A new study finds self-injury – suicide and drug self-intoxication – ties with diabetes as the seventh leading cause of death in the U.S. and ranks ahead of influenza and pneumonia combined and kidney disease.

Ian Rockett, Ph.D., professor in the West Virginia University School of Public Health’s Department of Epidemiology and affiliate of the Injury Control Research Center, led the study reported in JAMA Psychiatry online.

He collaborated with researchers from seven other universities. They analyzed death certificate data from the Centers for Disease Control and Prevention and found that self-injury mortality increased by 65 percent over a 15-year period – from an estimated 40,289 deaths in 1999 to 76,227 in 2014. The self-injury death rate rose from 14 to 24 for every 100,000 people, and it continually exceeded the kidney disease mortality rate, surpassed the influenza and pneumonia rate by 2006 and matched the diabetes rate in 2014.

The study combined estimated deaths from drug self-intoxication with registered suicides to better represent the true death toll from self-injury. Self-injury caused 1.4 times more deaths than suicide alone in 1999, but 1.8 times more by 2014.

Gender and age matter
The study also suggests escalating rates of self-injury death are disproportionately impacting women more than men. The ratio of male-to-female self-injury deaths shrank from 3.7 to 2.6 during the 15-year period. Females accounted for approximately 8,900 (22 percent) of the self-injury deaths in 1999 compared to 21,950 (29 percent) in 2014.

And Rockett and his team noted gender differences when it came to years of life lost. In 2014, self-injury deaths resulted in 32 lost years for males and 37 for females; this compared to 16 years of life lost from diabetes for males and 17 for females.

Age also made a difference. Self-injury caused six times more deaths among people under age 55 than did diabetes.

Barriers to prevention and treatment
“Although researchers, clinicians and medical examiners and coroners acknowledge that repeated opioid and other drug self-intoxication is a form of self-injury, death arising from such behavior continues to be labeled either as an ‘accident’ or ‘unintentional’ – despite the presence of individuals’ clinical history of deliberate, repeated substance misuse that fundamentally increases the probability of later death,” Rockett and his team reported.

They view this mischaracterization and the stigmatization of suicides and drug-intoxication deaths as major barriers to their prevention.

Suicides get more attention when they impact veterans and military personnel, and in the general public, it’s the overdose deaths that get more attention, Rockett pointed out. The way they get split up, he said, dilutes self-injury as a public health problem.

“Part of the challenge between drug overdose and suicides is that people try to separate them,” co-author Eric Caine, M.D., chair of the Department of Psychiatry and co-director of the Center for the Study and Prevention of Suicide at the University of Rochester Medical Center, said. “From a public health point of view, these are preventable deaths? We have to get away from what was going on at the last moments and start to say, ‘What can we do far before the person becomes suicidal?’”

Hilary Smith Connery, M.D., assistant professor of psychiatry at Harvard Medical School and clinical director of the Division of Alcohol and Drug Abuse at McLean Hospital, is an expert on mental illness and substance abuse disorders and has been in touch with Rockett about his study.

“It’s incredible how much life is being lost,” Connery said. “If this was any disease that wasn’t as highly stigmatized, you’d have an enormous public outcry ? Any time you hear about opioid overdose you hear them talk about accidental overdoses. It’s not true. They may feel trapped. Maybe they’ve tried treatment and failed. The risk-taking there is more driven by despair. It’s not the same as someone who just accidentally overdoses and never saw it coming.”

“It should be a national imperative to put comprehensive diagnosis, treatment and prevention of mental health disorders, including substance use disorders, on a front burner,” Rockett said. “The ripple effects from inadequate resourcing and planning are catastrophic for families, communities and society.”



CONTACT: Janey Cink, WVU School of Public Health
304.293.1699, jycink@hsc.wvu.edu

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