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Fatal self-injury in the United States, 1999-2018: Unmasking a national mental health crisis.
Rockett, Ian R H; Caine, Eric D; Banerjee, Aniruddha; Ali, Bina; Miller, Ted; Connery, Hilary S; Lulla, Vijay O; Nolte, Kurt B; Larkin, G Luke; Stack, Steven; Hendricks, Brian; McHugh, R Kathryn; White, Franklin M M; Greenfield, Shelly F; Bohnert, Amy S B; Cossman, Jeralynn S; D'Onofrio, Gail; Nelson, Lewis S; Nestadt, Paul S; Berry, James H; Jia, Haomiao.
  • Rockett IRH; Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, United States.
  • Caine ED; Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States.
  • Banerjee A; Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States.
  • Ali B; Department of Geography, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, United States.
  • Miller T; Pacific Institute for Research and Evaluation, Calverton, Maryland, United States.
  • Connery HS; Pacific Institute for Research and Evaluation, Calverton, Maryland, United States.
  • Lulla VO; School of Public Health, Curtin University, Perth, Western Australia, Australia.
  • Nolte KB; McLean Hospital, Belmont, Massachusetts, United States.
  • Larkin GL; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States.
  • Stack S; Department of Geography, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, United States.
  • Hendricks B; Department of Pathology and Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States.
  • McHugh RK; Northeast Ohio Medical University, Rootstown, Ohio, United States.
  • White FMM; Department of Criminal Justice, Wayne State University, Detroit, Michigan, United States.
  • Greenfield SF; Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, United States.
  • Bohnert ASB; Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, United States.
  • Cossman JS; McLean Hospital, Belmont, Massachusetts, United States.
  • D'Onofrio G; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States.
  • Nelson LS; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
  • Nestadt PS; McLean Hospital, Belmont, Massachusetts, United States.
  • Berry JH; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States.
  • Jia H; Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, United States.
EClinicalMedicine ; 32: 100741, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1071273
ABSTRACT

BACKGROUND:

Suicides by any method, plus 'nonsuicide' fatalities from drug self-intoxication (estimated from selected forensically undetermined and 'accidental' deaths), together represent self-injury mortality (SIM)-fatalities due to mental disorders or distress. SIM is especially important to examine given frequent undercounting of suicides amongst drug overdose deaths. We report suicide and SIM trends in the United States of America (US) during 1999-2018, portray interstate rate trends, and examine spatiotemporal (spacetime) diffusion or spread of the drug self-intoxication component of SIM, with attention to potential for differential suicide misclassification.

METHODS:

For this state-based, cross-sectional, panel time series, we used de-identified manner and underlying cause-of-death data for the 50 states and District of Columbia (DC) from CDC's Wide-ranging Online Data for Epidemiologic Research. Procedures comprised joinpoint regression to describe national trends; Spearman's rank-order correlation coefficient to assess interstate SIM and suicide rate congruence; and spacetime hierarchical modelling of the 'nonsuicide' SIM component.

FINDINGS:

The national annual average percentage change over the observation period in the SIM rate was 4.3% (95% CI 3.3%, 5.4%; p<0.001) versus 1.8% (95% CI 1.6%, 2.0%; p<0.001) for the suicide rate. By 2017/2018, all states except Nebraska (19.9) posted a SIM rate of at least 21.0 deaths per 100,000 population-the floor of the rate range for the top 5 ranking states in 1999/2000. The rank-order correlation coefficient for SIM and suicide rates was 0.82 (p<0.001) in 1999/2000 versus 0.34 (p = 0.02) by 2017/2018. Seven states in the West posted a ≥ 5.0% reduction in their standardised mortality ratios of 'nonsuicide' drug fatalities, relative to the national ratio, and 6 states from the other 3 major regions a >6.0% increase (p<0.05).

INTERPRETATION:

Depiction of rising SIM trends across states and major regions unmasks a burgeoning national mental health crisis. Geographic variation is plausibly a partial product of local heterogeneity in toxic drug availability and the quality of medicolegal death investigations. Like COVID-19, the nation will only be able to prevent SIM by responding with collective, comprehensive, systemic approaches. Injury surveillance and prevention, mental health, and societal well-being are poorly served by the continuing segregation of substance use disorders from other mental disorders in clinical medicine and public health practice.

FUNDING:

This study was partially funded by the National Centre for Injury Prevention and Control, US Centers for Disease Control and Prevention (R49CE002093) and the US National Institute on Drug Abuse (1UM1DA049412-01; 1R21DA046521-01A1).
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Prognostic study / Randomized controlled trials Language: English Journal: EClinicalMedicine Year: 2021 Document Type: Article Affiliation country: J.eclinm.2021.100741

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Prognostic study / Randomized controlled trials Language: English Journal: EClinicalMedicine Year: 2021 Document Type: Article Affiliation country: J.eclinm.2021.100741