Many of you noticed, in my post yesterday, that suicide dropped out of the top 10 leading causes of death in 2020. I thought this was worth a deeper dig…
Does the pandemic increase suicide rates? Unfortunately, this is a simple question with a very complex answer.
Our hypotheses
Throughout the pandemic, there has been a lingering hypothesis that suicide ideation and suicide rates would change. Some people think rates are increasing due to xenophobia, job loss, financial burden, increased internet use (among adolescents specifically), and low social support. After the 2008 Recession, excess suicide was observed in the Americans and Europe due to financial stress. This argument has been consistently used to advocate against lockdowns. On the other hand, some people thought that rates would decrease, as this has been the case after other national disasters (manmade and natural).
Complex health problem to measure
One thing is for sure, though: Measuring suicide is complex.
The most straightforward way is to evaluate excess deaths. However, this takes a while because it takes a lot of time to go through death certificates and develop a clean, useable database. We got a glimpse of the data yesterday, but do not have access to raw numbers. We only know suicide numbers in relation to other causes of death, which is a start.
Death by suicide isn’t the only outcome from self-harm or suicide ideation or attempted suicide. Other outcomes include morbidity, quality of life, financial implications, to name a few. This is much more difficult to measure than categorizing death certificates.
Another challenge is that, typically, specific groups are impacted by suicide fluctuations. Rates will increase among some groups, while rates will decrease in other groups. So, it’s possible that, on average, there are no excess deaths but specific groups increased while other groups decreased.
Along that same line, the mechanism of injury (e.g., hanging or overdose) can also change (but not necessarily change overall rates).
What is the science telling us?
Since March 2020, there have been 160 research articles that have evaluated the impact of the pandemic on suicide. (My colleague collected all of this information. I would link to the study, but it’s currently under review at a journal). Of the 160 studies, the majority of papers are commentaries (i.e. publications that talk about the importance of a topic) or case studies (i.e. describing one or two specific suicide events that can inform clinical or behavioral practices).
The other publications are research studies with a decent amount of suicides or attempted suicides studied. What is the scientific literature telling us so far? In short, findings are mixed and not straightforward.
Some studies have found an increase in suicide ideation…
China: Mandatory lockdown are associated with increased self-harm and suicidal ideation by 5 fold among college students in China (source)
United States: Nearly 15% of a sample of US adults were categorized as high risk for suicide (source)
U.K.: 18% of adults in a UK sample had thoughts of suicide or self-harm in the first month of lockdowns (source)
Some studies have found no change in suicides (and sometimes even a reduction)…
A meta-analysis (i.e. pool of studies looking at this topic) stated: “Overall, we found scarce and weak evidence for an increased risk of deaths by suicide during [outbreaks]” (source)
U.S.: A large reduction in suicides seen at a hospital after lockdowns: 8% to 0%
U.K.: A mild reduction in suicides (1% to 0.2%)
Japan: First wave of the COVID-19 pandemic has not significantly affected suicide rates among children and adolescents during the school closure in Japan. (source)
Peru: Suicides had a sudden drop after lockdowns, particularly among women (source)
Google: Initial stages of the pandemic were accompanied by a substantial reduction in Google searches related to suicide (source)
Bottom line
Measuring suicide is complex. While it dropped out of the top 10 leading causes of death, this does NOT mean it didn’t increase among certain groups. When the raw data is released, further analyses will certainly be needed (I’m looking at you- PhD students!).
Love, YLE
P.S. The pandemic (and everything that’s come with it) has been a LOT. You’re not alone and you can get better. There are resources out there to help. In the U.S., one great place to start is HERE (the National Suicide Prevention Hotline website). It is confidential, free, open 24/7, and resources are available in English or Spanish. They have a phone line (1-800-273-8255) or a chat option for immediate assistance. They also have a great webpage on “Emotional Wellbeing During the Pandemic” HERE.