In 2004, suicides were the leading cause of death from violence in North Carolina and the US. Consistent with national data, the 2004 NC‐VDRS data found that the mortality rates from suicide and homicide were consistently lower in females than in males. For both males and females, suicide rates were about twice as high as homicide rates (rate ratios of 1.7 in both males and females), and the proportion of suicides (61%) and homicide (35%) to all deaths from violence and unintentional firearms was the same for NC males and females. These data are supported by other larger and more long term studies on homicides and suicides, and suggest that these new insights may be immediately useful public health information.
NC‐VDRS data indicate that there are several critical factors specific to death from violence in females that are not as frequently reported in males. Females who committed suicide in NC were more likely than males to have a medical diagnosis of depression and females were also more likely than males to have a history of suicide attempts. Intimate partner violence was the dominant cause of female homicide, whereas a male homicide more often resulted from other types of arguments or conflict. The suspect in homicides was more likely to have been a spouse/ex‐spouse/intimate partner or former intimate partner of females than males. Among NC African American females, the homicide rate exceeded the suicide rate, whereas the opposite was true for white females.
Despite decades of research into suicide, many key questions remain unanswered. The NC‐VDRS clearly demonstrated that women commit suicide by poison more often than men. However, many more years of information on circumstances will need to be collected if we are to understand why
females select poisons over firearms, and what
are the inciting events. We need to know how we can capitalize on the advantages afforded by the facts that females are more likely than males to have seen a professional for depression or have had a prior suicide attempt, and that females are more likely than males to survive a suicide attempt. Research suggests that firearms have a higher case fatality rate than poisonings.19
Therefore, in terms of developing and implementing intervention strategies, the difference in the choice of suicide method may be the most profound difference between females and males since it the main reason that females are more likely than males to survive a suicide attempt.
NC‐VDRS data strongly suggest that more resources should be devoted to the primary prevention of suicide, and support the Institute of Medicine's recommendations on reducing suicides.20
This includes funding more gatekeeper training, currently underway in North Carolina; the piloting of programs for coping and resiliency training as part of the curriculum for school aged children and continuing education for seniors; and the development and dissemination to primary care providers of tools for the recognition, screening, and referral to mental health professionals of patients with acute and chronic suicide risk factors.20
Also necessary are improved availability of and access to mental health services and more effective suicide prevention counseling for youth and the elderly. Mental health services should be assessed to ensure that they are specific to the different needs of females and males, and that they are responsive to indicators of imminent crises that may lead to suicide. Although poisons were used in many suicides among females, firearms were the most common methods used in suicides among males and females. Research by others suggests that limiting access to firearms may be an important and effective strategy for reducing suicide deaths.7,19
Homicides in females showed some similarity to male homicides. However, NC‐VDRS data and other sources,11,12,13,14,17,21,22,23
make it clear that intimate partner violence plays a leading role in many female homicides. A study of female homicides among North Carolina adolescents also revealed that female adolescents were most commonly killed by an intimate partner.23
Primary prevention of intimate partner violence should include programs to teach adolescents about healthy relationships and how to prevent dating violence. A greater awareness of intimate partner violence and its potential for homicide among the general public may be a powerful agent for long term change. Thus, the provision of frequent, timely, and accurate statistics via the national and state VDRS programs is, in itself, an intervention. For the short term acute phase of these attacks, dedicated policing teams, stronger legislation aimed at protecting females, more support for, and use of, domestic violence protective orders, and the provision of safe havens and support networks, are critical prevention initiatives that need to be supported and strengthened at the local, state, and federal level.
One of the strengths of the North Carolina death investigation system is the North Carolina Office of the Chief Medical Examiner (OCME), which oversees a statewide system of trained medical examiners who investigate all non‐natural deaths, complete most sections of the death certificate, and complete a standardized field investigation report that is reviewed by an OCME pathologist. Most deaths from violence are autopsied and are part of the data abstracted by NC‐VDRS staff. Almost all North Carolina law enforcement agencies provide incident reports to the NC‐VDRS. This study also benefited from being associated with the NVDRS as it employs standard and consistent definitions and case‐finding methodologies for all deaths from violence from multiple sources of data.
However, because the system is based on the collection of data from existing records, the completeness of the information is limited by the accuracy and depth of detail recorded by sources such as the medical examiner investigating a non‐natural death and law enforcement officers completing incident reports. A specific weakness of the NC‐VDRS data is the high proportion of missing data on suspects, particularly in cases for which there are no known suspects. Another specific weakness is that circumstances information recorded by medical examiners amd law enforcement may be subject to underreporting, for example with regard to history of mental illness or previous attempts for suicide victims. Underreporting could occur if relatives or family members were unaware or unwilling to provide this information, or if authorities were unable or neglected to ascertain this information.
- Information from the Violent Death Reporting System is very useful in comparing violent deaths between males and females.
- Suicide and homicide rates are lower for females than males.
- Firearms are the most common method of death for male and female suicides and homicides.
- Females who commit suicide are more likely than males who commit suicide to have had mental health problems and previous suicide attempts.
- Female homicides are more likely than male homicides to involve intimate partner violence.