Preventing Suicide In Wyoming - Wyoming Department Of
Preventing Suicide in Wyoming2017-2021 State Suicide Prevention PlanJanuary 2017
#StopSuicideWyoPrepared byPrevention Management Organization of WyomingSubstance Abuse and Suicide Prevention Program, Public Health Division, Wyoming Department of HealthWyoming Suicide Prevention Advisory Council (WySPAC)Thomas O. ForslundDirectorWyoming Department of HealthWyoming Suicide Prevention Plan1
#StopSuicideWyoTable of ContentsNational Suicide Prevention Goals . 3State Suicide Prevention Goals . 4Introduction and Overview . 5A History of Suicide Prevention in Wyoming. 14Progress . 15Make a Difference. 15Conclusion . 15Wyoming Suicide Prevention Plan . 15References . 21Wyoming Suicide Prevention Plan2
#StopSuicideWyoNational Suicide Prevention GoalsGoal 1: Integrate and coordinate suicide prevention activities across multiple sectors and settingsGoal 2: Implement research-informed communication efforts designed to prevent suicide by changingknowledge, attitudes, and behaviorsGoal 3: Increase knowledge of the factors that offer protection from suicidal behaviors and that promotewellness and recoveryGoal 4: Promote responsible media reporting of suicide, accurate portrayals of suicide and mental illness inthe entertainment industry, and the safety of online content related to suicideGoal 5: Develop, implement, and monitor effective programs that promote wellness and prevent suicide andrelated behaviorsGoal 6: Promote efforts to reduce access to lethal means of suicide among individuals with identified suicideriskGoal 7: Provide training to community and clinical service providers on the prevention of suicide and relatedbehaviorsGoal 8: Promote suicide prevention as a core component of health care servicesGoal 9: Promote and implement effective clinical and professional practices for assessing and treating thoseidentified as being at risk for suicidal behaviorsGoal 10: Provide care and support to individuals affected by suicide deaths and attempts to promote healingand implement community strategies to help prevent further suicidesGoal 11: Increase the timeliness and usefulness of national surveillance systems relevant to suicide preventionand improve the ability to collect, analyze, and use this information for actionGoal 12: Promote and support research on suicide preventionGoal 13: Evaluate the impact and effectiveness of suicide prevention interventions and systems andsynthesize and disseminate findingsSource: U.S. Department of Health and Human Services (HHS) Office of the Surgeon General and National Action Alliance forSuicide Prevention, 2012Wyoming Suicide Prevention Plan3
#StopSuicideWyoState Suicide Prevention GoalsOverarching Goal: Reduce the annual suicide rate 20 percent by 2025Goal 1: Develop broad-based support for suicide prevention (National Goal 1)Goal 2: Develop and implement community-based suicide prevention programs and activities (National Goal5)Goal 3: Promote awareness that suicide is a public health problem that is preventable (National Goal 2)Goal 4: Develop and implement strategies to reduce the stigma associated with being a consumer of mentalhealth, substance abuse, and suicide prevention services (National Goal 3)Goal 5: Promote responsible media reporting of suicide, accurate portrayals of suicide and mental illness, andthe safety of online content related to suicide (National Goal 4)Goal 6: Promote efforts to reduce access to lethal means and methods of self-harm among individuals withidentified suicide risk (National Goal 6)Goal 7: Implement training for recognition of at-risk behavior and delivery of effective treatment (NationalGoal 7 & Goal 8)Goal 8: Increase key services for individuals at risk for suicide and suicide survivors (National Goal 9 & Goal10)Goal 9: Improve and expand surveillance systems to collect suicide-related data (National Goal 11)Goal 10: Support focused suicide prevention research projects (National Goal 12)Goal 11: Evaluate the impact and effectiveness of suicide prevention activities (National Goal 13)Wyoming Suicide Prevention Plan4
#StopSuicideWyoIntroduction and OverviewIntroductionSuicide is a leading cause of preventable death in Wyoming with negative impacts that are felt by individuals,families, and communities throughout the state. Over the past three decades Wyoming has consistently hadone of the highest per-capita suicide rates in the nation, currently ranking fourth with a suicide rate of 21.6suicide deaths per a population of 100,000 people in 2014, compared to the national average of 12.93(Wyoming Vital Statistics, 2016). Between 2011 and 2015, 705 Wyoming citizens have died by suicide(Wyoming Vital Statistics, 2016), meaning, on average, one person dies by suicide every three days inWyoming. For every individual who dies by suicide, several others attempt suicide. Suicide takes both anemotional and financial toll across the state. Suicide costs Wyoming a total of 155,148,000 of combinedlifetime medical and work loss cost, or an average of 1,184,336 per suicide death in 2010 dollars (AmericanFoundation for Suicide Prevention, 2016). Together we can work to change the current picture of suicide inWyoming.The following report provides an overview of suicide deaths in Wyoming, a historical perspective of suicideprevention efforts within the state, and current and planned goals and objectives for suicide preventioninitiatives to be implemented over the course of the next two years. The goals and objectives have beenclosely aligned with the 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action, a report fromthe U.S. Surgeon General and of the National Action Alliance for Suicide Prevention.Suicide as a Public Health IssueSummary from the Centers for Disease Control and Prevention: “Suicide Prevention: A Public Health Issue”Wyoming’s public health and mental health services systems can best be understood in the context of thestate’s unique demographics. Wyoming has been aptly characterized as “a small town with very long streets.”Geographically the tenth largest state in the country, Wyoming is the least populous, with an estimated586,107 people in 2015. The state has a population density of 5.8 persons per square mile, and the entire stateis considered rural or frontier with the exception of Laramie and Natrona Counties (U.S. Census Bureau,2016).Historically, suicide has been addressed by providing mental health services to individuals who were alreadyexperiencing or showing signs of suicidal thoughts or behavior. While therapy and hospitalization areextremely important for those who may be thinking about suicide or who have made a suicide attempt, theseservices do not prevent suicidal thoughts or behaviors from happening in the first place. There are manyadditional factors which place people at risk for suicide. A public health approach to suicide prevention canaddress the wide range of factors that contribute to suicide in several ways.Public health’s broad view places an emphasis on population health, expanding efforts beyond the health ofindividuals. A population approach focuses on prevention across social systems and supports efforts thatimpact groups of people, versus treatment of individuals. Second, public health focuses on preventing suicidalbehavior before it ever occurs, which is known as primary prevention. This approach addresses a broad rangeof risk and protective factors (See Figure 1).Suicide is often thought of as an individual problem, but it also impacts families, communities, and society ingeneral. The long-term goal of public health is to reduce suicide risk by addressing factors at the individual(e.g., substance abuse), family (e.g., poor quality parent-child relationships), community (e.g., lack ofWyoming Suicide Prevention Plan5
#StopSuicideWyoconnectedness to people or institutions), and societal levels (e.g., social norms that support suicide as anacceptable solution to problems; inequalities in access to opportunities and services).Figure 1. Examples of Risk and Protective Factors in a Social Ecological ModelSource: 2012 National Strategy for Suicide Prevention: Goals and Objectives for ActionAdapted from Dahlberg LL, Krug EG. Violence – a global public health problem. In: Krug E, Dahlberg LL, Mercy JA,Zwi, AB, Lozano R, eds. World report on violence and health. Geneva, Switzerland: World Health Organization; 2002.Wyoming Suicide Prevention Plan6
#StopSuicideWyoSuicide in WyomingSuicide impacts all ages and races, and no group remains unaffected. In Wyoming, suicide is the secondleading cause of death contributing to years of potential life lost (YPLL) (Centers for Disease Control andPrevention, 2016b). YPLL is an estimate of the average time person would have lived had he or she not diedprematurely.YPLL is used to help quantify social and economic loss due to premature death. Estimated total lifetime costsassociated with suicide in Wyoming, expressed in 2010 costs, is 155,148,000 (American Foundation forSuicide Prevention, 2016). This includes both medical and work loss costs.Table 1. Years of Potential Life Lost (YPLL) in Wyoming, 2010-2014Cause of DeathUnintentional InjurySuicideMalignant NeoplasmsHeart DiseasePerinatal PeriodLiver DiseaseCongenital AnomaliesHomicideChronic Lower Respiratory DiseaseCerebrovascularAll ,8683,0221,8991,48221,936115,723Figure 2. Years of Potential Life Lost in Wyoming, 2010-2014Unintentional InjruySuicideMalignant NeoplasmsHeart DiseasePerinatal PeriodLiver DiseaseCongenital AnomaliesHomicideChronic Lower Respitory DiseaseCerebrovascularAll OthersWyoming Suicide Prevention 8991,48221,9367
#StopSuicideWyoWyoming Suicide RatesWhile significant variation can exist from year to year in suicide mortality numbers and rates, Wyoming hasconsistently had a higher suicide rate than the national rate. The average suicide mortality rate in Wyomingbetween 2011 and 2015 was 25.9 per 100,000 people; this is twice the national suicide rate of 12.93 per100,000 people (Wyoming Vital Stastics, 2016).Figure 3. Wyoming Suicide Rates Compared to NationalRates, 2011-2015Axis Title4030Wyoming20National100WyomingAverage2011 2012 2013 2014 2015Table 2. Wyoming Suicide Rates per 100,000 and age-adjusted to the 2000 USstandard PopulationSuicide and AgeAlthough there is variation from year to year, certain age groups consistently have a higher suicide rate inWyoming. Younger groups have had consistently lower suicide rates than middle-aged and older adults.Figure 4. Age-Adjusted Wyoming Suicide Rates by Age, 2012-2015140Age-Adjusted SuicideRates by Age inWyoming, 2012Age-Adjusted SuicideRates by Age inWyoming, 2013Age-Adjusted SuicideRates by Age inWyoming, 2014Age-Adjusted SuicideRates by Age inWyoming, 2015Average1201008060400 15 Years15-19 years20-24 years25-29 years30-34 years35-39 years40-44 years45-49 years50-54 years55-59 years60-64 years65-69 years70-74 years75-79 years80-84 years85 years20Table 3. Age-AdjustedWyoming Suicide Rates byAge, 2011-2015Under 24 years25-34 years35-44 years45-54 years55-64 years65-74 years75 yearsAge-AdjustedRate, 2011-201510.633.235.131.131.331.348.7*Rates per 100,000 and age-adjusted to the2000 US standard PopulationWyoming residents 75 years or older are the highest of all age groups in terms of age-adjusted suicide rates, ata rate of 48.7 persons per 100,000 between 2011 and 2015. This age group is followed by individuals 35-44years of age, at a rate of 35.1 persons per 100,000. Among youth ages 15-24 in Wyoming, suicide is thesecond leading cause of death after unintentional injuries(Centers for Disease Control and Prevention,2016a). The burden of suicide on Wyoming youth is reflected by high rates of suicidal thoughts and non-fatalsuicide behaviors among high school students. While there has consistently been some annual variationWyoming Suicide Prevention Plan8
#StopSuicideWyoamong categories, suicidal thoughts and behaviors among high school students saw an increase in 2015 in allcategories.Suicide Risk Factors in YouthThe following data are taken from the Youth Risk Behavior Surveillance System (YRBS), a survey that isgiven at public high schools across Wyoming, which monitors six types of health risk behaviors thatcontribute to the leading causes of death and disability.Table 4. Wyoming Youth Suicidal Ideation and Behavior (Youth Risk Behavior Survey)CategoryHigh School Students who seriouslyconsidered attempting suicide in last yearHigh school students who made a plan abouthow they would attempt suicide in last yearHigh school students who attempted suicidein last yearHigh school students who attempted suicidein the last year that resulted in need to betreated by a doctorHigh school students .5%27.2%30.8%This equates to approximately three in ten high school students who responded to the survey in 2015 havedepression or hopelessness, one in five students seriously considered attempting suicide in the past year, onein six students made a suicide plan, and one in twenty students made a serious suicide attempt in the last year(Wyoming Department of Education, 2016).Figure 5. Wyoming High School Students Self-Reported Rates (Youth Risk Behavior Survey)1 in 5 high school students a seriouslyconsidered attempting suicide3 in 10 high school students has depressionor hopelessness1 in 6 high school students has made a planabout how they would attempt suicideWyoming Suicide Prevention Plan91 in 20 high school students has attemptedsuicide
#StopSuicideWyoSuicide prevention efforts seek to reduce the factors that increase the risk for suicidal thoughts and behaviorsand increase protective factors that help strengthen, support, and protect individuals from suicide. Riskfactors are characteristic that make it more likely that a person will think about suicide or engage in suicidalbehaviors (U.S. Department of Health and Human Services Office of the Surgeon General and NationalAlliance for Suicide Prevention, 2012). Risk factors for suicide among youth include substance abuseproblems, family discord and dysfunction, sexual abuse, access to guns or prescription medication, schoolsafety issues, and antisocial behaviors. Data on protective factors reflect that approximately one-third of highschool seniors lack appropriate social skills, religiosity, or belief in a moral order, all of which can protectagainst suicidal behaviors (Wyoming Survey & Analysis Center, 2014). While the presence or absence of anysingle risk or protective factors is not predictive of suicide, these data are alarming.Suicide Risk Factors in AdultsSuicide risk factors in adults include alcohol dependency and heavy drinking, marital status, employment andincome stressors, retirement, physical illness/disability, mental health issues and military veteran status.Suicidal behaviors have drastically increased for male active-duty military personnel and veterans over thepreceding decade, a problem receiving considerable attention and resources from the various militarybranches (Hyman, J et al., 2012). Unemployment has been show to increase risk of suicide in males by asmuch as 300% (Coleman, D, Kaplan, MS, Casey, JT., 2011). Wyoming’s unemployment rate in 2015 averaged4.1 which was lower than the 2015 national average of 5.2. The unemployment rate has since increased inWyoming; the current unemployment rate (January – August 2016 average) is 5.36. This is higher than thecurrent national average in 2016 of 4.9 (January – August 2016 average).Table 5. Wyoming Adult Behavioral Risk FactorsCategoryMental health, which includes stress,depression, and problems with emotions,was not good for 14 or more of the past30 daysBinge drinking at least once in pastmonthHeavy drinking (60 drinks for men; 30 drinks for women) in past 30 daysExtreme drinking (more than 10 drinkson one occasion in past 30 days)Driving after perhaps having too muchalcohol at least once in past 30 daysSmoked at least 100 cigarettes in lifetimeand currently smoking every day orsomedaysPhysical health, which includes physicalillness and injury, was not good for 14 ormore days during the past 30 daysDisability – adults limited in any way inany activities because of physical, mental, oremotional problems or they have a healthproblem that requires the use of specialequipment such as a cane, wheelchair,special bed, or special telephoneWyoming Suicide Prevention 1%11.6%10.3%12.2%25%20.4%21.7%21.8%24.0%10
#StopSuicideWyoNo health care coverage, which includeshealth insurance prepaid plans such asHMOs or government plans such asMedicareUnable to see a doctor for needed carebecause of the cost at least once in the past12 2.1%*Intervening years between data.Wyoming Suicide Rates by CountySuicide rates vary by county across Wyoming. The lowest suicide rates from 2011 to 2015 in Wyoming arefound in Washakie, Teton, and Goshen counties. The highest suicide rates are found in Sublette, Niobrara*,and Johnson counties (Wyoming Vital Statistics, 2016).Figure 6. Age-Adjusted Suicide Rates by County in Wyoming, colnSweetwaterUintaCarbonAlbanyLaramie*Caution should be used in the interpretation of vital statistic rates which are basedon small population or a small number of events. For example, Niobrara rates haveseen great fluctuations from year to year, but the numbers are very small.Wyoming Suicide Prevention Plan11
#StopSuicideWyoSuicide and RaceThe highest rate of suicides occurring in 2015 in Wyoming was among white residents. The second highestsuicide rate was among blacks, which is unusual given the low rates in previous years. American Indian andAlaska Natives followed closely behind (Wyoming Vital Stastics, 2016).Table 6. Age-Adjusted Suicide Rates by Race in Wyoming, 2015RaceAll racesWhiteBlackAmerican Indian/Alaska NativeAsian/Pacific 0019.70.02015Rate29.730.916.112.37.4*Rates per 100,000 and age-adjusted to the 2000 US standard PopulationSuicide and GenderNationally,
suicide deaths per a population of 100,000 people in 2014, compared to the national average of 12.93 (Wyoming Vital Statistics, 2016). Between 2011 and 2015, 705 Wyoming citizens have died by suicide (Wyoming Vital Statistics,
zero suicide nationwide. In conjunction with our goal to prevent Veteran suicide, VA supports the national goal of reducing suicide in the U.S. by 20 percent by the year 2025. In this National Strategy for Preventing Veteran Suicide, the goals and objectives of the 2012 National Strategy have been adapted to address suicide prevention among .
Suicide, Samaritans USA , Suicide Awareness Voices of Education , and Yellow Ribbon Suicide Prevention Program. The strategy also reflects the input of family members who have lost loved ones to suicide, those who have attempted suicide, national organizations dedicated
Suicide, Samaritans USA , Suicide Awareness Voices of Education , and Yellow Ribbon Suicide Prevention Program. The strategy also reflects the input of family members who have lost loved ones to suicide, those who have attempted suicide, national organizations dedicated to
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Suicide is now the second or third leading cause of death for youth in the US, Canada, Australia, New Zealand, and many countries of Western Europe. If youth suicide is an epidemic, attempted suicide is even more so. For every teen that commits suicide (one-hundredth of one percent each year), 400 teens report attempting suicide (4 percent
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Yellow Ribbon Suicide Prevention Program . Yellow Ribbon is dedicated to preventing youth suicide and suicide attempts by making suicide prevention accessible to everyone and removing barriers to help by empowering communities and individuals through leadership, awareness
Rough paths Guide for this section Hölder p-rough paths, which control the rough differential equations dxt F(xt)X(dt),d ϕt F X(dt), and play the role of the controlhin the model classical ordinary differential equation dxt Vi(xt)dh i t F(xt)dht are defined in section 3.1.2. As R -valued paths, they are not regular enough for the formula µts(x) x Xi ts Vi(x) to define an .
