Active surveillance of New York City suicides, 2007

Background/Purpose: Like the US, New York City's (NYC) suicide rate has been stable in recent years. Effective prevention is predicated on understanding the fatal incident's circumstances. Administrative databases offer limited detail; auxiliary data are needed. Methods: NYC's Department of Health and Mental Hygiene identified 477 suicides in 2007 through International Classification of Disease specific cause of death codes (X60-X84,Y87). Using a standardized abstraction form, corresponding electronic records at the medical examiner's office were reviewed for decedent sociodemographic and psychiatric information, as well as detailed information on circumstances. Results: In 2007, 72% of NYC's suicide completers were male, 41.1% foreign-born, and 33.1% lived alone. Seventy-one percent of suicides occurred at home, with 64% of decedents alone at time of incident. Two thirds of decedents (65%) had documented psychiatric history; 27% left a suicide note. Top-ranking mechanisms of suicide were hanging/strangulation (25.8%), jumping from high places (19.1%), drug overdose (17.0%), and subway-related (8%). Asians had a higher suicide rate by hanging (2.8/100,000) than whites (1.5/100,000). For drug-overdose deaths, rates among men and women were comparable (0.9 vs. 1.0/100,000). While 26% of suicide deaths by jumping were from a roof, others were not limited to upper floors; 25.3% occurred below the 6th floor. Conclusions: Preliminary findings on NYC's suicides advance understanding of incident circumstances and underscore differences by mechanism. Results suggest structural approaches could be critical complements to clinical approaches to prevention. Restricting access to roofs and creating safety pits in subway tracks, for instance, are proven prevention approaches.