Trends in Public Health
Suicide in Duval County: A Growing Crisis Katryne Lukens Bull, MPH, Ryan Butterfield, DrPH(c), Thomas Bryant III, MSW, Bonita Sorensen, MD, MPH. Suicide is the 10th leading cause of death in the U.S., with 36,891 deaths per year. In 2011, suicide was also the 10th leading cause of death in Duval County with 127 deaths. Suicide trends demonstrate an overall reduction since 1990, especially from 1993-2000, but starting in 2001 rates have increased and are now higher in Duval County (14.6/100,000) than Florida (13.8/100,000) and the U.S. (12.0/100,000). Suicide is recognized as a major public health issue by the U.S. Surgeon General and decreasing suicide morbidity and mortality is a Healthy People 2020 goal. Suicide is a gender, race, and religion neutral issue which affects civilians and military alike. The U.S. Armed Forces is now averaging over one suicide per day among active duty soldiers and reservists. Since July 2012, more servicemen and women were lost to suicide than killed in combat. Suicide attempts often result in significant morbidity. In 2011 in Duval County, 876 individuals were hospitalized due to a suicide attempt, 58% were female and 42% were male. Suicide is considered an external factor leading to hospitalization with an additional primary reason for being admitted (injury, mental health problem, etc.). Attempted suicide hospitalizations were most often due to an injury (70%) or a mental health diagnosis (27%). Over half of all individuals hospitalized were uninsured (30%) or on Medicaid (23%). Eighty-one percent (81%) reported their race as White. According to the CDC and the American Association of Suicidology, the majority of people who complete suicides have a history of up to 25 attempts. Completed suicides are most prevalent among White males 45 year and older, while attempts are most prevalent among adolescent females. Duval County currently has fewer adolescent deaths due to suicide than Florida (1.3 versus 1.9/100,000) but according to Duval’s 2011 Youth Risk Behavior Survey many still seriously consider suicide (14.9%) or have made a plan to commit suicide (14.7%). Duval’s high school students report more attempts (12.7%) than U.S. students (7.8%). In 2011, 60 Duval County high school students were hospitalized for a suicide attempt, 43% for a mental health diagnosis, most often adjustment reaction (75%), and 53% for an injury, most often poisoning (88%). From 2009-2011, seven students succeeded in committing suicide. The highest rates of suicide are among Duval residents ages 20 to 64 with rates peaking in the 40-59 year age group (26.2/100,000). In 2011, 775 individuals 20-64 years old were hospitalized for a suicide attempt; 72% for an injury, most often poisoning (86%) and 25% for a mental health 50 Vol. 64, No. 1 2013 Northeast Florida Medicine
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diagnosis, most often Episodic Mood Disorder (66%). From 2009-2011, 326 people 20-64 years of age succeeded in committing suicide. Individuals over 65 years of age are at risk for suicide, which often is under reported. In 2011, there were 25 hospitalizations for attempted suicide including 16% for a mental health diagnosis and 72% for an injury, most often poisoning (83%). From 2009-2011, 53 people 65 years of age and older succeeded in committing suicide. Suicide poses a significant public health problem, not only to those who attempt and/or commit suicide but for those who survive the suicide of a loved one. Surviving the loss of a loved one due to suicide is a risk factor for suicide. Surviving family members and close friends experience a range of complex grief reactions including, guilt, anger, abandonment, denial, helplessness, and shock. The Northeast Florida Coalition for Suicide Prevention and Awareness, the Northeast Florida Chapter of the American Foundation for Suicide Prevention, and the Florida Youth Suicide Prevention Project at Daniel are community organizations that provide educational training on identifying and responding to suicidal individuals. Clinician specific training is offered by Dr. Elise Fallucco at Nemours and through the Jacksonville System of Care Initiative (JSOCI). Downloadable screening tools, posters and handouts are available for Emergency Departments, Hospitals, and office settings at http://www.sprc.org/for-providers. Help numbers include: United Way Crisis Center (800) 346–6185, 1 800 SUICIDE (784- 2433), and the Crisis Line for suicide intervention for service members, veterans and families at 1-800-273-8255, Press “1.” Duval County is experiencing a growing suicide crisis among adolescents, adults, and service members; and Duval County clinicians have a unique opportunity to provide essential preventative care – screen and refer. Resources: 1) Agency for Health Care Administration: Hospitalization Discharge and Emergency Department Data 2011; 2) FDOH, Office of Vital Statistics, Death File 2011; 3) American Association of Suicidology. Accessed on December 20, 2012 at http://www.suicidology.org/home; and 4) Department of Defense accessed on December 20, 2012 at http://www.defense.gov/releases/. www . DCMS online . org
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