)], 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

Data Interpretation Issues

[http://live.laborstats.alaska.gov/pop/index.cfm Alaska population estimates] provided by the State Demographer in the [http://laborstats.alaska.gov/ Research and Analysis Section] of the [http://labor.alaska.gov/ Alaska Department of Labor and Workforce Development].

Definition

Crude rate of deaths resulting from the intentional use of force against oneself among those aged 15-24 years. 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 in the population aged 15-24 years resulting from self-injurious behavior with an intent to die as a result of the behavior for a specified time period.

Denominator

Mid-year resident population of 15-24 year olds for a specified time period.

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 or attempted suicide comes from looking in the rearview mirror - at data compiled about suicide victims and attempts. Suicide be higher with certain demographics - such as in military veterans and men over age 45 - more than others.^3^ 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 ideation include: * Mental or emotional disorders, particularly depression and bipolar disorder. * 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. A study published by the Centers for Disease Control and Prevention reviewing suicide deaths noted: * Approximately half of suicide deaths in the 27 states that were part of the study did not have a known mental health condition; and * As compared with individuals with a known mental health condition, those without a known mental health condition were somewhat more likely to have had relationship problems/loss, life stressors or a recent/impending crisis. * The study noted the need for prevention programs to address social and economic problems, restrict access to lethal means and provide training on coping and problem-solving skills.^1^ Other risk factors associated with adolescent suicide include: * Bullying; * Media screen time; * Inadequate sleep; and * Being gay, bisexual or transgender.^4^ 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.^3^[[br]] [[br]] ---- {{class .SmallerFont 1. Stone DM, Simon TR, Fowler KA, Kegler SR, et al. Vital signs: trends in state suicide rates - United States, 1999-2016 and circumstances contributing to suicide - 27 States, 2015. MMWR Centers for Disease Control and Prevention. June 8, 2018;67(22):617-624. [https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a1.htm?s_cid=mm6722al_x]. Accessed June 8, 2018. 3. 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. 4. Shain B. Suicide and suicide attempts in adolescents. Pediatrics. American Academy of Pediatrics, Committee on Adolescence, Clinical Report. July 2016;138(1):e1-12.}}

How Are We Doing?

In 2016, the suicide mortality rate among Alaskans aged 15-24 years was 47.5 deaths per 100,000. The rate among Alaska Native people aged 15-24 years was 111.5 deaths per 100,00, more than double the rate for all Alaskans in that age group. The suicide rate for Alaskans aged 15-24 years in 2016 exceeds the Healthy Alaskans 2020 goal of 43.2 deaths per 100,000. Alaskan males aged 15-24 years remain more likely to commit suicide than females in that age group, with a suicide mortality rate of more than triple that of females in 2016 (70.3 deaths per 100,000 for males compared to 21.6 deaths per 100,000 for females).

How Do We Compare With the U.S.?

The 2015 suicide mortality rate for all Alaskans 15-24 year olds at 55.4 deaths per 100,000 is more than 4-times higher than the rate among 15-24 year olds nationally for that year.

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. A comprehensive state plan addressing goals and strategies to prevent suicide developed by the council can be found at: [https://www.sprc.org/sites/default/files/Recasting-the-Net-Promoting-Wellness-to-Prevention-Suicide-2018-2022.pdf].

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

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.^3^ '''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. The Centers for Disease Control and Prevention has a technical package of policy, programs and practices aimed at preventing suicide at [https://www.cdc.gov/violenceprevention/pdf/suicideTechnicalPackage.pdf]. [[br]] [[br]] ---- {{class .SmallerFont 3. 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. }}
Page Content Updated On 10/02/2018, Published on 11/15/2018
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health (Ak-IBIS) web site (http://ibis.dhss.alaska.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Tue, 20 November 2018 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health web site: http://ibis.dhss.alaska.gov ".

Content updated: Thu, 15 Nov 2018 11:07:24 AKST
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Tue, 20 November 2018 16:33:00 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Indicator-Based Information System for Public Health Web site: http://ibis.dhss.alaska.gov/ ".

Content updated: Thu, 15 Nov 2018 11:07:24 AKST