Researchers examined the self-injury mortality(SIM), a composite of all methods of suicide and estimated non-suicide deaths from drug self-intoxication, has surpassed diabetes as the seventh leading cause of death in the United States, prompting researchers to call for a new unified approach to SIM prevention.

It is time to end the siloed approach to prevention. Mortality in the United States from self-injury surpasses diabetes: a prevention imperative. The study was published online by Injury Prevention. They are so entrenched in separating suicide from a drug overdose or alcohol poisoning deaths that people can't wrap their heads around the idea that they are related.

The mental health and social risk factors preceding suicidal behaviors and substance poisonings are largely overlapping. The comparative study showed the rising rate of estimated SIM in 2014 reached 24 deaths per 100,000 people, matching mortality from diabetes, which is officially the seventh leading cause of death behind Alzheimer's disease.

Drug Intoxication

Eighty percent of "accidental" drug intoxication deaths and ninety percent of corresponding undetermined intent deaths among the population 15 years and older were assumed to be dead from drug self-intoxication.

Mental Health Disorders

Let's talk about preventing suicide and substance-related deaths together by aggressively screening for trauma, mental health disorders, problematic substance use, and social determinants such as poverty and then providing quality evidence-based care for these risk factors so that self-injury behaviors are prevented.

Suicidal Thoughts

The different manner-of-death categories employed on death certificates have taken on added importance with the rise in an under-reporting of opioid-related suicides. A conservative estimate is about 25% of substance poisonings involved suicidal thoughts or planning before overdose.

Suicide Rate

The authors noted that after declining by 19% between 1986 and 2000, the US suicide rate was 345 higher in 2016 than in 2000. Moreover, they considered most of the opioid and other drug deaths were preceded by repeated self-harm behaviors even when not registered as suicide.

Researchers noted that drug-related suicides had a higher rate of requiring evidentiary documentation (e.g., a suicide note and diagnosed depression) than suicides by firearm or hanging, and drug ingestion was the most common form of attempted suicide, despite the higher rate of mortality for more violent means. 

Self-injury Deaths

That data is often lacking because of limited resources and the high volume of self-injury deaths, regardless of the manner of death, which has overwhelmed coroners and medical examiners.

Mental Health Crisis

America is in the midst of a persistent and major but underestimated mental health crisis. They want to unify mental health and substance use disorder experts to say we have a really serious but preventable problem of premature mortality due to self-injury, and artificial separation of drug deaths from suicide is slowing our efforts to prevent these deaths.


Ultimately, the authors declared, understanding self-injury mortality as transcending known or registered suicides will enable creation and implementation of effective broad-based prevention strategies like those that have reduced deaths from cardiovascular diseases, smoking-related lung cancer, HIV, and vehicular motor injury.

In the end, the authors asserted, what is needed is "both necessary epidemiologic understanding to define the problem and sufficient political will to address it. Without the former, it is impossible to build the latter.