Suicide Prevention

Goal

To create a healthy, safe, and empowered community by reducing suicide attempts and deaths.

Magnitude of the Problem

Suicides were the leading cause of fatal injuries among Hawaii residents, accounting for 25% of the total. (Drug poisonings would be the leading mechanism, if intent was not taken into account.) The number of fatalities varied inconsistently over the 5-year period, although the 219 deaths in 2019 was the highest total to date. A commensurate decrease in the number of deaths coded as “undetermined intent” (i.e. generally possible suicides) has also complicated the assessment of trends. Residents of Oahu had significantly lower mortality or morbidity rates than residents of any other county. Fatality rates among all Neighbor Islands were not significantly different. These findings are consistent with national reports of higher rates, or risk, of suicide among more rural populations. Fatality rates peaked among 20 to 29 year-old Hawaii residents, and progressively decreased over the age span. Males comprised 80% of the victims, and had significantly higher rates than female residents of nearly every age group. Related autopsy records documented a history of mental illness for at least two-thirds (68%) of suicide victims, most commonly a “depressed mood” (54%); 24% had a diagnosis of depression. However, only 31% of decedents with a mental health problem were receiving treatment, and this proportion was much lower for residents of Neighbor Islands (8%), compared to those living on Oahu (40%). The most common “life stressors” were “problems” or “crisis” with their intimate partner (17%) or health (17%), with the former more prevalent among younger victims (29%) and the latter more prevalent (43%) among victims 65 years of age and older.

Suicide attempts, as inferred by self-inflicted injuries treated at hospitals, present a different epidemiology than deaths by suicide. The patients are majority (58%) female, 20% are under 18 years of age and 15 to 19 year-olds have the highest rates, and nearly two-thirds (63%) of the attempts are drug overdoses. By the most conservative method, there are an estimated 912 nonfatal attempts that require treatment in Hawaii hospitals each year; inclusion of injuries of undetermined intent or self-inflicted injuries with other principal diagnoses (e.g. mental illness) would more than double that estimate. The Hawaii Poison Center annually receives 865 calls that are related to intentional drug exposures.

Long-Term Indicators

Mortality and morbidity of Hawaii residents only: County & Totals, annual number and rate (/100,000)

Mortality

SMART Objective: Decrease the 5-year Suicide related mortality rate among Hawaii Residents from 63.51/100,000 in 2013-2017 to 57.159/100,000 by 2018-2022


Morbidity

SMART Objective: Decrease the 5-year Suicide attempt morbidity rate among Hawaii Residents from 344.05/100,000 in 2013-2017 to 309.64/100,000 by 2018-2022

Annual Fatal and Nonfatal Trends


Recommended Strategies

The Emergency Medical Service and Injury Prevention System Branch (EMSIPSB) places a priority on having injury prevention strategies recommended by a community-driven action plan or informed by key implementing partners. Because a multitude of factors influence individual behavior, the strategies in the below table target risk and protective factors, framed across the individual, relationship, community, and policy levels.

Key Partners