眾所周知，糖尿病是美國(guó)人的一大健康威脅，近幾年該病發(fā)病率在美國(guó)達(dá)到了傳染病的水平。而研究人員新近報(bào)告認(rèn)為，從致命性看，還有其他死因超過(guò)糖尿病，就是自殺和嗑藥過(guò)量。

根據(jù)官方排名，糖尿病是全美范圍內(nèi)第七大死因。2014年，包括自殺和毒品相關(guān)的死亡在內(nèi)，自我傷害致死人數(shù)快速增長(zhǎng)，跟糖尿病的死亡人數(shù)相當(dāng)。美國(guó)弗吉尼亞州摩根敦市西弗吉尼亞大學(xué)的流行病學(xué)教授伊安·洛克特認(rèn)為，如果放任當(dāng)前危機(jī)蔓延，一大后果將是美國(guó)人的壽命縮短。

上周一，國(guó)際兒童和青少年傷害預(yù)防協(xié)會(huì)和暴力與傷害研究協(xié)會(huì)官方刊物《預(yù)防傷害》（Injury Prevention）發(fā)布了洛克特作為第一作者的研究報(bào)告。他表示：“很遺憾，我認(rèn)為在（自殺）防御措施方面做得不夠好。問(wèn)題日趨惡化。”

報(bào)告指出，雖然公眾對(duì)尼古丁和處方止痛藥的危害越來(lái)越了解，但由于驗(yàn)尸人員對(duì)死因報(bào)告處理方式存在問(wèn)題，大眾很難了解阿片類藥物危機(jī)實(shí)際上的嚴(yán)重程度，也無(wú)法明確解決手段。由于多數(shù)時(shí)候找不到自殺遺書，相關(guān)自殺案例的死亡鑒定報(bào)告都記錄為事故。與此同時(shí)，2005年以來(lái)自殺率持續(xù)攀升，最常見的方式就是過(guò)量服藥。

洛克特在接受電話采訪時(shí)表示：“自殺和阿片類藥物的致死率雙雙上升，其實(shí)并不孤立。認(rèn)真研究死者行為就會(huì)發(fā)現(xiàn)，大多數(shù)此類死亡都源于自我傷害。我們不是要責(zé)怪死者，但深究起來(lái)就是同一類死法。”

報(bào)告研究人員認(rèn)為，將自殺和阿片類藥物服用過(guò)量區(qū)分對(duì)待，實(shí)際上掩飾了故意自殘致死案例眾多的現(xiàn)狀。充分理解問(wèn)題的嚴(yán)重性之后，可能有助于公共衛(wèi)生官員采取有效措施干預(yù)危機(jī)。

在其他一些復(fù)雜的社會(huì)衛(wèi)生問(wèn)題上，包括吸煙相關(guān)的肺癌，還有心臟病、艾滋病和車禍等等，預(yù)防性的策略取得了成功。研究人員稱，關(guān)鍵在于準(zhǔn)確描述和評(píng)估問(wèn)題，然后發(fā)動(dòng)政界力量努力解決。

“對(duì)問(wèn)題沒(méi)有正確的認(rèn)識(shí)，預(yù)防就無(wú)從談起。”研究者表示。

洛克特說(shuō)，驗(yàn)尸官和法醫(yī)不應(yīng)花太多時(shí)間調(diào)查自殺，應(yīng)該將兩類死因并稱為自我傷害。這樣一來(lái)，就可以更廣泛地調(diào)查此類死因背后的心理健康問(wèn)題。

“美國(guó)正經(jīng)歷重大的心理健康危機(jī)，如果把自殺和嗑藥致死視為不同現(xiàn)象，就嚴(yán)重低估了這場(chǎng)危機(jī)，”洛克特稱，“應(yīng)該把心理健康作為當(dāng)務(wù)之急，這個(gè)問(wèn)題比想象中嚴(yán)重。”（財(cái)富中文網(wǎng))

譯者：Pessy

審校：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.”