Nav: Home

Investigating the full spectrum of suicide

October 15, 2019

A recent study published in Injury Prevention described a method for categorizing self-injury mortality (SIM) to help us better examine national trends for today's epidemics of suicide and drug-related deaths.

This SIM study compared trends among non-Hispanic blacks and Hispanics with those of whites. SIM included all suicides, regardless of method. The study also viewed most drug overdoses as self-injury, even where evidence did not meet the standard for a suicide classification. This approach is due to the observed pattern of intentionally repeated self-injury behaviors found in most drug deaths.

The SIM investigation, according to the researchers, underscores the need to view suicides and drug deaths as two fatal outcomes associated with common risk factors. In some cases, these outcomes also share symptoms of hopelessness and loss of behavioral control that may be amenable to targeted prevention efforts.

The researchers also said that their findings highlight the need for the US health care system to address data surveillance and health care delivery disparities that have important implications for innovative strategies to reduce "deaths of despair." The study was led by West Virginia University's Ian Rockett, PhD, MPH, MA. McLean Hospital's Hilary S. Connery, MD, PhD, was a co-investigator.

According to Rockett, SIM is important for several reasons. "SIM recognizes that suicides are not accurately accounted for," he said. "It allows most drug deaths to belong in the suicide category because they are not true accidents, providing a perspective on total death burden. This lens is important for revealing more granular data trends that may guide allocation of prevention and treatment resources. Examining SIM helps us better see the trends of the current mental health crisis for women and minorities as well as for white men."

While the SIM rate for whites rose by 55% between 2008 and 2017, it increased by 109% for blacks and 69% for Hispanics. Women in all three groups were more likely to die from drug overdoses than men. Although Hispanics had the lowest rates of SIM, they died at a younger age. Hispanics dying from self-injury in 2017 were projected to have lost 43 years of life versus 37 and 32 for whites and blacks, respectively.

The SIM study finds that suicide is likely underreported for females because women tend to use methods that are less violent and less obvious than those of men. Women who take their own lives are more likely to do so with drugs than by hanging or with guns.

The study also indicates that evidence of suicide is rarer for blacks and Hispanics than for whites because of unequal access to health care or because of different use of health care, when accessible. Black and Hispanic people who died by suicide had fewer previously documented mental health conditions than their white counterparts.

Connery provided more treatment context.

"The health care system has a long history of separating people coming for mental health disorders care from those coming for substance use disorders care," she said. "Considering today's concurrent epidemics, this system doesn't work well at a population level because of the high rates of co-occurrence of substance use disorders and other mental health disorders. It's extremely common for a depressed person to be misusing substances but asking only for help for depression. Likewise, a person asking for help with opioid use disorder may seek medical treatment but not report suicidal thoughts and planning. In both cases, screening for suicide risk factors and overdose risk factors will improve early detection, which may then allow targeted, integrated treatments to prevent SIM deaths."

The other major barrier to understanding and preventing self-injury deaths, according to Connery, is that they are portrayed as either "intentional" or "unintentional."

"This false dichotomy leads to depictions of self-injury deaths as either intentional suicide or accidental substance poisoning," she said. "The desire to die prior to self-injury deaths occurs along a spectrum of low to high desire to die, which may influence risk-taking behaviors even if a person's conscious intentions are not fully suicidal."

The study shows how the nation as well as states and local communities could improve prevention programs. Strategies would include greater emphasis on screening for common risk factors and consistently asking patients about their substance use and suicidal thoughts and behaviors.

"Too often, academic publications and mass media show suicides and drug deaths in the 21st century as separate problems," said Rockett. "To the contrary, these issues are intertwined, and constitute a mental health catastrophe."

McLean Hospital

Related Health Care Articles:

Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.
International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.
The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .
Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.
High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.
Health insurance changes, access to care by patients' mental health status
A research letter published by JAMA Psychiatry examined access to care before the Patient Protection and Affordable Care Act (ACA) and after the ACA for patients grouped by mental health status using a scale to assess mental illness in epidemiologic studies.
Medical expenditures rise in most categories except primary care physicians and home health care
This article was published in the July/August 2017 issue of Annals of Family Medicine research journal.
Care management program reduced health care costs in Partners Pioneer ACO
Pesearchers at Partners HealthCare published a study showing that Partners Pioneer ACO not only reduces spending growth, but does this by reducing avoidable hospitalizations for patients with elevated but modifiable risks.
Health care leaders predict patients will lose under President Trump's health care plans
According to a newly released NEJM Catalyst Insights Report, health care executives and industry insiders expect patients -- more than any other stakeholder -- to be the big losers of any comprehensive health care plan from the Trump administration.
The Lancet: The weaponisation of health care: Using people's need for health care as a weapon of war over six years of Syrian conflict
Marking six years since the start of the Syrian conflict (15 March), a study in The Lancet provides new estimates for the number of medical personnel killed: 814 from March 2011 to February 2017.
More Health Care News and Health Care Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Uncharted
There's so much we've yet to explore–from outer space to the deep ocean to our own brains. This hour, Manoush goes on a journey through those uncharted places, led by TED Science Curator David Biello.
Now Playing: Science for the People

#556 The Power of Friendship
It's 2020 and times are tough. Maybe some of us are learning about social distancing the hard way. Maybe we just are all a little anxious. No matter what, we could probably use a friend. But what is a friend, exactly? And why do we need them so much? This week host Bethany Brookshire speaks with Lydia Denworth, author of the new book "Friendship: The Evolution, Biology, and Extraordinary Power of Life's Fundamental Bond". This episode is hosted by Bethany Brookshire, science writer from Science News.
Now Playing: Radiolab

Dispatch 2: Every Day is Ignaz Semmelweis Day
It began with a tweet: "EVERY DAY IS IGNAZ SEMMELWEIS DAY." Carl Zimmer – tweet author, acclaimed science writer and friend of the show – tells the story of a mysterious, deadly illness that struck 19th century Vienna, and the ill-fated hero who uncovered its cure ... and gave us our best weapon (so far) against the current global pandemic. This episode was reported and produced with help from Bethel Habte and Latif Nasser. Support Radiolab today at Radiolab.org/donate.