{"id":566118,"date":"2026-07-24T15:14:08","date_gmt":"2026-07-24T15:14:08","guid":{"rendered":"https:\/\/www.newsbeep.com\/ie\/566118\/"},"modified":"2026-07-24T15:14:08","modified_gmt":"2026-07-24T15:14:08","slug":"the-suicides-were-not-counting","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/ie\/566118\/","title":{"rendered":"The Suicides We’re Not Counting"},"content":{"rendered":"

When someone dies of a drug overdose, a medical examiner or coroner faces a judgment call that shapes both a family\u2019s grief<\/a> and a nation\u2019s statistics: Was it an accident, or did the person mean to die? It sounds like a question with a clear answer. In practice, it is among the hardest determinations in all of medicine and public health \u2014 and I have come to believe we are getting it wrong more often than we used to.<\/p>\n

I have spent much of my career<\/a> as an injury epidemiologist studying how we count deaths, and I\u2019ve reached an unsettling conclusion: American suicide accounting has deteriorated over the past 25 years, even as suicide itself has climbed.<\/p>\n

Consider the numbers. Between 2000 and 2024, the national suicide rate rose 37.5%. Over the same stretch, the drug-poisoning death rate rose three and a half times. Yet the rate of deaths officially recorded as drug-poisoning suicides barely moved \u2014 drifting between 1.3 and 1.8 per 100,000 people, even as pills and fentanyl grew far more lethal and far more available. That gap should give us pause. By our best estimate, up to 30% of overdose deaths may in fact be suicides that were never recorded as such.<\/p>\n

The problem is part human, part structural. Suicide has always been stigmatized \u2014 shadowed by religious condemnation, legal prohibition, and insurance clauses that punish grieving families. Relatives may resist the label; investigators, sensitive to that pain and short on time, may reach for a gentler one. And the people who make these calls \u2014 medical examiners and coroners \u2014 have been overwhelmed, first by the opioid epidemic and then by COVID-19<\/a>, which buried them under what one colleague described as the \u201cpiling of bodies.\u201d<\/p>\n

To classify a death as suicide, an investigator generally needs evidence of intent: a note, a psychiatric<\/a> history, a record of prior attempts \u2014 some sign the person wanted to die. A gunshot wound or a hanging is forensically overt. A drug overdose is quiet and ambiguous. When corroborating evidence is missing, as it so often is, the default becomes \u201caccident.\u201d<\/p>\n

We cannot prevent what we cannot see. And the deaths we miss are not missed at random.<\/p>\n

We have known how to do better for a long time. In mid-20th-century Los Angeles County, a wave of barbiturate deaths defied easy classification. A team from the Los Angeles Suicide Prevention Center \u2014 the psychologists Edwin Shneidman and Norman Farberow, the psychiatrist Robert Litman, and the chief county coroner, Theodore (Ted) Curphey \u2014 pioneered what Shneidman called the \u201cpsychological autopsy\u201d: a careful reconstruction of a person\u2019s final weeks through records and interviews with those who knew them. It worked, uncovering hidden suicidality<\/a> in cases that had looked equivocal. Then, largely because of cost and inertia, the practice faded. That cost looks trivial beside a recent estimate that suicide drains American society of roughly half a trillion dollars a year.<\/p>\n

Why does the miscounting matter so much? Because the deaths we overlook are not missed at random. The undercounting falls more heavily on some groups than others. Using a broader, behavior-based measure my colleagues and I call self-injury<\/a> mortality, we found that from 2008 to 2017 such deaths rose 109% among Black Americans, against 55% among white Americans \u2014 and faster among women than men. Official suicide statistics hide those divergences. If we can\u2019t see who is dying, we can\u2019t design prevention that reaches them.<\/p>\n

So, what would help? A shift in how we think about these deaths. Rather than staking everything on inferring what a person intended in their final moments \u2014 often unknowable \u2014 we can pay attention<\/a> to how they lived in the weeks before: the patterned, repetitive self-harm of escalating substance use. Self-injury mortality gathers registered suicides together with the great majority of overdose deaths that reflect that behavior, whatever we can affirm about intent. A concrete first step would be adding a self-injury checkbox to the U.S. death certificate \u2014 one that cuts across suicide, \u201caccident,\u201d and undetermined \u2014 so this hidden toll finally becomes visible to the people who plan prevention and treatment.<\/p>\n

The stakes are only rising. With economic turbulence, cuts to the social safety net, and the early signs of an opioid crisis reaching Europe, this is no moment to look away from the deaths we aren\u2019t counting. The first task of prevention is honest arithmetic. We owe the people we\u2019ve lost \u2014 and the ones we still might save \u2014 an accurate count.<\/p>\n

If you or someone you love is contemplating suicide, seek help immediately. For help 24\/7 dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"When someone dies of a drug overdose, a medical examiner or coroner faces a judgment call that shapes…\n","protected":false},"author":2,"featured_media":566119,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[61,60,43],"class_list":["post-566118","post","type-post","status-publish","format-standard","has-post-thumbnail","category-ireland","tag-ie","tag-ireland","tag-news"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/566118","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/comments?post=566118"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/566118\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media\/566119"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media?parent=566118"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/categories?post=566118"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/tags?post=566118"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}