Ian R. H. Rockett
In 2015, self-injury mortality — comprising all methods of suicide and estimated non-suicide deaths from overdose and mixed drug effects — overtook diabetes as the seventh leading cause of death in the United States.
“In the 21st century, the United States has experienced rapidly rising mortality rates from suicide and from opioid and other drug intoxication,” Ian R. H. Rockett, PhD, MPH, from the Injury Control Research Center at West Virginia University, told Healio Psychiatry. “This research was motivated to show that these two trends, which have common determinants, actually represent a single epidemic of self-injury mortality.”
The rate of self-injury mortality has skyrocketed since 2000, increasing 80% by 2016, the report revealed. Drug overdose deaths tripled from 6.2 to 19.7 per 100,000 people during this period. In 2016, the suicide rate was 34% higher than in 2000, showing steady incline since 2005.
“Artificial separation of those two components by researchers, clinicians and public health practitioners has meant gross underestimation of the mental health crisis afflicting this nation. Consequently, injury prevention is severely challenged and falling well short,” Rockett explained. “In documenting that self-injury is now a bigger killer than diabetes, itself a national scourge, the report underscores the urgent need for society to put mental health on a front burner.”
The latest CDC data showed that combined non-suicide drug self-intoxication and suicide self-injury mortality exceeded diabetes mortality with rates of 26.1 vs. 24.7 per 100,000 in 2015 and 29.1 vs. 24.8 in 2016. Death from self-injury also disproportionally impacts young adults. The report also highlighted that drug ingestion was the most common form of attempted suicide, despite higher rate of mortality by hanging or firearm.
“Ending the [self-injury mortality] epidemic will require multifaceted, concerted and sustained efforts like those that dramatically reduced mortality from cardiovascular diseases, smoking-related lung cancer, HIV and motor vehicular traffic trauma during the 20th century,” Rockett said.
The researchers noted that suicide by opioids or other drugs are often underreported because of manner of death determinations made by medical examiners and coroners. Deaths of people who injected heroin and consumed alcohol but did not leave a suicide note are typically marked as accidental; however, this classification is misleading because most injection opioid users knowingly engage in a pattern of repetitive self-harm tied to significant morbidity and mortality.
More affirmative corroborating data is needed before medical examiners and coroners label drug deaths as suicides, but there are limited resources and high volume of self-injury deaths — which often overwhelm these professionals, according to a press release.
Hilary S. Connery
“Implications for clinicians are: 1) screen aggressively in childhood and ongoing to prevent risk from becoming behavior by intervening early; 2) with patients presenting in treatment, substance use disorder programs should integrate suicide prevention, and all mental health programs should include [substance use disorder] prevention and overdose prevention; and 3) every person post suicide attempt should be evaluated thoroughly for substance use, and every alcohol or drug poisoning case should be evaluated for suicidality — clinicians must be taught to associate these two phenomena rather than separate them,” Hilary S. Connery, MD, PhD, clinical director of the division of alcohol and drug abuse at McLean Hospital and assistant professor of psychiatry at Harvard Medical School, told Healio Psychiatry. – by Savannah Demko
Disclosure: The authors report no relevant financial disclosures.