嗑药作祟,美国人的自杀危机可能比想象中严重

众所周知，糖尿病是美国人的一大健康威胁，近几年该病发病率在美国达到了传染病的水平。而研究人员新近报告认为，从致命性看，还有其他死因超过糖尿病，就是自杀和嗑药过量。

根据官方排名，糖尿病是全美范围内第七大死因。2014年，包括自杀和毒品相关的死亡在内，自我伤害致死人数快速增长，跟糖尿病的死亡人数相当。美国弗吉尼亚州摩根敦市西弗吉尼亚大学的流行病学教授伊安·洛克特认为，如果放任当前危机蔓延，一大后果将是美国人的寿命缩短。

上周一，国际儿童和青少年伤害预防协会和暴力与伤害研究协会官方刊物《预防伤害》（Injury Prevention）发布了洛克特作为第一作者的研究报告。他表示：“很遗憾，我认为在（自杀）防御措施方面做得不够好。问题日趋恶化。”

报告指出，虽然公众对尼古丁和处方止痛药的危害越来越了解，但由于验尸人员对死因报告处理方式存在问题，大众很难了解阿片类药物危机实际上的严重程度，也无法明确解决手段。由于多数时候找不到自杀遗书，相关自杀案例的死亡鉴定报告都记录为事故。与此同时，2005年以来自杀率持续攀升，最常见的方式就是过量服药。

洛克特在接受电话采访时表示：“自杀和阿片类药物的致死率双双上升，其实并不孤立。认真研究死者行为就会发现，大多数此类死亡都源于自我伤害。我们不是要责怪死者，但深究起来就是同一类死法。”

报告研究人员认为，将自杀和阿片类药物服用过量区分对待，实际上掩饰了故意自残致死案例众多的现状。充分理解问题的严重性之后，可能有助于公共卫生官员采取有效措施干预危机。

在其他一些复杂的社会卫生问题上，包括吸烟相关的肺癌，还有心脏病、艾滋病和车祸等等，预防性的策略取得了成功。研究人员称，关键在于准确描述和评估问题，然后发动政界力量努力解决。

“对问题没有正确的认识，预防就无从谈起。”研究者表示。

洛克特说，验尸官和法医不应花太多时间调查自杀，应该将两类死因并称为自我伤害。这样一来，就可以更广泛地调查此类死因背后的心理健康问题。

“美国正经历重大的心理健康危机，如果把自杀和嗑药致死视为不同现象，就严重低估了这场危机，”洛克特称，“应该把心理健康作为当务之急，这个问题比想象中严重。”（财富中文网)

译者：Pessy

审校：夏林

Diabetes is a well-known health threat in the U.S., with rates that have reached epidemic levels in recent years. But now researchers are reporting that another scourge has surpassed it in terms of deadliness: suicides and deaths from drug overdoses.

Diabetes is officially ranked the seventh leading cause of death nationwide. Self-injury, as the combination of suicide and drug-related death is known, killed as many people as diabetes in 2014 and is continuing to accelerate. The primary consequence of this unchecked crisis will be decreasing U.S. life expectancy, said Ian Rockett, a professor of epidemiology at West Virginia University in Morgantown.

“Sadly, I don’t think we are doing a good job in terms of getting our arms around it,” said Rockett, the senior author of a study published Monday in the journal Injury Prevention. “It’s a growing problem.”

While there’s increased awareness of the dangers of narcotics and prescription pain medication, the true extent of the U.S. opioid crisis and the path to addressing it have been obscured by how medical examiners report deaths, according to the report. In the absence of a suicide note, most overdoses are recorded as accidents. Meanwhile, suicide rates have been rising since 2005, and the most common form of suicide attempt is a drug overdose.

“The rising suicide and opioid mortality rates aren’t really independent,” Rockett said in a phone interview. “If you put the focus on the behavior, most of these deaths are from self-harm. We don’t want to blame the victim, but descriptively they belong together.”

Keeping them separate masks the national burden of deaths caused by purposeful, self-injurious behaviors, the researchers said. Fully understanding the scope of the problem may help public health officials devise effective methods to intervene in the crisis.

Prevention strategies have found success with other socially complex health problems, including reducing death from smoking-related lung cancer, heart disease, HIV and car crashes. The key is accurately defining and measuring the problem and then finding the political will to address it, they said.

“Without the former, it’s impossible to build the latter,” the researchers said.

Medical examiners and coroners shouldn’t spend more time investigating suicides, Rockett said. Instead, the two categories should be joined so that self-injury, and the mental health issues that underlie it, can be examined more broadly.

“We have a major mental health crisis underway in America, and it’s very much underestimated when we think of suicides and drug intoxication deaths as different phenomenon,” he said. “We need to get mental health on the front burner. It’s an even bigger problem than people realize.”