1. Office of Health Status Monitoring (OHSM) HHS, November 20, 2013

2. HI Department of Health, OHSM Kathleen Kromer Baker, M.S., Ph.D. Research Statistician Office of Health Status Monitoring Hawaii Department of Health Hawaii Health Survey, HHS Hawaii Department of Health (DOH)

3. HI Department of Health, OHSM 3 Acknowledgements Department of Health, Adult Mental Health Division Mark A Fridovich, Ph.D., Chief Judith Clarke, Planner Department of Health, Office of Health Status Monitoring Alvin T. Onaka, Ph.D., Chief and State Registrar Brian Horiuchi, M.S. Supervisor of Statistics and Surveys SMS Research Jim Dannemiller, President of Research

4. HI Department of Health, OHSM 4 Public Health Approach The National Center for Injury Prevention and Control (NCIPC) has adopted the public health approach to systematically address the problem of self-directed violence. defining and describing the nature of the problem; studying the factors that increase or lower risk; developing and evaluating ways to prevent the problem; and implementing interventions and disseminating information. http://www.cdc.gov/violenceprevention/pdf/self-directed-violence-a.pdf

5. HI Department of Health, OHSM 5 Suicide as a Public Health Issue “*Also, except for rare exceptions there is neither systematic nor mandatory reporting of nonfatal suicidal behavior in the United States at the state or local level” http://www.cdc.gov/violenceprevention/pdf/self- directed-violence-a.pdf A controversial new Army plan would predict which soldiers might be considering suicide, potentially enabling military to provide mental health counseling and other services to treat troubled troops. Gregg Zoroya, USA TODAY 12:24 a.m. EDT October 7, 2013 *

6. HI Department of Health, OHSM State Ranks Suicide Rate Per 100,000, 2010 Age Adjusted, CDC, NCHS

7. HI Department of Health, OHSM 7 Suicide Ideation as a Public Health Issue GOALS: Hawaii Adult Population 1. How do Hawaii’s rates compare to National estimates. 2. Identify adults most at risk of considering suicide by analyzing variables: a. Demographics b. SES c. Health

8. HI Department of Health, OHSM 8 Topics Suicide Ideation Questions HHS Background HHS Methods HHS Results

9. HI Department of Health, OHSM 9 DOH, Adult Mental Health Division, Questions on Suicide Ideation 1.During the past 12 months, did you ever seriously consider attempting suicide? 2.During the past 12 months, did you ever make plans about how you would attempt suicide? 3.During the past 12 months, how many times did you actually attempt suicide?

10. HI Department of Health, OHSM 10 DOH, Adult Mental Health Division, Questions on Suicide Ideation 1.Are you aware that the Hawaii Department of Health has a suicide/crisis hotline called the ACCESS line that is available 24 hours a day, 7 days a week? 2005- 2.Would you like that number? 3.Did any attempt result in an injury, poisoning, or overdose that had to be treated by a doctor or medical professional? 2007-

11. HI Department of Health, OHSM 11 Topics Suicide Ideation Questions HHS Background HHS Methods HHS Results

12. HI Department of Health, OHSM 12 Population Surveys in Hawaii HHS – Unique to Hawaii - Only a few states have their own survey, Behavioral Risk Factor Surveillance System, BRFSS, All states and territories

13. HI Department of Health, OHSM 13 HHS Background House to house survey beginning 1968 Landline Telephone survey beginning 1996 Landline and Cell Phone Survey starting 2010 Provided multi-ethnic estimates prior to Census 2000 Hawai‘i Health Survey Procedure Manuals Prepared by SMS Research & Marketing Services, Inc. and OHSM.

14. HI Department of Health, OHSM 14 Topics Suicide Ideation Questions HHS Background HHS Methods HHS Results

15. HI Department of Health, OHSM 15 HHS Methods Asks questions of respondent for information on; The adult respondent age ≥18 years The household All household members

16. HI Department of Health, OHSM 16 HHS Methods Sampling and Weighting Sampling Landline Disproportionate Random Sample By Island Cell Phones Random Oversampled on islands other than Oahu Weighted Values Respondent represents adults (age ≥18 years) in Hawaii Numbers are Adjusted 2001-2009 Homeless, households without telephones, group quarters, and island of Ni‘ihau are not included 2010-Present Cell phones are also included so homeless, households without telephones are now included

17. HI Department of Health, OHSM 17 HHS Methods Statistics Age Adjusted Values For comparing prevalence values for groups with different age structure E.g. young population to an older population Odds Ratio – An odds ratio (OR) is defined as the ratio of the odds of an event occurring in one group to the odds of it occurring in another grouphttp://practice.sph.umich.edu/micphp/epicentral/odds_ratio.php SAS - Statistical Software; SUDAAN - Complex Survey Statistical Software

18. HI Department of Health, OHSM 1.For example, the odds ratio of being at risk for considering suicide for adults in moderate to extreme pain vs. adults considering suicide that say their pain is a little or none are 4.4. In other words, the odds are increased more than fourfold for adults in pain compared to adults not in pain for considering suicide. This effect is statistically significant at α=0.05, and hence the 95% confidence interval does not contain the null value of 1.0. 2.If the odds ratio is less then 1.0 there is a reduction in odds for the group being compared. HHS Methods Odds Ratio

19. HI Department of Health, OHSM 19 Topics Suicide Ideation Questions HHS Background HHS Methods HHS Results

20. HI Department of Health, OHSM 20 Suicide Ideation as a Public Health Issue GOALS: Hawaii Adult Population 1. How do Hawaii’s rates compare to National estimates. 2. Identify adults most at risk of suicide. a. Demographics b. SES c. Health

21. HI Department of Health, OHSM Suicide Rate US and Hawaii, Per 100,000 population Considered Suicide, HHS Adult Population of Hawaii, Age Adjusted Data Source : National Vital Statistics System-Mortality (NVSS-M); DOH, Office of Health Status Monitoring Vital Records Hawaii Sample Size 5,092-6,769

22. HI Department of Health, OHSM 22 Percent Considered, Make A Plan, Attempted Suicide By Year, HHS Adult Population Sample Size 5,092-6,769

23. HI Department of Health, OHSM 23 Percent Attempted Suicide By Considered and Made A Plan, HHS Adult Population, Five Year Dataset Suicide Ideation VariablePercent Attempted Suicide Considered Suicide14.6% Made A Plan18.7% *2006-2011 excluding 2008

24. HI Department of Health, OHSM 24 Know Access Number and Attempt Requiring Medical Treatment By Suicide Ideation Questions, HHS Adult Population of Hawaii, HHS 2010, 2011

25. HI Department of Health, OHSM 25 Comparison of National to Hawaii Data on Suicide Ideation and Suicides, Adult Population *http://www.samhsa.gov/data/

26. HI Department of Health, OHSM 26 Suicide Ideation as a Public Health Issue GOALS: Hawaii Adult Population 1. How do Hawaii’s rates compare to National estimates. 2. Identify adults most at risk of suicide. a. Demographics b. SES c. Health

27. HI Department of Health, OHSM 27 HHS 2006-2011 excluding 2008; *indicates odds ratio does not include 1; sample size 27,463 Odds Ratios for Considered and Attempted, HHS Adult Population, Five Year Dataset

28. HI Department of Health, OHSM 28 HHS 2006-2011 excluding 2008; *indicates odds ratio does not include 1; sample size 27,463 Odds Ratios for Considered and Attempted, HHS Adult Population, Five Year Dataset

29. HI Department of Health, OHSM 29 HHS, 2006-2011 excluding 2008; *indicates odds ratio does not include ; sample size 27,463 1

30. HI Department of Health, OHSM 30 HHS, 2006-2011 excluding 2008; *indicates odds ratio does not include 1; sample size 27,463

31. HI Department of Health, OHSM 31 HHS, 2006-2011 excluding 2008; *indicates odds ratio does not include 1; sample size 27,463

32. HI Department of Health, OHSM 32 Odds Ratios for Considered and Attempted, HHS Adult Population, Five Year Dataset HHS, 2006-2011 excluding 2008; *indicates odds ratio does not include 1; sample size 27,463

33. HI Department of Health, OHSM 33 Higher Risk of Considering Suicide  Other Islands than Oahu  Age – younger ages <65 Years  Marital Status – Not married and Never married  Employment – Not employed  Poverty – Below Poverty Guideline  Native Hawaiian, Samoan, and Other Ethnicity

34. HI Department of Health, OHSM 34 Higher Risk of Attempting Suicide  Age – <45 Years  Marital Status –Never married  Less then a High School Diploma  Employment – Not employed  Poverty – Below Poverty Guideline  Native Hawaiian, Samoan, and OPI

35. HI Department of Health, OHSM 35 Odds Ratios for Considered and Attempted, HHS Adult Population, Five Year Dataset HHS, 2006-2011 excluding 2008; *indicates odds ratio does not include 1; sample size 27,463

36. HI Department of Health, OHSM 36 Odds Ratios for Considered and Attempted, HHS Adult Population, Five Year Dataset 2006-2011 excluding 2008; *indicates odds ratio does not include 1; sample size 27,463

37. HI Department of Health, OHSM 37 Odds Ratios for Considered and Attempted, HHS Adult Population, Five Year Dataset HHS, 2006-2011 excluding 2008; *indicates odds ratio does not include 1; sample size 27,463 O BESE CALCULATED FROM BMI SF12® Q UALITY M ETRIC S URVEY Q UESTIONS : D URING THE LAST FOUR WEEKS, HOW MUCH DID PAIN INTERFERE WITH YOUR NORMAL WORK ( BOTH WORK OUTSIDE THE HOME AND HOUSEWORK )? H OW MUCH OF THE TIME … HAVE YOU FELT DOWN - HEARTED AND DEPRESSED ?

38. HI Department of Health, OHSM 38 Higher Risk of Considering Suicide  Less then Excellent General Health Status  Chronic Health Conditions  Lower Scores Mental Health - MCS SF12®  Pain  Depression  Lower Scores Physical Health - PCS SF12®  Obesity

39. HI Department of Health, OHSM 39 Higher Risk of Attempting Suicide  Fair-Poor General Health Status  Lower Scores Mental Health - MCS SF12®  Pain  Depression  Lower Scores Physical Health - PCS SF12®

40. HI Department of Health, OHSM 40 Topics HHS Background HHS Methods HHS Results Limitations of Survey Data

41. HI Department of Health, OHSM 41 Limitations of HHS 1.Telephone survey 2.Estimates are based on samples (drawn by a complex sample design) therefore, there is variability among estimates 3.Self-reported health information 4.Survey data are a ‘point in time survey’ – cross-sectional data 5.Not longitudinal 6.Cannot draw causation only association

42. HI Department of Health, OHSM 42 Significantly Higher Risk of Considering Suicide  Lower Scores Mental Health - MCS SF12®  Lower Scores Physical Health - PCS SF12®  Both PCS and MCS are significant after adjusting for age, ethnicity, and number of (below poverty, not employed, and not married)

43. HI Department of Health, OHSM 43 Future Steps 1.Multivariate Models – compare multiple variables 2.Compare to Vital Record Data

44. HI Department of Health, OHSM Mahalo