Debra L. Karch

Race/ethnicity, substance abuse, and mental illness among suicide victims in 13 US states: 2004 data from the National Violent Death Reporting System

Objective: To calculate the prevalence of substance abuse and mental illness among suicide victims of different racial/ethnic groups and to identify race/ethnicity trends in mental health and substance abuse that may be used to improve suicide prevention. Methods: Data are from the National Violent Death Reporting System (NVDRS), a state-based data integration system that, for 2004, includes data from 13 US states. The NVDRS integrates medical examiner, toxicology, death certificate, and law enforcement data. Results: Within participating states, for data year 2004, 6865 suicide incidents in which race/ethnicity are known were identified. This included 5797 (84.4%) non-Hispanic whites, 501 (7.3%) non-Hispanic blacks, 257 (3.7%) Hispanics, and 310 (4.5%) persons from other racial/ethnic groups. At the time of the suicide event, non-Hispanic blacks had lower blood alcohol contents than other groups. Non-Hispanic whites had less cocaine but more antidepressants and opiates. There were no differences in the levels of amphetamines or marijuana by race/ethnicity. Hispanics were less likely to have been diagnosed with a mental illness or to have received treatment, although family reports of depression were comparable to non-Hispanic whites and other racial/ethnic groups. Non-Hispanic whites were more likely to be diagnosed with depression or bipolar disorder and non-Hispanic blacks with schizophrenia. Comorbid substance abuse and mental health problems were more likely among non-Hispanic whites and non-Hispanic blacks, while Hispanics were more likely to have a substance abuse problem without comorbid mental health problems. Conclusion: The results support earlier research documenting differences in race/ethnicity, substance abuse, and mental health problems as they relate to completed suicide. The data suggest that suicide prevention efforts must address not only substance abuse and mental health problems in general, but the unique personal, family, and social characteristics of different racial/ethnic groups.

The National Violent Death Reporting System: an exciting new tool for public health surveillance

The US does not have a unified system for surveillance of violent deaths. This report describes the National Violent Death Reporting System (NVDRS), a system for collecting data on all violent deaths (homicides, suicides, accidental firearms deaths, deaths of undetermined intent, and deaths from legal intervention, excluding legal executions) in participating states. The NVDRS centralizes data from many sources, providing a more comprehensive picture of violent deaths than would otherwise be available. The NVDRS collects data on victims, suspects, and circumstances related to the violent deaths. Currently, 17 US states participate in the NVDRS; the intention is for the NVDRS to become a truly national system, representing all 50 states, the District of Columbia, and the US territories. This report describes the history of the NVDRS, provides an overview of how the NVDRS functions, and describes future directions.

Precipitating Circumstances of Suicide Among Youth Aged 10–17 Years by Sex: Data From the National Violent Death Reporting System, 16 States, 2005–2008

We examined the circumstances that precipitated suicide among 1,046 youth aged 10-17 years in 16 U.S. states from 2005 to 2008. The majority of deaths were among male subjects (75.2%), non-Hispanic whites (69.3%), those aged 16-17 years (58.1%), those who died by hanging/strangulation/suffocation (50.2%) and those who died in a house or an apartment (82.5%). Relationship problems, recent crises, mental health problems, and intimate partner and school problems were the most common precipitating factors and many differed by sex. School problems were reported for 25% of decedents, of which 30.3% were a drop in grades and 12.4% were bullying related. Prevention strategies directed toward relationship-building, problem-solving, and increasing access to treatment may be beneficial for this population.

Characteristics of Suicides Among US Army Active Duty Personnel in 17 US States From 2005 to 2007

Suicides are increasing among active duty US Army soldiers. To help focus prevention strategies, we characterized 56 US Army suicides that occurred from 2005 to 2007 in 17 US states using 2 large-scale surveillance systems. We found that intimate partner problems and military-related stress, particularly job stress, were common among decedents. Many decedents were also identified as having suicidal ideation, a sad or depressed mood, or a recent crisis before death. Focusing efforts to prevent these forms of stress might reduce suicides among soldiers.

Sex Differences in Suicide Incident Characteristics and Circumstances among Older Adults: Surveillance Data from the National Violent Death Reporting System—17 U.S. States, 2007–2009

Each year in the U.S. more than 7,000 adults aged 60 years and older die of suicide and as the population ages, these numbers are expected to increase. While sex is an important predictor of older adult suicide, differences between males and females are often overlooked due to low occurrence, particularly among women. The National Violent Death Reporting System (NVDRS) bridges this gap by providing detailed information on older adult suicide by sex in 17 US states (covering approximately 26% of the U.S. population). NVDRS data for 2007–2009 were used to characterize male (n = 5,004) and female (n = 1,123) suicide decedents aged 60 years and older, including incident characteristics and circumstances precipitating suicide. Stratification of NVDRS data by sex shows significant differences with regard to the presence of antidepressants (19% and 45% respectively), opiates (18%, 37%), and 14 precipitating circumstances concerning mental health, interpersonal problems, life stressors and a history of suicide attempts. No differences were found for alcohol problems, suicide/other death of family or friends, non-criminal legal problems, financial problems, or disclosure of intent to take their own life. The findings of this study demonstrate the value of using comprehensive surveillance data to understand sex-specific suicide circumstances so that opportunities for targeted prevention strategies may be considered.

Characteristics of Elderly and Other Vulnerable Adult Victims of Homicide by a Caregiver: National Violent Death Reporting System—17 U.S. States, 2003-2007

Homicides of dependent elderly and nonelderly adults by their caregivers violate trust and have long-term consequences for families. A better understanding of the characteristics of homicide by caregivers may provide insights that can inform prevention efforts. Data collected in the National Violent Death Reporting System (NVDRS) between 2003 and 2007 are used to characterize victims, perpetrators, and caregiver roles, and circumstances that precipitated homicides by a caregiver. A total 68 incidents are categorized into either homicide by neglect ( n = 17), intentional injury of the victim only (n = 21), or homicide followed by suicide of the perpetrator (n = 30). Demographics, mechanism of injury, location of injury, and victim—suspect relationship variables are supplemented by narrative accounts of incidents. In general, findings show that adult homicide victims of a caregiver were widowed (42.6%), non-Hispanic (97.1%), White (88.2%), women (63.2%) killed in their homes (92.6%) with a firearm (35.3%) or by intentional neglect (25.0%) by a husband (30.9%) or a son (22.1%). Nearly half were aged 80 years and older (48.5%), 42.6% were aged 50 to 79 years, and 0.9% were aged 20 to 49 years. Many homicide by caregiver incidents are precipitated by physical illness of the victim or caregiver, opportunity for perpetrator financial gain, mental illness of the caregiver, substance use by the caregiver, or an impending crisis in the life of the caregiver not related to illness. Understanding the vulnerabilities of victims, the characteristics of suspects, and the multiple types of motivations is key to developing effective prevention efforts.

Sexual Homicide and Sexual Violence-Associated Homicide: Findings From the National Violent Death Reporting System

Sexual violence is linked to homicide in a variety of ways. In this study the authors analyzed narratives that described the homicide circumstances of 285 homicide victims from 17 states who participated in the National Violent Death Reporting System during 2003-2007. The authors discuss a narrative analysis conducted using qualitative methods that revealed four categories of homicide linked to sexual violence, in addition to classic sexual homicide. In this article, the authors provide descriptions of the circumstances involved in sexual violence—related homicides, narrative examples of each type, and offer an expanded classification of these crimes. The analyses reveal specific types of homicide that are related to the perpetration of sexual violence, some of which have received little to no attention in the sexual violence or homicide literature. The study demonstrates the potential of the NVDRS as a strong data source for sexual homicides as well as other forms of homicide. Finally, the authors discuss implications for ongoing monitoring of homicides that are linked to sexual violence.

Characteristics of U.S. Suicide Decedents in 2005–2010 Who Had Received Mental Health Treatment

OBJECTIVE To inform suicide prevention efforts in mental health treatment, the study assessed associations between recent mental health treatment, personal characteristics, and circumstances of suicide among suicide decedents. METHODS Data from 18 states reporting to the National Violent Death Reporting System between 2005 and 2010 (N=57,877 suicides) were used to compare circumstances among adult decedents receiving any or no type of mental health treatment within two months before death. RESULTS Of suicide decedents, 28.5% received treatment before suicide. Several variables were associated with higher odds of receiving treatment, including death by poisoning with commonly prescribed substances (adjusted odds ratio [AOR]=3.04, 95% confidence interval [CI]=2.84-3.26), a history of suicide attempts (AOR=2.77, CI=2.64-2.90), depressed mood (AOR=1.69, CI=1.62-1.76), and nonalcoholic substance abuse or dependence (AOR=1.13, CI=1.07-1.19). CONCLUSIONS For nearly a third of all suicide decedents, better mental health care might have prevented death. Efforts to reduce access to lethal doses of prescription medications seem warranted to prevent overdosing with commonly prescribed substances.

Reducing “Unknown” Data in Violent Death Surveillance: A Study of Death Certificates, Coroner/Medical Examiner and Police Reports From the National Violent Death Reporting System, 2003-2004

To better understand the determinants of violent deaths, researchers need surveillance systems that include a broad spectrum of information (e.g., victim demographics, event characteristics [date/location of death] and preceding circumstances). Missing information can limit the ability to develop preventive interventions.This study examines the value of using multiple source documents (i.e., death certificates, coroner/medical examiner reports, and police reports) to reduce missing or “unknown” data on violent deaths. When all sources are accessible, more sources should reduce the amount of unknown data. This study finds this to be true only for certain variables, that is, those capturing preceding circumstances.

Data Consistency in Multiple Source Documents Findings From Homicide Incidents in the National Violent Death Reporting System, 2003-2004

Data from the 2003-2004 National Violent Death Reporting System were used to compare consistency of homicide variables across multiple source documents. The NVDRS integrates death certificate, coroner/medical examiner and law enforcement data. Included in this analysis are 5,737 homicide incidents. Variables include victim demographics, manner of death, autopsy and pregnancy status, place, date and location of injury/death, and suspected use of alcohol. Demographic variables matched from lows of 70.9% for marital status to 99.9% for race. Injury/death variables matched from 72.6% for date of injury to 99.5% for state of injury. Situational variables ranged from 75.6% for suspected alcohol use to 97.5% for pregnancy status. Overall, data collected across multiple source documents matched at greater than 70%; however inconsistencies have implications for analyzing data from systems with multiple source documents. Understanding and mitigating data mismatches will increase the consistency of data on which violence prevention programs are developed.