Critical social and environmental factors for assessing self-harm and suicide mortality rates

According to the results of a 20-year American cross-sectional study published in Open JAMA Network.

“This nationwide study breaks new ground by identifying state characteristics that are associated with high or low rates of self-harm mortality,” Ian RH Rockett, PhD, MPH, from the Department of Epidemiology and Biostatistics at West Virginia University School of Public Health, Healio told Healio. “These characteristics represent economic inequality, social isolation, demographics, barriers to health care, means or mechanisms of injury, and type of system as a proxy for the variable quality of forensic death investigations. themselves.”

“Self-injury mortality (SIM) was designed to transcend recorded suicides by increasing those known suicides, by any method, with most fatal opioid and other drug overdoses,” Rockett added. “Currently unknowable, some and possibly many of these overdoses are misclassified suicides.”

Rockett and colleagues sought to examine all of the administrative and contextual factors associated with both state-level DIS as well as suicide rates, and to explore regional and state differences to underestimate suicides due to misclassification of drug-related deaths.

The researchers used a partial-panel time series with underlying cause-of-death data in 101,325 SIM cards from all 50 states and Washington, DC, for the intervals of 1999-2000, 2007-2008, 2013-2014 and 2018 to 2019, which included all suicides, accidental and undetermined drug poisoning deaths, and self-injurious behavior.

Baseline MIS/suicide rate ratios per 100,000 people were analyzed for possible misclassification. Data was analyzed from February 2021 to June 2021.

The results showed that the rate ratios of SIM to suicide increased sharply over the study intervals, with a concomitant increase in overdose deaths classified as unintentional or undetermined (1999-2000: 1.39; 95%, 1.38-1.41; 2018-2019: 2.12; 95% CI, 2.11-2.14). Rockett and his colleagues also found that eight states had a SIM-suicide rate of less than 1.5 in 2018 to 2019, compared to 39 states in 1999 to 2000.

Eight factors were found to have associations with MIS rate by 2018 to 2019: centralized medical examiner system, labor underutilization rate, manufacturing employment, homelessness rate , percentage of non-religious, non-Hispanic Caucasian, and ethnicity people who were prescribed opioids for 30 days or more. , and the percentage of those without health insurance. Five additional factors associated with the suicide rate were percentage male, veteran, rural location, possession of firearms, and overuse of painkillers.

“This study suggests that reversing the growing MIS trends in the 21st century, exacerbated by the COVID-19 pandemic, will require proactive preventive measures that target the economy, the healthcare industry, schools and colleges, the military, jails and prisons, and other large institutions, as well as the need to expand treatment interventions for high-risk patients in hospital emergency departments and care facilities psychiatric,” Rockett said.