1. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 1 PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA ADOLESCENT SUICIDE IN CANADA: TRENDS IN OCCURRENCE BETWEEN 1980 AND 2004. Robin Skinner and Susan G. Mackenzie Health Surveillance and Epidemiology Division Presented at the CPHA Annual Conference June 1-4, 2008

2. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 2 Objective Methods Examine trends in suicides among 10-19-year-olds. Discuss possible explanations. Public Health Agency of Canada holdings of Statistics Canada mortality data for 1980-2004 were used in the study. Implementation of ICD-10 in 2000 had no effect on the continuity of suicide data. Suicide in Canada - 2004 1,200 deaths of Canadians 10-19 years 30% motor vehicle 20% suicides 2nd leading cause of death among adolescents.

3. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 3 10-14 years Crude rate of 1.3/100,000 (61% male) 15-19 years Crude rate of 9.9/100,000 (77% male) 2004 Adolescent Suicide Rates in Canada 71% suffocations 18% firearms 4% poisonings 74% suffocations 12% firearms 7% poisonings

4. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 4 2004 RateMethodRateMethod 1.6/100,0001.1/100,000 14.7/100,0004.7/100,000 10-14 years Males 15-19 years 2004 Adolescent Suicide Rates in Canada Females 1.Suffocation 2.Firearms 3.Poisoning 1.Suffocation 2.Poisoning 3.Firearm

5. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 5 All injuries (incl. unint.,suicide, homicide, undetermined) Unintentional injuries Suicides Figure 1. Injury rates in Canada (per 100,000), males, 10-19 years

6. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 6 Figure 2. Injury rates in Canada (per 100,000), females, 10-19 years Suicides Unintentional injuries All injuries (incl. unint.,suicide, homicide, undetermined)

7. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 7 15-19 years 10-14 years Average annual percent change -1.27% (95% CI -1.83,-0.70) Average annual percent change 0.05% (95% CI -1.60,1.73) Figure 3. Suicide rates in Canada (per 100,000), all causes, males

8. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 8 15-19 years 10-14 years Average annual percent change 2.10% (95% CI 1.28, 2.93) Average annual percent change 4.80% (95% CI 2.45, 7.13) Figure 4. Suicide rates in Canada (per 100,000), all causes, females

9. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 9 Changes to firearm legislation (1980-2004) 1991 Bill C-171995 Bill C-68 Control access to firearms.(1993) 28 day waiting period for FAC Minimum age from 16 to 18 Safer storage Firearms Act New licensing and registration system for all firearms. 1977-1991 No changes

10. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 10 Figure 5. Suicide rates in Canada (per 100,000), males, 10-14 years Bill C-17 Firearms Act Firearm Suffocation Poisoning Suicide, Total Phasing in Bill C-17

11. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 11 Figure 6. Suicide rates in Canada (per 100,000), males, 15-19 years Bill C-17 Firearms Act Phasing in Bill C-17 Firearm Suffocation Poisoning Suicide, Total

12. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 12 Figure 7. Suicide rates in Canada (per 100,000), females, 10-14 years Bill C-17 Firearms Act Phasing in Bill C-17 Firearm Suffocation Poisoning Suicide, Total

13. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 13 Figure 8. Suicide rates in Canada (per 100,000), females, 15-19 years Bill C-17 Firearms Act Phasing in Bill C-17 Firearm Suffocation Poisoning Suicide, Total

14. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 14 Summary: 1980-2004 in Canada Suicides by firearms and poisonings Suicides by suffocation 10-14 years 15-19 years Males Suicide, Total NS Change SuffocationNS Change PoisoningNS Change FirearmNS Change Females Suicide, Total+4.8% Suffocation+9.0% Poisoning-3.6% FirearmNS Change Males Suicide, Total-1.3% Suffocation+3.1% Poisoning-4.0% Firearm-6.2% Females Suicide, Total+2.1% Suffocation+9.3% Poisoning-5.2% Firearm-5.9

15. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 15 Common themes in the literature: oDecrease in firearm suicides oIncrease in suffocation suicides oOverall, little improvement in suicide rates o Varies by sex oPossible replacement effect Cheung AH, Dewa CS. Current trends in youth suicide and firearms regulations. Can J Public Health; 2005 Mar-Apr;96(2):131-5. Pan SY et al. Adolescent injury deaths and hospitalization in Canada: Magnitude and temporal trends (1979-2003). J Adolesc Health; 2007 Jul (41)1: 84-92. Bridge JA, Barbe RP, Brent DA. Recent trends in suicide among U.S. adolescent males, 1992-2001. Psychiatr Serv; May 2005 (56):522.

16. PUBLIC HEALTH AGENCY of CANADA AGENCE DE LA SANTÉ PUBLIQUE du CANADA 16 Conclusion oYouth unintentional injury rates oSuicide more difficult issue oFirearm legislation Firearm rates Suffocation rate oDifferences in suicide rates between and among male and female adolescents oOngoing surveillance/further study o10-14 year old females oSuffocation method