National Trends in hospitalizations for self-directed violence related to opioids and/or depression - United States, 2000-2015

Prev Med. 2020 May;134:106051. doi: 10.1016/j.ypmed.2020.106051. Epub 2020 Mar 7.


This study examined national trends in self-directed violence in the context of changes in opioid use and depression to better inform prevention measures. Using 2000-2015 National Inpatient Sample (NIS) data, we identified 625,064 hospitalizations for self-directed violence among persons aged ≥10 years in the United States. Based on whether co-listing opioid related diagnosis and depression, we categorized hospitalizations for self-directed violence into four comorbid categories as 1) related to opioids alone; 2) related to depression alone; 3) related to both opioids and depression; and 4) related to neither opioids nor depression. Census population estimates served as the denominator for calculating hospitalization rates for self-directed violence. Hospitalization rates for self-directed violence related to opioids doubled from 5.1 per 100,000 persons in 2000 to 11.0 in 2015. The rate of increase was highest for self-directed violence related to both opioids and depression, which increased 9.4% annually during 2000-2011 and then decreased 4.3% annually during 2011-2015. Hospitalizations for self-directed violence related to depression alone remained the predominant category, accounting for approximately 60% of hospitalizations for self-directed violence; the rates among females aged 10-24 years were the highest among all subgroups, and rose 7.8% annually since 2011 reaching 93.2 per 100,000 persons in 2015. These findings highlight the importance of assessing the risk for self-directed violence among patients misusing opioids and the importance of treating opioid use disorder and depression, particularly when they co-occur. Prevention and treatment of depression is especially important for young females.

Keywords: Depression; Opioid; Self-directed violence; Suicidal; Trends.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Analgesics, Opioid / adverse effects*
  • Child
  • Depression / psychology*
  • Female
  • Hospitalization* / statistics & numerical data
  • Hospitalization* / trends
  • Humans
  • Male
  • Middle Aged
  • Opioid-Related Disorders / epidemiology
  • Self-Injurious Behavior*
  • Sex Factors
  • United States
  • Violence*
  • Young Adult


  • Analgesics, Opioid