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The State of Health in New Mexico 2018

10. Violence

The Violence Epidemic in New Mexico

Violence is a public health problem of epidemic proportions, both nationally and in New Mexico. In 2016, violence accounted for nearly 65,000 deaths in the United States. New Mexico had the second highest intentional injury death rate in the U.S. in 2016, 32.8 deaths per 100,000 population.

Intentional Self-harm

For over two decades, suicide rates in New Mexico have been at least 50% higher than U.S. rates. In 2016, New Mexico had the fourth highest suicide rate among all U.S. states. Over the last decade, the suicide rate in New Mexico increased 25%, from 17.7 per 100,000 in 2006 to 22.2 per 100,000 in 2016, mirroring a similar increase (21%) in suicides at the national level.

In 2016, suicide was the ninth leading of cause of death in New Mexico, accounting for a total of 469 deaths. However, among persons 15-44 years of age, suicide was the 2nd leading cause of death. Suicide was responsible for 13,523 Years of Potential Life Lost (YPLL), fourth after unintentional injuries, cancer, and heart disease deaths.

Most suicides were caused by firearm injuries (52.9%), followed by suffocation (25.5%), poisoning (16.8%), and other injury mechanisms (4.8%). Over the past 8 years, firearm suicide rates in New Mexico increased by 21%; and suffocation suicide rates increased by 38%.

Assault

Homicide, or death caused by an injury purposely inflicted by other persons, is a significant public health problem in New Mexico. Annual homicide rates in New Mexico have consistently been higher than U.S. rates. In 2016, New Mexico had the sixth highest homicide rate (9.4 per 100,000) in the nation. Recently, homicide rates in New Mexico increased by 42%, from 6.6 per 100,000 in 2013 to 9.4 per 100,000 in 2016, the highest homicide rate in New Mexico in the past 18 years.

Firearm injury was the leading cause of assault deaths, accounting for 59.8% of homicides, followed by other causes (21.9%), cut/pierce (15.7%), and suffocation (2.7%). Between 2010-2012 and 2014-2016, firearm assault death rates in New Mexico increased by 20% and suffocation assault death rates tripled from 0.1 to 0.3 per 100,000 population.

Firearm Violence

Firearm-related violence is associated with significant morbidity and mortality. In the U.S., more than 36,000 persons died of a firearm injury in 2016. New Mexico had the eighth highest rate of firearm death among U.S. states. Over the past 17 years, firearm death rates in New Mexico have been consistently higher than U.S. rates and have been increasing more steeply than the U.S. rate.

In 2016, the firearm death rate was 17.8 per 100,000, accounting for 381 deaths among New Mexico residents. From 2012-2016, most firearm deaths were due to intentional self-harm (69.0%), followed by assault (25.7%) and legal intervention (3.3%). Only 0.6% of firearm injury deaths were unintentional. During this 5-year period, firearm suicide rates increased by less than 2%, whereas firearm homicide rates increased by 35.7%.

Sexual Violence

Sexual violence is a major public health problem with serious long-term physical and mental health consequences that disproportionately impact young people. Nearly half of women, and nearly all men, who report ever having been forced to have sex were first raped as a child. Youth with a history of forced sex report lower emotional well-being and self-esteem and feelings of sadness and hopelessness. Numerous studies have documented the long-term impact of sexual violence victimization on mental health, suicide risk, and substance abuse.

Data from the National Intimate Partner and Sexual Violence Survey 2010-2012 State Report indicate that more than one third of women in New Mexico (37.8% or an estimated 296,000 women) experienced some form of contact sexual violence victimization during their lifetime; and one in five women (20.4%) experienced rape at some point in life. In addition, 16.0% of New Mexico men (or an estimated 120,000 victims) experienced some form of contact sexual violence victimization during their lifetime; and 5.5% of New Mexico men were made to penetrate someone at some point in their life.

Contributing Factors

Health Disparities

Intentional Self-harm
From 2012-2016, the male suicide rate (33.5 per 100,000) was more than three times higher than the female suicide rate (9.9 per 100,000). Males tend to use more lethal means and do not typically disclose their intent to harm themselves. However, the sex disparity in New Mexico suicides has narrowed since 1999 due to a larger increase in death rates among females (55%) compared to males (14%). There was an almost threefold increase in suicides among American Indian females from 1999-2003 (3.6 per 100,000) to 2012-2016 (9.9 per 100,000).

According to U.S. Department of Veterans Affairs, the New Mexico veteran suicide rate was significantly higher than the U.S. rate after accounting for differences in age. The suicide rate among New Mexico veterans has been on average 2.5 times higher than the suicide rate in the New Mexico non-veteran population (Figure 2).
Assault
From 2012-2016, the male homicide rate (11.7 per 100,000) was 3.6 times higher than the female homicide rate (3.2 per 100,000). During this 5-year period, the female homicide rate doubled, whereas the male homicide rate increased by 28%. Homicide rates increased with age until 25-34 years, then decreased with age through 65 years and older. The highest homicide rate (24.7 per 100,000) was among males 20-24 years of age.

From 2012-2016, homicide rates were highest among persons of color. American Indians and Blacks were disproportionately represented in assault deaths. The highest homicide rates were among Black males (26.4 per 100,000) and American Indian males (23.7 per 100,000).

Fifteen percent of assault deaths in New Mexico were intimate partner violence (IPV) related, i.e. the victim was killed by a current or former girlfriend/boyfriend, dating partner, ongoing sexual partner, or spouse. More than half (53.1%) of female homicides were IPV related compared to 3.6% of male homicides.
Firearm Violence
The firearm death rate among males (28.4 per 100,000) was nearly six times higher than among females (5.0 per 100,000). Males 85 years and older had the highest firearm death rate in the state. Blacks (20.1 per 100,000) and Whites (20.0 per 100,000) had the highest firearm death rates; the rate among Whites was significantly higher than the rates among Hispanics (13.5 per 100,000) and American Indians (9.6 per 100,000). White and Black males had the highest firearm death rates, 33.7 and 32.2 per 100,000, respectively.
Sexual Violence
According to results from the 2016 New Mexico Behavioral Risk Factor Surveillance System, 10.7% of New Mexico adults were raped or experienced attempted rape at some time in their lives. Sexual violence victimization was more common among females (17.0%) than males (4.0%); and among Whites (11.5%) compared to Hispanics (8.0%) and American Indians (6.8%). Adults living in households with an income <$15,000 (15.8%) were more likely to report a lifetime history of rape than adults living in households with an income of $75,000 or more (6.8%). Adults who identified as lesbian, gay, bisexual, transgender, or questioning (LGBTQ) were 2.5 times more likely to have experienced sexual assault in their lives (26.7%) compared to straight adults (10.2%). Among high school students in New Mexico, 10.1% of girls and 4.1% of boys reported having been physically forced to have sexual intercourse when they did not want to.

Risk and Resiliency Factors

Risk factors associated with suicide include mental disorders, previous suicide attempts, substance abuse, a history of child maltreatment, feelings of hopelessness, isolation, barriers to mental health treatment, loss (of relationships, social connections, work, finances), physical illness, and easy access to lethal means, such as firearms.

The most common circumstances associated with New Mexico suicides in 2015 were a depressed mood at the time of death (61.2%); a recent crisis in the person's life (36.5%); a history of suicidal thoughts (35.8%); and a current diagnosed mental health problem (34.9%). Female suicide victims were more likely to have a mental health problem, to have received mental health treatment, and to have previously attempted suicide than males (Figure 3). Male suicides were more likely to have been precipitated by a felony crime; and to have had a contributing intimate partner problem, such as a divorce, break-up, or relationship conflict.

Substance use, particularly alcohol use, was a common risk factor in suicides. Approximately one in five males (22.3%) and females (18.5%) had an alcohol problem or addiction at the time of death. Toxicology results indicate that nearly one third of suicide victims (30.2%) who were tested for blood alcohol had a positive test. And, among those who tested positive, 70% of both males and females had a blood alcohol concentration (BAC) greater than or equal to the legal limit of 80 mg/dl or 0.08%.

Approximately 30% of both male and female suicide victims in New Mexico had disclosed their suicidal intent prior to their death (Figure 3). Raising public awareness about risk factors for suicide is an important component of a comprehensive suicide prevention strategy to identify persons with elevated suicide risk and refer them for needed treatment and support.

From 2012-2016, 53% of suicides and 60% of homicides were caused by firearms. The presence of a household firearm is a known risk factor for firearm related death due to self-inflicted or assault injuries. According to 2016 results from the New Mexico Behavioral Risk Factor Surveillance System, nearly 38% of New Mexico households had a firearm in or around the house. Among households with a firearm, one in five households (20.6%) had a loaded and unlocked firearm in or around the house; and among all New Mexico households, nearly 8%, or about one in 13 households, had a loaded and unlocked firearm in or around the house.

Temporarily removing a firearm from the homes of persons with increased suicidal risk has been shown to reduce suicides. This strategy can be implemented by families, local communities, or through legislation that mandates temporary removal of a firearm by law enforcement or licensed firearm dealers.

Assets and Resources

The New Mexico Department of Health collaborates with many violence prevention stakeholders across the state to develop, implement, and evaluate evidence based suicide prevention programs. These partners include other state agencies, researchers, medical facilities and providers, schools, coalitions, and community health councils.

Summary

The biggest violence problem in New Mexico is suicide. A comprehensive, coordinated approach to violence prevention is necessary to reduce intentional self-harm and interpersonal assault morbidity and mortality. These violence related health outcomes have many risk factors in common. By addressing these risk factors at the population and community levels, targeting population or geographic areas with heightened risks, and implementing and evaluating evidence based prevention strategies and policies, we can reduce and prevent violence related injury and death in New Mexico and make our communities safer places in which to thrive. References
  1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2015) [accessed 2017 Nov 02]. Available from URL: www.cdc.gov/ncipc/wisqars.
  2. See reference #1
  3. Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2015 on CDC WONDER Online Database, released December 2016. Data are from the Compressed Mortality File 1999-2015 Series 20 No. 2U, 2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/cmf-icd10.html on Sep 13, 2017 4:30:37 PM.
  4. See reference #1
  5. See reference #1
  6. See reference #4
  7. Smith, S.G., Chen, J., Basile, K.C., Gilbert, L.K., Merrick, M.T., Patel, N., Walling, M., & Jain, A. (2017). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010-2012 State Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
  8. New Mexico Veteran Suicide Fact Sheet. Available at: https://www.mentalhealth.va.gov/docs/data-sheets/Suicide-Data-Sheet-New-Mexico.pdf.
  9. U.S. Census Bureau, 2005-2016 American Community Survey, 1-Year Population Estimates. Available at https://factfinder.census.gov/.
  10. U.S. Department of Health and Human Services (HHS) Office of the Surgeon General and National Action Alliance for Suicide Prevention. 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action. Washington, DC: HHS, September 2012.
  11. Siegel M, Ross C, King C. The relationship between gun ownership and firearm homicide rates in the United State, 1981-2010. Am J Public Health. 2013; 103:2098-2105.
  12. Barber CW, Miller MJ. Reducing a suicidal person's access to lethal means of suicide: a research agenda. Am J Prev Med. 2014;47(3S2):S264-S272.


Figure 1. Suicide Rates by Age Group, New Mexico, 2006-2016 Suicide Rates by Age Group, New Mexico, 2006-2016 Sources: NMDOH BVRHS, UNM GPS Program Figure 2. Suicide Rates in the Adult Population 18 Years and Older by Veteran Status, New Mexico, 2005-2016 Suicide Rates in the Adult Population 18 Years and Older by Veteran Status, New Mexico, 2005-2016 Data have been age-adjusted to the 2000 U.S. Standard Population. Veteran status from the NM Death Certificate.
Sources: NMDOH BVRHS; U.S. Census Bureau, 2005-2016 American Community Survey, 1-Year population estimates.
Figure 3. Circumstances Associated with Suicides by Sex, New Mexico, 2015  Circumstances Associated with Suicides by Sex, New Mexico, 2015 Source: NMDOH, New Mexico Violent Death Reporting System (NM-VDRS)

What is Being Done?

  • NMDOH epidemiologists are analyzing and disseminating county level mental health and suicidal behaviors data to support local suicide prevention efforts; and working with suicide prevention stakeholders to support the development and implementation of evidence-based suicide prevention strategies.
  • The NMDOH Office of School and Adolescent Health Behavioral Health Team provides youth suicide prevention and postvention training and technical assistance to schools and community partners. All behavioral health staff are trained in QPR (Question, Persuade, Refer), an evidence-based suicide prevention gatekeeper modality; and offer this training to local suicide prevention stakeholders.
  • The NMDOH contracts with eleven community-based sexual violence prevention programs across the state to deliver primary prevention programs that focus on identifying and understanding healthy relationships, rape myth, gender norms, and bystander intervention. Some programs focus specifically on members of disparate communities, including people living with disabilities, the immigrant community, and lesbian, gay, bisexual, transgender, or questioning (LGBTQ) populations to reduce sexual violence victimization risk factors and promote protective factors.

What Needs to be Done?

  • Strengthening economic supports to families. Economic and financial strain may increase a person's risk of suicide. Strategies to strengthen household financial security and to provide family-friendly work policies enable parents to provide for their children's basic needs, reduce parental stress and depression, and reduce child abuse and neglect.
  • Strengthening access and delivery of behavioral health care through coverage of mental health conditions in health insurance policies and reduction of provider shortages in underserved areas.
  • Create protective environments by reducing access to lethal means among persons at risk of suicide. Education and counseling on safe firearm storage, i.e. storing firearms in a secure place, unloaded, and separate from ammunition; and keeping medications and other household products in a secure location away from people who may be at risk or who have made prior attempts.
  • Teaching coping and problem-solving skills. Social-emotional learning programs address a range of suicide and intimate partner violence risk factors and provide children and youth with help seeking, conflict resolution, and coping skills that enable them to resolve problems and address negative behaviors. Parenting skill and family relationship programs can reduce anxiety, depression and substance use; and prevent intimate partner violence perpetration and victimization.
  • Identifying and supporting people at risk of suicide, through gatekeeper training programs, crisis intervention, and treatment for people at risk of suicide, targeting high risk populations, such as veterans and older adults.
  • Promoting family environments that support healthy development through early childhood home visitation programs, which have been shown to prevent youth violence and other adolescent health risk behaviors.
The information provided above is from the New Mexico Department of Health's NM-IBIS web site (http://ibis.health.state.nm.us). The information published on this website may be reproduced without permission. Please use the following citation: "Retrieved Sun, 16 June 2019 from New Mexico Department of Health, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.nm.us".

Content updated: Tue, 20 Mar 2018 15:16:58 MDT