Transcript New Mexico Los Alamos County I am a part of

Risk Factors for Suicidal Behaviors Among Los
Alamos Youth
Presented for the LAPS Healthy Schools Initiative and the United Way of
Northern New Mexico’s Behavioral Health Initiative
January 19, 2017
Objectives
• Examine trends of fatal and non-fatal suicidal behaviors
• January 1999 - September 2016
• Youth 10-19 years of age
• Los Alamos County
• Investigate behaviors among youth 10-19 years to help inform
prevention strategies
• Make recommendations to LAPS to reduce the risk of youth
suicide.
Methods
• Trends in fatal and non-fatal suicidal behaviors among youth ages 10 - 19 years, using the
following data sources
Data
Source
NM Death Certificate Database
Bureau of Vital Records and Health
Statistics, NMDOH
NM Hospital Emergency Department
Data
Health Systems Epidemiology Program,
NMDOH
Youth Risk and Resiliency Survey (YRRS)
Injury & Behavioral Epidemiology Bureau,
NMDOH
Suicide attempt and suicidal ideation
Emergency Department (ED) visits
Los Alamos Medical Center
Syndromic Surveillance System
Health Systems Epidemiology Program,
NMDOH
• Descriptive epidemiology findings & statistical tests of significance
Medical Chart Abstraction:
Los Alamos Medical Center ED
• Case Definition
• January 01, 2014 – May 2016
• Ages 10 – 19 years
• ICD-9/10 codes - external cause of injury code/diagnosis
code
• Suicide attempt, or any mention of intentional self-injury with
expressed intent to cause injury or die
1. MRN #: _____________
2. Last Name: ____________
5. Date of ED Visit:____/____/____
9. Race/Ethnicity:
=American Indian
=Asian/Pacific Islander
=Black
=White
=Other
=Hispanic
=Non-Hispanic
12. Residence City:
3. First Name: _____________
6. DOB:____/____/____
7. Age:_____
10. Relationship Status:
=Married
=Never married/single
=Divorced
=Separated
=Widowed
=Unknown
=Unmarried couple
8. Gender:
17. Number of Prior Attempts: _________
20. History of Substance Use:
Alcohol:
Yes
Rx Drug Misuse:
Yes
Illicit Drug Use:
Yes
Current Tobacco Use:
Yes
Generalized
anxiety
disorder
Conduct
disorder
Personality
disorder
Drug use/
dependence
disorder
Alcohol
use/dependence
disorder
=Inhalation of gases/vapors
=Motor vehicle crash
=Other __________________
__________________________
16a. Date of Injury: ____/____/______
16b. Place where injury occurred: _________________________
18. Diagnosed Mental Disorder (check all that apply):
PTSD
Unknown
14. Injury County:
=LA =Other:
13. Residence County:
=LA =Other:
Schizophrenia
=Female
11a. Current/highest grade completed: ______
11b. Current school: _____________________
16. Primary Method of Injury:
=Medication/Drug Overdose
=Cutting/Laceration
=Hanging/Suffocation
=Gunshot
Bipolar
disorder
=Male
11. Education:
=Less than high school (If <HS degree 11a)
=High school graduate (grade 12 or GED)
=Some college or technical school
=College or technical school graduate
15. Level of Suicidal Behavior:
=Suicidal thoughts only (Skip to QN17)
= Suicidal thoughts with a plan (Skip to QN17)
= Suicide attempt with injury
= Suicide death
= Other: _________________________________
Depressive
disorder
4. Middle Name: _____________
AD/HD
Panic
disorder
21. Toxicology Screen:
Alcohol:
Yes
19. Are any firearms kept in or around the patient’s home:
Yes
No
Unknown
22. Contributing Factors (check all that apply):
=Physical health problem
=Divorce/separation/breakup of relationship
=Intimate partner problem
=Other relationship problem
=Job problem
=School problem
=Financial problem
=Suicide by friend or relative
=Other death of friend or relative
=Criminal/legal problem
=Victim of interpersonal violence (past month)
=Victim of interpersonal violence (>1month ago)
Unknown
Unknown
Unknown
Unknown
Unknown
If yes, list BAL w/units:____________
Other:
18a. Did the patient receive mental health treatment in the
past 30 days:
Yes
No
Unknown
No
No
No
No
No
Drugs:
Yes
No
Unknown
If yes, list all positive results w/ units:
_________________________________________________________
_________________________________________________________
23. ED Diagnosis: _________________________________________
________________________________________________________
24. ICD-CM Codes: 1._________ 2. _________ 3.__________
25. ED Discharge Status:
=Hospitalized
=Admitted to inpatient behavioral health unit
=Discharged with referral to outpatient mental health care
=Discharged
Medical Chart Abstraction: Suicide Attempt
16 visits met case definition from 2014-2016
3 11 2
Visits in 2014
Visits in 2015
Visits in 2016
Suicide Deaths among Youth
Suicide Deaths Among Youth 10-19 Years,
Los Alamos, Rio Arriba, and Santa Fe Counties, 1999-2016*
7
6
Number of deaths
5
4
3
2
1
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Los Alamos
Rio Arriba
Santa Fe
*2016 death data are preliminary; 2016 deaths include deaths registered at the NMBVRHS through 3/16/2016
Suicide Rate among Youth, 10-19 years,
Los Alamos, Rio Arriba, Santa Fe, and Statewide, 1999-2015
40.0
35.0
Age-specific rate per 100,000
30.0
25.0
20.0
15.0
10.0
5.0
0.0
Los Alamos County
Rio Arriba County
Santa Fe County
New Mexico
Source: New Mexico Death Certificate Database, Bureau of Vital Records and Health Statistics, New Mexico Department of Health. Retrieved November 28, 2016 from New Mexico Department of Health, Indicator-Based Information System for Public
Health website: http://ibis.health.state.nm.us/.
Non-Fatal Intentional Self-Injury
(Suicide Attempt)
Non-Fatal Intentional Self-Injury ED Visit Rates among Youth Aged 10-19 Years
by Geographic Region, 2010 -2015
600.0
500.0
400.0
300.0
200.0
100.0
0.0
Los Alamos County
Santa Fe County
Rio Arriba County
New Mexico Statewide
Sources: NMDOH, Health Systems Epidemiology Program (HSEP), 2010-2014 Statewide Emergency Department Data and 2015 Preliminary Statewide Emergency Department Data, September 23, 2016.
Non-Fatal Intentional Self-Injury ED Visit Rates Among Youth Aged 10-19 Years
Los Alamos County, 2010-2015
800.0
18
700.0
Rate per 100,000
600.0
15
13
500.0
400.0
9
300.0
200.0
6
4
100.0
0.0
2010
2011
2012
2013
2014
Sources: NMDOH, HSEP, 2010-2014 Statewide Emergency Department Data and 2015 Preliminary Statewide Emergency Department Data, September 23, 2016.
2015
Suicidal Ideation
Suicidal Ideation Emergency Department Visit Rates Among Youth Aged 1019 Years by Geographic Region, 2010-2015
900
800
700
600
500
400
300
200
100
0
Los Alamos County
Santa Fe County
Rio Arriba County
Sources: NMDOH, HSEP, 2010-2014 Statewide Emergency Department Data and 2015 Preliminary Statewide Emergency Department Data, September 23, 2016.
New Mexico Statewide
Suicidal Ideation Emergency Department Visit Rates Among Youth
Aged 10-19 Years by Year, Los Alamos County, 2010-2015
1000.0
22
900.0
800.0
19
700.0
18
16
600.0
500.0
12
400.0
300.0
8
200.0
100.0
0.0
2010
2011
2012
2013
2014
Sources: NMDOH, HSEP, 2010-2014 Statewide Emergency Department Data and 2015 Preliminary Statewide Emergency Department Data, September 23, 2016.
2015
LAMC Medical Chart Abstraction
LAMC ED Visits with any Complaint of Suicide Attempt
among Youth Aged 10-19 Years, January 2014 – September 2016 (n=16)
5
Number of Visits
4
3
2
1
2014
2015
April
March
February
January
December
November
October
September
August
July
June
May
April
March
February
January
December
November
October
September
August
July
June
May
April
0
2016
Sources: NMDOH, HSEP, 2014 Statewide Emergency Department Data, 2015 Preliminary Statewide Emergency Department Data, and 2016 Syndromic Surveillance Data, May 10, 2016. Medical record abstraction, LAMC
Medical Records Department, May 9 and 11, 2016.
Characteristic
Gender
Male
Female
Age (years)
Median
Mean
Range
Race/ethnicity
White
Hispanic
Number (percent)
(n=16)
3 (19%)
13 (81%)
15.5 yrs
15.4 yrs
12 – 19 yrs
100%
0%
Self-Inflicted Injury ED Visits Among Youth 10-19 Years
Los Alamos County, 2010-2016
12
Number of ED visits
10
8
6
4
2
0
2010
2011
2012
2013
Female
Male
2014
2015
2016
% of Cases with History of Prior Attempt
50%
44%
45%
40%
35%
30%
25%
25%
20%
15%
10%
6%
5%
0%
0
1
Number of Prior Attempts
4
Primary Method of Injury
90%
80%
81%
70%
60%
50%
40%
30%
19%
20%
10%
0%
Medication/Drug OD
Cutting/laceration
Percent of Cases with Alcohol Involved
100%
88%
90%
80%
70%
60%
50%
40%
30%
20%
13%
10%
0%
Yes
No
Percent of Cases with Diagnosis of Mental Disorder
80%
75%
70%
60%
50%
40%
30%
20%
10%
6%
6%
AD/HD
Bipolar Disorder
0%
Depressive Disorder
Percent Received Mental Health Treatment in the Past 30 Days
60%
50%
50%
40%
38%
30%
20%
13%
10%
0%
Yes
Unknown
No
Percent of Cases with Medication(s) for Depression
80%
75%
70%
60%
50%
40%
30%
20%
13%
13%
No
Unkown
10%
0%
Yes
Percent of Cases Discharge Status
80%
75%
70%
60%
50%
40%
30%
25%
20%
10%
0%
Transferred to a Psych Facility
Dicharged Home
LAMC Suicidal Ideation ED Visits Among Youth Aged 10-19 Years
January 2014 – September 2016 (n=57)
7
Number of Visits
6
5
4
3
2
1
January
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
0
2014
2015
Sources: NMDOH, HSEP, 2014-2015 Statewide Emergency Department Data and 2016 Syndromic Surveillance Data, October 19, 2016.
2016
LAMC Suicidal Ideation ED Visits
Youth Characteristics (n=57)
47%
53%
Female
Male
16
Mean and median age
LAMC ED Surveillance June – September 2016
5
Number of Visits
4
3
2
1
0
June
July
August
2016
Source: LAMC Emergency Department Adolescent Suicide Attempts reporting log.
September
Protective Factors for Suicidal Behaviors Among High School
Students, Los Alamos County and New Mexico, 2015
New Mexico
Los Alamos County
I plan to go to college or some other school after high school
A parent or other adult believes I will be a success
I have a friend about my own age who really cares about me
There are clear rules about what students can and cannot do
A parent or other adult is interested in my homework
There is an adult who really cares about me
If I am gone, a parent or other adult knows where I am and knows…
A teacher or other adult believes I will be a success
I have a friend about my own age who helps me when I’m having a…
I am involved in music, art, literature, sports, or a hobby
A teacher or other adult listens to me when I have something to say
There is an adult who tells me when I do a good job
I am involved in sports, clubs, or other extra-curricular activities
I am a part of group activities
0
20
40
60
Percent
80
100
Conclusions
• 1999-2015, 4 suicides among Los Alamos County youth 10-19 years
• Not different from suicide rates compared to surrounding counties/statewide
• 2010-2015
• 65 ED visits for suicide attempt
• 95 ED visits for suicidal ideation
• LA County youth suicide attempt rate higher than for Rio Arriba &
statewide, but not Santa Fe County
• LA County youth suicidal ideation rate higher for Rio Arriba, but not
Santa Fe County or statewide
Conclusions
• Peak in ED visits for suicide attempt during May and August, 2015
• Majority of suicide attempts
• Female
• White
• Median age, 15.5 years
• Many with prior attempt
• 75% have prior diagnosis of depressive disorder
• Have medications for depression
• Primary method of injury is by medication/drug OD
• Second leading method of injury is cutting/laceration
• 75% transferred to an inpatient psychiatric treatment facility
Recommendations
• Provide education to parents on navigating mental health care resources
• Improve care coordination. Data suggest:
• youth who attempted suicide had previous exposure to mental health care
• 88% had history of mental illness; of those 86% had depressive disorder, 50% history of prior
suicide attempt
• Primary care providers - screen youth for suicide risk; help combat negative social
views, norms that keep individuals and families from seeking treatments, support
• Increase education regarding “means restrictions”
http://www.sprc.org/resources-programs/calm-counseling-access-lethal-means
• Training for ED providers: http://www.sprc.org/events-trainings/advancingsuicide-prevention-practice-emergency-department-setting
• SAMSHA’s: “Preventing Suicide: A Toolkit for High Schools”
• Develop partnerships with community organizations and agencies in different
sectors to combine resources, for example:
• PSA campaign developed by youth and aired on local radio
Recommendations
• Resources for primary care providers to screen for suicidal thoughts and behaviors:
• Zero Suicide (www.zerosuicide.com)
• Columbia Suicide Severity Rating Scale (http://www.cssrs.columbia.edu)
• MacArthur Depression Toolkit (http://www.integration.samhsa.gov/clinicalpractice/macarthur_depression_toolkit.pdf)
• Behavioral Health in Primary Care: Clinical Strategies and Program Models for Working
and High-Risk Youth (http://www.parecovery.org/documents/BH_Primary_Care.pdf)
• Recognizing and Responding to Suicide Risk in Primary Care
(http://www.sprc.org/settings/primary-care/toolkit )
• Engaging Primary Care Providers in Suicide Prevention
(http://www.sprc.org/system/files/private/event-training/Wintersteen_Engaging.pdf))
• Tip and Strategies for Billing for Mental Health Services in a Primary Care Setting
(http://www.sprc.org/sites/default/files/tipsandstrategiesforbilling.pdf)
Thank You
Report prepared by:
Nicole Middaugh, ScD, MS, EIS Officer
Centers for Disease Control and Prevention
Assigned to New Mexico Department of Health
Tierney Murphy, MD, MPH, Injury Epidemiologist
Nancy Kirkpatrick, Youth Suicide Prevention Coordinator
Kelly Gallagher, PhD, Community Health Epidemiologist
Michael Landen, MD, MPH, State Epidemiologist
New Mexico Department of Health
Questions?