Martin O’Malley, Governor Anthony G. Brown, Lt. Governor



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Linkages to Life: The Maryland State Plan For Suicide Prevention: FY 2008-2012




Linkages to Life:


Maryland's Plan for Youth Suicide Prevention



Martin O’Malley, Governor

Anthony G. Brown, Lt. Governor


John M. Colmers, Secretary

Arlene Stephenson, Acting Deputy Secretary, Public Health Services

Brian M. Hepburn, M.D., Executive Director

The Maryland Committee on Youth Suicide Prevention

2008



The ginkgo tree is a survivor. It is over 300 million years old. It has survived despite all obstacles and is used as a symbol of healing. We chose the leaf from this tree to represent our message: "A Caring Community Saves Lives". This message too will survive and heal.

_________________________________________________________
“The services and facilities of the Maryland Department of Health and Mental Hygiene (DHMH) are operated on a non-discriminatory basis. This policy prohibits discrimination on the basis of race, color, sex, or national origin and applies to the provisions of employment and granting of advantages, privileges and accommodations.”
“The Department, in compliance with the Americans with Disabilities Act, ensures that qualified individuals with disabilities are given an opportunity to participate in and benefit from DHMH services, programs, benefits, and employment opportunities.”


TABLE OF CONTENTS


  1. EXECUTIVE SUMMARY 1





  1. INTRODUCTION 3




  1. VALUES AND GOALS 6




  1. DEMOGRAPHIC AND STATISTICAL INFORMATION 7




  1. PROCESS, FINDINGS AND RECOMMENDATIONS 21




  1. MARYLAND SUICIDE PREVENTION PLAN 25




  1. APPENDICES:


APPENDIX A: INTERAGENCY PLANNING COMMITTEE

MEMBERS 40
APPENDIX B: MARYLAND COMMITTEE ON YOUTH

SUICIDE PREVENTION 42
APPENDIX C: SUICIDE PREVENTION RESOURCE CENTER

MARYLAND SUICIDE FACT SHEET 2000-2004 48


  1. EXECUTIVE SUMMARY:

In FY 2007 – 2008, an interagency group drafted Linkages to Life: The Maryland State Plan For Suicide Prevention, FY 2008-2012, to update the State’s original plan, completed in 1986. This proposed new plan for Maryland is modeled on The Surgeon General’s Call to Action to Prevent Suicide.1 The latter publication emphasized suicide as a serious public health problem and recommended the development of a national strategy for suicide prevention. Moreover, the President’s New Freedom Commission on Mental Health Report recommended: “Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention.”2 The proposed Maryland State Plan for Suicide Prevention is based on national strategy recommendations.


The proposed plan aligns with national goal categories:


  • Awareness: Goal is to increase and broaden the public’s awareness of suicide and its risk factors, and understand suicide is preventable;

  • Intervention: Goal is to enhance culturally competent, effective and accessible community based services and programs; and

  • Methodology: Goal is to advance the science of suicide prevention.

In addition, the proposed Maryland Plan has added Postvention as a category, to assure effective services to those who have attempted suicide and/or to other people affected by the suicide attempt or completion. For each of the four goal categories, the Plan lists objective/strategies, responsible parties/persons for implementation, time lines, and outcome and performance measures.


The recommendations presented are based on extensive literature reviews, data analysis, multi-agency input and feedback, and evidenced based practices. Furthermore, each of the agencies involved in this process stand ready to assist in the implementation.
The FY 2008-2012 Maryland Suicide Prevention Plan proposes:


  1. Establish an Office of Suicide Prevention within the Department of Health and Mental Hygiene Administration;




  1. Develop a more coordinated prevention, intervention, and postvention services across the State, to include youth and young adults (up to age 25), including high-risk returning war veterans, and their families;

  2. Address core components in youth suicide prevention programs by the local school systems and other educational networks;




  1. Increase funding for youth suicide prevention, intervention, and postvention, including increased funding to the Maryland Crisis Hotline programs and capacity building;




  1. Develop a Website and new technologies to access and help youth;




  1. Infusion of cultural competence throughout services to youth;




  1. Develop a youth suicide plan in each child serving agency;



  1. Increase inservice training to local departments of correction and to youth detained in local jails;




  1. Strengthen the State's capacity to respond to crises and serve at-risk-youth in need;



  1. Increase the number and quality of trainers in suicide prevention, intervention, and post-vention;




  1. Increase outreach and the number of training geared to gatekeepers and the public around youth suicide issues;




  1. Work with faith based organization around youth suicide prevention issues;




  1. Implement a model Hospital/Urgent Care suicide postcard follow-up program for at-risk- youth in emergency departments; and




  1. Establish a baseline listing of existing support systems for survivors and attempters.

The report concludes there is a desperate need for additional resources to be devoted to helping troubled youth, distraught parents, and others who are touched by the turmoil of youth suicide. The Maryland Committee on Youth Suicide Prevention strongly believes the FY 2008-2012 Plan will to be the vital "linkage to life" to save young lives.



  1. INTRODUCTION:

Governmental support and leadership, along with interagency collaboration, coordination and intervention, is required to develop and implement a comprehensive suicide prevention plan. With recognition that there are limited new resources for suicide prevention, it is imperative to develop a plan that is acceptable to key state officials and the advocacy community. The newly developed Maryland plan is based on the strengths of the existing programs and services, and intends to increase collaborative relationships through consensus building and joint program planning and implementation. The primary goals of this proposed plan are to increase awareness, develop and implement the best evidence-based clinical prevention/intervention practices, and advance knowledge about suicide and effective methods of prevention. The goals and many of the objectives/strategies often overlap; however, this overlap contributes to a unified, integrated and coordinated plan.


The proposed five-year plan (fiscal years 2008 through 2012) provides opportunities and challenges to improve upon current Maryland efforts. This plan addresses youth and young adults up to age 25, including returning veterans who are at high risk for suicide. Throughout the country, numerous states are developing suicide prevention plans and many efforts are underway to fund these programs through public and private funding sources. The future success of preventing suicide in Maryland is contingent upon the continuation and expansion of prevention efforts promoted and supported by federal, state, public and private agencies working collaboratively.


As a result of the marked increase in the suicide rate among military personnel deployed to Iraq and Afghanistan this plan addresses returning Maryland veterans. The Associated Press reported in 2006: “Of the confirmed suicides last year, 25 were soldiers deployed to the Iraq and Afghanistan wars….which amounts to 40 percent of the 64 suicides by Army soldiers in Iraq since the conflict began in March 2003….accounting for nearly one in five of all noncombat Army deaths.” In a 2007 CBS News investigation, which surveyed 45 states, it was reported that in 2005 there were 6,256 veteran suicides—120 every week, 17 a day. In 2008, numerous reports were published pertaining to the increase of suicides among soldiers who served in Iraq and Afghanistan. It was reported the number of suicides among American soldiers increased 20 percent between 2006 and 2007 when 121 died as a result of suicide. Furthermore, a 2008 Associated Press report stated “Suicide attempts and other self-injuries….jumped six-fold between 2002 and last year.”

Military reports and interviews with soldiers’ relatives have shown that some of the service members who committed suicide were kept on duty despite signs and symptom of distress. It has been estimated 25 percent of enlistees and 50 percent of reservists who have returned from the war have serious mental health issues. To date, four Maryland National Guard veterans of this war have committed suicide. Thus, this plan includes young returning Maryland veterans.


BACKGROUND INFORMATION

The State of Maryland has an exemplary 25-year history in the area of youth suicide prevention and intervention. Youth suicide initiatives began with survivors who formed an advocacy organization called Marylanders Against Youth Suicide (MAYS) in the 1980’s. Many members of MAYS had felt the devastation of losing loved ones to suicide; thus, they organized across the State to specifically address the problem of youth suicide. In 1986, MAYS and other concerned citizens worked for the passage of Maryland General Assembly resolutions creating a Gubernatorial Task Force on Child, Teenage, and Young Adult Suicide and Other Associated Mental Health Problems.


As a result of these resolutions the first suicide prevention programs commenced in Maryland schools and the first Maryland plan, “For a Better Tomorrow: A Plan for Youth Suicide Prevention” was completed (1987). One of the primary objectives in this plan called for the development of the nation’s first decentralized hotline network. Under this plan, troubled youth could call one number from anywhere in the State and get immediate help from trained personnel 24 hours a day, seven days a week. The Maryland Youth Crisis Hotline Network, comprised of The Grassroots Hotline, Frederick County Hotline, Life Crisis Center, Community Crisis Services, Inc., Walden/Sierra and the Montgomery County Hotline, was established in 1990. In 2002, the Baltimore Crisis Response became a part of the network.
Additionally, the Governor requested the Department of Health and Mental Hygiene (DHMH), Mental Hygiene Administration to assume responsibility for suicide prevention. In 1987, an administrator was hired and charged by the Governor to establish and chair an Interagency Workgroup on Youth Suicide Prevention. The Workgroup consisted of representatives from the Mental Hygiene Administration (MHA), the Maryland State Department of Education (MSDE), Department of Juvenile Services (DJS), Department of Human Resources (DHR), Department of Alcohol and Drug Abuse Administration, Office of the Chief Medical Examiner, and the AIDS Administration; other departments with a youth focus were added later.
Other major accomplishments over the past 25 years include the following:


  • First decentralized crisis hotline in the country (1-800-422-0009). National hotlines 1-800 Suicide and 1-888-273-TALK were based on this model. With the University of Maryland and the Alcohol and Drug Abuse Administration, and the Maryland Youth Crisis Hotline network, developed the first Internet based collection system for a coordinated statewide hotline network, Hotline Online Tracking System (HOTS).

  • First Maryland Town Meeting on Suicide.

  • First state to establish Youth Suicide Prevention Month.

  • State law established suicide prevention programs in the schools in all 24 political jurisdictions. Many school programs provide gatekeeper training, crisis teams, peer helpers, suicide prevention education and referral.

  • Convened 19 Annual Suicide Prevention Conferences—Maryland’s conference is the oldest and largest State conference in the nation.

  • Funding provided to the Hotline network to provide gatekeeper training to State Colleges and Universities.

  • Established a DJS task force on suicide prevention that resulted in DJS policy changes.

  • Extensive media awareness campaigns included, but not limited to: Public Service Advertisements (PSAs) with the Baltimore Orioles to promote the Maryland Youth Crisis Hotlines; statewide bill board ads; Maryland hotline program highlighted on nationally syndicated show, Inside Edition; assisted to organize national teleconference on youth violence with the Harvard School of Public Health; The American Psychiatric Association highlighted the program in the April 21, 2000 Psychiatric News; partnered with the Mental Health Association of Maryland, the Hotline network and the MHA, on the “Caring for Every Child’s Mental Health” campaign; outreached to the faith community included organizing seminars and panel presentations; worked with Marylanders Against Handgun Abuse to present workshops and pass legislation to reduce access to guns in Maryland; collaborated with advocacy groups such as Suicide Prevention Education Awareness for Kids (SPEAK) to do outreach and to get phones on Maryland bridges and student I.D. cards posted with the Maryland Youth Crisis Hotline number; and coordinated with other groups, e.g., Gay and Lesbian Center of Baltimore, Hearts and Ears, to develop workshops on Gay, Lesbian, Bisexual, Transgender and Questioning (GLBTQ) issues.



  1. VALUES AND GOALS:

The proposed FY 2008-2012 Maryland Plan is presented based on the following values:




  • Address statewide needs;

  • Build upon existing system strengths;

  • Focus on prevention;

  • Utilize data-based decision-making

  • Implement evidence-based, best practices; and

  • Demonstrate cultural competence.

The aim of the national strategy, which Maryland is adopting, includes the following goals:




  • Prevent premature deaths due to suicide across the life span;

  • Reduce the harmful after effects associated with suicidal behaviors and the traumatic impact on family and friends; and

  • Promote opportunities to enhance resiliency, resourcefulness, respect, and interconnectedness for individuals, families and communities.




MARYLAND GOALS – FY 2008 TO 2012
GOAL 1: AWARENESSMaryland youth, their families and the professionals who work with them understand suicide is preventable.
GOAL 2: INTERVENTIONCulturally competent, effective and accessible community-based intervention services and programs for youth are in place.
GOAL 3: POSTVENTION Effective, culturally competent professional services are accessible to youth who have attempted suicide and/or to other people affected by the suicide attempt or completion.
GOAL 4: METHODOLOGY – Maryland will advance the science of youth suicide prevention.




  1. DEMOGRAPHIC AND STATISTICAL INFORMATION:

IV. Demographic and Statistical Information:

Suicide is a major preventable public health issue in the United States. It is the third leading cause of death for people under the age of 24, and suicide is an increasing problem among the elderly, young African American males, college age young adults and the GLBTQ community. In 2006, Maryland lost 514 people to suicide. This number does not include deaths caused by overdoses, drowning, car crashes, and self-inflicted gun shot wounds that were ruled as accidents.


According to 2006 statistics presented by the National Institute of Mental Health, suicide was the 11th leading cause of death in the U.S., accounting for 32,439 deaths in 2004. The overall rate reported was 10.9 suicide deaths per 100,000 people.
According to the National Institute of Mental Health, in 2004, suicide was the third leading cause of death in children, adolescents and young adults.3
Children ages 10 to 14: 1.3 per 100,000

Adolescents ages 15 to 19: 8.2 per 100,000



Young adults ages 20 to 24: 12.5 per 100,000
Youth were more likely to use firearms, suffocation and poisoning than other methods of suicide; however, while adolescents and young adults frequently used firearms, children were more likely to use suffocation. Additionally, four times as many males as females, ages 15 to 19, died by suicide and more than six times as many males as females, ages 20 to 24, died by suicide.
Suicidal behavior is extremely complex. Youth suicide involves risk factors associated with age, sex, ethnicity, and race. Risk factors may occur in combination and also change over time. Research has demonstrated that risk factors include:4


  • Depression and other mental disorders (more than 90 percent who die by suicide have a mental illness)

  • Substance abuse disorders

  • Stressful life events in combination with other risk factors

  • Prior suicide attempt

  • Family history of psychiatric illness or substance abuse

  • Family history of suicide

  • Family violence, including physical or sexual abuse

  • Firearms in the home (the method used on more than half of suicides)

  • Incarceration

  • Exposure to the suicidal behavior of others, such as family members, peers or media figures


Statistical Analysis of Completed Suicides by Youth in MD from 1990-2006
This section reviews the completed suicides (i.e., deaths attributed to intentional self-injury) by young people in Maryland from 1990-2006. The previous Maryland Plan for Youth Suicide Prevention presented data from 1970-1985. Both reports follow a similar format to facilitate comparison between past and current data. The current data comes from Office of Chief Medical Examiner; data from 1986-1989 were not available. The current review examines the relationship between completed suicide and geographic region (i.e., counties), age (ages 10-24 inclusive), sex, race, and method over time (i.e., years). Data on suicide attempts is presented in the following section.
From 1990-2006, there were 1,219 completed suicides by Maryland youths, as compared to 1,520 documented suicide deaths from 1970-1985. The number of deaths per year ranged from 63 (1996, 2001) to 84 (2003). Tables 1 and 2 present the 2000-2004 suicide rates per 100,000 for Maryland and United States residents aged 10-24. Calculation of crude rates is based on the entire population. Crude rates are the absolute number of cases or deaths in a given population (in Table 1, ages 10-24 in Maryland) during a given time frame (2000-2004) divided by the population in the given geographic area (in Table 1, the size of the total Maryland population). There are no adjustments (e.g., for age) made when a crude rate is presented. At the time of analysis, national data were only available through 2004.

Table 1: 2000 - 2004, Maryland
Suicide Injury Deaths and Rates per 100,000
All Races, Both Sexes, Ages 10 to 24



Number of
Deaths


Population

Crude
Rate


374

5,591,969

6.69


Table 2: 2000 - 2004, United States
Suicide Injury Deaths and Rates per 100,000
All Races, Both Sexes, Ages 10 to 24

 


Number of
Deaths


Population

Crude
Rate


21,638

307,860,064

7.03

Table 3 examines recent completed suicides by county. Together, these data show the overall Maryland youth suicide rate follows the national trend, but there are geographic regions of Maryland with higher youth suicide rates. Counties with rates higher than 8 per 100,000 are (highlighted below): Allegany, Calvert, Cecil, Dorchester, Queen Anne’s, Washington, and Wicomico. Examination of adjusted rates and inclusion of 2005-2006 data did not change the findings except that Worcester County also was identified as having a higher than expected rate. In addition to examining rates, it is important to consider counties with higher frequencies of completed suicides (e.g., Baltimore City, and Baltimore, Prince George’s and Montgomery Counties).



Table 3: 2000 - 2004, Maryland Suicide Injury Deaths and Rates

per 100,000 by County (All Races, Both Sexes, Ages 10-24)
County , Total # Completed Crude Rate

Maryland Population Suicides per 100,000

Allegany County 72,831 9 12.36

Anne Arundel County 509,300 25 4.91

Baltimore County 787,384 46 5.84

Calvert County 88,804 13 14.64

Caroline County 32,617 1 3.07

Carroll County 170,260 11 6.46

Cecil County 99,506 8 8.04

Charles County 140,416 10 7.12



Dorchester County 31,631 5 15.81

Frederick County 222,938 13 5.83

Garrett County 29,859 1 3.35

Harford County 241,402 13 5.39

Howard County 272,452 14 5.14

Kent County 19,983 1 5.00

Montgomery County 932,131 48 5.15

Prince George's County 841,315 51 6.06



Queen Anne's County 46,241 5 10.81

St. Mary's County 98,854 3 3.03

Somerset County 25,774 2 7.76

Talbot County 36,062 2 5.55



Washington County 143,748 12 8.35

Wicomico County 91,987 8 8.70

Worcester County 48,866 3 6.14

Baltimore City 631,366 40 6.34
DATA SUMMARY


  • From 1990-2006, there were 1,219 documented suicide deaths completed by Maryland youth aged 10-24, as compared to 1,520 from 1970-1985. The number of deaths per year ranged from 63 (1996, 2001) to 84 (2003).




  • The 2000-2004 suicide rate per 100,000 for Maryland residents aged 10-24 (6.69) is comparable to the national rate (7.03), but there are geographic regions of Maryland with higher youth suicide rates (Allegany, Calvert, Cecil, Dorchester, Queen Anne’s, Washington, Wicomico, and Worcester Counties for this time period. In addition, several counties had higher frequencies (>40) of completed suicides (e.g., Baltimore City, and Baltimore, Prince George’s and Montgomery Counties).



  • The following percentages pertain to the 1,219 completed suicides by individuals under age 25 from 1990 through 2006 in Maryland. While the overall number of completed suicides decreased from the last report, the number of cases in those aged 10-14 increased. In addition, the male-to-female ratio has widened slightly.

Ages 10-14 6%

15-19 32%

20-24 62%
Male 86%

Female 14%


White 70%

Non-white 30% (26% Black)




  • The following are the 2006 suicide rates per 100,000 for demographic groups of Maryland residents aged 15-24. Suicide rates among white males and females have decreased since the last report, while the rates among non-white males and females have increased.

White Male 17.8

Non-white Male 14.2

White Female 4.4

Non-white Female 3.2




  • Firearms were used in 51 percent and hanging in 30 percent of all suicides by Maryland youth from 1990-2006. The data support use of firearms and overdose/poisoning has appeared to decrease, while the use of hanging has increased, especially among certain demographic groups. The use of firearms was the most common method selected by white males, black males and males of other races. Hanging was the most common method selected by white and black females, while poisoning/overdose was most common for females of other races.

Effects of Age
Figure 1 shows the number of completed suicides for each age from 1990 to 2006. No suicides by children younger than 10 years old were recorded. For 10, 11 and 12 year olds, 2, 6 and 14 cases, respectively, were recorded. This is in comparison to 0, 5, and 6 completed suicides for the same age groups from 1970-1985. Examination of the figure shows that frequency increased with age and then leveled off somewhat in the 20’s age group. The peak was age 23, with 165 cases in that time period. In the 1970-1985 report, the peak was age 24 (215 cases).
Figure 1: Suicide cases by age in Maryland, 1990-2006

The same data is collapsed into three age groups in Figure 2. There were 79 (6% of total) cases by those aged 10-14; 387 (32%) cases by ages 15-19; and 753 (62%) cases by ages 20-24. This data also strongly supports that the frequency of suicides increases with age, and that ages 20-24 are responsible for the majority of completed suicides in youth. During 1970-1985, 62 (4%), 476 (31%) and 982 (65%) completed suicides were recorded for those aged 10-14, 15-19 and 20-24 respectively. Of note, while the overall number of completed suicides decreased from the last report, the number of cases in those aged 10-14 increased.


Figure 3 compares the Maryland rate for those aged 15-24 to the US rates for this age group and all ages from 1990-2006. The Maryland rate is pretty consistently below the other rates. The rate went from 11.17 in 1990 to 9.48 in 2006 (maximum rate: 12.1 in 1994; minimum rate: 7.65 in 2005); from the previous report, the rate went from 4.4 in 1950 to 11.6 in 1980. When the rates for age category were broken down further into those aged 10-14, 15-19, and 20-24, the rates were variable over time; thus, the data must be interpreted cautiously. The rate for 10-14 year-olds in Maryland appears to be rising slightly to trend closer to the national average. For those aged 15-19, the Maryland rate was pretty consistently below the US rate until it peaked in 1999 (9.13 per 100,000) and remained more consistent with the national data; however in more recent years the rate has declined again and should be compared to updated US data when available. The rate for those aged 20-24 has consistently been higher than those aged 10-14 and 15-19. For 20-24-year-olds, the rate went from 11.7 in 1990 to 14.4 in 2006 with the maximum rate recorded at 17 in 1994; in the previous report, the rate went from 13.5 in 1970 to 16.6 in 1984 with the maximum recorded at 21.2 in 1977.

Figure 2: Suicide cases by age group in Maryland, 1990-2006




Figure 3: Suicide rates for ages 15-24 from 1990-2006

Effects of Sex and Race
From 1990-2006, there were 1,046 (86% of total) suicides completed by males in Maryland, as compared to 173 (14%) by females (approximately 6:1 ratio). The previous report indicated 82% of completed suicides were males (18% female) and the ratio was 5.2 males: 1 female (1982, 15-24 year olds). Thus, over 1990-2006, the male-to-female ratio has appeared to widen slightly.
From 1990-2006, there were 846 (70% of total) completed suicides by whites, 321 (26%) by blacks, and 50 (4%) by other races/ethnic groups; data points were missing for 2 cases. From 1970-1985, 83 percent of completed suicides were by whites (17% non-whites). Figure 4 shows the suicide rates for 15-24 year-olds in each of four demographic groups for 2006: white males (17.8), non-white males (14.2), white females (4.4), and non-white females (3.2). In the previous report, the 1982 rates were as follows for the same age group: white males (25.3), non-white males (10.8), white females (4.9), and non-white females (1.7). Thus, for 2006, higher suicide rates among white males are evident; however they have decreased since the last report, while the rates among non-white males have increased. Similarly, rates for white females have decreased slightly, while they have increased for non-white females.

Figure 4: Maryland 2006 suicide rate by race and sex, Ages 15-24




Suicide Methods
For this report, suicide methods have been categorized into eight groups: firearms (FA), hanging (HA), overdose and poisoning (OD), gaseous inhalation (GA), drowning (DR), laceration (LA), jumping from height (JU) and miscellaneous/other causes (MI). Figure 5 represents the 1,219 Maryland suicides by individuals under 25 from 1990 through 2006. Percentages of this total by choice of method are shown. In the later figures, gaseous inhalation is included with the overdose/poisoning category.

Figure 5: Percent of total Maryland suicide cases for 1990-2006 by method

FA Firearms

HA Hanging

OD Overdose/

Poisoning



GA Gaseous Inhalation

DR Drowning

LA Laceration/

Stabbing


JU Jumping

MI Miscellaneous

Fifty-one percent of all of the suicide deaths in this age range resulted from the use of firearms. Hangings accounted for the next most frequent cause of death at 30 percent of the cases. The overdose/poisoning and gaseous inhalation (mostly carbon monoxide) categories together accounted for 9 percent. Jumping from height, drowning, and laceration each were responsible for one percent or less of documented deaths. The miscellaneous category accounted for about 7% of reported cases. During 1970-1985, the percent of total Maryland suicide cases for this age range by method were as follows: 54% firearms; 19% hanging; 19% overdose/poisoning including gaseous inhalation; and less than 2.5% each for the remaining categories. The most striking differences between the current and previous report are that the number of youth completing suicide by hanging has increased while overdose/poisoning has decreased.

Percentages of individuals in each age group by choice of method are indicated in Figure 6. The majority of those aged 10-14 committing suicide involved hanging, with firearms the second most common choice. Both the 15-19 and 20-24 age groups employed firearms in greater than 50% of their suicides, with hanging the second most common choice. The percentage of individuals choosing the overdose/poisoning method increased with age. The only major difference from the last report was that hanging surpassed overdose/poisoning as the second most common method among 20-24 year-olds.
Method selection for males and females is graphically depicted in Figure 7. Clearly, firearms represent the primary method used by males, with hanging the second and overdose/poisoning the third most common causes. Females were most likely to choose hanging as their method of suicide, with firearms the second and overdose/poisoning the third most common causes, but the discrepancies were not as large as in males. Comparing to the 1970-1985 data, the findings for males are similar; however, for females, the prior report documented firearms, overdose/poisoning and hanging as the three most common methods respectively.
Figure 6: % of total Maryland suicide cases by method and age, 1990-2006

Key: FA=Firearms; HA=Hanging; OD=Overdose/Poisoning; GA=Gaseous Inhalation;

DR=Drowning; LA=Laceration/Stabbing; JU=Jumping; MI=Miscellaneous

For the purposes of this analysis, non-whites were separated into black and other races (see Figure 8). Both whites and non-whites were most likely to choose firearms as the primary suicide method, which is consistent with the 1970-1985 report. In addition, for both whites and non-whites, the second and third choices were hanging and overdose/poisoning respectively if the miscellaneous methods are separated out. Compared to the 1970-1985 data, hanging surpassed overdose/poisoning as the second most common choice among whites. Interestingly, the discrepancy between firearms and hanging was not as large for other races as it was for whites and blacks.


Figure 7: % of total Maryland suicide cases by method and sex, 1990-2006




Key: FA=Firearms; HA=Hanging; OD=Overdose/Poisoning; GA=Gaseous Inhalation;

DR=Drowning; LA=Laceration/Stabbing; JU=Jumping; MI=Miscellaneous

Figure 8: % of total Maryland suicide cases by method and race, 2000-2006

Percentages for selection of each method by race and sex are shown in Figure 9. It is striking that white males, black males, and males of other races had similar patterns of findings with firearms, hanging, and overdose/poisoning the three most common choices respectively. Among white and black females, hanging, firearms and overdose/poisoning were the three most common choices respectively. For females of other races, overdose/poisoning and hanging were the two most common choices; however, this demographic group had a high number of suicides classified as miscellaneous which may be because they were not able to be classified more specifically. In the last report, all demographic groups were most likely to choose firearms as the primary method of suicide.


Method selection can be examined alternately by considering the degree to which each demographic group utilized individual methods. Firearms, for instance, while high in all male demographic groups, were most likely selected by black males. Hanging was most likely selected by black females, while overdose/poisoning was most likely selected by females of other races. Laceration, which includes stabbing, was most likely selected by males of other races. This contrasts with the previous report: firearms (white males); hanging (non-white males); overdose/poisoning (white females); and less-common methods (non-white females).

Figure 9: % of total Maryland suicides by method, race and sex, 1990-2006

Key: FA=Firearms; HA=Hanging; OD=Overdose/Poisoning; GA=Gaseous Inhalation;

DR=Drowning; LA=Laceration/Stabbing; JU=Jumping; MI=Miscellaneous
Suicide Method Selection Trends
Figure 10 (next page) shows the rates per 100,000 for selected methods by those aged 10-24 from 1990-2006. This data supports that use of firearms has appeared to decrease, while the use of hanging has increased. Rates for overdose/poisoning have remained relatively stable. This data is in contrast to the prior report which indicated an increase in the firearm rate.

Figure 10: Maryland youth suicide rate for selected methods, 1990-2006

Other Data on Completed and Attempted Suicide in MD Youth
The following more detailed data refer to a sub-group of completed suicides from 2003-2005 in youth aged 0-18 (see Figure 11).5 This data comes from the Maryland Violent Death Reporting System, which gathers information from the following sources:

  • Maryland Office of Vital Statistics

  • Maryland Office of the Chief Medical Examiner

  • Police Reports

  • Crime Lab Reports

  • Supplemental Homicide Reports

  • Maryland Health Services Cost Review Commission (Hospital Discharge Data)


Figure 11: Youth Suicides and Attempted Suicides

in Maryland: Ages 0 – 18, 2003-2005

Source: Partnership for a Safer Maryland (May 2, 2006)



  • Of the 65 youth suicides, circumstances of suicide were known in 80% (52) of the cases.




  • Of the 52 victims with known circumstances:

- Approximately 44% (23) had current mental health problems

- Approximately 35% (18) left a suicide note

- Approximately 27% (14) had a crisis in the past two weeks


  • Of the 58 tested for antidepressants at autopsy, 20.7% tested positive for antidepressants.




  • The youngest attempted suicide was in a five year old




  • Over 70% of the youth who attempted suicide were female (see Figure 12).




  • The majority of persons who attempted suicide were white (66.5%).




  • The majority of suicide attempts were caused by poisoning (see Table 4).




  • Montgomery County had the most suicide attempts (246) during this time period, followed by Prince George’s County (149) and Baltimore County (145). Attempts may be higher in these jurisdictions due to the respective size of the youth populations.



Figure 12:





Hospitalized Attempted Suicide by Gender and Age, 2003-2005



  1. FINDINGS AND RECOMMENDATIONS:


Table 4: Hospitalized Attempted Suicide by Manner



Manner

Total

Cutting/Piercing

259

Firearms

7

Hanging

10

Strangulation/Suffocation

#

Jumping High Place

14

Other Unspecified

56

Poisoning

877

# Cells less than 6 are removed to preserve confidentiality



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