Contents

10. Social and Mental Health. 10-1

Core Indicators for Community Social and Mental Health. 10-3

Self-Reported Mental Status. 10-3

Projecting Mental Health Service Need. 10-5

Adults with Serious Mental Illness and Addiction. 10-5

Child and Youth Projections. 10-6

Self-Reported Substance Abuse Treatment Need. 10-7

Children and Youth. 10-8

Domestic Violence. 10-8

Child Abuse. 10-10

Homelessness In Marion County. 10-11

Acute Care Hospitalizations Due to Mental Health Conditions. 10-13

Mental Health Care Resources. 10-13

Drug-Related Mortality. 10-14

Suicide. 10-15

Homicide. 10-17

Tables and Figures

Table 10‑1: Social and Mental Health Summary Table. 10-1

Figure 10‑1: Marion County Adults Reporting Days with Depression Symptoms in the Past 30 Days, 2005  10-4

Figure 10‑2: Mean Depression Days in Past 30 Days, by Gender, Age Group, and Race, Marion County Adults 2005  10-5

Table 10‑2: DMHA Estimated Marion County Adult Population with Serious Mental Illness and Co-Occurring Disorder, 2006. 10-6

Table 10‑3: Indiana DMHA Estimated Marion County Youths 9-17 Years Old with Serious Emotional Disturbance, 2006. 10-7

Figure 10‑3: Percent of Indiana and Marion County Adults Seeking Alcohol or Drug Treatment When Needed: 2003 IN FSSA, DMHA.. 10-8

Table 10‑4: Substantiated Child Abuse and Neglect Rates: Marion County, Indiana and U.S., 2000 and 2005  10-11

Table 10‑5: Percent Mental Illness Diagnoses Among Marion County Discharges (2005) and of Total U.S. Hospital Discharges (2004), by Age. 10-13

Table 10‑6: Frequency and Rate of Psychoses Admissions per 100,000 Marion County Resident, 2000 and 2005  10-13

Table 10‑7: Inpatient Psychiatric Care Providers in Marion County. 10-14

Table 10‑8: Marion County Drug Induced Death Rates per 100,000 Persons by Age, 2005. 10-15

Table 10‑9: Drug Induced Deaths per 100,000 Persons, by Gender and Race, Marion County 2005 and U.S. 2003-2004. 10-15

Table 10‑10: Age-Adjusted Suicide Rate per 100,000: Marion County, Indiana, U.S., and Comparison Counties  10-17

10. Social and Mental Health

Table 10‑1: Social and Mental Health Summary Table

Measure	County Data	Recent Change				U.S. Comparison		IN Comparison		HP 2010
		yrs		% Change	DC	U.S. Data	DC	IN Data	DC
Positive Indicators for Marion County
Confirmed Child Abuse/ Neglect per 1,000	14.2 (2005)	5	-35% (2000-2005)		C	12.1 (2005)	DC	11.9 (2005)	DC	15-33 10.1
Neutral Indicators for Marion County
Drug-related mortality per 100,000 persons	11.0 (2005)	NA				9.7 (2003-2004)	DC	NA		26-3 1.2
% Adults with Serious Mental Illness (SMI)/ past 12 months	NA* (5.4% projected) (2005)	NA				9.8% (2003-2004)		10.3% (2002)		NA.
% Domestic violence in Women aged 15-44	11.3 Estimated (2005)	NA				8-17% (1999)	DC	NA		15-34 3.3% both sexes
Suicide deaths per 100,000 persons	10.0 (2005)	5		-9% (2000-2005)	DC	10.9 (2004)	DC	11.3 (2004)	DC	18-1. 4.8
Psychoses Discharges per 100,000 persons	513 (2005)	5		+22% (2000-2005)	DC	548 (2004)	DC	NA		NA
Negative Indicators for Marion County
1 +“Poor Mental Health Day/ Past 30 Days”	46.7%** (2005)	NA				33.5% (2004)	D	34.6% (2004)	D	NA
Uniform Crime Report: MSA Homicide per 100,000  persons	7.5 (2005)	NA				5.6 (2005)	D	5.7 (2005)	D	15-32 2.8
% Substance- abusing Adult Males Seeking Care	11.8% (2003)	NA				NA		14.6% (2003)	DC	18-9b 16%
% Substance- abusing Adult Females Seeking Care	5.2% (2003)	NA				NA		21.3% (2003)	D	18-9b 16%

* DMHA uses 5.4 percent to project all county adult SMI prevalence (2005) estimates.

** Marion County self reported “depression days” differs from U.S. and Indiana BRFSS Survey “Poor mental health days” question

Table notes: County data: Is for most recent year available. Recent Change: Percent change of most recent measurement from a measurement the noted number of years prior.  Changes of more than 5 percent in either direction are denoted by thumbs up or thumbs down symbols.  Neutral thumbs indicate no change, even though no change may be a negative outcome; U.S. or IN population data: Is for most recent year available; U.S. (or IN) Comparison: Comparison of most recent data using thumbs up or thumbs down symbolsthumbs up or thumbs down to denote differences that are statistically significant or deemed to be noteworthy from the analysts’ professional perspective. Note: When there is no public health implication associated with a measure, directional arrows replace thumb icons to indicate the direction of change or the relationship of the Marion County measure (higher/lower/not different) to the U.S./IN measure.  

 

Social and mental factors and conditions directly or indirectly influence overall health status as well as individual and community quality of life. Mental health conditions and overall psychological well being and community safety may be influenced by substance abuse and violence within the home and within the community.[355]

The Centers for Disease Control and Prevention’s Healthy People 2010 report defines mental health as a state of successful mental functioning, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity[356]. An estimated one in four (26.2%) of Americans over age 18 suffers from a diagnosable mental disorder in a given year and mental disorders are the leading cause of disability in the U.S. for ages 15 to 44 years.[357]

Core Indicators for Community Social and Mental Health

A 1997 Institute of Medicine report outlined several indicators of a community’s emotional and social well being.[358]  These include self-reported days of poor emotional mental health in the past 30 days, frequency indicators of familial/community violence and substance abuse, mental-health related acute care service utilization, and direct morbidity/mortality outcomes for the population. While many more indicators may be pertinent to the overall social and mental well-being of a community, these are basic, commonly reported measures allowing comparisons between geographic units and national health objectives.

Self-Reported Mental Status

One-third of U.S. adults (33.5%) in 2004 reported they had “poor” mental health status on at least one or more days in the past 30 days.[359]  In Indiana, 34.6 percent of adults report poor mental health, or one in three Whites (33.7%), 40.3 percent of Blacks and 42.3 percent of Hispanics (2004). Poor mental health prevalence among Indiana Blacks and Hispanics was higher than the national averages for these groups (34.4%, and 34.7%, respectively).[360]  By gender, Indiana does not differ from the national pattern, with 28.8 percent of men and 40.1 percent of women reporting poor mental health.

The 2005 BRFSS survey asked Indiana adults how many days in the past month their mental health was “not good” due to “stress, depression, or problems with emotions.”  Overall, 5.3 percent felt they had poor mental health every day, 10.5 percent reported from 7 to 29 affected days, while 2/3rds (62.7%) reported no poor mental health days in the past month. Prevalence of poor mental health “every day” is highest among respondents who were unemployed (12.7%), earned under $15,000/year (12.8%), had less than a high school education (11.7%) or who were not Black, White, or Hispanic (12.1%).[361]

In 2005 a representative random sample of nearly 5,000 Marion County adults over age 18 reported the number of depression symptom days they experienced in the past 30 days (Figure 10‑1).  Over half reported no days with depression symptoms (53.3%), but 8.1 percent reported between 8 to 29 days with some symptoms; 5 percent experienced “blues” or depression on all the past 30 days.[362]  Depression affects 9.5 percent of the U.S. adult population.[363]

Figure 10‑1: Marion County Adults Reporting Days with Depression Symptoms in the Past 30 Days, 2005

 

Source: 2005 MCHD Adult Obesity Survey (DR0502)

 

While not directly comparable to the BRFSS question asked of the state population (poor mental health days for stress, depression; emotional problems), the proportion of Marion County adults reporting “no days” with a depression/mental health problem (53.3%)[364] is somewhat lower that the overall percentage of adults in the state reporting “no poor mental health” days (62.7%).[365]

The mean number of depression days for Marion County adults by gender, age and race are seen in Figure 10‑2. As in national and state patterns, women report nearly 60 percent more depressed days than men, and Blacks and Whites lead all other racial groups in mean number of depression days in the past month.

Figure 10‑2: Mean Depression Days in Past 30 Days, by Gender, Age Group, and Race, Marion County Adults 2005

Source: 2005 MCHD Adult Obesity Survey (DR0502)

 

Projecting Mental Health Service Need

Adults with Serious Mental Illness and Addiction

The prevalence of serious mental illness (SMI)[366] in the previous year among adults over 18 for Indiana is 39 per 1,000 in 2002[367], nearly one-quarter of a million residents (246,467 or 10.3 percent of the adult population).This is similar to both the U.S. age-adjusted rate (40 per 1,000), and prevalence (9.8 percent of adults) reporting SMI in the past year for 2003 through 2004 (CI: 8.72-12.15).[368]  If applied to Marion County’s population over age 18, Indiana’s 10.3 percent SMI prevalence among 635,625 adults would result in over 63,000 cases.

In 2006 the Indiana Family and Social Services Administration Division of Mental Health and Addiction released the following imputed adult prevalence of SMI and co-existing addictions, applying national average estimates to county population figures.[369]  An overall prevalence of 5.4 percent SMI was applied to Marion County’s adult population, yielding an age-adjusted prevalence estimate of 34,324 cases (Table 10‑2). Of these, 14,876 are estimated to be below 200 percent FPG and would be eligible for DMHA-funded services.

Additionally, 23.2 percent of U.S. adults with SMI also have one or more chronic addictions[370] or, 7,963 of the estimated 34,324 SMI cases would have a co-occurring addiction, requiring specialized addiction services. Nationally the HP 2010 objective 18-9 is that 68 percent of adults with serious mental illness, and 57 percent of those with co-occurring substance abuse would receive treatment.[371]

Table 10‑2: DMHA Estimated Marion County Adult Population with Serious Mental Illness and Co-Occurring Disorder, 2006

Condition	State Percentage	Estimated MC Affected Adults	Percent < 200% FPG
SMI	5.4%	34, 324	14,876
Co-Occurring Addiction	23.2% of SMI cases	7,963	2,201

Source: Indiana FSSA DMHA INDIANA Estimated Prevalence of Adults with Serious Mental Illness (Age 18 Years and Over) by County, State Fiscal Year 2006 (Based on Year 2005 Recalculated U.S. Census Data), June 20 2005. SFY2006 Prevalence Reports.xls

 

Child and Youth Projections

Among children ages 9 to 17, national estimates indicate between 6 to 10 percent suffer serious emotional disturbance (SED), depending on a child’s score on a Global Assessment Functioning Scale (50 or 60). Applying this estimate to the 9 to 17 year old population in Marion County, between 7,430 to 12,384 youngsters would meet one of the GAF scale criteria for SED.[372]

Table 10‑3: Indiana DMHA Estimated Marion County Youths 9-17 Years Old with Serious Emotional Disturbance, 2006

Condition	State Percentage	Estimated MC Affected Youth	Percent < 200% FPG and Eligible for DMHA Services
SED	6-10%	7,430 to 12,384	5,592

Source: Substance Abuse and Mental Health Services Administration. Estimation Methodology for Children with a Serious Emotional Disturbance (SED) . Federal Register, October 6, 1997. Volume 62, Number 193, 52139 - 52145. SFY2006 Prevalence Reports.

 

Self-Reported Substance Abuse Treatment Need

The Indiana Family and Social Services Administration Division of Mental Health and Addiction’s 2003 survey of Indiana adults regarding their need for and use of various mental health and addiction services[373], published county-level prevalence estimates of self-reported substance abuse and affected individuals’ seeking of care.

In 2003, 70,031 Marion County men and 31,229 women reported abusing alcohol or drugs in the previous year, yet only 11.8 percent of men and 5.2 percent of women reported seeking substance abuse treatment from a professional or non-professional provider.  In the state 14.6 percent of men and 21.3 percent of women reporting substance abuse problems said that they sought care.  The HP 2010 objective 18-9b is for 16 percent of persons over age 12 who abuse alcohol or illicit drugs receive specialty treatment.[374]

While Marion County men were somewhat less likely to seek care than their state peers, Marion County women were only one-quarter as likely to report seeking care than other substance abusing women in the state (Figure 10‑3).

Figure 10‑3: Percent of Indiana and Marion County Adults Seeking Alcohol or Drug Treatment When Needed: 2003 IN FSSA, DMHA

Source: IN Adult Household Survey 2003 http://www.sis.indiana.edu/AdultHouseSurvey.aspx

 

Children and Youth

Some 66 percent of Indiana children aged 1 to 17 years with severe emotional, developmental or behavioral problems received mental health services, somewhat higher than the 59 percent nationwide (2004).[375] At the time of this writing comparable figures were not available for Marion County children and youth.

Individuals who are untreated for mental illness are more likely to be victimized by others. However, when combined with substance abuse, untreated individuals with a mental illness are at a high risk of posing danger to themselves and others. Approximately 30 percent of all incarcerated persons have a significant mental illness and/or addiction diagnosis. If they remain untreated, they are at high risk for repeated incarcerations.

Domestic Violence

The Centers for Disease Control and Prevention defines domestic- or intimate partner violence (IPV) as "actual or threatened physical or sexual violence, or psychological and emotional abuse, directed toward a spouse, ex-spouse, current or former boyfriend or girlfriend, or current or former dating partner."[376] IPV is a common public health problem with mental health consequences for victims and for children who witness the violence. The National Crime Victimization Survey found that 85 percent of IPV victims were women.[377]

IPV features a pattern of physical and sexual abuse, psychological abuse with verbal intimidation, and/or social isolation or deprivation. Between 8 to 17 percent of U.S. women are estimated to experience IPV[378], a major cause of injury for women aged 15 to 44. IPV accounts for about 30 percent of all emergency department treated injuries among women. According to CDC, an intimate partner physically or sexually assaults approximately 1.5 million women and 834,700 men in the United States each year. Most IPV incidents are not reported to the police. About 20 percent of IPV rapes or sexual assaults, 25 percent of physical assaults, and 50 percent of stalkings directed toward women are reported. Even fewer IPV incidents against men are reported.[379]

In Marion County nearly 21,000 women per year are physically abused in domestic relationships, of which approximately 4,000 domestic violence cases are prosecuted. Applying these 21,000 cases to the total Marion County population 15 and older (650,024) gives an estimated IPV assault rate of 32.3 per 1,000 persons (not including victims who are men).  Using these same reported cases to estimate prevalence of IPV among Marion County women aged 15 to 44 years (186,394) yields a rough estimate of 11.3 percent of women having experienced IPV in 2005, which falls within the national estimated range of 8 to 17 percent. The national Healthy People 2010 objective15-34 is to reduce physical assault by current or former intimate partnersto 3.3 assaults per 1,000 persons over age 12.[380]

Domestic violence is one of the leading causes of homelessness and poverty among women. Service providers estimate that two percent of domestic violence survivors seek shelter. Since 35,000 Marion County families are directly affected by domestic violence each year, as many as 700 local families every year could become homeless due to domestic violence.[381] Some 70 percent of Marion County court protective order requests involve violence-threatening domestic disputes (The Julian Center, Indianapolis, 2006).[382]  In fiscal year 2005-2006, the Marion County Connect2Help call line received 2,889 domestic abuse related calls, including 1218 for emergency shelter, and others for mental health or addiction service referrals or legal services.

The mental health consequences of domestic violence include depression, anxiety disorders (e.g., post-traumatic stress disorder), suicide, eating disorders, and substance abuse.[383] Children who witness domestic violence may suffer acute and long-term emotional disturbances, including nightmares, depression, learning difficulties, and aggressive behavior.

Children also become at risk for subsequent use of violence against their dating partners and wives.[384]  More than one-third of Marion County juvenile offenders in secure detention and one-half of Children in Need of Services (CHINS) clients in foster care have witnessed domestic violence.[385]

Child Abuse

The national child maltreatment[386] rate as reported by child protection agencies (abuse and neglect) was 12.1 per 1,000 children in 2005[387], or approximately 5 percent of all U.S. children.[388] The Healthy People 2010 Objective 15-33 is to reduce this rate to 10.1 cases per 1,000.[389]

Nationally 40.4 percent of child victims were maltreated by their mothers acting alone; 18.3 percent by their fathers; and 17.3 percent were abused by both parents. Non-parental perpetrators accounted for the remaining 10.7 percent of cases. In a nationally representative survey, 14 percent of U.S. children experienced some maltreatment: 8 percent of those were sexually abused, 22 percent were victims of neglect, 48 percent reported physical abuse, and 75 percent reported emotional abuse.[390]

In Indiana, 19,062 confirmed cases were reported in 2005[391], for a rate of 11.9 cases per 1000 children (2005 population: 1.6 million children).  This represented a slight decline from 13 per 1000 in 2001, and reflected national trends.[392]

Marion County’s rate of substantiated cases of abused and neglected children by Child Protective Services (CPS) was 14.2 per 1000 children under 18 during the state’s fiscal year 2005[393] (Table 10‑4).  Of these cases, 1853 (59 percent) were confirmed cases of neglect, 818 (26 percent) were cases of physical abuse and 466 (15 percent) were for sexual abuse.  There were ten deaths due to child abuse and neglect.

The overall rate of 14.2 per 1000 is a significant decrease from 2000 when the rate was 21.9 per 1,000.  In 2005 CPS processed over 5,500 reports of abuse and 6,300 reports of neglect for Marion County children and youth[394], an increase of over 40 percent since 2000.

Table 10‑4: Substantiated Child Abuse and Neglect Rates: Marion County, Indiana and U.S., 2000 and 2005

Source : Child Maltreatment 2005 Children's Bureau, U.S. Department of Health and Human Services

[1] Includes only those children with substantiated, indicated, or alternative response victim dispositions or a maltreatment death. Indiana and U.S. rates are based on federal fiscal year reporting (FFY).

2. Indiana Youth Institute  Kids Count in Indiana 2006 Data Book  2005 Marion County Fact Sheet http://www.iyi.org/reports/order-indiana-data-book.aspx

Homelessness In Marion County

Homelessness is a condition that results from low paying jobs, addictions, and mental illness, with the major reason being the lack of affordable housing.[395]    The average period of being homelessness among surveyed Marion County homeless was 2.2 years.[396] The average number of times individuals had been homeless was 3.6 times.[397]

A one-day street and shelter survey in January 2005 identified 2080 homeless individuals in Indianapolis: 740 (36 percent) in transitional housing, 1193 (57 percent) in emergency shelters and 147 (7 percent) on the streets.  This was about the same as counted in January 2003.[398] The local homelessness prevention coalition estimates from these numbers that 9,000 to13,000 Indianapolis residents will experience homelessness within the year, down somewhat from the 2000 through 2002 estimates of 15,000 homeless annually, and 3500 homeless on any given day. The 2005 survey found:

·        There are more newly or first-time homeless, especially among families, and women reporting domestic violence.

·        Correctional and foster care settings add to the count of homeless when discharged clients have no stable source of shelter.

·        Mental illness and lack of treatment is a growing problem, especially among women.

·        While Hispanics are increasing as a portion of the general population, they are not adding to numbers of homeless. Anecdotal accounts indicate that Hispanic social norms may promote sheltering vulnerable members with other family and friends.

 

Families account for 40 percent of this number and are the fastest-growing group of homeless people.[399]   Children account for another 30 percent of the homeless.   A local coalition estimated in 2002 that some 4,500 local childrenin Marion County become homeless each year. Children who become homeless are more likely to suffer physically and mentally and to do poorly in school. Over 20 percent will repeat a grade in school due to homelessness, compared to five percent of non-homeless children. About 100 young Marion County residents at age 18 also “age out” of the foster care system each year.  Currently, an estimated 40 percent of such young people become homeless or incarcerated within 18 months.[400]

A significant number of these homeless residents come from prisons, jails, or the foster care system.A 30-day survey of Indianapolis adults in homeless shelters found about 15 percent reported being recently released from prison or jail.[401]  The same survey found fewer than half of those with mental health or substance abuse problems had received treatment for these problems.[402]  National estimates suggest that 40 percent of homeless adults suffer from mental illness or addiction.  

Non-affordable housing is a major barrier for the homeless. In order for housing to be affordable, it should cost no more than 30 percent of a household’s income. In Marion County, working families receiving welfare payments earn an average of $7.62 per hour. However, they need to earn $11.31 per hour to afford a two bedroom apartment.  As a result, many of these families do not have access to affordable housing and, therefore, become homeless.[403] The “Blueprint To End Homelessness” initiative is one local effort to provide housing and services to the homeless residents of Marion County.

Acute Care Hospitalizations Due to Mental Health Conditions

The overall Marion County 2005 percentage of discharges for all mental conditions (ICD9 CM codes 290 through 319) is slightly higher than the most recently available U.S. figure (2004) but can’t be defined as significantly different, as these are two different reporting years (Table 10‑5).

Table 10‑5: Percent Mental Illness Diagnoses Among Marion County Discharges (2005) and of Total U.S. Hospital Discharges (2004), by Age

Source; Marion County Hospital Discharge data 2005 (DR 0490-T11)

 

Marion County’s hospital discharge rate for psychoses (513) per 100,000 persons increased 35 percent between 1994 and 1999, and increased a further 22 percent between 2000 and 2005 (Table 10‑6.). 

Marion County’s 2005 rate for psychoses discharges is not significantly different than the national discharge rate of 548 per 100,000 (2004).  Psychiatric illness discharge was the third leading diagnosis for the U.S. following heart disease and delivery of newborns.[405]  There are no associated HP 2010 objectives for either psychiatric or mental health acute care episodes.

Table 10‑6: Frequency and Rate of Psychoses Admissions per 100,000 Marion County Resident, 2000 and 2005

Cause	2000		2005		Change
	Frequency	Rate	Frequency	Rate
Psychoses[406]	3612	419	4428	513	22.4%

Source; Marion County Hospital Discharge data 2005 (DR 0490-T11)  NCHS.Advance Data From Vital and Health Statistics Number 371, May 4 2006; http://www.cdc.gov/nchs/data/ad/ad371.pdf  Table 3. Rate of discharges

Mental Health Care Resources

Marion County’s licensed physicians in 2001 included 116 psychiatrists among its 1,986 specialist (non-primary care) physicians, or approximately 6 percent of medical specialists practicing in the mental health field.  This is similar to the 7 percent of specialists practicing psychiatry in the state.

Indiana had 1,519 licensed psychiatric acute care beds (1998) and an inpatient census of 1,894 (2000).[407]  Marion County has five hospitals and one mental health center offering acute and long-term in-patient care (Table 10‑8.). The total number of psychiatric in-patient beds in Marion County’s acute care hospitals was not available at the time of this report.

Table 10‑7: Inpatient Psychiatric Care Providers in Marion County

Name	Type	Care
Fairbanks Hospital	Voluntary Not for Profit	Psychiatric Residential short-and long term, Partial hospitalization - Adults and adolescents
Larue Carter Hospital	State; Public	Long-term Psychiatric
Community Hospital North	Voluntary Not for Profit	Short term Psychiatric- & Detox - Adults
St. Vincent Hospital Harcourt Road	Voluntary Not for Profit	Short term Psychiatric- & Detox - Adults
Wishard Hospital	County; Public	Short term Detox - Adults
Wishard Hospital	Voluntary Not for Profit	Short term Psychiatric- Adults (direct admission & referrals from Midtown Mental Health Center)

Source: FSSA HAP http://www.in.gov/apps/fssa/hap/clinicdetails.jsp?facid=294&selectby=Adults&searchvalue=marion&facilityid=47

 

Drug-Related Mortality

Substance abuse is a major factor in both accidental and intentional injury deaths.  One indicator of the impact of illicit drug use, other than alcohol, is death certificate indication of drug use as a leading or contributing cause of death, including but not limited to drug psychoses, drug dependence or abuse of drugs, and fetal deaths indicating fetal exposure to maternal drug abuse.  In the U.S., 28,457 deaths were coded as “drug-induced”, for an age-adjusted rate of 9.7 deaths per 100,000 persons. The Healthy People 2010 objective 26-3 is to reduce the rate of drug-related mortality to 1.2 deaths per 100,000 persons.[408]

For age-adjusted drug-induced deaths, Marion County has an overall rate of 11.0 per 100,000, similar to the U.S. rate[409], with men having a higher rate (12.8 per 100,000) than women (9.1 per 100,000).  By age group, drug-induced deaths are too few to estimate rates for persons under 14; but, for 15 to 24 year olds, the rate was 8.3 per 100,000, increasing to 19.5 among 25 to 44 year olds and 17.0 for those aged 45 to 64 years. By comparison, persons 65 and older have a rate of 2.0 per 100,000 in Marion County (Table 10‑8.).

Table 10‑8: Marion County Drug Induced Death Rates per 100,000 Persons by Age, 2005

Source: Marion County Death Certificates2005 (DR 0490-T11)

 

By ethnicity Whites have over twice the rate of drug-induced deaths (13.7) than do Blacks (6.4), and an over ten-fold rate compared to Hispanics (1.0) per 100,000).  Gender and race specific rates for Marion County are seen in Table 10‑9.

Table 10‑9: Drug Induced Deaths per 100,000 Persons, by Gender and Race, Marion County 2005 and U.S. 2003-2004

	Marion County Males	Marion County Females	Marion County Total 2005	U.S. Rate 2003-2004	HP 2010 Objective
Total	12.8	9.1	11.0	9.7	1.2
White	15.3	12.0	13.7
Black	10.1	3.3	6.4
Hispanic	1.6	0.0	1.0
Other	0.0	0.0	0.0

Source: Marion County Death Certificates; Miniño AM, Heron MP, Smith BL. Deaths: Preliminary Data for 2004. NVSR; vol 54 no 19. Hyattsville, MD. National Center for Health Statistics 2006. http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_19.pdf

 

Suicide

Suicide was the eleventh leading cause of death in the U.S. in 2004[410], for an overall age-adjusted rate of 10.8 intentional injury (suicide) deaths per 100,000 persons.[411]  An estimated eight to 25 attempted suicides occur per every suicide death.[412]  Suicide was the 8^th leading cause of death among U.S. men in 2004. Overall, men are four times more likely than women to die by suicide, especially at younger ages.

Among young adults suicide was the 3rd leading cause of death nationally for those age 20 to 24 years, and the 5^th ranked cause for those aged 15 to 19 years.[413] Individuals over age 65 years also have higher suicide rates than the national average (14.3 deaths per 100,000).  By race, Whites and Native American/Alaskan Natives have 2.5 times the risk of suicide than Blacks and Hispanics in the U.S. (12.5 each respectively, versus 5.6 per100,000).[414]  The Healthy People 2010 objective 18-1. for suicides is to reduce the rate to 4.8 deaths per 100,000.[415]

Nationally, over 90 percent of suicide deaths are preceded by risk factors such as depression, singularly or in combination with other mental disorders, or a substance-abuse disorder.[416] Having a firearm in the home is also a risk factor, as over half of suicides among men and one-third among women involve firearms.[417] Alcohol use is also implicated in 23 percent of suicides.[418]

In Indiana suicides and homicides were the 11th and 13th leading causes of death in 2001.[419] Self-inflicted deaths were caused by firearms (59 percent), suffocation (19 percent), and poisoning (17 percent). Age adjusted suicide rates have been relatively stable in both Indiana (range: 11.3 to 12.1 per 100,000) and the nation (range: 10.4 to 10.9 per 100,000) between 2000 and 2004.

In 2004 Marion County’s suicide rate of 12.0 per 100,000 was similar to both the age-adjusted suicide rate in Indiana (11.3 per 100,000)[420] and the U.S. (10.9 per 100,000), but was higher than the Healthy People 2010 objective of 4.8 deaths per 100,000 (Table 10‑10).

Table 10‑10: Age-Adjusted Suicide Rate per 100,000: Marion County, Indiana, U.S., and Comparison Counties

Cause of Death	Marion County			Indiana 2004	Milwaukee 2005	Nash-ville 2004	U.S. 2004	HP 2010
	2000	2004	2005
Suicide	11.0	12.0	10.0	11.3	10.0	12.0	10.9	4.8

Age-adjusted to match the age distribution of the 2000 U.S. population, so comparisons across regions will not be affected by differences between regions’ age distributions.

ICD10 codes for intentional self-injury (suicide) deaths include U03,X60–X84,Y87.0

Source: Marion County Death Certificates; IN: Indiana Mortality Report 2004, ISDH[421]; U.S.: CDC, National Center for Health Statistics;[422] WI: WISH Data Query System, Wisconsin Dept. of Health & Family Services[423]; TN: HIT (Health Information Tennessee), Tennessee Dept. of Health.[424] Suicide rates by Race and Age

 

As a previous suicide attempt is one of the strongest predictors of subsequent suicide, cognitive therapy helps attempters consider alternatives, if thoughts of self-harm occur.[425] A majority of older adults and female suicide victims saw a primary care provider in the year before death.  Improving providers’ recognition and treatment of risk factor conditions may prevent suicides in these populations.[426]

Homicide

Nationally[427] the Uniform Crime Reports (UCR) indicate a rate of 5.6 homicide deaths per 100,000 persons and national homicide rates increased 2.4 percent between 2000 and 2004.  The UCR data reflect criminal events reported from local police agencies[428].  In cities with populations over 250,000, the mean homicide rate was 12.6 per 100,000.  The UCR event reports are given here, as they are a major source for comparison of large metropolitan areas of the country.

The 2005 Indianapolis metropolitan statistical area (MSA)’s rate of 7.5 homicides per 100,000 persons[429] is the same as the St. Louis MSA, and is similar to Nashville (8.1 per 100,000) and Milwaukee (8.6). 

For homicide mortality data specific to residents of Marion County reflecting death certificate data for 2005, see Table 13‑1: Causes of Death Summary Table.[430]  By either UCR or vital statistics data, most urban areas, including Marion County, are a long way from achieving the Healthy People 2010 objective 15-32 of 2.8 homicide deaths per 100,000 persons.[431]