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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. 1Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA
  2. 2Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
  3. 3Injury Control Research Center for Suicide Prevention, University of Rochester Medical Center, Rochester, New York, USA
  4. 4Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA
  5. 5Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
  6. 6Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
  7. 7Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
  8. 8Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  9. 9Department of Biostatistics, Columbia University, New York, New York, USA
  10. 10School 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}hsc.wvu.edu

Abstract

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

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • 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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