Examine

State suicide prevention efforts must be data driven in order to be effective, and in order to determine effectiveness and continuously improve, the efforts must be evaluated. As a result, capabilities related to data collection, analysis, use, evaluation design, and dissemination are needed. No single source can provide all data needed to understand the suicide problem, including data on suicide deaths, attempts, thoughts, and related risk and protective factors in the state.

For this reason, suicide prevention leads and coalitions must also be able to access, compile, analyze, and use existing data collected by multiple entities at the local, state, and federal levels, as well as understand which data are appropriate for use in evaluation. This will allow the state to do the following:

  • Collect better data on suicidal behaviors
  • Identify populations at risk
  • Select the most appropriate strategies
  • Monitor impact
  • Disseminate information to decision makers, local programs, and others to advance suicide prevention efforts across the state

Regular analysis of this data will also help to identify new emerging needs and inform new prevention efforts.

Recommendations

Allocate sufficient funding and personnel to support high-quality, privacy-protected suicide data collection and analysis

These resources must support hardware, software, and personnel needs for a well-functioning data system. They include access to the state epidemiologist or another data analyst who has the capabilities required to collect data from different sources, perform targeted analyses, and develop action reports. Improving suicide data collection systems and training for partners like coroners and medical examiners can assist in getting rich and complete morbidity and mortality data.

 

Identify, connect with, and strengthen existing data sources

As data related to state-level suicide prevention efforts often reside in various systems, it is critical to identify and connect with multiple existing state data collection sources, such as those described in SPRC’s online course Locating and Understanding Data for Suicide Prevention. It’s also important for the state to help strengthen and support systems within their purview. These data sources include the following:

  • State Violent Death Reporting System, included in CDC’s National Violent Death Reporting System (NVDRS) and its Web-based Injury Statistics Query and Reporting System (WISQARS™)
  • CDC national surveys: The Youth Risk Behavior Surveillance System (YRBSS), and optional add-on questions for the Behavioral Risk Factor Surveillance System (BRFSS)
  • State-sponsored health surveys
  • The National Survey on Drug Use and Health (NSDUH) conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), which provides state-level estimates of adult suicidal ideation, plans, and attempts
  • State and/or local Child Fatality Review Teams (CFRTs), a data collection effort funded by the Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCHB)
  • State and/or local suicide fatality review committee, if one exists in your state
  • For states with small to medium population and where NVDRS still in its initial stages, suicide deaths data available from medical examiners or coroners (coroner/medical examiner reports, death certificates), local law enforcement (police reports)
  • Suicide attempt data available from hospitals and emergency departments (e.g., claims, discharge and syndromic surveillance data) and from Poison Control
  • State contacts (often in the state health department) for the National Syndromic Surveillance Program (NSSP) BioSense Platform,1 which provides public health officials with a common cloud-based health information system for collecting, evaluating, storing, and sharing real-time information about suicidal ideation and attempts from participating hospitals

It is also important to identify and connect with other data sources within the state. Examples include the following:

  • Community-level sources (e.g., funeral homes, crisis response services, first responders)
  • Organizations and individuals with a role in serving veterans and active duty service members (e.g., veterans commission, veteran-serving agencies, VA suicide prevention coordinators, military base suicide prevention coordinators, National Guard and Reserve psychological health directors)
  • Federal suicide prevention and related grantees, who may be collecting their own data
  • Youth-serving state systems (juvenile justice, child welfare, mental health), crisis systems, adult corrections systems
  • Public and private mental health care systems

 

Ensure that high-risk and underserved populations are represented in data collection

Well-established, large datasets may not always adequately include underserved communities. In these cases, it’s important to make efforts to ensure that underserved communities are better represented (e.g., by targeted recruitment, oversampling, or other methods). When data on underserved populations cannot be obtained reliably or in a large enough number through such channels, the state suicide prevention program should work to address these gaps through stakeholder conversations about other data options, including alternate existing sources and/or the creation of new ones.

Partners who represent specific communities can help in a number of ways:

  • Locating existing data on their specific population(s)
  • Exploring gaps in traditional data sources
  • Supporting data collection among their key audience via qualitative methods such as focus groups and key informant interviews
  • Providing data and insight themselves

In particular, states should actively consult with and include tribes and urban Indian groups in conversations about appropriate ways to ensure that accurate data on suicidal behaviors is collected, protected, and only shared with tribal permission. State leaders should also consult with other affected stakeholders on the best data collection methods and ways of sharing analyses.

 

Develop the skills and a plan for regularly analyzing and using data to inform action at the state and local levels

Data is critical to informing the broad state plan and specific programming decisions at the state and local levels. It is also important for strategically prioritizing populations, geographic areas, partners to engage, and risk and protective factors to address. Process, impact, and outcome data evaluation must be planned and examined appropriately so data reflect barriers and true progress rather than coincidence or findings with insufficient strength.

State programs must therefore develop the capacity to integrate findings from diverse sources and nimbly address emerging trends/patterns while not being pulled off course by current events or brief changes to real-time data (such as a suicide that gains public attention or a short-term but sharp increase in suicides) that could propel them to prematurely change course on prevention activities.

In addition, state leadership must be able to respond to data requests and disseminate key findings to partners and the general public (e.g., via reports, presentations, fact sheets, infographics, and social media). Some states have created a data dashboard that provides surveillance data and other information and resources to legislators, local health departments, the media, and other audiences. The data should also be made available at the local level and to grassroots agencies while protecting privacy.

 

To further strengthen your infrastructure

Link data from different systems while protecting privacy

In order to get richer data in a number of areas (e.g., suicide deaths and attempts, needs of high-risk populations, system improvement opportunities, risk and protective factors), states can connect data from different systems through available linking variables. Using linking variables may require additional investments in technical and legal infrastructure (memoranda of understanding, business associate agreements) as there may be challenges to sharing data across systems.

Some examples of data system connections include:

  • Linking health care claims database and vital statistics data to show trends in diagnoses and suicide deaths
  • Linking state mental health system records, death certificates, and criminal justice system records to identify groups of offenders who have unmet mental health needs
  • Securely sharing data between health providers’ differing medical record systems about individuals at high risk for suicide in order to identify areas for improvement of patient care coordination

 

 

References

  1. Centers for Disease Control and Prevention. National Syndromic Surveillance Program (NSSP): BioSense Platform. Retrieved on April 9, 2019 from https://www.cdc.gov/nssp/biosense/index.html.