"Self injury is a major killer and it encompasses more than
suicide," said study leader Ian Rockett, of West Virginia University
School of Public Health in Morgantown.
He and his colleagues write in JAMA Psychiatry that self-injury
deaths in the U.S. are generally underestimated because suicides by
poisoning and drug overdose are often misclassified as "accidents"
on death certificates.
In 2004, the U.S. Centers for Disease Control and Prevention (CDC)
listed diabetes as the country's seventh leading cause of death,
influenza and pneumonia as the eighth leading cause and kidney
disease as the ninth leading cause. Intentional self-injury -
including suicide - was tenth.
For the new study, the researchers used data from the CDC on deaths
occurring in the U.S. between 1999 and 2014. In addition to deaths
already attributed to suicide or self-injury, the researchers also
classified 80 percent of deaths labeled "accidental" drug
intoxication deaths and 90 percent of undetermined drug intoxication
deaths in people aged 15 and older as self-injury deaths.
While people who die of drug intoxication may not intentionally
overdose, they are engaging in risky life-threatening behavior,
Rockett told Reuters Health.
By combining those numbers, the researchers found 40,289 self-injury
deaths in 1999. That rose to 76,227 self-injury deaths in 2014.
Overall, those numbers reflect a 65 percent increase over that
period, from about 14 deaths per 100,000 people to about 24 deaths
per 100,000 people.
The new self-injury death rate was higher than the rate from kidney
disease at any point between 1999 and 2014. It surpassed deaths from
influenza and pneumonia in 2006, and tied with the number of
diabetes deaths by the end of the study period.
"If we had data for 2016, who knows, we may have seen the (self
injury) rates surpass diabetes," Rockett said.
Rockett also said self-injury deaths appear to affect younger people
in particular, being six times more common than diabetes-related
deaths among people under age 55.
The researchers found roughly four self-injury deaths among men for
every one self-injury death among women in 1999. By the end of the
study, there were about three self-injury deaths among men for every
self-injury death among women.
[to top of second column]
The evidence suggests that self-injury deaths are an escalating
problem disproportionately affecting women, Rockett said.
At the end of the study, the researchers found men lost about 32
years of life from a self-injury death, compared to about 37 years
of life for women.
The number of lost years was at least double the years lost after
death from diabetes, kidney disease, or influenza and pneumonia.
One reason women may be bearing the weight of self-injury deaths is
because they are more likely to use the healthcare system and be
prescribed opioids, Rockett suggested.
He also cautioned that the new estimate of self-injury deaths may be
conservative, because deaths from some car accidents and other
situations might be caused by reckless behavior.
Rockett believes society and the government are diluting the
clinical and public health importance of self-injury by separately
viewing suicides and drug-intoxication deaths.
"The private and public sectors must coalesce to address self-injury
deaths, which are both predictable and avoidable," he said.
"Concerted action will be vital for reversing the ripple effects
from these deaths that are so catastrophic for families,
communities, and the nation."
SOURCE: http://bit.ly/2bW5QO7 JAMA Psychiatry, online August 24,
[© 2016 Thomson Reuters. All rights
Copyright 2016 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.