Epidemiologist says suicide, death from intentional self-injury is greatly underestimated in U.S.

Together with Eric D. Caine, M.D., chair of the Department of Psychiatry and director of the Injury Control Research Center for Suicide Prevention at the University of Rochester Medical Center, Rockett concluded that self-inflicted injury is actually the eighth leading cause of death, above kidney disease, and pneumonia and influenza.

When a person dies, state or local officials determine whether the manner of death was the result of injury -- homicide, suicide, accident or undetermined -- or from natural causes, but many fatal self-injury acts are not labeled as suicides.

For example, many deaths caused by self-poisoning, which includes drug overdose, are categorized as accidents or unintentional deaths due to a lack of evidence of suicidal intent at the time of death, despite a preceding pattern of self-injuring behaviors.

Additionally, determination of manner of death can vary from county to county and state to state, depending on statutory guidelines, reporting systems, investigations and other considerations.

In JAMA Psychiatry, Rockett and Caine emphasize that separating drug-intoxication suicides from those labeled as accidental or unintentional injury death "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 problematic as the nation experiences a persisting and growing epidemic of opioid and other drug-poisoning deaths."

"Dr. Caine and I believe that it hurts the search for understanding and prevention if the self-injury category arbitrarily is split into suicides and so-called 'accidents,' when most drug-intoxication deaths involve self-harm and deliberate behaviors," Rockett said.

"At a time in the U.S. when there is increasing urgency to stem the tide of prescription- and opiate-related overdose deaths, we are failing to appreciate that most often the life circumstances and behaviors that contributed to these tragedies were similar to those we label as suicide -- except, in the latter, the intent to die was more clearly expressed," Rockett said. "However someone felt immediately before death, many of the public health strategies to prevent these problems and preserve life are the same.

"We must begin to recognize and address the growth of deaths from self-harm through sustained interest, concern and action," Rockett said. "Successful prevention and treatment of drug abuse and misuse will have a positive multiplier effect psychologically, socially, and economically."