in ’s East Region Data Center Report

Data is important for understanding the scope or magnitude of suicide. It can not only show rates, but also the distribution of suicidal behaviors among the population (e.g., in various age groups and racial or ethnic groups). Data can also point to the factors that play a role in suicidal behavior. Without data, it is difficult to know exactly what groups are at particular risk in a community and what risk and protective factors a program or strategy should focus on to reduce . Data can make a difference to decision makers, such as coordinators or policymakers, because it can be used to determine how to most effectively direct—or redirect—resources to the communities and populations that need them most. East Region • Family , including physical or sexual abuse Washington State has 39 counties. For the purposes • Having guns or other firearms in the home of this report, staff more closely examine suicide in • Incarceration, being in prison or jail the east region of the state. The emergency medical • Being exposed to others’ suicidal behavior, such as services (EMS) system specific to this area is that of family members, peers, or media figures. comprised of the following counties: Adams, Asotin, Ferry, Garfield, Lincoln, Pend Oreille, Spokane, Fatal Suicides Stevens, and Whitman. Spokane County is considered an urban county and the others are rural counties. The east region in Washington had an increasing trend in suicide rates over the last 25 years. Statewide Suicide Data there was a decreasing trend from 1990-2006 and then an increasing trend from 2006-2014. Information about suicide in Washington’s east Suicide Mortality Rates Over Time region is presented using data from certificates. 25 Non-fatal suicide attempts are described using

inpatient hospitalization data. This information 20 provides an understanding of the more severe 17… 0

0 15.94 0 , 15 suicide attempts. There are more suicide attempts 0

0 13.93 1

r 12.07 where people may be injured, but are treated in an e p

e 10 t

emergency room, urgent care center, or health care a R East Region provider’s office. Information about these types of Washington State 5 health care visits is not available for analysis.

0

Suicide is the seventh leading in the 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 east region of Washington. It is the second leading 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 cause of death among individuals 15-44 years of age.i Over the last 25 years, the pattern of suicides in the Family and friends of people who die by suicide may east region was fairly variable – more so for rural experience feelings of shock, anger, or guilt about the counties than the urban county. The urban county suicide.ii demonstrated a significant increasing trend in the More people attempt suicide than die from suicide. suicide death rate. There was no identified trend in Nationally, there are approximately 11 suicide rural suicide rates. Rural counties in the east region attempts for every one death from suicide.iii were Adams, Asotin, Ferry, Garfield, Lincoln, Pend People who survive a may then Oreille, Stevens, and Whitman. Spokane County was have a serious , such as a broken bone, the urban county. , or organ damage. Suicide Mortality Rates Over Time, WA East Region Suicide affects people across the lifespan, all genders, 25 and all race and ethnicities. While all groups are 20 impacted, some people may be more at risk than 18.58

other. Factors that increase the risk for suicide are 0 0 15.7 0 iv , 15 0

below. If an individual has a risk factor, it does not 0 1

12.57 r

e 11.9

mean they will attempt suicide, it only increases the p

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likelihood that they may. R Rural Urban • , other mental disorders, or 5 disorder

0

• A prior suicide attempt 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • Family history of a or 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 substance abuse • Family During 2010-2014, an average of 106 people suicide rate for men (also see method chart on page died each year from suicide in the east region 5). Compared to individuals 25-44 years of age, those of Washington. The five-year suicide rate was who were younger had lower suicide rates. Among significantly higher for the east region compared to seniors, individuals 75-84 years of age had the Washington State. In the east region, there were highest suicide rate. Compared to whites, Asians/ differences in the suicide rate by demographics. Males Pacific Islanders had a significantly lower suicide rate. had a significantly higher suicide rate than females. There were no differences in the suicide rates among Generally, men tend to use more lethal means when other races. Hispanics had a significantly lower suicide attempting suicide, which is reflected in the higher rate than non-Hispanics.

Suicide Rates by Demographics, WA East Region, 2010-2014 (n=530) Rate per 100,000

35 35

30 30 27.29 25 25

20 20 16.55 14.91 15 15

10 10 5.95 5 5

0 0 East Region Washington State Male Female

35 35

30 30 28.85 25.2 25 22.93 23.07 25 21.49 20 20 16.7 15 15 10.3 10 10

5 5 0.84 0 0 <15 15-24 25-44 45-64 65+ 65-74 75-84 85+

35 35

30 30

25 25 20.54 20 18.75 20 16.72 17.4 15 15

10 10 6.02 5 5 3.55

0 0 White Black AIAN API Hispanic Non-Hispanic In the east region of Washington, the suicide rate analysis. Individuals 15-24 years of age had a had some statistically significant trends over time for decreasing trend from 1997-2001. Individuals 45-64 different age groups. A three-year rolling rate was years of age had an increasing trend from 1992-2009. used to stabilize the rate. There were too few suicides There was no trend for individuals 25-44 years of age among younger than 15 years of age for trend and among seniors, the rates were stable.

Suicide Mortality, 3 Year Rolling Rate per 100,000, WA East Region, 1990-2014

15-24 Years 25-44 Years 35 35

30 30

25 25

20 20

15 15

10 10

5 5

0 0

45-64 Years 65+ Years 35 35

30 30

25 25

20 20

15 15

10 10

5 5

0 0 The most prevalent manner in which suicide occurred This includes , strangulation, and suffocation. was the use of a firearm. More than half of suicides Third was poisoning. Among poisoning suicides, half in the east region during 2010-2014 were due to a were due to an unspecified drug or mediation. One in firearm. Among the firearm suicides, 39% used a five (21%) were from gasses or vapors. Eleven percent handgun, 21% used a rifle or shotgun, and in 40% of were from narcotics or hallucinogens. Another 12% the , the type of firearm was not specified. were from or hypnotic drugs. The second most prevalent manner was suffocation.

Method of Suicide, WA East Region, 2010-2014 Falls 3% Other 6%

Poisoning 17%

Firearm 55% Suffocation 19%

Males had a higher use of a firearm for dying by suicide than females. Females had a higher proportion of suicide by poisoning.

Suicide Method by Sex WA East Region, 2010-2014

70% Male 59.2% 60% Female 50% 40% 37.5% 30.2% 30% 18.9%20.8% 14.2% 20% 7.6% 11.4% 10% 0% Firearm Suffocation Poisoning Other Non-Fatal Suicide Attempts Approximately 390 residents in the east region of Washington were hospitalized annually from The rate of suicide attempts ending in a an attempted suicide. The 2010-2014 rate of hospitalization varied from year to year in the east hospitalization from non-fatal suicide attempts region of Washington over the last 25 years. Overall, was significantly higher in the east region than in the suicide attempt rate increased a small amount. Washington State. Females had a significantly higher This increase was statistically significant. Washington suicide attempt rate than males. Adults 25-44 years of State had three significant trends during that time. age had the highest suicide attempt rate. The rate was The suicide attempt rate decreased from 1990-1999, significantly lower for all other age groups. increased from 1999-2009, and then decreased again from 2009-2014.

Non-Fatal Attempted Suicide Hospitalizations Over Time Attempted Suicide Hospitalization Rates by Demographics, WA East Region, 2010-2014 (n=1,951)

100 Spokane County 60.74

75 Washington State 51.3 0 0 0 , 55.2 0 51.4 57.4 0 1

r 50

e 47.4 p

e t a R Male 51.27 25 East Region Washington State Female 70.08 0 4 3 2 1 0 9 8 7 6 5 4 3 2 1 0 9 8 7 6 5 4 3 2 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 9 9 9 9 9 9 9 9 9 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1

Over the last 25 years, the pattern of suicide attempts in the east region was fairly variable, in both rural <15 19.39 counties and the urban county. The urban county demonstrated a significant increasing trend in the 15-24 83.32 non-fatal suicide hospitalization rates from 1990- 2014. The non-fatal suicide hospitalization rates in 25-44 96.77 the rural counties had a significantly decreasing trend from 1990-2014. Rural counties in the east region 45-64 65.54 were Adams, Asotin, Ferry, Garfield, Lincoln, Pend 65+ Oreille, Stevens, and Whitman. Spokane County was 18.81 the urban county. 0 25 50 75 100 Rate per 100,000 Non-Fatal Attempted Suicide Hospitalizations Over Time, WA East Region

100 Rural Urban

75

0 62.1 0 64.9 0 , 0 0 1

r 50

e 47.5 p

e t

a 36 R 25

0 4 3 2 1 0 9 8 7 6 5 4 3 2 1 0 9 8 7 6 5 4 3 2 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 9 9 9 9 9 9 9 9 9 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 The majority of suicide attempts resulting in a Gatekeepers are anyone who has regular hospitalization in the east region of Washington interaction with others, such as parents, friends, during 2010-2014 were from poisoning, followed by neighbors, teachers, coaches, case worker, and cutting or piercing . The manner of suicide police officers. Individuals of all ages can be attempts was similar for males and females. impacted by QPR. Method of Suicide Attempt Requiring Prevent Suicide Spokane Coalition is a grassroots Hospitalization, WA East Region, 2010 - 2014 group that focuses on best-practice interventions including training of professionals and community members in QPR, SafeTALK and Applied Suicide Firearm, 1% Intervention Skills Training (ASIST). SafeTALK and Suffocation, 2% Other, ASIST are both programs of Living Works, an 6% international suicide prevention training organization. Other best practices addressed by this coalition are guidelines for responsible media reporting on suicide, Cut/Pierce, 13% www.reportingonsuicide.org, and reducing access to means of suicide. Some interventions are based on medical treatment. Poisoning, 78% Multisystemic Therapy provides psychiatric treatment in the home of a suicidal child. Prevention of suicide in primary care elderly: collaborative trial (PROSPECT) reduces and depression among seniors. It works with primary care physicians to recognize depression and suicidal ideation, a treatment algorithm is used, and treatment is managed by health specialists. Prevention It is important to note that while some non-fatal suicide attempts result in hospitalization, some of the There are many best-practice interventions for suicide self-injurious behaviors may be perceived as a suicide prevention. A listing of these can be found on the attempt when in fact there was not a clear intent to Suicide Prevention Resource Center’s Best die. Self-injury, also known as cutting or self- Practices Registry.v Many focus on education and mutilation, occurs when someone intentionally and training. Examples include Lifelines curriculum. This repeatedly harms herself/himself. The method most is a school-based curriculum to increase positive often used is cutting but other common behaviors outcomes and prevent suicide. Sources of Strength is include burning, punching, and drinking something another youth program in implementation in a school. harmful, like bleach or detergent.vi This program trains youth as peer leaders with support from adults. There are one on one Self-injury is often thought to be directly linked with conversations, development of posters, classroom suicide because sometimes people who self-harm will presentations, and individual and media messaging. later attempt suicide, but this isn’t always the case. Through this, the peer group norms are changed to Self-injury hospitalizations are often recorded as a reduce the acceptability of suicide as a response to non-fatal suicide attempt. However, from a distress and to increase the acceptability of seeking prevention perspective it is important to identify the help, improving communication between youth and behavior and ask clearly about whether or not there adults, and to develop healthy attitudes. is an intent to die or if the behavior is a way to cope with life. Information on treatment of self-injury QPR gatekeeper training is another example of is available from S.A.F.E. Alternatives®, training to reduce suicide. It stands for Question, http://selfinjury.com. Persuade, and Refer. The program trains gatekeepers; someone who is in a position to recognize if someone is at risk of suicide and refer them to help. i Washington State Department of Health. Center for Health Statistics. 2014. ii Centers for Disease Control and Prevention. Understanding Suicide, Factsheet 2015. http://www.cdc.gov/violenceprevention/pdf/suicide_factsheet-a.pdf iii Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS). 2014. http://www.cdc.gov/injury/wisqars/ iv National Institute of . Suicide in America. 2015. http://www.nimh.nih.gov/health/publications/suicide-faq/index.shtml v Suicide Prevention Resource Center. www.sprc.org/ vi Mental Health America. http://www.mentalhealthamerica.net/self-injury

Suicide in Washington’s East Region Report author:

Amy Riffe, Epidemiologist

Spokane Regional Health District - Data Center In partnership 1101 W. College Ave., Spokane, WA 99201 with srhd.org | 509.324.3605