Suicides Did Not Rise During Pandemic

Since the start of the coronavirus pandemic a year ago, more than 6,500 Wisconsin residents have died, more than half a million Wisconsin residents tested positive for the virus and almost as many people in the state lost jobs.

In public debate over the human and economic cost of COVID-19, there’s been another recurring claim: that suicides have spiked.

It’s not true.

The belief that suicides have escalated in the pandemic has surfaced on social media, in legislative meetings and on the floors of the state Senate and the Assembly. Last week, Rep. Paul Tittl (R-Manitowoc) rose to advocate for his bill updating the state’s licensing procedures for psychologists. “In this COVID crisis,” he intoned, “mental health needs are increasing, suicides are on the uprise, young people are in distress.”

Mental health advocates and practitioners agree on his first and third points. The stress brought on by the public health crisis and the economic crisis that came with it has put a burden on mental health. And young people are among those bearing that burden.

But when it comes to the widespread claims that many more people have taken their lives in the last year, the evidence suggests that is simply not so.

According to preliminary data from the Wisconsin Department of Health Services (DHS), in 2020 there were 802 suicides: 420 with firearms and 382 by all other methods. The year before, 845 people took their lives: 428 with firearms and 417 by other means.

Although preliminary, the numbers are presumed to be complete or nearly so.

Wisconsin’s data parallels other findings, although it is more up to date than national statistics so far. An early review of information from around the world through June 2020 in the British Medical Journal found indications that suicide rates did not skyrocket in the U.S., western Europe or Japan, but also cautioned that it would take time and more data to draw more certain conclusions.

The Centers for Disease Control and Prevention (CDC) released an early cut for January through July 2020 that showed a 4.6% decline nationally in suicide compared with the same period in 2019.

Alternative measurement

Tyler Black, a Canadian psychiatrist and suicide researcher, says the CDC numbers are close to what he’s seen from a survey that he conducts using media references to suicide. He uses his approach to generate data faster than waiting for official reports, which may take much longer to produce.

His dataset encompasses 28 U.S. states and counties, four Canadian provinces and 11 countries; it counts references to suicide in news reports and scientific articles.

Where the CDC data showed a 4.6% decline in suicides compared with the first seven months of 2019, Black’s tally of suicide references fell 4.1% from the same period the previous year. Examining his data for all of 2020, he estimates suicides may be down anywhere from 1% to 4% from 2019.

Black, who is the medical director for emergency psychiatry at the British Columbia Children’s Hospital in Vancouver, B.C., cautions that his dataset isn’t a true random sample. But by comparing the same locations from year to year, he believes it can help spot trends, particularly when official reports may take much longer to be produced.

A real spike in suicides would seem likely to show up from the information he collects, Black says. And while he doesn’t consider his conclusions definitive, he finds  support for his approach in how closely his January-July 2020 numbers track those of the CDC.

“The best way to interpret my data is that there’s no reason to believe that suicide has significantly increased in 2020,” he says.

There have been scattered, local increases in suicide, and individual suicides at least casually associated with the pandemic.

Milwaukee County recorded 124 suicides in 2020, 10 more than the 114 logged in 2019. Two of the 2020 deaths were linked to the pandemic in the county Medical Examiner’s reports. Parents of a 16-year-old boy who took his life told investigators he had been “struggling with virtual learning and the subsequent decline of his grades,” according to a summary from the ME’s office.

A 59-year-old man’s death was more indirectly related to COVID-19. The man had a history of “depression and extreme anxiety,” the summary states; because of a previous suicide attempt, he had been put in emergency detention, where he hanged himself with a cord from a CPAP machine, used to assist breathing in patients with sleep apnea.

The Medical Examiner’s summary reported that the man had been isolated in the facility after a COVID-19 diagnosis.

At the same time, though, a Milwaukee TV news report in September 2020 showed the hazards of drawing conclusions on very partial data. After a dramatic increase in suicides in August — 23, following just three in July — the report aired a projection from the ME’s office that there would be “nearly 200” by the end of the year if that rate persisted, surpassing the 2017 record number of 156.

It didn’t turn out that way.

Moral panic

“There probably are some people that are showing some degree of being able to handle the pandemic and others that are much more affected by it,” says Tony Thrasher, Medical Director for Crisis Services in the Milwaukee County Behavioral Health Division. “It doesn’t mean that the overall number is higher.”

Black calls the widespread expectation that suicides would skyrocket — and the apparently erroneous belief that they have — “one of the better examples in recent history of moral panic.” It’s of a piece with the assumption that video games cause violence or fantasy games like Dungeons and Dragons draw kids into Satanism, he says — and it fits with many people’s expectations.

When there are claims of a hazard, “politicians and the media are more likely to report that because people are more interested in it,” Black says, while reports that contradict the concern “are more likely to be ignored.”

The absence of a spike doesn’t mean that there’s no reason for concern, he adds. In three states where some data has been available based on race, suicides increased for Black residents while they fell for white ones.

“I think the underprivileged are more likely to experience hardship during the pandemic than your average middle class person who could take time off work, or work virtually,” Black says — and there remains reason to pay attention, and take steps to ensure help is available for people. “Suicide is a societal concern.”

Unpredictable

Even if evidence points to no increase in suicide, there have been reports of more instances of people contemplating taking their own lives. But what people think about doesn’t necessarily point to what they will do.

“Even though we have all these screenings and assessments, suicide is ultimately not something you can predict,” says Leah Rolando, suicide prevention program coordinator for Mental Health America of Wisconsin. “It’s very complex. A lot of factors go into, personally, why someone makes a decision to kill themselves.”

Rolando understands how anxiety over the pandemic and the economic stress that came with it might have stoked expectations for increased suicide. So could awareness of specific risks — she offers the hypothetical  example of a young person, identifying as LGBTQ and possibly already at higher risk for suicide, being stuck at home with an unaccepting family.

But people in her field reject alarmist forecasts, Rolando says, because of suicide’s unpredictable nature, but also because it can be counterproductive.

“We’re not dismissing the fact that mental health issues are going to be kind of escalated during the pandemic,” Rolando says. “But we’re not trying to strike fear. We want people to know creative ways to support one another — creative ways to create belonging.”

A sense of belonging and supportive relationships are “one of the best protective factors against suicide,” she adds. So, when counseling people who express concern about potentially suicidal loved ones, “we always try to make the pivot to [saying], ‘These are the things you can do to make sure your loved ones are being cared for and supported.’”

Rolando also cautions against tying suicide too tightly to mental illness.

“I think there’s this common narrative out there, that suicide is only the result of a mental illness — and so if someone died by suicide and wasn’t diagnosed with a mental illness, people say, ‘Oh, well, it must have been undiagnosed,’” she says.

That’s not necessarily true, Renaldo says. That points to another concern she has: that too often there might be barriers between help and people who need it, including where to go, how to pay for it if there is a cost involved, even whether they qualify.

“I don’t think people need a diagnosis to be able to receive support, and treatment,” Renaldo says. “It’s hard to just make that first call to a crisis line or to a professional and figure out all of that.”

Reasons for hope

One alternative is peer support, including peer-run respite homes. Another is a “warm line” — an alternative to a crisis hotline, she explains — “where folks can just call in and talk about whatever issue they might be dealing with.”

Even with the concern about racial disparities in suicides and the pandemic’s toll on mental health in other ways, Black says there is some hopeful news if the worst fears from the pandemic when it comes to suicide turn out to have been unfounded.

“What I would want people to take away from it is that there’s good reason to think that, during this really stressful time, as we reached out and did things to take care of other people — including acts of heroes in health care, personal sacrifice, doing things to protect others like wearing masks and those types of things — we probably prevented an increase in suicide rates,” Black says.

“And so it tells us what we need to do in 2021 and beyond,” he continues. “We need to continue to look out for people, and most importantly, the disadvantaged among us, who will always bear the worst in these trying times.”

Reprinted with permission of Wisconsin Examiner.