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Unrecognised self-injury mortality (SIM) trends among racial/ethnic minorities and women in the USA
  1. Ian R H Rockett1,2,3,
  2. Eric D Caine2,
  3. Hilary S Connery4,5,
  4. Kurt B Nolte6,
  5. Paul S Nestadt7,
  6. Lewis S Nelson8,
  7. Haomiao Jia9,10
  1. 1 Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA
  2. 2 Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
  3. 3 Injury Control Research Center for Suicide Prevention, University of Rochester Medical Center, Rochester, New York, USA
  4. 4 Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA
  5. 5 Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
  6. 6 Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
  7. 7 Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
  8. 8 Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  9. 9 Department of Biostatistics, Columbia University, New York, New York, USA
  10. 10 School of Nursing, Columbia University, New York, New York, USA
  1. Correspondence to Dr Ian R H Rockett, Epidemiology, West Virginia University, Morgantown, WV 26506, USA; irockett{at}


Aim To assess whether an enhanced category combining suicides with nonsuicide drug self-intoxication fatalities more effectively captures the burden of self-injury mortality (SIM) in the USA among US non-Hispanic black and Hispanic populations and women irrespective of race/ethnicity.

Methods This observational study used deidentified national mortality data for 2008–2017 from the CDC’s Web-based Injury Statistics Query and Reporting System. SIM comprised suicides by any method and age at death plus estimated nonsuicide drug self-intoxication deaths at age ≥15 years. Measures were crude SIM and suicide rates; SIM-to-suicide rate ratios; and indices of premature mortality.

Results While the suicide rate increased by 29% for blacks, 36% for Hispanics and 25% for non-Hispanic whites between 2008 and 2017, corresponding SIM rate increases were larger at 109%, 69% and 55% (p<0.0001). SIM:suicide rate ratio gaps were widest among blacks but similar for the other two groups. Gaps were wider for females than males, especially black females whose ratios measured ≥3.71 across the observation period versus <3.00 for white and Hispanic counterparts. Total lost years of life for Hispanic, white and black SIM decedents in 2017 were projected to be 42.6, 37.1 and 32.4, respectively.

Conclusion Application of SIM exposed substantial excess burdens from substance poisoning relative to suicide for minorities, particularly non-Hispanic blacks and for women generally. Results underscored the need to define, develop, implement and evaluate comprehensive strategies to address common antecedents of self-injurious behaviours.

  • Suicide/Self?Harm
  • Poisoning
  • Mental Health
  • Drugs
  • Mortality
  • Cross Sectional Study

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  • Contributors IRHR conceived and designed the study and acquired the data. IRHR, EDC, HSC, HJ and KBN prepared the first draft of the manuscript. IRHR and HJ conducted the analysis. All authors were involved in the interpretation of the data, revision of the manuscript and provided final approval of the submission.

  • Funding This study was partially funded by the National Center for Injury Prevention and Control (grant no: R49CE002093).

  • Disclaimer The views expressed are those of the authors and do not necessarily represent the position or policy of the Centers for Disease Control and Prevention or the United States' Government.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open-access repository. All data relevant to the study are included in the article or uploaded as supplementary information.

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