Webinar Presenters - Safe States Alliance · Source: Bowles JR. Suicide in Western Samoa: an...

Webinar Presenters

Alex E. Crosby, MD, MPH

Medical Epidemiologist

Division of Injury Prevention

Centers for Disease Control and Prevention

Janet M. Blair, PhD, MPH

Team Lead

Division of Violence Prevention


Rana Bayakly, MPH

Chief Epidemiologist

Health Behaviors and Injury Epidemiology Section

Georgia Department of Public Health

Dorian A. Lamis, PhD, ABPP

Assistant Professor, Emory University School of Medicine

Director of Education and Training, Injury Prevention Research Center at Emory

3

The epidemiology and prevention of

suicidal behaviorSoutheastern and Southwestern Injury Prevention

Network

Dec 2019Alex E. Crosby

Division of Injury Prevention (DIP),

Centers for Disease Control and Prevention (CDC)

Atlanta, GA

"The findings and conclusions in this presentation have not been formally

disseminated by the Centers for Disease Control and Prevention/the Agency for

Toxic Substances and Disease Registry nor the Substance Abuse and Mental Health

Services Administration and should not be construed to represent any agency

determination or policy."

4

Learning Objectives

❑At the conclusion of the session, participants

should be able to:

▪ Describe why suicide is an important public health

problem

▪ Describe the magnitude of suicidal behaviors

▪ Identify high risk groups for suicidal behaviors

▪ Identify risk and protective factors for suicide in various

age groups

▪ Cite examples of useful interventions to prevent suicide

5

Why is suicidal behavior a public health

issue?

• Morbidity and mortality• 10th leading cause of death in 2017 accounted for over 47,000 deaths

• Estimated 492,037 emergency dept visits for self-inflicted injury in 2017

(NEISS)

• Health consequences in many areas

• Physical, mental, behavioral, reproductive, sexual transmitted diseases

• Potential for impact by public health• Focus on prevention

• Science base

• Stresses multi-disciplinary approach

• Mission of public health includes this issue• “ … to reduce the amount of disease, premature death, and disease-

producing discomfort and disability in the population.” - J. Last, Dictionary of

Epidemiology 1988

6

Public Health Approach to

Suicide Prevention

❑The public health approach

seeks to answer the

foundational questions:

• What is the problem?

• How could we prevent it from

occurring

in the first place?

❑To answer these questions,

public health uses a

systematic, scientific method

for understanding and

preventing suicide.

1. Define and monitor the

problem

2. Identify risk and protective factors

3. Develop and test prevention

strategies

4. Disseminate successful strategies

widely

7

The Public Health Approach

to Prevention

1. Define and monitor the problem


3. Develop and test prevention strategies


widely

8

Leading causes of death for selected age

groups – United States, 2017

Rank 10-14 years 15-19 years 20-29 years 30-39 years 40-49 years 50-59 years

1 Unintentional

Injuries

Unintentional

Injuries

Unintentional

Injuries

Unintentional

Injuries

Unintentional

Injuries

Malignant

Neoplasms

2 Suicide Suicide Suicide Suicide Malignant

Neoplasms

Heart

Disease

3 Malignant

Neoplasms

Homicide Homicide Malignant

Neoplasms

Heart

Disease

Unintentional

Injuries

4 Congenital

Malformations

Malignant

Neoplasms

Malignant

Neoplasms

Heart

DiseaseSuicide Liver

Disease

5 Homicide Heart

Disease

Heart

Disease

Homicide Liver

Disease

Diabetes

Mellitus

6 Heart

Disease

Congenital

Malformations

Diabetes

Mellitus

Liver Disease Diabetes

Mellitus

Chronic Lower

Respiratory Ds

7 Chronic Lower

Respiratory Ds

Diabetes

Mellitus

Congenital

Malformations

Diabetes

Mellitus

Cerebro-

VascularSuicide

8 Cerebro-

Vascular

Influenza and

Pneumonia

Complicated

pregnancy

Cerebro-

Vascular

Homicide Cerebro-

Vascular

Source: CDC vital statistics

9

0

5

10

15

20

25

30

1933

1938

1943

1948

1953

1958

1963

1968

1973

1978

1983

1988

1993

1998

2003

2008

2013

Year

Ra

te p

er

10

0,0

00

po

pu

lati

on

Male

Female

Total


Suicide among all persons by sex -- United States, 1933-2017

10

Suicidal rates among by age group and sex -- United

States, 1999 and 2017

0

5

10

15

20

25

30

35

40

45

50R

ate

pe

r 10

0,0

00

Age group

Males

1999 2017

0

2

4

6

8

10

12

Rate

pe

r 10

0,0

00

Age group

Females

1999 2017

NH = Non-Hispanic

Source: WISQARS and Curtin SC, Warner M, Hedegaard H. Suicide rates for females and males by race and

ethnicity: United States, 1999 and 2014. NCHS Health E-Stat. National Center for Health Statistics. April 2016.

11

Suicidal rates among by race/ethnicity and

by sex -- United States, 1999 and 2017

0

5

10

15

20

25

30

35

40

Rate

pe

r 10

0,0

00

Race/ethnicity

Males

1999 2017

0

2

4

6

8

10

12

Ra

te p

er

10

0,0

00

Race/ethnicity

Females

1999 2017

NH = Non-HispanicSource: WISQARS and Curtin SC, Warner M, Hedegaard H. Suicide rates for females and males by race and ethnicity: United States, 1999 and 2014. NCHS Health E-Stat. National Center for Health Statistics. April 2016.

12

Suicide by method – United States, 2017

Firearms

50.6%

Suffocation

27.7%

Cut/pierce

1.8%

Poisoning

13.9%

Fall

2.4%

Other

3.6%

sa


13

DC

Age-adjusted suicide rates among all persons by

state -- United States, 2017 (U.S. avg 14.0)

11.0-14.0

6.6-11.0

14.1-18.9

19.0-28.9


Rate per

100,000

14

Number and ratio of persons affected by suicidal thoughts

and behavior among adults aged ≥18 years — United

States, 2016

*Source: CDC’s National Vital Statistics System,†Source: Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS) only 1st diagnosis § Source: Source: CDC’s National Electronic Injury Surveillance System-All Injury Program ¶ Source: SAMHSA’s National Survey on Drug Use and Health

** Source: SAMHSA’s National Survey on Drug Use and Health

Number in parentheses represent the ratio of deaths to other categories

Deaths*

Hospitalizations †

Emergency Department visits§

Suicide attempts ¶

Seriously considered suicide**

43,427 (1)

114,725 (2.6)

397,975 (9.1)

1,319,000 (30.4)

9,829,000 (226.3)

15

0

50

100

150

200

250

300

350

400

450

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

465

+

Age Group in years

Ra

te p

er

10

0,0

00

po

pu

lati

on

Males

Females

Self-inflicted injury among all persons by

age and sex--United States, 2017

Source: CDC WISQARS NEISS-AIP

16

Suicidal behavior*^ among high school students

by sexual identity# and sexual contact – U.S., 2017

0

5

10

15

20

25

Sexual identity Sex of sexual contacts

Category

Perc

en

tag

e o

f all

stu

den

ts

Heterosexual/opposite sex only

LGB/same sex only or both sexes

Unsure/no sexual contact

* During the 12 months before the survey.

^ One or more times.

# Among students who ever had sexual contact

Source: Youth Risk Behavior Survey

17


to Prevention





widely

18

Overlap of spheres of influence for suicidal behavior

Individual Peer/Family

• Spirituality

• Incarceration

• Social isolation vs

support

CommunitySociety

• Age

• Sex

• Mental illness

• Substance misuse

• Stressful life events

• Inappropriate access

to lethal means

• Geography

• Economy

• Cultural values

• Family history of

interpersonal or self-

directed violence

• Exposure to violence

19


to Prevention





widely

20

CDC’s Technical Packages

http://www.cdc.gov/violenceprevention/pub/technical-packages.html

Source: Stone, D.M., Holland, K.M., Bartholow, B., Crosby, A.E., Davis, S., & Wilkins, N. (2017). Preventing Suicide: A Technical

Package of Policy, Programs, and Practices. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease

Control and Prevention.

▪ Child Abuse and Neglect

▪ Sexual Violence

▪ Youth Violence

▪ Intimate Partner Violence

▪ Suicide Prevention

http://www.cdc.gov/violenceprevention/pub/technical-packages.html

21

Suicidal behavior prevention

Strategy Approach

Strengthen Economic Supports • Strengthen household financial security

• Housing stabilization policies

Strengthen access and delivery of suicide care • Coverage of mental health conditions in health

• insurance policies

• Reduce provider shortages in underserved areas

• Safer suicide care through systems change

Create Protective Environments • Reducing access to lethal means among persons at-risk of suicide

• Organizational policies and culture

• Community-based policies to reduce excessive alcohol use

Promote Connectedness • Peer norm programs

• Community engagement activities

Teach Coping and Problem-Solving Skills • Social-emotional learning programs

• Parenting skill and family relationship approaches

Identify and Support People At Risk • Gatekeeper training

• Crisis intervention

• Treatment for people at-risk of suicide

• Treatment to prevent re-attempts

Lessen harms and prevent future risk • Postvention

• Safe reporting and messaging about suicide

22

Suicide rates by method – Samoa,

1956-1990

0

10

20

30

40

50

60

1956

1960 62 64 66 68

1970 72 74 76 78

1980 82 84 86 88

Total suicidesParaquat suicides

Arrival of Paraquat

Control of Paraquat availability

Suic

ide r

ate

Source: Bowles JR. Suicide in Western Samoa: an example of a suicide prevention program in a developing country. In:

Diekstra RFW et al., eds. Preventive strategies on suicide. Leiden, Brill, 1995:173–206.

23


to Prevention





widely

24

National Strategy for Suicide

Prevention (NSSP)

❑4 strategic directions; 13 goals; 60 objectives

❑Strategic Directions

1.Healthy and Empowered Individuals, Families, and Communities

2.Clinical and Community Preventive Services

3.Treatment and Support Services

4.Surveillance, Research, and Evaluation

Source: U.S. Department of Health and Human Services (HHS) Office of the

Surgeon General and National Action Alliance for Suicide Prevention. 2012

National Strategy for Suicide Prevention: Goals and Objectives for Action.

Washington, DC: HHS, September 2012

25

VetoViolence.cdc.gov

Violence Prevention in Practice

26

7 phases in comprehensive

violence prevention

Evaluation

Partnership

Implementation

Planning Policy Efforts

AdaptationStrategies and Approaches

28

Conclusion

• Suicide is a significant public health problem

• Results from an interaction of factors• never a single issue that causes a suicide

• multiple opportunities for action

• Research has shown much of suicidal behavior can be prevented

• Broad responsibility for addressing the issue

• communities must work together

• no one person or group can do it alone

29

Thank You

For more information please contact


1600 Clifton Road NE, Atlanta, GA 30333

Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info

National Center for Injury Prevention and Control

National Violent Death Reporting System (NVDRS) Overview

Janet M. Blair, PhD MPH

Team Lead, Mortality Surveillance Team

Surveillance BranchSoutheastern and Southwestern Injury Prevention Network

Safe States Alliance

December 4, 2019

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.

Division of Violence Prevention

What Do We Know About Violence?

▪ Number of violent deaths only tells part of story

▪ Millions of people experience adverse physical, mental, and economic consequences

▪ Violence erodes communities by reducing productivity, decreasing property values, and disrupting social services

▪ Devastating impact on families, communities, and society

▪ Violence is preventable

– Information needed for prevention

600+ data fields

Death Certificates LE Reports C/ME Reports

Two narratives describing the incident: ▪ 1 based on LE report▪ 1 on C/ME report

600+ variables

Death Certificates LE Reports

Injury characteristics Demographics Circumstances Mental Health Diagnoses Toxicology

C/ME Reports

What is an NVDRS Case?

▪ Suicide

▪ Homicide

▪ Deaths of undetermined intent

▪ Legal intervention (excluding executions)

▪ Unintentional firearm deaths

NVDRS is Unique

▪ Tells the who, what, when, where, why, and how

▪ Is comprehensive - includes all age groups

▪ Combines sources to get full picture

– Details about incident

– Information about victims, suspects

– Information about circumstances: events that preceded or were determined to be related to the violent death

NVDRS▪ Data collected by recipients through partnerships

▪ No personally identifying information collected in system

▪ Information collected using a web-based application

▪ Trained abstractors enter data consistent with CDC guidance

▪ Provides information for prevention

What can NVDRS do?

▪ Uncover timely topics and emerging issues

▪ Reveal important variations in patterns

▪ Lead to better understanding of circumstances contributing to violence

▪ Guide and evaluate violence prevention efforts

▪ Help create safer and healthier communities

Recent CDC Suicide-Related Publications

Factors Contributing to Suicide

Suicides Among American Indian/Alaska Natives

NVDRS: Responding to Timely Topics Affecting Military Personnel

▪ Circumstances preceding suicide in U.S. soldiers: A qualitative analysis of narrative data (Psychological Services, 2019)

▪ NVDRS Special Report - Deaths from Suicide among U.S. Veterans and Armed Forces in 16 States (Safe States Alliance, 2018)

▪ Surveillance for Violent Deaths — National Violent Death Reporting System, 27 States, 2015 (Special feature: Suicide among military personnel) (MMWR, 2018)

▪ Suicide Among Military Personnel and Veterans Aged 18–35 Years by County—16 States (Am J Preventive Medicine, 2016)

Chronic Pain and Suicide

Cancer and Suicide

Suicides among Lesbian and Gay Individuals

NVDRS MMWR Surveillance Summary

Using VDRS Data for Suicide Prevention

Data Supports Suicide PreventionRhode Island

▪ Data used to provide an overview of the epidemiology of youth suicide

▪ Mental health issues often precipitated suicides

▪ Information used to inform communities on signs and risks of suicide

Data Supports Suicide PreventionOregon

▪ Data indicated need to target older adults

▪ Developed state suicide prevention plan and targeted prevention efforts on older adults

▪ Over 1/3 of decedents had visited a physician in the last 30 days of their life

▪ Suggested that training physicians could be a promising approach

Suicides of Active Duty Military and VeteransAlaska

▪ Using VDRS data to identify veteran

suicides and circumstances

▪ Working with the Alaska Veterans Affairs

suicide prevention program

▪ Information will be used to develop policies, intervention and prevention strategies

Suicides Among First Responders

Colorado

▪ First responders (law enforcement, fire, EMS) more likely to have been a veteran than general population of suicide decedents

▪ Raises issues about needs veterans may have as they transition from one high-stress position to another

▪ Acknowledges needs of veterans continuing work as first responders

▪ Prevention can focus on positive mental and physical health

Data Supports Suicide Prevention

North Carolina

▪ Report, Burden of Suicide in North Carolina

created using North Carolina VDRS data

▪ Quantified problem

▪ Identified circumstances and populations at risk

▪ Informed the statewide Suicide Prevention Plan development process

NVDRS Restricted Access Database (RAD)▪ For researchers who meet established criteria

▪ Opportunity to conduct analyses using NVDRS data

▪ Data available as a flat file to promote ease of use and analysis

▪ More information available at the NVDRS RAD website:

https://www.cdc.gov/violenceprevention/nvdrs/rad.html

https://www.cdc.gov/violenceprevention/nvdrs/rad.html

NVDRS Restricted Access Database (RAD) Requests by Year, 2014 – October 28, 2019

3

1216

28

55

69

0

10

20

30

40

50

60

70

80

2014 2015 2016 2017 2018 2019

Year

Number of Requests

NVDRS WISQARS Data – Available to Public

▪ Public access on the Web

http://wisqars.cdc.gov:8080/nvdrs/nvdrsDisplay.jsp

▪ 2015 NVDRS WISQARS data released in January 2018

– 2016 data coming soon

▪ Select variables to run your own reports

– Manner of death

– Victim/suspect relationship

– Weapon type

– Vulnerable populations

– Circumstances

http://wisqars.cdc.gov:8080/nvdrs/nvdrsDisplay.jsp

To learn more, visit the NVDRS website

https://www.cdc.gov/violenceprevention/datasources/nvdrs/index.html

https://www.cdc.gov/violenceprevention/datasources/nvdrs/index.html

NVDRS Grantees

Vital Statistics, Coroner/Medical Examiner, and Law Enforcement staff in NVDRS States

Surveillance Branch, Office of the Chief▪ Kathleen McDavid Harrison PhD MPH FACE,

Surveillance Branch Chief▪ Leroy Frazier Jr. MSPH CHES,

Surveillance Branch Deputy Chief▪ Shannon Bryan MA,

Health Education Specialist

Mortality Surveillance Team/Surveillance Coordination Team

▪ Apreal Bailey MPH, Project Officer▪ Jamar Barnes MPH, Project Officer▪ Carter Betz MS, Programmer/Analyst▪ Janet Blair PhD MPH, Team Lead▪ Craig Bryant Computer Scientist▪ Jacqueline Crain, Public Health Advisor▪ Shane Davis Jack PhD, Science Officer▪ James Diggs MPH CHES, Public Health Advisor ▪ Allison Ertl PhD Science Officer▪ Katherine Fowler PhD, Senior Scientist ▪ Bernita Frazier PhD MPA, Public Health Advisor▪ Rachel Leavitt MPH, Project Officer▪ Colby Lokey MPH, Project Officer▪ Michele LaLand Project Officer▪ Bridget Lyons MPH, Science Officer ▪ Emiko Petrosky MD, MPH, Science Officer▪ Lennisha Pinckney, MPH ORISE Fellow▪ Kameron Sheats PhD, Science Officer▪ Rebecca Wilson PhD, Project Officer▪ Keming Yuan MS, Mathematical Statistician

Acknowledgments

For more information, contact CDC1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348 www.cdc.gov

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.

Thank you!

GEORGIA DEPARTMENT OF PUBLIC HEALTH

Georgia Violent Death Report System (GA-VDRS)

Southeastern & Southwestern Injury Prevention Network, Rana Bayakly, December 4, 2019


Outline

DATA COLLECTION PROCESS INFORMATION ABSTRACTED VS INFORMATION CODED

DATA AVAILABILITY AND ACCESS


What is NVDRS

The National Violent Death Reporting System (NVDRS) is a state-based surveillance system that assist states in designing and implementing tailored prevention and intervention efforts.

NVDRS defines violent death as "a death resulting from the intentional use of physical force or power against oneself, another person, or against a group or community.“

NVDRS collects data on homicides, suicides, deaths by legal intervention-excluding executions-and deaths of undetermined intent. In addition, information about unintentional firearm injury deaths is collected.

NVDRS is incident-based, each record includes data on all victims and suspects associated with a given incident. Multiple victims and/or suspects are determined for inclusion into a single incident record by the violent injuries.


Data Collection Process

Data Sources➢ GA-VDRS consolidate information from various sources into one record:

• Death Certificates (GA Vital Records)

• Medical Examiner (5) and Coroner Reports (154)

✓ GA is Decentralized and Mixed system

• Police Reports --Police Department and Sheriff Offices (> 800 offices)

• Georgia Bureau of Investigation (GBI)

✓ Supplemental Homicide Reports --GBI

✓ Crime Laboratory Reports --GBI

✓ Toxicology Reports--GBI/ME

✓ Child Fatality Review--GBI

• Emergency Medical Services (EMS)—(GA office of EMS and Trauma)

• Online/Newspaper and Other Media Sources

➢ GA-VDRS collect uniform data elements developed by CDC/NVDRS in

collaboration with funded states.


Data FlowNational Violent Death Reporting System

(CDC)

GEMSIS (DPH)

GA-VDRS data product

GEORGIA VIOLENT DEATH REPORTING SYSTEM (2018)

SYMBOLS

Beginning and/or end of data flow

Dynamic data base with direct access to data modification

Process

Static data sets for analyses

Data flow direction

Death certificate data file

Law Enforcement

Georgia Bureau of Investigation (GBI)

GBI’s Supplemental

Homicide Report

ME’s Toxicology

Report

Mass Media

Vital Records (DPH)

Emergency Medical Services (EMS) Agencies

Coroner’s Office

Funeral Homes Hospitals

GBI’s Toxicology Report

GBI’s Child Fatality Report

Data abstractors (DPH)

EMS data search (DPH)

Medical Examiner’s (ME)

Office

GA-VDRS Import

GA-VDRS Export


Data FlowNational Violent Death Reporting System

(CDC)

GEMSIS (DPH)



SYMBOLS



Process


Data flow direction


Law Enforcement



Homicide Report

ME’s Toxicology

Report

Mass Media

Vital Records (DPH)


Coroner’s Office







Office

GA-VDRS Import

GA-VDRS Export


Data Flow National Violent Death Reporting System (CDC)

GEMSIS (DPH)



SYMBOLS



Process


Data flow direction


Law Enforcement



Homicide Report

ME’s Toxicology

Report

Mass Media

Vital Records (DPH)


Coroner’s Office







Office

GA-VDRS Import

GA-VDRS Export


Timeline

• Case initiation within 120 days from date of death.

• Year close 16 months after close of calendar year (April 30th).

• Data released by CDC/NVDRS to states in September of each year

• Data released on CDC website (WISQARS) in November/December of each year


Added Information to the Death Certificate

Circumstantial Information

Narrative that build your story

Health• Mental Health• Depression• Physical Health• Substance Abuse

Life Stressors• Financial Problems/Job Loss• Recent Family Loss• Incarceration• School Problem

Relationship Problem• Intimate Partner Problem/Violence• Child/Adult Abuse• Bullying

Weapon Information Gained

• Handgun, Shotgun, Rifle etc..

• Model and Make

• Bullets

• Ownership

Type of Gun

• Scene Description

EMS Report

Suicide Among Persons With

Dementia, Georgia, 2013 to

2016

Francis B. Annor, PhD, Rana A. Bayakly, MPH, Reynolds A. Morrison, MPH, Michael J. Bryan, PhD, Leah K. Gilbert, MD, Asha Z. Ivey-Stephenson, PhD, Kristin M. Holland, PhD, Thomas Simon, PhD

Journal of Geriatric Psychiatryand Neurology, 2018

DOI: 10.1177/0891988718814363journals.sagepub.com/home/jgp

Characteristics and Contextual Stressors in Farmer and Agricultural Worker Suicides in Georgia From 2008–2015

Journal of Rural Mental Health

Authors

Anna Scheyett, Rana Bayakly, and Michael

Whitaker

Online First Publication, March 14, 2019.

http://dx.doi.org/10.1037/rmh0000114

Narrative

Financial

Victim was depressed because of financial problems & declining health. Victim had a heart attack 3 months prior. V[ictim]’s [primary relationship] had lost her job and there were hospital bills. V[ictim] . . . did not leave a note, however, there was an unopened First Bank envelope on the kitchen table and Hartford life insurance

policy.

Health

The Victim’s [close relative] advised that the decedent was depressed and voiced suicidal ideation in the past month because he was “hurting so badly and did not want to live anymore”. . . The Victim’s medical history included cardiovascular issues, chronic pain, degenerative arthritis, knee replacement, shoulder surgery, and ostomy due to colitis.

Narrative

Health Behavior

Victim and his [primary relationship] were fighting about Victim’s heavy drinking, [with the primary relationship] wanting Victim to get help for his drinking . . . [primary relationship] stated that they cooked dinner and they were still fighting about his drinking and the Victim stated he would just kill himself . . . She then heard the gun go off.

Relationship Problem

The Victim’s [primary relationship] of 23 years recently left the Victim for another man approximately 3 weeks ago. The Victim was reportedly very upset with the situation. The date of the incident is actually the [primary relationship’s] birthday. Included in the note were apologies to his children for not being able to go on and also stating that now his [primary relationship] was free to marry


Data Availability and Access

Data Availability (NVDRS)

Web-Based Injury Statistics Query And Reporting System (WISQARS)

https://www.cdc.gov/injury/wisqars/nvdrs.html

• Descriptive Statistics• Trends• Comparison

https://www.cdc.gov/violenceprevention/datasources/nvdrs/RAD.html

• Research that include multiple states

Georgia

https://oasis.state.ga.us/

Contact Information

Rana Bayakly, MPH Elizabeth Blankenship, MPH

GA-VDRS Principal Investigator GA-VDRS Epidemiologist

2 Peachtree Street NW 2 Peachtree Street NW

14th Floor, Ste 14-440 14th Floor

Atlanta, Georgia, 30303 Atlanta, Georgia, 30303

[email protected] [email protected]

(404) 657-2617 (404) 657-2635

mailto:[email protected]


https://dph.georgia.gov/GVDRS


Georgia Violent Death Reporting System

https://dph.georgia.gov/institutional-review-board


Georgia Violent Death Reporting Systemhttps://dph.georgia.gov/institutional-review-board

DPH Sponsor

Rana Bayakly, MPHGA-VDRS Principal Investigator2 Peachtree Street NW14th Floor, Ste 14-440Atlanta, Georgia, [email protected](404) 657-2617

Elizabeth Blankenship, MPHGA-VDRS [email protected](404) 657-2635



Suicide Risk Assessment

and Safety Planning


Department of Psychiatry and Behavioral Sciences

External Industry Relationships * Company Name(s) Role

Equity, stock, or options in biomedical industry companies or publishers**

None

Board of Directors or officer None

Royalties from Emory or from external entity

None

Industry funds to Emory for my research None

Other None

*Consulting, scientific advisory board, industry-sponsored CME, expert witness for company, FDA representative for company,

publishing contract, etc.

**Does not include stock in publicly-traded companies in retirement funds and other pooled investment accounts managed by others.

Dr. Dorian A. Lamis Personal/Professional Financial Relationships with Industry

Webinar Covers

• Suicide Risk and Protective Factors

• Suicide Risk Assessment and Formulation

• Safety Planning Intervention

Suicide: A Multi-factorial Event

Neurobiology

Severe MedicalIllness

Impulsiveness

Access To Weapons

Hopelessness

Life Stressors

Family History

SuicidalBehavior

Personality Disorder/Traits

Psychiatric IllnessCo-morbidity

Psychodynamics/Psychological Vulnerability

Substance Use/Abuse

Suicide

Key Risk Factors

• Demographics (Older, Male, White)

• Family history (suicide, family violence)

• Suicide and psychiatric history

• Genetics & Epigenetics

• Psychiatric symptoms & disorders (SUD, BD)

• Physical illnesses (MS, HIV)

Key Risk Factors• Childhood abuse, Intimate Partner Violence

• Acquired capability (desire to die, ability to do so)

• Access to lethal means

• Social support challenges and stress

• Cognitive deficits

• Environmental stressors (financial, legal, job loss)

• Responsibility to family

• Religious involvement

• Meaning/Purpose

• Cultural beliefs opposed to suicide

• Life satisfaction

• Reasons for living

• Positive coping skills

• Emotion regulation

• Positive problem-solving skills

• Social support: Connectedness

• Positive therapeutic alliance

• Good clinical care

• Adherence with psychiatric medications

Key Protective Factors

Webinar Covers





• Establish rapport

• Give the patient an opportunity to say what is

troubling them

• Convey interest in patient’s problems/concerns

• Ask about continuum of suicidal behavior after

discussing concerns

• Allow time for a thorough assessment


• Systematic and disciplined, and more than a guess

or intuition

• Requires one to:

• Ask directly about suicidal thoughts, feelings, and

actions

• Obtain history regarding risk/protective factors

• Determine full mental status

• Gather collateral data

• Columbia Suicide Severity Rating Scale (CSSRS)

• Beck Scale for Suicide Ideation (BSSI)

• Suicidal Behaviors Questionnaire–Revised (SBQ-R)

• Suicide Status Form (SSF)

• Modified Scale for Suicidal Ideation (MSSI)

Assessment Instruments

Webinar Covers




What is a Safety Plan?

• A prioritized written list of:

– Coping strategies

– Sources of support

– Can be used during or preceding a

suicidal crises

• Safety Plan found at: http://www.suicidesafetyplan.com/

• Suicide Safety Plan Apps: “BeyondNow”; “Suicide Safety Plan”;

“My3”

• Developed after suicide assessment

– Or a recent distressing event

• Use their story about the current crisis

– Events transpired before, during, and after the crisis.

• Collaborative process

– Sit side-by-side

• Use a “Safety Plan” form or App

– Use patient’s own words

– Should be easy-to-read

Developing a Safety Plan

Patient’s Warning Signs:

Thoughts: “I’m worthless”

Thinking Processes: Racing thoughts; catastrophizing

Mood: Irritable/anger

Body: Tense

Behavior: Pacing; time by yourself

Helpful Question:

How do you know when the safety plan should be

used?

Step 1: Recognizing Warning Signs

• Help patients cope on their own

– Distraction

▪Go on a walk (count your steps)

▪Pray

▪Listen to music

▪Take a shower

▪Play with a pet

▪Engage in a hobby

Helpful Question:

What can you do on your own if you start to become

distressed or suicidal?

Step 2: Using Internal Coping Strategies

• Help identify distractors: key social settings/people− NOT for reaching out to others for help w/crisis

1. Healthy Social Settings (list location)− Coffee shops

− Places of religion

2. Individuals (list phone #)− Family

− Friends

Helpful Question:

Who or what social settings help you take your mind off

your problems and/or reduce stress and suicidal thoughts?

Step 3: Utilizing Social Contacts

Step 4: Contacting Family or Friends

• Help identify others to disclose/manage crisis

– Clergy, family, close friend (list phone #s)

• Plan is intended to be helpful and supportive

– Weigh the pros and cons of disclosing

– Not a source of stress

Helpful Questions:

1) Among your family or friends, who do you think you could

contact for help during a crisis?

2) Who is supportive of you and who do you feel that you can

talk with when you’re under stress or suicidal?

• Help identify a professional or agency

• Prioritize the list of professionals and agencies

– Clinician, PCP, Crisis Line, 911

• Include names and contact information

– Esp. those reached during non-business hours

Helpful Question:

Who are the mental health professionals that we

should identify to be on your safety plan?

Step 5: Contacting Professionals/Agencies

Step 6: ↓ Potential for Use of Lethal Means

A KEY component of a safety plan

• Routinely ask about access to:

– Guns, knives, drugs, or medications

• Restrict access to means

– Friend store gun, medications locked in safe place

• NOTE on plan:

– Behaviors necessary to make environment safer

Safety Plan Example

Implementation of the Safety Plan

• Assess the likelihood that plan will be used

– Obstacles?

– Solutions?

• Periodically review/revise Safety Plan in therapy

Helpful Questions:

1) How likely is it that you will use the safety plan?

2) What might get in the way of using the plan?


Department of Psychiatry and Behavioral Sciences

Emory University School of Medicine

[email protected]

Questions or Comments

Contact InformationBelinda-Rose Young, MSPH, CPH

Outreach & Network Coordinator

Southeastern and Southwestern Injury Prevention Network

E-mail: [email protected]

Webinar Presenters - Safe States Alliance · Source: Bowles JR. Suicide in Western Samoa: an...

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