1. Using Suicide Data for Prevention Novgorod Fall 2010 Institute Lisa Wexler, PhD, MSW Department of Public Health University of Massachusetts Amherst

2. Overview Significance of the Problem –Global Rates per Country –United States, Alaska –Regional: Northwest Alaska Factors Associated with Suicidality in NW Alaska How this data informs suicide prevention programming on three levels.

3. Suicide is… Social, cultural, biological, psychological, personal, etc…

4. Significance of the Problem Each year, approximately 900,000 lives are lost to suicide worldwide. Suicide represents 1.5% of the global burden of disease with nearly 20 million years of life lost through premature death. (Mann, Apter, Bertolote, Beautrais, Haas, Hegerl, et. al., 2005)

5. Global Prevalence Distribution Eastern Europe has the highest annual suicide rates, where 10 countries report greater than 27 deaths per 100,000. Latin American and Muslim countries report the lowest rates of suicide with less than 6.5 per 100,000. –(Mann, Apter, Bertolote, Beautrais, Haas, Hegerl, et. al., 2005)

6. Suicide Rates (per 100,000) by country, by gender --Statistics Reported by the World Health Organization

7. Age-Adjusted Suicide Rate in Each State per 100,000, 2004 Centers for Disease Control and Prevention, National Injury Mortality Data.

8. Alaska Suicide Rates by Ethnicity, Age

9. Indigenous Groups in Alaska Allen, J., & Butler, J. EPIDEMIOLOGY OF SUICIDE IN ALASKA. Presentation at Behavioral and Mental Health Research in the Arctic Conference - June 2009

10. Allen, J., & Butler, J. EPIDEMIOLOGY OF SUICIDE IN ALASKA. Presentation at: Behavioral and Mental Health Research in the Arctic Conference - June 2009 Disparities in Suicide Rates

11. 3. Suicidal (Tertiary Prevention) 1. Everyone (Primary Prevention) 2. “At risk” (Secondary Prevention) Levels of Prevention: Using data to shape prevention efforts

12. What do we know about Inupiaq suicidality (attempts and deaths)? How can these understandings, patterns and issues contribute to suicide intervention efforts? Tertiary-level Patterns and Issues:

13. What do we know about suicide in Northwest Alaska? (Wexler, Hill, Bertone-Johnson, & Fenaughty, 2008) Numbers: Attempts? Deaths Age/Gender Method Situational factors Substance use Counseling experience

14. Suicide Attempts by Age and Gender

15. Suicide Deaths by Age and Gender

16. Who are at the greatest risk for suicide? Inupiat men between the ages of 15 and 34 are most likely to die by suicide. Young Inupiat people are most likely to exhibit suicidality.

17. Substance Abuse & Suicide Deaths

18. Service History & Suicide

19. Retrospective Suicide Study Hill, Perkins & Wexler, 2007 Description of FactorsCasesControls Visits per person2.4/person2.1/person Reasons for visit38% Injury11% Injury Alcohol Related Visits19% of Visits2% of Visits Alcohol Related Injury Visits41% of Injury Visits Ax related 0% Emergency Room Visits75% of Visits56% of Visits

20. What do these data tell us that can inform tertiary prevention programming? Drinking alcohol increases a person’s suicide risk Key risk factor: alcohol & injury (Emergency room) Lethality of method matters Informal systems of support are commonly used by people who are suicidal. –Peers*, Family members, Pastor or other mentor -- Sometimes (not often)…counselors

21. Medical staff in emergency room and village clinics should screen for suicide risk if a patient is seen for an alcohol-related injury. Mental Health workers and clinicians should educate close peers and family members of suicidal person about the risks of alcohol use and availability of guns. Data-Driven Tertiary Prevention:

22. Secondary Prevention What kind of information will help shape programming targeted at young, indigenous people who are at higher risk for suicide in the region?

23. Community Members’ Perceived Reasons for Suicide (Wexler & Goodwin, 2006)

24. What Could Adults in your Community Do to Help Prevent Suicide? (Wexler & Goodwin, 2006)

25. What is Important for Helping Kids Get Excited about their Future?

26. Adult-Youth Understandings (Wexler & Goodwin, 2006) Young People: Stress! Prevention Approach: Talking and spending time with adults on an everyday basis. More value placed on informal relationships. Adults: Boredom Prevention Approach: More organized activities for youth. More emphasis on programs for youth.

27. Differences but the same goal! Adults: “more programs” Youth want adults to spend more time talking to them. *Young people want help figuring out how to get through everyday problems and planning their future. They want guidance from adults!

28. Informal: Adults reaching out to young people, talking to them about their lives regularly, and modeling healthy behavior and problem solving. Formal: Youth programs that link young people with adults, public spaces for youth/community activities, and opportunities for meaningful engagement in a group. Secondary Prevention:

29. What larger, community-level factors are contributing to suicide? Research to understand the huge variance in suicide rates among indigenous communities.

30. Indigenous Communities with All of these “Cultural Continuity” factors had extremely low rates of suicide. 1. Self-government* 2. Land Claims* 3. Education Services* 4. Police and Fire Services 5. Health Services 6. Cultural Facilities • (Chandler & Lalonde, 1998) •

31. Primary Suicide Prevention: Promoting Community-level Protective Factors (Wexler, DiFluvio, Burke, 2009) Providing young people with opportunities to participate and contribute. Creating feelings of purpose (e.g. being a part of something bigger than oneself) through engagement. Having role models to show them how to be “responsible” adults (pathways).

32. 3. Tertiary  Institute screening in village clinics and emergency room.  Train medical staff MH counselors in local trends 1. Primary Using Data to Inform Suicide Prevention on Three Levels in Northwest Alaska 2. Secondary  Youth digital storytelling to focus on positives in their lives and share these with adults in the community.  Current community- empowerment model (SPSA) that is working with tribal leaders to reach out to youth and contribute to their communities.

33. Thank You! Thanks to Maniilaq Association, NSF, SAMHSA, KTC, Aqqaluk Trust, and many community members from NW AK for contributing to this research.