Fatal self-injury in the United States, 1999-2018: Unmasking a national mental health crisis.
Mental health; Mortality; Prevention; Mental disorders; Drugs; Injury; Suicide; Poisoning; Substance misuse
BACKGROUND: Suicides by any method, plus 'nonsuicide' fatalities from drug self-intoxication (estimated from selected forensically undetermined and 'accidental' deaths), together represent self-injury mortality (SIM)-fatalities due to mental disorders or distress. SIM is especially important to examine given frequent undercounting of suicides amongst drug overdose deaths. We report suicide and SIM trends in the United States of America (US) during 1999-2018, portray interstate rate trends, and examine spatiotemporal (spacetime) diffusion or spread of the drug self-intoxication component of SIM, with attention to potential for differential suicide misclassification. METHODS: For this state-based, cross-sectional, panel time series, we used de-identified manner and underlying cause-of-death data for the 50 states and District of Columbia (DC) from CDC's Wide-ranging Online Data for Epidemiologic Research. Procedures comprised joinpoint regression to describe national trends; Spearman's rank-order correlation coefficient to assess interstate SIM and suicide rate congruence; and spacetime hierarchical modelling of the 'nonsuicide' SIM component. FINDINGS: The national annual average percentage change over the observation period in the SIM rate was 4.3% (95% CI: 3.3%, 5.4%; p<0.001) versus 1.8% (95% CI: 1.6%, 2.0%; p<0.001) for the suicide rate. By 2017/2018, all states except Nebraska (19.9) posted a SIM rate of at least 21.0 deaths per 100,000 population-the floor of the rate range for the top 5 ranking states in 1999/2000. The rank-order correlation coefficient for SIM and suicide rates was 0.82 (p<0.001) in 1999/2000 versus 0.34 (p = 0.02) by 2017/2018. Seven states in the West posted a ≥ 5.0% reduction in their standardised mortality ratios of 'nonsuicide' drug fatalities, relative to the national ratio, and 6 states from the other 3 major regions a >6.0% increase (p<0.05). INTERPRETATION: Depiction of rising SIM trends across states and major regions unmasks a burgeoning national mental health crisis. Geographic variation is plausibly a partial product of local heterogeneity in toxic drug availability and the quality of medicolegal death investigations. Like COVID-19, the nation will only be able to prevent SIM by responding with collective, comprehensive, systemic approaches. Injury surveillance and prevention, mental health, and societal well-being are poorly served by the continuing segregation of substance use disorders from other mental disorders in clinical medicine and public health practice. FUNDING: This study was partially funded by the National Centre for Injury Prevention and Control, US Centers for Disease Control and Prevention (R49CE002093) and the US National Institute on Drug Abuse (1UM1DA049412-01; 1R21DA046521-01A1).
Rockett IRH; Caine ED; Banerjee A; Ali B; Miller T; Connery HS; Lulla VO; Nolte KB; Larkin GL; Stack S; Hendricks B; McHugh RK; White FMM; Greenfield SF; Bohnert ASB; Cossman JS; D'Onofrio G; Nelson LS; Nestadt PS; Berry JH; Jia H
EClinicalMedicine
2021
2021-02
journalArticle
<a href="http://doi.org/10.1016/j.eclinm.2021.100741" target="_blank" rel="noreferrer noopener">10.1016/j.eclinm.2021.100741</a>
Fatal self-injury in the United States, 1999–2018: Unmasking a national mental health crisis
Mental health; Mortality; Prevention; Mental disorders; Drugs; Injury; Suicide; Poisoning; Substance misuse
Background Suicides by any method, plus ‘nonsuicide’ fatalities from drug self-intoxication (estimated from selected forensically undetermined and ‘accidental’ deaths), together represent self-injury mortality (SIM)—fatalities due to mental disorders or distress. SIM is especially important to examine given frequent undercounting of suicides amongst drug overdose deaths. We report suicide and SIM trends in the United States of America (US) during 1999–2018, portray interstate rate trends, and examine spatiotemporal (spacetime) diffusion or spread of the drug self-intoxication component of SIM, with attention to potential for differential suicide misclassification.
Rockett IRH; Caine ED; Banerjee A; Ali B; Miller T; Connery HS; Lulla VO; Nolte KB; Larkin GL; Stack S; Hendricks B; McHugh RK; White FMM; Greenfield SF; Bohnert ASB; Cossman JS; D'Onofrio G; Nelson LS; Nestadt PS; Berry JH; Jia H
EClinicalMedicine
2021
2021-02-01
journalArticle
<a href="http://doi.org/10.1016/j.eclinm.2021.100741" target="_blank" rel="noreferrer noopener">10.1016/j.eclinm.2021.100741</a>
Analysis of Early Job Market Experiences and Perceptions Among Bariatric Surgery Fellowship Graduates and Bariatric Surgery Program Directors
Training; Surgery; Bariatric; Fellow; Job market; Job market analysis
Purpose Over the past decade, an increasing number of bariatric surgeons are trained in fellowships annually despite only a modest increase in nationwide bariatric surgery volume. The study surveys the bariatric surgery job market trend in order to inform better career-choice decisions for trainees interested in this field. Materials and Methods A national retrospective cohort survey over an 11-year period was conducted. Bariatric surgery fellowship graduates from 2008 to 2019 and program directors (PDs) were surveyed electronically. Univariate analysis was performed comparing responses between earlier (2008-2016) and recent graduates (2017-2019). Results We identified a total of 996 graduates and 143 PDs. Response rates were 9% and 20% respectively (n = 88, 29). Sixty-eight percent of graduates felt there are not enough bariatric jobs for new graduates. Seventy-nine percent of PDs felt that it is more difficult to find a bariatric job for their fellows now than 5-10 years ago. Forty-eight percent of PDs felt that we are training too many bariatric fellows. Seventy-seven percent of all graduates want the majority of their practice to be comprised bariatric cases; however, only 42% of them reported achieving this. In the univariate analysis, recent graduates were less likely to be currently employed as a bariatric surgeon (64% vs. 86%, p = 0.02) and were less satisfied with their current case volume (42% vs. 66%, p = 0.01). Conclusions The temporal increase in bariatric fellowship graduates over the past decade has resulted in a significant decline in the likelihood of employment in a full-time bariatric surgical practice and a decline in surgeons' bariatric case volumes.
Lu Y;Juo Y;Martin MJ;Dan AG;Banerjee A;Jones DB;Dakin GF;Jain-Spangler K;Chen Y
Obesity Surgery
2021
2021-01
journalArticle
<a href="http://doi.org/10.1007/s11695-020-05150-7" target="_blank" rel="noreferrer noopener">10.1007/s11695-020-05150-7</a>
Robust protein nitration contributes to acetaminophen-induced mitochondrial dysfunction and acute liver injury
3-Nitrotyrosine; Acetaminophen; Acute liver injury; Biochemistry & Molecular Biology; covalent binding; CYP2E1; Endocrinology & Metabolism; Free radicals; immunohistochemical localization; induced hepatotoxicity; knockout mice; Mitochondrial dysfunction; mouse-liver; n-acetylcysteine; n-acetylcysteine; nitration; nitric-oxide synthase; oxidative stress; protein; superoxide-dismutase; terminal kinase
Acetaminophen (APAP), a widely used analgesic/antipyretic agent, can cause liver injury through increased nitrative stress, leading to protein nitration. However, the identities of nitrated proteins and their roles in hepatotoxicity are poorly understood. Thus, we aimed at studying the mechanism of APAP-induced hepatotoxicity by systematic identification and characterization of nitrated proteins in the absence or presence of an antioxidant, N-acetylcysteine (NAC). The levels of nitrated proteins markedly increased at 2 h in mice exposed to a single APAP dose (350 mg/kg ip), which caused severe liver necrosis at 24 h. Protein nitration and liver necrosis were minimal in mice exposed to nontoxic 3-hydroxyacetanilide or animals co-treated with APAP and NAC. Mass-spectral analysis of the affinity-purified nitrated proteins identified numerous mitochondrial and cytosolic proteins, including mitochondrial aldehyde dehydrogenase, Mn-superoxide dismutase, glutathione peroxidase, ATP synthase, and 3-ketoacyl-CoA thiolase, involved in antioxidant defense, energy supply, or fatty acid metabolism. Immunoprecipitation followed by immunoblot with anti-3-nitrotyrosine antibody confirmed that the aforementioned proteins were nitrated in APAP-exposed mice but not in NAC-cotreated mice. Consistently, NAC cotreatment significantly restored the suppressed activity of these enzymes. Thus, we demonstrate a new mechanism by which many nitrated proteins with concomitantly suppressed activity promotes APAP-induced mitochondrial dysfunction and hepatotoxicity. Published by Elsevier Inc.
Abdelmegeed M A; Jang S; Banerjee A; Hardwick J P; Song B J
Free Radical Biology and Medicine
2013
2013-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.freeradbiomed.2013.02.018" target="_blank" rel="noreferrer noopener">10.1016/j.freeradbiomed.2013.02.018</a>