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IINN MMAASSSSAACCHHUUSSEETTTTSS:: DDAATTAA UUPPDDAATTEE The Injury Surveillance Program and the Injury Prevention and Control Program, MA Department of Public Health February, 2006

Suicides

This bulletin provides an overview of and self-inflicted injuries among Massachusetts residents. These data may be used to inform decisions regarding the development and evaluation of initiatives and policies. The data reported represents the latest year available at publication (for death and youth behavioral survey data this is 2003, and for hospitalizations, emergency department visits, and adult behavioral survey data this is 2004).

Figure 1. Suicide and Homicide Rates,* MA Residents Ages 10 and Older, 1996-2003

10.0 8.9 9.1 In 2003: 8.8 • 423 Massachusetts residents died 7.7 7.4 7.5 7.4 8.0 7.2 by suicide (age-adjusted rate, 7.4 per 100,000 residents). 6.0 • There were more than 3 times

Homicides 4.1** the number of suicides than

3.3 4.0 3.2 homicides. 2.4 2.4 2.1 2.2 2.2 • The suicide rate from 2000 Rate per 100,000 per Rate 2.0 through 2003 was relatively stable (from 7.2 to 7.4 per

0.0 100,000). 1996 1997 1998 1999 2000 2001 2002 2003 • Nationally, the age-adjusted Year suicide rate among persons ages

Source: Registry of Vital Records and Statistics, Massachusetts Department of Public Health 10 and older was 12.5 per *Rates are age-adjusted using the Standard US Census 2000 population 100,000 in 2003. ** 2001 homicide deaths include victims of the September 11 terrorist attacks.

Figure 2. Magnitude of Suicides and Self-Inflicted Injuries resulting in Acute Care Hospitalization or Emergency Department Visit, MA Residents Ages 10 and Older

423 Completed Suicides (2003)

3,765 Hospitalizations for Self-Inflicted Injuries (FY2004)

6,304 Emergency Department Visits for Self-Inflicted Injuries (FY2004) Sources: see Methods section

Suicides and Self-Inflicted Injuries in Massachusetts: Data Update

Figure 3. Suicides by Method and Sex, Massachusetts Residents Ages 10 and Older, 2003

• Overall, for both sexes Females Males combined, suffocation (including (N=104) (N=319) , suffocation by plastic bag, etc.) was the leading method Other of suicide (n=160) in

Other 12% Massachusetts, followed by (15%) Suffocation/ (n=121) and poisoning (n=87). (Data Not Shown) Firearm (13%) Hanging Poisoning • The leading , (13%) (41%) (46%) however, varied by sex. For Firearm Suffocation/ males, suffocation (n=133) and Hanging (34%) firearm (n=107) were the most (26%) common methods. For females, the leading methods were

poisoning (n=47), followed by suffocation (n=27). Source: Registry of Vital Records and Statistics, Massachusetts Department of Public Health

Figure 4. Suicides by Age Group and Sex, Massachusetts Residents Ages 10 and Older, 2003

80 • The number of male suicides exceeded female suicides. In 70 2003, there were 319 suicides by males (11.8 per 100,000) 60 Male compared with 104 by females 50 Female (3.5 per 100,000). • Most suicides occur in the 40 middle age population; 44% of all suicides were among 30 individuals ages 35-54 years. Number of Suicides 20 • Although the highest number of suicides among males 10 occurred in middle age, the 0 highest rate of suicides occurred among men ages 85 4 4 4 4 + -24 -3 -64 -7 5 5-4 5-8 8 and older (27 per 100,000). 10-14 15 25 3 45-54 55 65 7 (Data Not Shown) Age Group (in years) • The highest rate of suicide among females was in the 45- Source: Registry of Vital Records and Statistics, Massachusetts Department of Public Health 54 year age group (5.2 per 100,000). (Data Not Shown)

2 Suicides and Self-Inflicted Injuries in Massachusetts: Data Update

Figure 5. Average Annual Suicide Rates* by Race/Ethnicity, Massachusetts Residents Ages 10

and Older, 2002-2003

10.0 9.1 For the 2 year period 2002 and 7.9 2003: 8.0 • The highest average annual

6.0 suicide rates were among Asian, 6.0 non-Hispanic and White, non- 4.7 Hispanic residents. 4.0 • The lowest suicide rates were among Hispanic and Black,

2.0 non-Hispanic residents. (n=753) (n=30) (n=27) (n=29)

100,000 per Rate Annual Average 0.0 White, non- Black, non- Hispanic Asian, non- Hispanic Hispanic Hispanic

Race/Ethnicity

Source: Registry of Vital Records and Statistics, Massachusetts Department of Public Health *Rates are age-adjusted using the Standard US Census 2000 population. The two most recent years of data were used to improve the stability of the rates.

Figure 6. Circumstances that may be Associated with Suicide, Massachusetts Residents, 2003

Some information on suicide 60% circumstances is available from the MA Violent Death Reporting System, a surveillance system that 50% 48% collects detailed information on homicides, suicides, and deaths of 40% undetermined intent from medical examiners, police lab data, and 30% death certificates. In 2003, among 23% 21% suicides where circumstances 19% 20% were documented:

Percent of Suicides of Percent • 48% had a current mental health problem such as 10% depression; • 23% had a history of 0% substance/; Current Mental Substance/Alcohol Intimate Partner Physical Health • 21% had current intimate Health Problem Use Problems Problems partner problems; and • 19% had physical health Circumstance* problems.

Source: Massachusetts Violent Death Reporting System, Massachusetts Department of Public Health * More than one circumstance may be noted for a suicide.

3 Suicides and Self-Inflicted Injuries in Massachusetts: Data Update

Non-Fatal Self-Inflicted Injuries

Non-fatal self-inflicted injuries include non-fatal suicide attempts as well as injuries sustained during other intentional acts of self-harm (e.g., cutting, burning).

Figure 7. Self-Inflicted Injury Hospitalization Rates by Age Group and Sex, Massachusetts

Residents Ages 10 and Older, FY 2004 • The overall rate of hospitalization 140.0 for self-inflicted injury among 120.0 MA residents ages 10 and older Females was 67 per 100,000 (n=3,765). 100.0 Males • Females had a higher rate (76 per

80.0 100,000, n=2,230) than males (57 per 100,000, n=1,535). 60.0 • Up to the age of 85, females had

40.0 higher rates of hospitalization for Rate per 100,000 per Rate self-inflicted injury than did men. 20.0 • Among females, the highest rate 0.0 was in the 15-24 year age group (132 per 100,000); among males, 14 54 5- 85+ the highest rate was in the 35-44 10- 15-24 25-34 35-44 4 55-64 65-74 75-84 year age group (84 per 100,000). Age Group (in years)

Source: Massachusetts Hospital Discharge Database, MA Division of Health Care Finance and Policy

Source: Massachusetts Hospital Discharge Database, MA Division of Health Care Finance and Policy Figure 8. Self-Inflicted Injury Hospitalizations by Method, Massachusetts Residents Ages 10 and Older, FY 2004

All Other Causes • The vast majority (79%) of

(6%) hospitalizations for self- inflicted injuries were due to Stabbing/Cut (15%) poisoning (n=2,995). • Unlike completed suicides,

the leading method of hospitalizations for self- inflicted injuries for both males and females was poisoning. Poisoning • Stabbing and cutting (79%) accounted for 15% of the hospitalizations for self- inflicted injuries (n=551).

Source: Massachusetts Hospital Discharge Database, MA Division of Health Care Finance and Policy

4 Suicides and Self-Inflicted Injuries in Massachusetts: Data Update

Survey Findings

Figure 9. Suicidal Thinking and Behavior among Massachusetts Residents Ages 18

and Older, 2004

Survey findings from the MA 3.5 Behavioral Risk Factor Surveillance 2.9 3.0 System, an anonymous random digit 2.65 Males dialing telephone survey of 2.5 Females Massachusetts residents ages 18 and older, indicate that in 2004: 2.0 • 2.65%, or approximately 139,000 1.5 MA adults, considered attempting suicide during the past year (2.65% 1.0 0.86 or 62,500 males and 2.9% or 76,500 females); 0.5 Percentage of Respondents 0.25 • 0.57%, or approximately 28,500 0.0 MA adults, attempted suicide Seriously considered suicide Attempted suicide during the past year (0.25% or 6,000 males and 0.86% or 22,600 females). Source: MA Behavioral Risk Factor Surveillance System, Health Survey Program, MA Department of Public Health

Figure 10. Suicidal Thinking and Behavior among Massachusetts High School Students, 2003 Survey findings from the MA

Youth Risk Behavior Survey, an

anonymous written survey of youth 30 28.0 in public high schools in MA,

25 indicate that in 2003:

• 28% of high school students 20 16.3 reported feeling sad or hopeless for 2 or more weeks during the 15 12.5 past year; 10 8.4 • 16.3% of students seriously considered suicide during the 5 2.8 past year, and 8.4% made an Percent of Respondents attempt; and 0 • Students more likely to have Felt sad or Seriously Made a suicide Attempted Received hopeless for 2 considered plan suicide medical made a compared or more weeks suicide attention for a to peers included sexual minority suicide attempt youth (32%), students who experienced dating violence or Source: Massachusetts Youth Risk Behavior Survey 2003, MA Department of Education sexual contact against their will

(27%), youth living in the U.S. for less than 6 years (16%), and students with physical disabilities (13%).

5 Suicides and Self-Inflicted Injuries in Massachusetts: Data Update

Resources

For more information on suicide data or to learn more about suicide prevention activities in Massachusetts, please contact:

The Injury Surveillance Program Massachusetts Coalition for Suicide Prevention MA Violent Death Reporting System Chapel Park Center for Health Information, Statistics, Research, & 55 Chapel Street Evaluation Room 3217 Massachusetts Department of Public Health Newton, MA 02458 250 Washington Street, 6th Floor 617-817-6977 Boston, MA 02108 http://www.MassPreventsSuicide.org 617-624-5648 (general injury)/617-624-5663 (MA-VDRS) http://www.mass.gov/dph/bhsre/isp/isp.htm

The Suicide Prevention Program The Injury Prevention and Control Program Help lines: Center for Community Health Samaritans (Boston) 1-877-870-HOPE Massachusetts Department of Public Health National LifeLine: 1-800-273-TALK 250 Washington Street, 4th Floor Boston, MA 02108 617-624-5476 http://www.state.ma.us/dph/fch/injury/index.htm

Methods

Data Sources: Death Data (with the exception of Figure 6): Registry of Vital Records and Statistics, MA Department of Public Health. Data reported are for calendar year. Death Data (Figure 6 only): Massachusetts Violent Death Reporting System, MA Department of Public Health. Data reported are for calendar year. Statewide Acute-care Hospitalizations: Massachusetts Inpatient Hospital Discharge Database, MA Division of Health Care Finance and Policy. Data reported are for fiscal years (October 1 -September 30). Deaths occurring during the hospital stay and transfers to another acute care facility were excluded from the counts presented. All discharge diagnoses were analyzed to ascertain injury. Statewide Emergency Department Discharges at Acute Care Hospitals: Massachusetts Emergency Department Discharge Database, MA Division of Health Care Finance and Policy. Data reported are for fiscal years (October 1 -September 30). Deaths occurring during treatment or those admitted to the hospital were excluded from the counts presented. All discharge diagnoses were analyzed to ascertain injury. MA Youth Risk Behavior Survey: MA Department of Education. MA Behavioral Risk Factor Surveillance System: MA Department of Public Health. Population Data: (with the exception of Figure 5) Population Estimates Program, U.S. Census Bureau. Release Date August 11, 2005. Population data from the 2000 U.S. Census was used to calculate age-adjusted rates for Figure 5. U. S. Data: Centers for Disease Control and Prevention, National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2006) {Accessed 2/1/06}. Available from: www.cdc.gov/ncipc/wisqars All suicides and self-inflicted injuries were ascertained using guidelines recommended by the Centers for Disease Control and Prevention and are based upon the International Classification of Disease codes for morbidity and mortality. Suicides and self-inflicted injuries were identified utilizing the first listed external cause of injury. As suicide and self-inflicted injury events are rare under age 10, we excluded any event occurring under age 10, in order to display rates for those most at risk. All rates reported in this bulletin are crude rates with the exception of Figures 1 & 5. Age-adjusted rates are used for Figures 1 & 5 to minimize distortions that may occur by differences in age distribution among compared groups.

This publication was developed by the Injury Surveillance Program, Center for Health Information, Statistics, Research and Evaluation, and the Injury Prevention and Control Program, Center for Community Health. Support for this publication in part comes from the Centers for Disease Control and Prevention (#U17/CCU124799 and #U17/CCU122394). Its contents are solely the responsibility of the authors and do not represent the official views of the Centers for Disease Control and Prevention. Figure 5 Revised 2/7/06.