Q&A with researcher Catherine Barber: NVDRS death data can bolster public health – ‘Learn from the dead and let the data live and breathe’
====================================================================================================================================================

* Kim Krisberg

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/51/4/S3/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/51/4/S3/F1)

Violent deaths can shatter families and communities. Tracking U.S. deaths may help advocates develop preventive measures.

Photo by Azndc, courtesy iStockphoto

Catherine Barber, MPA, is a senior researcher at the Harvard T.H. Chan School of Public Health’s Injury Control Research Center. She led work to design and test the pilot for the Centers for Disease Control and Prevention’s National Violent Death Reporting System. Barber is also founding director of Means Matter, a project to disseminate research and interventions that reduce access to lethal means of suicide for at-risk indviduals.

## How has NVDRS changed what we know about violent death?

NVDRS gives us incident-based reporting on suicides and homicides, and a few other types of deaths, and provides highly detailed data, because it joins existing information from vital records, the coroner or medical examiner's office, and police reports together. So you get a ton of information in one place. It includes quantitative data, but also incident narratives, so you get a qualitative feel for what happened.

It gives us critical details on violent deaths like suicides, such as whether the person was known to be in mental health care, were they struggling with a particular problem, and what was the nature of that problem. We get just a tremendous amount of detail on context.

Another benefit of the NVDRS is it gives us the ability to get the count right for things like legal intervention deaths, mass public shootings, fatal firearm accidents. For example, official death certificate data and FBI data miss almost half of police shooting deaths, but NVDRS captures the vast majority. And the incident narratives provide substantive insights on these deaths.

You've got to really learn from the dead and let the data live and breathe on its own. You can't prevent something if you don't really understand the dynamics of what is causing the problem.

## Over the system's two decades, what kind of data has been especially surprising?

I became really struck by the suicides, both for their greater numbers than homicides, but also because within each suicide story, there were often clues to things — that had they been different, that person probably wouldn’t have died.

One thing that was very surprising, as I was reading through the first 100 or so suicide reports that came in during the pilot phase, I realized about one of five mentioned a crisis that happened that day. This wasn't at all what I had pictured.

Back then, I had often thought of suicide as being the end point of a very long, linear process of greater and greater distress and more deliberative planning. But it was clear that in a lot of cases, the person did not wake up that morning thinking “I'm going to take my life.”

Often, there was a precipitating event that spiked an already-troubled person’s risk. So the lethality of the method that’s easily accessible in that moment makes a difference. That led me and others to work with groups like firearm instructors and gun shops on suicide prevention — to take sort of a “friends don’t let friends drive drunk” approach to urging your friend or loved one to store their guns away from home temporarily if they’re really struggling.

## Preventing gun-related deaths is a top public health priority. What’s an example of how NVDRS data is useful there?

With prevention, you want to look at data and then slice it as thin as possible to find the right people who can help you prevent the deaths.

Take suicides that occur at shooting ranges, which are a tiny proportion of the suicide problem: NVDRS data is really helpful in detailing the circumstances of those deaths. It turns out, if a gun range has certain rules such as requiring people to bring their own guns to the range as opposed to renting them, or come with another person, it could probably prevent most of the suicides. And, really, nobody's more committed to preventing these deaths than the person who owns the shooting range.

## In 2018, NVDRS expanded to all 50 states. What does that mean for violence prevention work?

The system already gets really good data, and once NVDRS is truly statewide in all 50 states — a few big states aren’t quite there yet — we can focus on both improving data quality and putting it to use. And because CDC funds not just data collection, but also state epidemiologists to use the data, it gives us local capacity to turn that data into actionable findings.

*For more information on NVDRS, visit [bit.ly/CDC\_NVDRS](http://bit.ly/CDC_NVDRS). For more on Means Matter, see [www.hsph.harvard.edu/means-matter](http://www.hsph.harvard.edu/means-matter)*.

*   Copyright The Nation’s Health, American Public Health Association