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Reducing Suicide: A National Imperative
ever, given that some suicide attempts may never come to medical attention or result in hospitalization, self-report measures like YRBS remain a valuable source of information.
Oregon State Adolescent Suicide Attempt Data System (ASADS)
In 1987, Oregon became the only state with a law requiring the reporting of suicide attempts by youth under 18 to the state health department (Hopkins et al., 1995). Failure to comply with this regulation is a Class A misdemeanor; however, it has been unnecessary to charge any hospital thus far (personal communication, D. Hopkins, Oregon Department of Human Services, April 19, 2002). Oregon law also specifies that the treating hospital must refer attempters to “in-patient or out-patient community resources, crisis intervention or other appropriate intervention by the patient’s attending physician, hospital social work staff or other appropriate staff1”.
ASADS contains information such as demographics, date, county, method, place of attempt, living arrangement, psychological history, drug/alcohol use, previous attempt(s), reason(s), and seriousness and intent of attempt. Data are collected from emergency department records for all youth treated for a suicide attempt. Under-reporting is thought to occur. Training of staff and consistency of information is also an issue since only the information included in the patient’s medical chart can be collected. The system could be improved through better documentation by the health care provider (personal communication, L. Millet, Oregon Department of Human Services, April 22, 2002).
Limitations of the Model Systems
There exist many potential sources of information, but most often these are unlinked and in some cases represent redundant efforts. Most of what is available is based on hospitalization records or self-reports; however, studies have shown that injury surveillance based on hospitalization information alone may underestimate incidence by as much as 65 percent (Washington Department of Health, 1997). Currently, there is no systematic way of following repeat attempters over time. Elderly patients have among the highest rates of suicide completion, yet they are not included in some of the attempt surveillance systems that exist. Addi-
Oregon Revised Statutes, 441.750. Suicide attempts by minors; referral; report; disclosure of information; limitation of liability.