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Self-injury Is the Eighth Leading Cause of Death in the United States It Is Time to Pay Attention

Ian R. H. Rockett, PhD, MPH1; Eric D. Caine, MD2
[+] Author Affiliations
1Department of Epidemiology, School of Public Health and the Injury Control Research Center, West Virginia University, Morgantown
2Department of Psychiatry and the Injury Control Research Center for Suicide Prevention, University of Rochester Medical Center, Rochester, New York
JAMA Psychiatry. 2015;72(11):1069-1070. doi:10.1001/jamapsychiatry.2015.1418.
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This Viewpoint discusses the false dichotomy of separating suicides from fatal self-injurious acts that are labeled “accidents” or “unintentional” deaths.

Establishing a person’s intention to die has been a central element separating suicides from fatal self-injurious acts that are labeled “accidents” or “unintentional” deaths. We argue that this is a false dichotomy—certainly at the level of populations—that masks the overall magnitude of fatalities arising from deliberate, self-destructive behaviors. In so doing, it mutes the urgency for demanding effective preventive interventions and is particularly problematic as the nation experiences a persisting and growing epidemic of opioid and other drug-poisoning deaths.1 Firearm trauma and hanging/asphyxiation, the 2 leading methods of suicide, typically generate ample forensic evidence for assuring accurate determinations by medical examiners and coroners. However, corroborative evidence is less available for poisoning, the third leading method of suicide overall, and first among women. Parenthetically, we acknowledge that the Centers for Disease Control and Prevention use “unintentional injury" in lieu of the term accident for surveillance and prevention purposes. However, medical examiners and coroners remain bound by statutes in using “accident” as 1 of 6 manner-of-death entries (homicide, suicide, accident, undetermined, natural causes, and unknown) that alternatively appear on death certificates.

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Figure.
Selected Manner and Cause-of-Death Rates per 100 000 Population: United States, 1999-2013

The year-specific self-injury 1 death rate equals total suicide rate, +0.7 and 0.8 of respective accidental and undetermined drug-intoxication death rates for ages 15 years and older. The corresponding self-injury 2 death rate substituted constants of 0.8 and 0.9.

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