Suicide, according to the Centers for Disease Control and Prevention, is the 10th leading cause of death in the United States. In 2013, this meant 41,149 people — more people than were killed in traffic accidents. This number is shocking enough, but Ian Rockett, a professor of epidemiology in the School of Public Health at West Virginia University, says the problem is even bigger than it appears.

Along with Eric D. Caine, chair of the Department of Psychiatry and director of the Injury Control Research Center for Suicide Prevention at the University of Rochester Medical Center, Rockett came to the conclusion that self-inflicted injury should actually be listed as the eighth leading cause of death, above kidney disease, pneumonia, and influenza.

He reasoned that there were many factors involved in determining a death by suicide that can affect how and if it is recognized as such. When a person dies, officials are called upon to determine the manner of death, and if it resulted from natural causes or injury — homicide, suicide, accident, or undetermined.

Many self-injury acts are never labeled such, though. A prime example is deaths caused by self-poisoning, which includes drug overdose. Lack of evidence or suicidal intent at the time can cause the death to be categorized as an accident or unintentional death. In addition, the way a state or county determines the cause of death varies from state to state depending on reporting systems, statutory guidelines, and other considerations.

In the piece, published in JAMA Psychiatry, Rockett and Caine explan that separating drug-intoxication suicides from those labeled as unintentional death “masks the overall magnitude of fatalities arising from deliberate, self-destructing behaviors.”

They go on to say that this misclassification stifles the urgency for effective preventive measures and interventions. The nation is experiencing an epidemic of drug-poisoning deaths, and this issue is particularly harmful.

“Dr. Caine and I believe that it hurts the search for understanding and prevention if the self-injury category arbitrarily is split into suicides and so-called ‘accidents,’ when most drug-intoxication deaths involve self-harm and deliberate behaviors,” Rockett said in a press release.

He says that in many opioid-related overdose deaths, life circumstances and behaviors were often similar to those we label as suicide. The only difference is that the intent to die was more clearly expressed in some cases.

“We must begin to recognize and address the growth of deaths from self-harm through sustained interest, concern and action,” Rockett said. “Successful prevention and treatment of drug abuse and misuse will have a positive multiplier effect psychologically, socially, and economically.”

Source: Rockett I, Caine E. Self-Injury Is The Eighth Leading Cause Of Death In The United States, It Is Time To Pay Attention. JAMA Psychiatry. 2015.