Deaths from Self-Injury Increase 65% Over 15 Year Period Interview with:

Ian Rockett, PhD, MPH, FACE Professor, Department of Epidemiology School of Public Health West Virginia University Morgantown, WV

Dr. Ian Rockett

Ian Rockett, PhD, MPH, FACE
Professor, Department of Epidemiology
School of Public Health
West Virginia University
Morgantown, WV What is the background for this study?

Response: Self-injury deaths in the United States are seriously underestimated because they are officially limited to registered suicides, and exclude non-suicide deaths from drug self-intoxication. Suicides themselves are undercounted due primarily to under-resourcing of medical examiner and coroner offices and associated challenges in detecting drug suicides. Although most drug-intoxication deaths involve deliberate behaviors that markedly elevate risk of premature death, they are formally classified, but mischaracterized, as “accidents” on death certificates. Representing self-injury mortality (SIM) as a combination of registered suicides and estimated deaths from drug self-intoxication (DDSI), this study compared its national trends and patterns with those of 3 proximally ranked top 10 causes of death. What are the main findings?

Response: The estimated crude rate for  self-injury mortality increased 65% between 1999 and 2014, from 14 to 24 per 100,000 persons. It continuously exceeded the death rate from kidney disease, and surpassed that of influenza and pneumonia by 2006. By 2014, the SIM rate had converged with the diabetes death rate, and was 1.8 times higher than the suicide rate versus 1.4 times higher in 1999. The male-to-female ratio for SIM contracted from 3.7 in 1999 to 2.6 in 2014. SIM accounted for 32 and 37 years of life lost for respective male and female decedents, compared to 16 and 17 years from diabetes, 15 and 17 years from pneumonia and influenza, and 14 and 16 years from kidney disease. What should readers take away from your report?

Response: The escalation of official suicide and drug-intoxication death rates during the first 14 years of the 21st century reveals a burgeoning crisis. There are significant inconsistencies in these trends that seriously compromise the study of fatal self-harm or self-injury. Although researchers, clinicians, and medical examiners and coroners acknowledge that repeated opioid and other drug self-intoxication is a form of self-injury, death arising from such behavior continues to be labeled either as an “accident” or “unintentional” — despite the presence of individuals’ clinical history of deliberate, repeated substance misuse that fundamentally increases the probability of later death. The surging  self-injury mortality rate has converged with the diabetes rate, but SIM accounts for approximately 6 times more deaths under age 55, and is increasingly affecting women relative to men. Accurately characterizing, measuring, and monitoring this major clinical and public health problem will be essential for scientific understanding and evaluation of preventive and therapeutic interventions. What recommendations do you have for future research as a result of this study?

Response: Future research on  self-injury mortality trends will need to examine a wide array of potential individual-level and contextual determinants — social, economic, political, health, and environmental — differentiating such decedent characteristics as race/ethnicity, military veteran status, state, and region. Is there anything else you would like to add?

Response: Continuing to view suicides and most drug-intoxication deaths as separate entities, rather than as integral elements of  self-injury mortality, dilutes the clinical and public health importance of both for planning and prioritizing the allocation of scarce resources. The results of this study underscore an imperative for society to put diagnosis, treatment, and prevention of mental health disorders on a front burner. Thank you for your contribution to the community.


Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on

[wysija_form id=”5″]

Last Updated on August 25, 2016 by Marie Benz MD FAAD