Epi-Aid # 2017-019: Undetermined Risk Factors for Suicide among Youth Aged 10-17 years – Utah, 2017 Final Report Prepared by: Francis Annor, PhD, MPH1 Amanda Wilkinson, PhD2 Marissa Zwald, PhD, MPH3 To be submitted to: Allyn Nakashima, MD State Epidemiologist Utah Department of Health Affiliation: 1Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention 2Child Health and Mortality Prevention Surveillance (CHAMPS), Center for Global Health, Centers for Disease Control and Prevention 3Division of Health Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Page 1 of 140 Contents Acronyms and Abbreviations ........................................................................................................................ 6 Executive Summary ....................................................................................................................................... 7 Background ............................................................................................................................................... 7 Datasets Used ........................................................................................................................................... 8 Key Findings by Dataset ............................................................................................................................ 9 Recommendations .................................................................................................................................. 13 Background ................................................................................................................................................. 14 Introduction ............................................................................................................................................ 14 Timeline of Activities ............................................................................................................................... 16 About Utah .............................................................................................................................................. 16 Epi-Aid Investigation Background ........................................................................................................... 17 Methods .................................................................................................................................................. 17 Suicide - data sources and description ............................................................................................... 18 CDC WONDER .................................................................................................................................. 18 UTVDRS ........................................................................................................................................... 19 Additional data collected in the field .............................................................................................. 20 Non-fatal suicidal behaviors – data sources and description ............................................................. 22 Emergency Department (ED) Visits and Inpatient Discharge Data ................................................. 22 Prevention Needs Assessment (PNA) ............................................................................................. 24 Suicide Prevention Program Documentations .................................................................................... 31 Other data analyses considerations .................................................................................................... 31 Results ......................................................................................................................................................... 33 Objective 1: ............................................................................................................................................. 33 CDC WONDER ...................................................................................................................................... 33 UTVDRS ............................................................................................................................................... 34 Precipitating Circumstances ............................................................................................................ 35 Alcohol and Other Substances Found in Decedents’ System at Time of Death ............................. 37 Additional Data Abstracted in the Field .............................................................................................. 38 Sexual Orientation .......................................................................................................................... 38 Religiosity/religious affiliation ........................................................................................................ 38 Family relationship problems that were the result of or that resulted in technology restriction . 39 Page 2 of 140 Ever Disclosed Intent to Die by Suicide ........................................................................................... 40 Cutting and History of Cutting ........................................................................................................ 41 Emergency Department (ED) Visits and Inpatient Discharge Data ..................................................... 41 Self-inflicted Injury .......................................................................................................................... 41 Suicidal Ideation .............................................................................................................................. 42 Disposition from the ED to a psychiatric facility ............................................................................. 43 Mapping .......................................................................................................................................... 44 Objective 2 .............................................................................................................................................. 45 Demographic Characteristics .......................................................................................................... 45 Adjusted Models ............................................................................................................................. 50 Geographic Differences in Suicidal Behaviors ................................................................................. 52 Objective 3: ............................................................................................................................................. 53 Inclusion Criteria ............................................................................................................................. 53 Question, Persuade and Refer (QPR) .............................................................................................. 54 Hope Squad ..................................................................................................................................... 55 Hope for Tomorrow ........................................................................................................................ 56 Review Limitation............................................................................................................................ 57 Program Evaluation ......................................................................................................................... 57 Programs Alignment with Risks and Protective Factors among Utah Youth .................................. 58 Mapping .......................................................................................................................................... 59 Synthesis of the evidence and recommendations ...................................................................................... 60 Mental Health Care ................................................................................................................................. 61 Strengthening Family Relationships........................................................................................................ 63 Promote Connectedness ......................................................................................................................... 64 Identify and Support Youth At-risk of Suicidal Behaviors ....................................................................... 66 Prevent Other Forms of Violence ........................................................................................................... 69 Reduce Access to Lethal Means among Youth at Risk for Suicide .......................................................... 70 Teach Coping and Problem-solving Skills ................................................................................................ 71 Selection and Implementation of Evidence-based Programs ................................................................. 72 Conduct an Ongoing Comprehensive Evaluation of Suicide Prevention Programs ................................ 73 Conclusion 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