Implementation of a countywide adult suicide review commission: Development, lessons learned, and recommendations.

INTRODUCTION: Fatality review is a public health approach designed to inform efforts to prevent fatalities of a certain kind (e.g., suicide, homicide) or in a specific setting or population (e.g., hospitals, youth). Despite extensive literature on fatality review generally, the literature on suicide review teams specifically is scant. The aim of this paper is to: describe the implementation of a local adult suicide review commission, detail examples of initial outcomes and recommendations developed by the commission, and provide recommendations and/or best practices for how to develop and implement an adult suicide review team. METHODS: We utilize framing questions from the American Association of Suicidology's psychological autopsy framework. By using these guiding questions in the discussion, members are invited to explore not only the stressors that may have more immediately preceded the suicide event itself, but to situate those stressors in the context of the individual's life course. RESULTS: Several recommendations proposed by our commission have resulted in tangible outcomes and are detailed using Haddon's Matrix as a guiding prevention planning tool. IMPLICATIONS: We have highlighted the need to move beyond looking at individual-level help-seeking to focus on structural/systemic issues that result in stress or create unsafe environments for at-risk individuals.

Trends in Adult Suicide Rates in Milwaukee County, Wisconsin, 2002 through 2020.

BACKGROUND: Monitoring suicide rates is an important public health strategy to inform prevention efforts. We describe rates of adult suicide in Milwaukee County, Wisconsin, over a 19-year period. METHODS: Data on all adult suicides from 2002 through 2020 (n = 981) were obtained from the Milwaukee County Medical Examiner's Office. Subpopulation rates were identified using the Wisconsin Interactive Statistics on Health System. RESULTS: Suicide rates increased significantly over the study period, with disproportionate increases among Black and Latinx residents. DISCUSSION: Expanded prevention efforts are needed to reverse this concerning trend. Further research should guide development of culturally relevant interventions, provide data for the equitable allocation of limited resources.

Linking emergency care and police department data to strengthen timely information on violence-related paediatric injuries.

BACKGROUND: Combined ED and police department (PD) data have improved violence surveillance in the UK, enabling significantly improved prevention. We sought to determine if the addition of emergency medical service (EMS) data to ED data would contribute meaningful information on violence-related paediatric injuries beyond PD record data in a US city. METHODS: Cross-sectional data on self-reported violence-related injuries of youth treated in the ED between January 2015 and September 2016 were combined with incidents classified by EMS as intentional interpersonal violence and incidents in which the PD responded to a youth injury from a simple or aggravated assault, robbery or sexual offence. Nearest neighbour hierarchical spatial clustering detected areas in which 10 or more incidents occurred during this period (hotspots), with the radii of the area being 1000, 1500, 2000 and 3000 ft. Overlap of PD incidents within ED&EMS hotspots (and vice versa) was calculated and Spearman's r tested statistical associations between the data sets, or ED&EMS contribution to PD violence information. RESULTS: There were 935 unique ED&EMS records (ED=381; EMS=554). Of these, 877 (94%) were not in PD records. In large hotspots >2000 ft, ED&EMS records identified one additional incident for every three in the PD database. ED and EMS provided significant numbers of incidents not reported to PD. Significant correlations of ED&EMS incidents in PD hotspots imply that the ED&EMS incidents are as pervasive across the city as that reported by PD. In addition, ED and EMS provided unique violence information, as ED&EMS hotspots never included a majority (>50%) of PD records. Most (676/877; 77%) incidents unique to ED&EMS records were within 1000 ft of a school or park. CONCLUSIONS: Many violence locations in ED and EMS data were not present in PD records. A combined PD, ED and EMS database resulted in new knowledge of the geospatial distribution of violence-related paediatric injuries and can be used for data-informed and targeted prevention of violence in which children are injured-especially in and around schools and parks.

"I've given up": Biopsychosocial factors preceding farmer suicide in Wisconsin.

Recent studies have suggested that individuals working in certain occupations may be at increased risk for suicide. While occupation is an individual-level factor, one's work is situated in organizations, communities, and societies that are impacted by policies and systems. Analysis of existing data has identified that farmers are among those with elevated rates of suicide. This qualitative study reports themes that capture the experience of farmers prior to their death by suicide in Wisconsin. This retrospective qualitative study analyzed data from the Wisconsin Violent Death Reporting System. Data on farmer suicides that occurred in Wisconsin between 2004 and 2018 were accessed. Qualitative analyses followed an inductive thematic analysis approach. All study activities were approved by the institutional review board at the Medical College of Wisconsin. Between 2004 and 2018, 190 farmers died by suicide in Wisconsin. Five themes were identified in the qualitative analysis: "rugged individualism" clashes with a need to rely on others, interpersonal loss causes intense emotional pain and suffering, financial stress and strain overwhelm Wisconsin farmers, farmers are providers for families and communities, and alcohol and firearms are a lethal combination. Farmers who died by suicide in Wisconsin were facing significant stressors at the time of their death, many of which were not directly related to verifiable diagnosed mental illness. These circumstances varied, from physical health issues to financial stressors, to emotional pain from interpersonal conflict, and to access to lethal means. This study provides evidence calling for a public health solution to this issue, through changes at the policy, systems, and cultural levels. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Disparities in disposition from trauma centers to inpatient psychiatric treatment in a national sample of patients with self-inflicted injury.

BACKGROUND: Surgery providers are integral to the treatment of patients with self-inflicted injuries. Patient disposition (eg, home, inpatient psychiatric treatment, rehabilitation) is important to long-term outcomes, but little is known about factors influencing disposition after discharge following traumatic self-inflicted injury. We tested whether patient or injury characteristics were associated with disposition after treatment for self-inflicted injury. METHODS: National Trauma Data Bank query for self-inflicted injuries from 2010 to 2018. RESULTS: There were 77,731 patients treated for self-inflicted injuries during the study period. Discharge home was the most common disposition (45%), and those without insurance were less likely to discharge to inpatient psychiatric treatment than those with insurance. Racial minority patients were less likely to discharge to inpatient psychiatric treatment (18.9%) than nonminority patients (23.8%, P < .001). Additionally, patients discharged to inpatient psychiatric treatment had significantly lower injury severity score (7.24 ± 7.5) than those who did not (8.69 ± 9.1, P < .001). CONCLUSION: Racial/ethnic minority patients and those without insurance were significantly less likely to discharge to an inpatient psychiatric facility after treatment at a trauma center for self-inflicted injury. Future research is needed to evaluate the internal factors (eg, trauma center practices) and external factors (eg, inpatient psychiatric facilities not accepting patients with wound care needs) driving disposition variability.

Implementation and initial analysis of Cardiff Model data collection procedures in a level I trauma adult emergency department.

OBJECTIVES: Our understanding of community violence is limited by incomplete information, which can potentially be resolved by collecting violence-related injury information through healthcare systems in tandem with prior data streams. This study assessed the feasibility of implementing Cardiff Model data collection procedures in the emergency department (ED) setting to improve multisystem data sharing capabilities and create more representative datasets. DESIGN: Information collection fields were incorporated into the ED electronic health record (EHR), which gathered additional information from patients reporting assaultive injuries. ED nurses were surveyed to evaluate implementation and feasibility of information collection. Logistic regression was performed to determine associations between missing location information and patient demographic data. SETTING: 60-bed academic level I trauma adult ED in a large Midwestern city. PARTICIPANTS: 2648 patients screened positive for assault injuries between 2017 and 2020. 198 patients were omitted due to age outside the range served by this ED. Unselected inclusion of 150 ED nurses was surveyed. MAIN OUTCOME MEASURES: Main outcomes include nursing staff survey responses and ORs for providing complete injury information across various patient demographics. RESULTS: Most ED nurses believed that information collection aligned with the hospital's mission (92%), wanted information collection to continue (88%), did not believe that information collection impacted their workflow (88%), and reported taking under 1 min to screen and document violence information (77%). 825 patients (31.2%) provided sufficient information for geospatial mapping. Likelihood of providing complete location information was significantly associated with patient gender, race, arrival means, accompaniment, trauma type and year. CONCLUSIONS: It is feasible to implement information collection procedures about location-based, assault-related injuries through the EHR in the adult ED setting. Nurses reported being receptive to collecting information. Analyses suggest patient-level and time variables impact information collection completeness. The geospatial information collected can greatly improve preexisting law enforcement and emergency medical systems datasets.

The Association Between Repealing the 48-Hour Mandatory Waiting Period on Handgun Purchases and Suicide Rates in Wisconsin.

IMPORTANCE: Suicide is a significant public health burden in the United States. There is little understanding how policies regarding gun purchasing affects suicide rates. Wisconsin state legislature rescinded a 48-hour waiting period for handgun purchases, which took effect in June 2015. OBJECTIVE: To determine whether firearm-related suicide increased with the repeal of the 48-hour waiting period for handgun purchases in 2015. METHOD: We obtained data through the Wisconsin Department of Health Services via the Wisconsin Interactive Statistics on Health Query System. Suicide rates were compared by Comparative Mortality Figures (CMF). RESULTS: We reviewed all suicides in Wisconsin between 2012-2014 and 2016-2018. The rate ratios (R) and second generation P values (pδ) comparing deaths between 2012-2014 and 2016-2018 indicate significant increases in firearm-related suicide among people of color (R = 1.927; pδ = 0.0) and among Wisconsinites residing in urban counties (R = 1.379, pδ = 0.0). There was no significant increase in non-firearm-related suicide (R = 1.117, pδ = 0.092), nor in firearm-related suicide among White non-Hispanics (R = 1.107, pδ = 0.164) or Wisconsinites residing in rural counties (R = 1.085, pδ = 0.500). CONCLUSION: Our findings suggest that the repeal of the 48-hour waiting period on handgun purchases in 2015 is correlated with the increase of firearm-related suicides among Wisconsin residents of color and Wisconsinites residing in urban counties.Key Messages:Firearm policies are associated with changes in suicide rates.

Shift in Drug vs Alcohol Prevalence in Milwaukee County Motor Vehicle Decedents, 2010-2016.

OBJECTIVE: The purpose of this study is to examine the prevalence of alcohol and nonalcohol drugs in motor vehicle crash (MVC) decedents in Milwaukee County, Wisconsin. METHODS: A retrospective review of MVC decedents in Milwaukee County from 2010 to 2016 was performed. Substances were divided into 5 categories based on chemical composition and clinical effects: alcohol, cocaine and its metabolite benzoylecgonine, opioids, cannabinoids, amphetamines and methamphetamines. Decedents were determined to be positive if any of these substances were detected on blood toxicology analysis. RESULTS: Sixty-five percent (n = 113) of MVC decedents tested positive for 1 substance, while polysubstance use (≥ 2 substances) was seen in 27% (n = 47). Alcohol was the most prevalent substance (n = 77, 44%), while cannabinoids were the second most prevalent (n = 50, 29%), and opioids were third most prevalent (n = 24, 14%). There was a statistically significant increase in the number of MVC decedents who tested positive for opioids from 2010 to 2016 (slope = 3.9, P < 0.01). The number of decedents who tested positive for alcohol only from 2010 to 2016 decreased significantly (slope = -3.9, P < 0.05), and 2016 was the first year in which the number of drug-positive decedents exceeded the number of alcohol-positive decedents. CONCLUSION: The prevalence of drugs exceeded that of alcohol in decedents for the first time in 2016 in Milwaukee County. While continued efforts to reduce alcohol-positive driving are encouraged, increased attention to drugged driving is needed to prevent further drug-positive fatalities.