Do Geographic Regions with Higher Suicide Rates also have Higher Rates of Nonfatal Intentional Self-Harm?

Fatal and nonfatal Intentional self-harm events in eight U.S. states were compared using emergency department, hospital, and vital statistics data. Nonfatal event rates increased by an estimated 24.20%, over 6 years. Case fatality ratios varied widely, but two northeastern states' total event rates (fatal plus nonfatal) were very high (New Hampshire 206.5/100,000 person years; Massachusetts 166.7/100,000). Geographic context did not uniformly Impact the likelihood of self-harm across event types. The state-level public health burden posed by such acts cannot, therefore, be accurately estimated from either mortality or morbidity data alone.