1.
The Burden of Suicide Among
Youth in North Carolina
Child Fatality Task Force – Intentional Death Prevention Committee
December 8th, 2014

2.
Data Sources: Suicide and Self-Inflicted Injury
• North Carolina Violent Death Reporting System (NC-VDRS)
• Death Certificate
• Law Enforcement Incident Reports
• Medical Examiner Reports
• Hospital Discharge
• Emergency Department Admissions
• NC-DETECT
• N.C. Youth Risk Behavior Survey (YRBS)
• Web-based Injury Statistics Query and Reporting System
(WISQARS)

3.
Source: NC State Center for Health Statistics; Analysis by Injury Epidemiology and Surveillance Unit
Leading Causes of Injury Deaths: N.C. Residents 2013
* Unintentional Other and Unintentional Unspecified are two separate categories. Other comprises several smaller defined causes of death, while
Unspecified refers to unintentional deaths that were not categorized due to coding challenges.
Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2012
Analysis by Injury Epidemiology and Surveillance Unit
aUnintentional Other and Unintentional Unspecified are two separate categories. Other comprises several smaller defined
causes of death, while Unspecified refers to unintentional deaths that were not categorized due to coding challenges.

4.
Source: NC-VDRS, 2004-2012; N.C. State Center for Health Statistics, Vital Statistics-
Hospitalizations, 2004-2012; NC DETECT, 2008-2012
Analysis by Injury Epidemiology and Surveillance Unit
Suicide and Self-Inflicted Injury: N.C. Residents 2004-2012
0
30
60
90
120
150
180
210
240
CrudeRateper100,000
Age (Years)
Suicide Death Rate
Hospitalization Rate
ED Visit Rate

5.
Suicide and Self-Inflicted Injury among
Youth ages 10 to 17 in North Carolina

6.
Source: NC-VDRS, 2004-2012; N.C. State Center for Health Statistics, Vital Statistics-
Hospitalizations, 2004-2012; NC DETECT, 2008-2012
Analysis by Injury Epidemiology and Surveillance Unit
Suicide and Self-Inflicted Injury: N.C. Residents ages 10-17, 2004-2012
2.6 3.0 2.7 2.9 2.3 3.6 2.3 2.3 3.4
54.0 50.0 49.6 56.1
47.6
62.5
57.1
67.9 67.9
107.2
132.5
115.2
123.5
139.5
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
160.0
2004 2005 2006 2007 2008 2009 2010 2011 2012
CrudeRateper100,000
Suicide Death Rate Hospitalization Rate ED Visit Rate

7.
Source: NC-VDRS, 2004-2012; N.C. State Center for Health Statistics, Vital Statistics-
Hospitalizations, 2004-2012; NC DETECT, 2008-2012
Analysis by Injury Epidemiology and Surveillance Unit
4.0
32.8
80.4
1.5
82.7
169.0
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
160.0
180.0
Suicide Rate Hospitalization Rate ED Visit Rate
CrudeRateper100,000
Male
Female
Suicide and Self-Inflicted Injury: N.C. Residents ages 10-17, 2004-2012

8.
Source: NC-VDRS, 2004-2012; N.C. State Center for Health Statistics, Vital Statistics-
Hospitalizations, 2004-2012; NC DETECT, 2008-2012
Analysis by Injury Epidemiology and Surveillance Unit
Suicide and Self-Inflicted Injury: N.C. Residents ages 10-17, 2004-2012
1.3
27.5
59.2
5.2
106.0
230.6
0.0
50.0
100.0
150.0
200.0
250.0
Suicide Rate Hosptialization Rate ED Visit Rate
CrudeRateper100,000
Age (years)
Ages 10-14
Ages 15-17

9.
Source: NC-VDRS, 2004-2012
Analysis by Injury Epidemiology and Surveillance Unit
Suicide : N.C. Residents ages 10-17, 2004-2012
79.1%
18.4%
1.2% 1.2%
White
Black
American Indian
Asian

10.
Source: NC-VDRS, 2004-2012
Analysis by Injury Epidemiology and Surveillance Unit
Suicides by County of Residence: N.C. Residents ages 10-17, 2004-2012

11.
Source: NC-N.C. State Center for Health Statistics, Vital Statistics-Hospitalizations, 2004-
2012; NC DETECT, 2008-2012
Analysis by Injury Epidemiology and Surveillance Unit
Self-Inflicted Injury : N.C. Residents ages 10-17, 2004-2012
79.1%
18.4%
1.2%
0.5%
12.0%
Self-Inflicted Injury Hospitalizations
Poisoning
Cut/pierce
Suffocation
Firearm
Other/Unspecified
58.6%30.0%
1.2%
0.3%
9.9%
Self-Inflicted Injury ED Visits

12.
Source: N.C. YRBS, 2013
Suicidal Behavior: N.C. High School Students, 2013
11.6%
21.7%
10.9%
15.8%
5.5% 5.2%
0%
10%
20%
30%
Male Female
Seriously considered
attempting suicide during the
last 12 months
Made a plan for suicide
attempt during the last 12
months
Made a suicide attempt that
resulted in an injury needing
treatment by a medical
professional during the last 12
months

13.
Source: N.C. YRBS, 2013
Suicidal Behavior: N.C. High School Students, 2013
14.3%
40.2%
10.6%
38.0%
4.8%
12.3%
0%
10%
20%
30%
40%
50%
Heterosexual Gay, Lesbian, or
Bisexual
Seriously considered
attempting suicide during
past 12 months
Made a plan for suicide
attempt during past 12
months
Made a suicide attempt
during past 12 months that
resulted in an injury
needing treatment by a
medical professional

14.
Source: WISQARS, 2004-2012
Analysis by Injury Epidemiology and Surveillance Unit
Suicide: Youth ages 10-17, 2004-2012
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
2004 2005 2006 2007 2008 2009 2010 2011 2012
CrudeRateper100,000
United States North Carolina

15.
Source: NC-VDRS, 2004-2012
Analysis by Injury Epidemiology and Surveillance Unit
Suicide: N.C. Residents, 2004-2012
2.0
11.2
21.7 22.1
25.1
28.0
24.5
27.4
34.7
49.4
0.6
2.9 4.0 6.1
8.4
10.9
8.0
5.4 3.3
3.3
0.0
10.0
20.0
30.0
40.0
50.0
60.0
10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
CrudeRateper100,000
Male Female

16.
NC Child Fatality Prevention System
 Child Fatality Task Force
 Local Child Fatality Prevention Teams
 Children and Youth Branch
 Confidential county-level reviews
 Non-maltreatment deaths
 Make recommendations for local and state changes
 Community Child Protection Teams
 Division of Social Services
 Confidential county-level reviews
 Active maltreatment cases or maltreatment deaths
 Make recommendations for local and state changes
 Child Fatality Review Teams
 Division of Social Services
 Confidential state-level reviews of select cases
 CPS involvement within 12 months of death
 Suspicion that death was due to abuse or neglect

17.
NC Child Fatality Prevention System
NC Child Fatality Prevention Team
 Reviews deaths of children 17 years old and under
 Deaths must be certified by the Medical Examiner system:
 Homicides, suicides, accidents, poisonings
 Trauma, disaster, violence
 Unknown, unnatural or suspicious circumstances
 In police custody, jail or prison
 In state-operated mental health facilities
 Potential public health hazards
 During surgical or anesthetic procedures
 Sudden and not reasonably related to previously-known disease
 Without medical attendance
 Provides assistance and consultation to local teams
 Provides aggregate data reports to the public and other
agencies/organizations upon request

18.
Data
Review ≈ 500 cases/year approximately 12 months
after the date of death
Public sources of information
 OCME
 Vital Records
 Department of Corrections
 Department of Motor Vehicles
Confidential sources of information
 Division of Social Services records
 Law enforcement investigation reports
 Hospital/ED/pediatric/mental health records
 Team findings and discussions
Goal is to obtain the most complete picture
of a child’s life as it pertains to his/her death

19.
Youth Suicide in NC by Year
n=247
24
28 27
30
21
35
23 24
35
0
5
10
15
20
25
30
35
40
2004 2005 2006 2007 2008 2009 2010 2011 2012
NumberofSuicides

20.
2
73
172
0
20
40
60
80
100
120
140
160
180
200
5 - 9 yrs 10 - 14 yrs 15 - 17 yrs
NumberofSuicides
Youth Suicide in NC by Age

21.
Youth Suicide in NC by Year & Age Group
9
7
9 9
5
7
3
11
15
15
21
18
21
16
28
20
13
20
0
5
10
15
20
25
30
2004 2005 2006 2007 2008 2009 2010 2011 2012
NumberofSuicides
14 yo & under 15-17 yo

22.
Youth Suicide in NC by Age & Sex
0
10
20
30
40
50
60
70
6 7 8 9 10 11 12 13 14 15 16 17
NumberofSuicides
Age (in years)
Male Female

23.
Youth Suicide in NC by Year & Sex
20
17
22
25
15
27
16
17
25
4
11
5 5
6
8
7 7
10
0
5
10
15
20
25
30
2004 2005 2006 2007 2008 2009 2010 2011 2012
NumberofSuicides Male Female

24.
Youth Suicide in NC by Means
47.8%
42.9%
6.9%
1.2% 1.2%
ASPHYXIA
GUN
TOXIN
MOTOR VEHICLE
FALL or JUMP /
DROWNING / OTHER

25.
Youth Suicide in NC by Means & Sex
66.7%20.6%
9.5%
3.2%
41.3%
50.5%
6.0%
1.6% 0.5%
ASPHYXIA
GUN
TOXIN
MOTOR
VEHICLE
FALL or JUMP /
DROWNING /
OTHER
Female Male

26.
Youth Suicide in NC: Looking Back
 Child Protective Services
At least 32% of children who committed suicide between
2004 and 2012 had some type of prior contact with CPS
 Mental Health
At least 20% of children had a documented mental illness
at some point in their lifetime
60% were receiving treatment at time of death
15% were not receiving treatment at time of death
Treatment status unknown for remaining 25%
An additional 12% of children were characterized as
depressed by friends and/or family members in the weeks
or months leading up to their death

27.
Youth Suicide in NC: Looking Back
 History
11% of children had attempted suicide at least once before
 Circumstances of interest
18% of children reported recent relationship problems
(e.g., friend, family member, boyfriend/girlfriend)
11% of children had issues in the school environment
(e.g., academics, behavior, victim/perpetrator of bullying)
A suicide note was recovered in only 12% of cases
 Case Examples

28.
Youth Suicide in NC: Looking Ahead
Preliminary data
2013: 41 suicides
2014: 40 suicides as of 12/4/2014
Suicide case review session - update

29.
Elyssa Trani, MS
NC Child Fatality Prevention Team
Office of the Chief Medical Examiner
elyssa.trani@dhhs.nc.gov
Anna Austin, MPH
Injury and Violence Prevention Branch
NC Division of Public Health
anna.austin@dhhs.nc.gov
Contact Information