We investigate recent trends in U.S. suicide mortality using a “structural determinants of health” framework. We access restricted-use multiple cause of death files to track suicide rates among U.S. Black, White, American Indian/Alaska Native, and Latino/a men and women between 1990 and 2017. We examine suicide deaths separately by poisonings and nonpoisonings to illustrate that (1) women’s suicide rates from poisonings track strongly with increases in prescription drug availability and (2) nonpoisoning suicide rates among all adult Americans track strongly with worsening economic conditions coinciding with the financial crash and Great Recession. These findings suggest that institutional failures elevated U.S. suicide risk between 1990 and 2017 by increasing access to more lethal means of self-harm and by increasing both exposure and vulnerability to economic downturns. Together, these results support calls to scale up to focus on the structural determinants of U.S. suicide.

中文翻译：

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制度失败是自杀的结构性决定因素：阿片类药物的流行和美国的大衰退


我们使用“健康的结构性决定因素”框架来调查美国自杀死亡率的最新趋势。我们访问限制使用的多种死因文件，以跟踪 1990 年至 2017 年间美国黑人、白人、美洲印第安人/阿拉斯加原住民和拉丁裔/男女的自杀率。我们分别按中毒和非中毒情况检查自杀死亡情况，以说明(1) 女性中毒自杀率与处方药供应量的增加密切相关；(2) 所有成年美国人的非中毒自杀率与金融危机和大衰退同时发生的经济状况恶化密切相关。这些发现表明，1990 年至 2017 年间，制度失灵增加了更致命的自残手段，并增加了经济衰退的风险和脆弱性，从而提高了美国的自杀风险。总之，这些结果支持了扩大规模以关注美国自杀的结构性决定因素的呼吁。