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Opiate Use and Rise in U.S. Suicide Rates: a Network Analysis Approach on the National Violent Death Reporting System Data

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Abstract

Suicide is a serious public health threat in the U.S. as evidenced by increases in suicide rates between 1999 and 2018 and between 2020 and 2022. Opiate use has been implicated as a contributor of such trends in suicide rates by directly influencing overdose deaths and indirectly by exacerbating mental health and life circumstances. A moderated network model was estimated on a subset of the National Violent Death Reporting System Data (n = 78,089) to examine the partial correlation structure of suicidal thoughts and behaviors, opiate use at the time of death, stressful life circumstances, experience of depression, alcohol abuse, and substance abuse. Moderation effects of year of death and opiate use at the time of death were independently tested to compare network structures across suicide decedent cohorts/years and opiate use at the time of death. Results showed that overall network structures appeared to be very stable over years/cohorts. Opiate use at the time of death, stressful life circumstances, experience of depression, alcohol abuse, and substance abuse explained limited variance of suicidal thoughts and behaviors. Simultaneously, connections between suicidal thoughts and behaviors, as well as depressed mood, increasingly strengthened over years/cohorts. Alcohol and substance abuse were also increasingly co-occurring over years/cohorts, although they were less co-occurring in decedents who had used opiates at the time of death. Future studies should aim to examine if partial correlation structures identified in the current study generalize in non-decedents and in those with marginalized identities.

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Data Availability

The data that support the findings of this study are available from the Centers for Disease Control and Prevention. Restrictions apply to the availability of these data, which were used under license for this study. Data access requests should be directed to the Centers for Disease Control and Prevention (link: https://www.cdc.gov/violenceprevention/datasources/nvdrs/dataaccess.html).

Notes

  1. We examined the network structure of suicidal thoughts and behaviors, opiate use at the time of death, stressful life circumstances, experience of depression, alcohol abuse, and substance abuse with both year of death and opiate use at the time of death set as moderators. Results showed year of death did not moderate any edges involving opiate use as a node and opiate use did not moderate any edges that included year of death in the node pairs.

  2. Only one outlier (i.e., decedent listed as less than one year of age) was removed. In the final dataset of decedents whose data met our inclusion criteria, no decedent was listed as being less than 7 years old.

  3. Sparsity in network analysis is a central assumption (i.e., assuming that true network structure is more likely sparse than dense) that must be carefully applied in smaller samples (n<500) as EBIC may not accurately identify the network if the true network structure is dense. However, this assumption becomes less problematic in larger samples (n > 5,000), as unregularized and regularized estimations tend to converge (Epskamp et al., 2017). Given our sample size was well over this threshold, we opted to use EBIC.

  4. “Latine” was used to refer to individuals of Hispanic, Latin, and Spanish-speaking descent residing in the U.S. due to Latine being inclusive of all gender identities and the -e suffix already existing in Spanish phonological and lexical systems (vs. “Latinx,” although the two terms are sometimes used interchangeably).

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Funding

This work was supported in part by the Military Suicide Research Consortium (MSRC), an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs under Award Nos. (W81XWH-10-2-0181 and W81XWH-10-2-0178). The MSRC supported personnel time for Min Eun Jeon, Morgan Robison, and Thomas E. Joiner.

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  1. Department of Psychology, Florida State University, 1107 West Call St, Tallahassee, FL, 32306, USA

    Min Eun Jeon, Morgan Robison & Thomas E. Joiner

  2. Department of Psychology, Texas State University, San Marcos, TX, USA

    Megan L. Rogers

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  1. Min Eun Jeon
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Jeon, M.E., Robison, M., Rogers, M.L. et al. Opiate Use and Rise in U.S. Suicide Rates: a Network Analysis Approach on the National Violent Death Reporting System Data. J Cogn Ther 17, 6–30 (2024). https://doi.org/10.1007/s41811-023-00187-9

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