Ian R H Rockett, Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, United States; Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States
Eric D. Caine, Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States
Aniruddha Banerjee, Department of Geography, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, United States
Bina Ali, Pacific Institute for Research and Evaluation, Calverton, Maryland, United States
Ted Miller, Pacific Institute for Research and Evaluation, Calverton, Maryland, United States; School of Public Health, Curtin University, Perth, Western Australia, Australia
Hilary S. Connery, McLean Hospital, Belmont, Massachusetts, United States; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
Vijay O. Lulla, Department of Geography, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, United States
Kurt B. Nolte, Department of Pathology and Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
G Luke Larkin, Northeast Ohio Medical University, Rootstown, Ohio, United States
Steven Stack, Department of Criminal Justice, Wayne State University, Detroit, Michigan, United States; Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, United States
Brian Hendricks, Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, United States
R Kathryn McHugh, McLean Hospital, Belmont, Massachusetts, United States; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
Franklin M M White, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
Shelly F. Greenfield, McLean Hospital, Belmont, Massachusetts, United States; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
Amy S B S B Bohnert, Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, United States; Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, United States
Jeralynn S. Cossman, College for Health, Community and Policy, University of Texas-San Antonio, San Antonio, Texas, United States
Gail D'Onofrio, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States
Lewis S. Nelson, Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States
Paul S. Nestadt, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
James H. Berry, Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, United States
Haomiao Jia, Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States; School of Nursing, Columbia University, New York, New York, United States

Document Type

Article

Publication Date

2-1-2021

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

FINDINGS: The national annual average percentage change over the observation period in the SIM rate was 4.3% (95% CI: 3.3%, 5.4%;

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).

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