{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:34:39Z","timestamp":1784097279346,"version":"3.55.0"},"reference-count":42,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T00:00:00Z","timestamp":1612137600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T00:00:00Z","timestamp":1612137600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T00:00:00Z","timestamp":1611532800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["thelancet.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["EClinicalMedicine"],"published-print":{"date-parts":[[2021,2]]},"DOI":"10.1016\/j.eclinm.2021.100741","type":"journal-article","created":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T15:55:24Z","timestamp":1612799724000},"page":"100741","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":34,"special_numbering":"C","title":["Fatal self-injury in the United States, 1999\u20132018: Unmasking a national mental health crisis"],"prefix":"10.1016","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4584-9337","authenticated-orcid":false,"given":"Ian R.H.","family":"Rockett","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric D.","family":"Caine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aniruddha","family":"Banerjee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bina","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ted","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary S.","family":"Connery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay O.","family":"Lulla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt B.","family":"Nolte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Luke","family":"Larkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Stack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Hendricks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Kathryn","family":"McHugh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franklin M.M.","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelly F.","family":"Greenfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy S.B.","family":"Bohnert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeralynn S.","family":"Cossman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"D'Onofrio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewis S.","family":"Nelson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul S.","family":"Nestadt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James H.","family":"Berry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haomiao","family":"Jia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.eclinm.2021.100741_bib0001","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1056\/NEJMp1801417","article-title":"Suicide: a silent contributor to opioid-overdose deaths","volume":"378","author":"Oquendo","year":"2018","journal-title":"N Engl J Med"},{"key":"10.1016\/j.eclinm.2021.100741_bib0002","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1056\/NEJMra1802148","article-title":"Understanding links among opioid use, overdose, and suicide","volume":"380","author":"Bohnert","year":"2019","journal-title":"N Engl J Med"},{"key":"10.1016\/j.eclinm.2021.100741_bib0003","doi-asserted-by":"crossref","first-page":"822","DOI":"10.2105\/AJPH.2012.301078","article-title":"Forging an agenda for suicide prevention in the United States","volume":"103","author":"Caine","year":"2013","journal-title":"A J Public Health"},{"key":"10.1016\/j.eclinm.2021.100741_bib0004","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.1017\/S2045796019000659","article-title":"Building the foundation for comprehensive suicide prevention - based on intention and planning in a social-ecological context","volume":"29","author":"Caine","year":"2019","journal-title":"Epidemiol Psychiatr Sci"},{"key":"10.1016\/j.eclinm.2021.100741_bib0005","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1001\/jamapsychiatry.2016.1870","article-title":"Self-injury mortality in the United States in the early 21st century: a comparison with proximally ranked diseases","volume":"73","author":"Rockett","year":"2016","journal-title":"JAMA Psychiatry"},{"key":"10.1016\/j.eclinm.2021.100741_bib0006","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1136\/injuryprev-2019-043371","article-title":"Unrecognised self-injury mortality (SIM) trends among racial\/ethnic minorities and women in the USA","volume":"26","author":"Rockett","year":"2020","journal-title":"Inj Prev"},{"key":"10.1016\/j.eclinm.2021.100741_bib0007","series-title":"Deaths of despair and the future of capitalism","author":"Case","year":"2020"},{"key":"10.1016\/j.eclinm.2021.100741_bib0008","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1016\/S0140-6736(12)61141-6","article-title":"Premature death after self-harm: a multicentre cohort study","volume":"380","author":"Bergen","year":"2012","journal-title":"Lancet"},{"key":"10.1016\/j.eclinm.2021.100741_bib0009","doi-asserted-by":"crossref","DOI":"10.1093\/pm\/pnaa214","article-title":"All-cause and overdose mortality risk among people prescribed opioids: a systematic review and meta-analysis","author":"Larney","year":"2020","journal-title":"Pain Med"},{"key":"10.1016\/j.eclinm.2021.100741_bib0010","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.2105\/AJPH.2014.302244","article-title":"Confronting death from drug self-intoxication (DDSI): prevention through a better definition","volume":"104","author":"Rockett","year":"2014","journal-title":"Am J Public Health"},{"key":"10.1016\/j.eclinm.2021.100741_bib0011","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1001\/jamapsychiatry.2018.1471","article-title":"Causes of death after nonfatal opioid overdose","volume":"75","author":"Olfson","year":"2018","journal-title":"JAMA Psychiatry"},{"key":"10.1016\/j.eclinm.2021.100741_bib0012","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1080\/09595230500286039","article-title":"The characteristics of heroin users entering treatment: findings from the Australian treatment outcome study (ATOS)","volume":"24","author":"Ross","year":"2005","journal-title":"Drug Alcohol Rev"},{"key":"10.1016\/j.eclinm.2021.100741_bib0013","first-page":"1","article-title":"Intervention in an opioid overdose event increases interest in treatment among individuals with opioid use disorder","author":"Jones","year":"2020","journal-title":"Subst Abus"},{"key":"10.1016\/j.eclinm.2021.100741_bib0014","article-title":"Variable classification of drug-intoxication suicides across US states: a partial artifact of forensics?","volume":"10","author":"Rockett","year":"2015","journal-title":"PLoS ONE"},{"key":"10.1016\/j.eclinm.2021.100741_bib0015","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.2105\/AJPH.2017.303863","article-title":"Deciphering suicide and other manners of death associated with drug intoxication: a centers for disease control and prevention consultation meeting summary","volume":"107","author":"Stone","year":"2017","journal-title":"Am J Public Health"},{"key":"10.1016\/j.eclinm.2021.100741_bib0016","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0190200","article-title":"Discerning suicide in drug intoxication deaths: paucity and primacy of suicide notes and psychiatric history","volume":"13","author":"Rockett","year":"2018","journal-title":"PLoS ONE"},{"key":"10.1016\/j.eclinm.2021.100741_bib0017","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0197805","article-title":"Method overtness, forensic autopsy, and the evidentiary suicide note: a multilevel national violent death reporting system analysis","volume":"13","author":"Rockett","year":"2018","journal-title":"PLoS ONE"},{"key":"10.1016\/j.eclinm.2021.100741_bib0018","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1016\/S2215-0366(20)30171-1","article-title":"Suicide risk and prevention during the COVID-19 pandemic","volume":"7","author":"Gunnell","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"10.1016\/j.eclinm.2021.100741_bib0019","unstructured":"CDC Health Alert Network. Increase in fatal drug overdoses across the United States driven by synthetic opioids before and during the COVID-19 pandemic. https:\/\/emergency.cdc.gov\/han\/2020\/han00438.asp (accessed 22 December 2020)."},{"key":"10.1016\/j.eclinm.2021.100741_bib0020","unstructured":"Department of Health and Human Services. Wide-ranging online data for epidemiologic research (WONDER) https:\/\/wonder.cdc.gov\/wonder\/help\/ucd.html (accessed 14 June 2020)."},{"key":"10.1016\/j.eclinm.2021.100741_bib0021","series-title":"International classification of diseases, tenth revision (ICD-10)","year":"1992"},{"key":"10.1016\/j.eclinm.2021.100741_bib0022","first-page":"1","article-title":"Deaths: final data for 2017","volume":"689","author":"Kochanek","year":"2019","journal-title":"Natl Vital Stat Rep"},{"key":"10.1016\/j.eclinm.2021.100741_bib0023","series-title":"Surveillance research program","article-title":"Joinpoint regression program","year":"2018"},{"key":"10.1016\/j.eclinm.2021.100741_bib0024","series-title":"Spatial and spatio-temporal Bayesian models with R-inla","author":"Blangiardo","year":"2015"},{"key":"10.1016\/j.eclinm.2021.100741_bib0025","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"12","author":"von Elm","year":"2014","journal-title":"Int J Surg"},{"key":"10.1016\/j.eclinm.2021.100741_bib0026","first-page":"789","article-title":"Regional variations in suicide rates \u2014 United States, 1990\u20131994","volume":"46","year":"1997","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"10.1016\/j.eclinm.2021.100741_bib0027","series-title":"Diagnostic and statistical manual of mental disorders","year":"2013"},{"key":"10.1016\/j.eclinm.2021.100741_bib0028","article-title":"Medical examiners skip some autopsies, as opioid crisis mounts","author":"Calvert","year":"2017","journal-title":"Wall Street Journal"},{"key":"10.1016\/j.eclinm.2021.100741_bib0029","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.0040","article-title":"Assessment of changes in the geographical distribution of opioid-related mortality across the United States by opioid-type, 1999-2016","volume":"2","author":"Kiang","year":"2019","journal-title":"JAMA Netw Open"},{"key":"10.1016\/j.eclinm.2021.100741_bib0030","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.2105\/AJPH.2016.303182","article-title":"Firearm ownership and suicide rates among US men and women, 1981-2013","volume":"106","author":"Siegel","year":"2016","journal-title":"Am J Public Health"},{"key":"10.1016\/j.eclinm.2021.100741_bib0031","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1136\/injuryprev-2015-041586","article-title":"Gun ownership and social gun culture","volume":"22","author":"Kalesan","year":"2016","journal-title":"Inj Prev"},{"key":"10.1016\/j.eclinm.2021.100741_bib0032","article-title":"Drug overdoses in the United States, 1999-2018","volume":"356","author":"Hedegaard","year":"2020","journal-title":"NCHS Data Brief"},{"key":"10.1016\/j.eclinm.2021.100741_bib0033","article-title":"Maryland medical examiner's resignation underscores resource limitations amid opioid crisis","year":"2019","journal-title":"Baltimore Sun"},{"key":"10.1016\/j.eclinm.2021.100741_bib0034","doi-asserted-by":"crossref","first-page":"243","DOI":"10.5498\/wjp.v5.i2.243","article-title":"Systematic review of suicide in economic recession","volume":"5","author":"Oyesanya","year":"2015","journal-title":"World Psychiatry"},{"key":"10.1016\/j.eclinm.2021.100741_bib0035","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1001\/jama.2020.9740","article-title":"Psychological distress and loneliness reported by US adults in 2018 and April 2020","volume":"324","author":"McGinty","year":"2020","journal-title":"JAMA"},{"key":"10.1016\/j.eclinm.2021.100741_bib0036","doi-asserted-by":"crossref","DOI":"10.1001\/jamapsychiatry.2020.1060","article-title":"Suicide mortality and coronavirus disease 2019-A perfect storm?","author":"Reger","year":"2020","journal-title":"JAMA Psychiatry"},{"issue":"Suppl 5","key":"10.1016\/j.eclinm.2021.100741_bib0037","doi-asserted-by":"crossref","first-page":"S451","DOI":"10.1093\/infdis\/jiaa012","article-title":"Trends in morbidity, mortality, and cost of hospitalisations associated with infectious disease sequelae of the opioid epidemic","volume":"222","author":"Coyle","year":"2020","journal-title":"J Infect Dis"},{"key":"10.1016\/j.eclinm.2021.100741_bib0038","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofaa347","article-title":"Concurrent hepatitis C and B virus and human immunodeficiency virus infections are associated with higher mortality risk illustrating the impact of syndemics on health outcomes","volume":"7","author":"Butt","year":"2020","journal-title":"Open Forum Infect Dis"},{"key":"10.1016\/j.eclinm.2021.100741_bib0039","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2019.107612","article-title":"Suicidal motivations reported by opioid overdose survivors: a cross-sectional study of adults with opioid use disorder","volume":"205","author":"Connery","year":"2019","journal-title":"Drug Alcohol Depend"},{"key":"10.1016\/j.eclinm.2021.100741_bib0040","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2020.108041","article-title":"Links between suicidal intent, polysubstance use, and medical treatment after non-fatal overdose","volume":"212","author":"Gicquelais","year":"2020","journal-title":"Drug Alcohol Depend"},{"key":"10.1016\/j.eclinm.2021.100741_bib0041","article-title":"Overcoming the limitations of \u2018accident\u2019 as a manner of death for drug overdose mortality: case for a death certificate checkbox","author":"Rockett","year":"2020","journal-title":"Inj Prev"},{"key":"10.1016\/j.eclinm.2021.100741_bib0042","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1097\/PAF.0000000000000550","article-title":"Position paper: recommendations for the investigation, diagnosis, and certification of deaths related to opioid and other drugs","volume":"41","author":"Davis","year":"2020","journal-title":"Am Forensic Med Pathol"}],"container-title":["EClinicalMedicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2589537021000213?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2589537021000213?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T19:03:50Z","timestamp":1762887830000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2589537021000213"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2]]},"references-count":42,"alternative-id":["S2589537021000213"],"URL":"https:\/\/doi.org\/10.1016\/j.eclinm.2021.100741","relation":{},"ISSN":["2589-5370"],"issn-type":[{"value":"2589-5370","type":"print"}],"subject":[],"published":{"date-parts":[[2021,2]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Fatal self-injury in the United States, 1999\u20132018: Unmasking a national mental health crisis","name":"articletitle","label":"Article Title"},{"value":"EClinicalMedicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.eclinm.2021.100741","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2021 The Author(s). Published by Elsevier Ltd.","name":"copyright","label":"Copyright"}],"article-number":"100741"}}