Suicide trends in the early months of the Covid-19 pandemic | Hacker News Reader

Suicide trends in the early months of the Covid-19 pandemic

thelancet.com

66 pointsDanBC58 comments

While it's kind of a non-event, and given that it's only the early months of the pandemic maybe not even a particularly surprising non-event, I think it is important that even studies which don't find anything noteworthy get published. So, while I still have serious concerns about the long-term mental health impacts of the pandemic (for several reasons), I do think it's good that this got published.

Why do you say that this isn't noteworthy?

They found there was no significant increase in suicide in any of the 35 regions they studied, and in fact found a statistically significant decrease in suicide in 12 of them. Given that many people were concerned there might be an increase in suicides due to pandemic lockdowns, particularly in the early months when restrictions were most severe, this seems like a very noteworthy result.

Yeah, I don't know how many times on HN I've seen comments like "we need to open things up because suicides are up due to shutdowns!" without any supporting data. And now we see suicides were actually down in some places and mostly unchanged everywhere else.

There are hundreds of stories like this one by NPR, which not an expected source for anti-lockdown fake news:

https://www.npr.org/sections/health-shots/2021/02/02/9620601...

So people read it and think the suicide rate is going up. It may actually be going up for some groups in some places, but the bigger message here is that the media loves a good horror story, and is willing to report anything based on anecdotes.

I wouldn't really expect suicides to rise much within the first few months, if at all. It's 3+ months an onward that I would expect to start seeing increases due to prolonged isolation.

But deaths of despair are on the rise. Perhaps pro-lockdown and anti-lockdown people focus on the wrong data points.

https://www.sciencenews.org/article/deaths-of-despair-depres...

But this was just for the first three months, and for those regions... I'm not for hasty reopenings, rather for more money for mental health, and intuition says the loss of jobs and financial security must have an effect on mental health, and unfortunately along with that, suicides.

E.g. in India: https://www.latimes.com/world-nation/story/2020-10-06/suicid...

The data doesn't show that lockdowns didn't cause suicide, either though. For example, Norway is in the dataset, and Norway didn't lock down, or only locked down for a couple weeks. It might also be interesting to see what the results were in urban areas with tight restrictions, maybe even in countries with already high suicide rates, like South Korea and Japan, to see the results. But either way, you cannot isolate the "lockdown" variable because there was a full spectrum of policy responses from different countries, cities, and subregions. So, let's just say the jury is still out.

We know that social isolation causes depression. We know that economic hardship causes depression. When people argue against lockdowns, this is why.

We had more lockdowns, we didnt have more suicides, how is that not showing the claim doesnt hold?

That caveat about this only covering the first few months of the pandemic is actually important. I know that Japan for example has seen a substantial rise in suicides but it happened after the time period covered by this article (though well before it was actually published).

Yes. One of the authors is very clear that this is early data.

https://twitter.com/ProfLAppleby/status/1382248431272480769?...

  What is message from our new paper showing no rise in suicide in pandemic? 
  •early figures, risks remain, #suicideprevention still a priority
  •main risk is economic downturn - protecting income, jobs, housing vital 
  •MH care & community supports needed for those most at risk

https://twitter.com/ProfLAppleby/status/1382257477111140358?...

  Some cautions re our new paper on suicide post-Covid
  •England data not included, to be reported soon
  •mainly rich countries, impact may be greater in poorer parts of world 
  •early figs, we are still in mid-pandemic
  •no analysis by age, race or region

People who rejoice about this study because they want to use it to defend policies that are criticized for potential negative mental health impacts willingly neglect the nature of suicide: Of course sucide numbers go down because many suicidal people want their death to be noticed.

Say the policies are lifted and suicides go up again, will the rejoicing ones account for that as well? Of course not, they will rather gaslight the argument by blaming the increase on the lifting

Perhaps change title to “Suicide rates mostly unchanged due to Covid-19 pandemic”

From the introduction: "The evidence so far is insufficient to indicate what the effect of COVID-19 on suicides has been or will be"

Perhaps there has to differentiation between impact of lockdowns and the long term effects of the pandemic.

Any economic downturn like whats happening now is significant trigger for mental health issues and suicides, and will take lot of time to surface and in turn be measured.

The narrower question is whether there has been strong impact on suicide rates and mental health as result of last year of staying home involuntarily could perhaps be answered now.

One thing for sure is that there's an obvious increase in report of anguish. It might not lead to catastrophic events but it's for everyone to see. That said it can also be an emotional mirroring effect.. seeing people talk about how they're losing it might make you want to write that too.

Actually decreased in the US, it's now documented.

I’m surprised the numbers between NSW & QLD are similar to Victoria. As Victoria (Melbourne specifically, but that represents the majority of the population) had a long, harsh lockdown, where as QLD & NSW did not.

Maybe looking at suicides within specific populations would be more telling. I imagine for many, working from home was an opportunity. For others, it meant unemployment.

Looking at how small the numbers are, I think the error on finer grain analysis would end up being misleading. The data seems to be saying lockdowns are not really a significant factor

Well, it all depends on the exact mechanisms for how "I'm depressed" gets all the way to suicide. No question that the lockdown was depressing for a lot of people, but there's all kinds of reasons it might not (in the early months) have led to an increase in suicides, including:

- a feeling that it wasn't just you, lots of people felt this way

- a feeling that an end was in sight, unlike if you think you've just screwed up your life somehow

- an understanding that the way you were feeling was not your fault, and had an external cause, rather than being about your worth or etc.

Not saying any of these theories (guesses) are right, just suggesting there are lots of possibilities which would need to be examined to really understand what went on (and didn't) during a lockdown.

I apologize if this is dark. Could it be that the change-up in our routines and the world in general has made some suicidal people reconsider? We live in very interesting times.. I have never been close to considering suicide, but I imagine I would at least have wanted to find out what happens next now that there's a global pandemic.

That take isn't unintuitive, but I think it discounts the degree to which suicidal thoughts are the product of mental illness. It's not that a suicidal person needs a reason to live, or a logical argument to change their mind. In most cases (some estimates say 90%) the individual needs treatment for a specific mental illness.

I don't think that's true at all. For example in Japan most suicides are by older men who become single. It's not like they suddenly develop a mental illness.

Suicide and what motivates people to complete it is an incredibly complex topic. If you're looking at somewhere to start reading, I found Durkheim's theories interesting (and somewhat comforting, given recent experiences).

If someone reading this is considering it, please reach out to someone. I won't say that it will get better, but most people who survive their attempts regret attempting it in the first place.

My guess is, it's because in the beginning of the pandemic many people started reconnecting with people they hadn't talked to in a long time, and some suicidal people found sympathetic ears.

Fascinatingly, social media and messenger apps probably have data to back my guess, "Of people that interacted with each other, give me the time interval since their last interaction", and my guess is, the average of that interval would've increased in March/April 2020.

No, I just want to watch the world burn.

Should HN automatically post the suicide prevention lines on posts that mention suicide and have a certain number of votes? I feel like it should.

Why do you feel that way? I don’t have any context on your worldview and don’t really understand that meme. What does suicide prevention copypasta actually do, what does it hope to accomplish, is there any quantitative study on the efficacy, and do people even want data as opposed to a feeling?

It's part of the guidelines put together for the media based on studies for reporting about suicide to include resources.

> Provide information on warning signs of suicide risk as well as hotline and treatment resources. At a minimum, include the National Suicide Prevention Lifeline and Crisis Text Line (listed below) or local crisis phone numbers.

https://reportingonsuicide.org/

I don't think I would expect this from a scientific paper but it doesn't seem inappropriate for HN.

Serious answer: suicidal ideation is MUCH more common than almost anyone realizes, and it correlates with news about other suicides more than we'd like to admit. Making sure that people who would be otherwise encouraged in that direction have access to help at the sites doing the inducement is mostly just common sense.

Can I flip this around? Why did you feel compelled to post that, in particular the last clause ("data as opposed to a feeling") which seems surprisingly dismissive of a position on a subject that by your own admission you lack expertise with?

I'll be honest: that looks like anti-woke virtue signalling if I ever saw it.

What happens on the suicide hotline?

Is it adequate, does it cover the use case of people that don’t want to be here anymore?

Does the common sense have any peer reviewed backing? (I previously wrote quantitative, which I would like to evaluate in the peer reviewed study)

If my question provided no introspection for you, do you really think asking me my own question provided introspection for me? I am still left curious. Still lacking the context, I think the current approach is feelings based, emotion, based on heavy reactive assumptions that don’t address anything, but I don't actually know.

Regarding the phrasing, I’m actually trying not to come across with my actual pretty negative opinions of this because I’m hoping someone will actually explain the cause and effect before I make those conclusions known.

Explain the common sense, if the answer is “actually only a small sliver of some suicide is adequately addressed by simply talking about and we have no study and no other information about the other suicides” then just say that. I would be a lot more content if people were just able to say that or cite some other stat. As opposed to copypasta and group think.

I’m not necessarily convinced that “help” is the right word for all use cases, and think people just don't want to honestly talk about. So lets just start with the basics of basics, why are we doing this.

> If my question provided no introspection for you

This is more taunting hyperbole. It doesn't leave me with the impression that you want to take this seriously, and more that you want to position yourself in yet another culture war skirmish.

It was a spontaneous thought that came to mind when I saw this post. I am not aware of any such research but know that search engines do it automatically and people do on Reddit posts that are related to this topic.

You could post the links yourself and let the hivemind decide.

> suicide prevention lines on posts that mention suicide

Is there any evidence that such support lines actually help prevent suicide?

Found this article:

https://www.healthyplace.com/suicide/how-does-a-suicide-prev...

"It is difficult to gather strict evidence about the effectiveness of suicide prevention hotlines, but Dr. Madelyn Gould of Columbia University found that of Lifeline callers:

    12% of suicidal callers said that talking to someone at Lifeline prevented them from harming or killing themselves

    Almost 50% followed through with a counselor's referral to seek emergency services or contacted mental health services

    About 80% said that Lifeline had something to do with keeping them alive"

Not a ton, but initial studies do seem to suggest they push people from "executing on a plan with the means to do so" to not. Some recent meta-analysis I read seemed to indicate there needs to be more research done, but it's not something you really want to A/B test.

If I don’t ask this well, please be kind. Are you saying there is evidence hotlines back people off of dangerous levels of intent, or that there is evidence they play some role in dismantling the means—convincing to remove weapons and pills, for example, so that the strong suicidal desire is less likely to lead to action? Either way it’s good news.

From my initial readings I _believe_ it's the backing out of intent. "Making action plans" and "provision of referrals" has also been mentioned so it could be both! I'm only looking at the lit reviews at the moment though.

In my experience, the "talking off the ledge" was always the most important part in the moment. I found that the follow up from someone who knows what they're doing helped keep me away from the ledge too.

I feel like a lot more work could be done in this area, but I'm not in psych and I wouldn't know where to contribute.

imo no, it's a trite gesture that I can't help but feel is robotic and lacking in human warmth..

Just because something is robotic does not mean it can't be of immense help to people in that moment.

Very trivial nudges have been known to help people who have had suicidal thoughts and prevented them from committing actions.

Please don't. Posting the suicide hotlines does not make you a hero.

Does that have any effect on reducing suicide rates?

In this climate if it saves just one life it's worth it.

In what climate wouldn't it be?

But we don't know if it does. It sounds like a kind of thing that does almost nothing on its own and becomes irrelevant the moment a halfway decent solution is found.

You're right that if we do find something that makes it irrelevant, it won't be needed. Let's not make perfect the enemy of good here though - it's a mild preventative that actually may help someone at risk. There have been studies that show that even _reporting_ on suicide can cause an uptick of rates without the proper precautions. If it doesn't impact you, great. If it helps pull someone else off the edge though, it's worth it.

Cars kill people. We don't pull them off the road to save a life.

Do you think anyone has ever been helped by such a thing? I'm highly skeptical.

Why are you skeptical? Having the resources prominent immediately after someone is thinking about suicide based on external stimulus seems like it could help someone, and even if it only helps one person, that seems like it would be worth it to me.

Frankly I'm skeptical that suicide hotlines are an effective tool, and then on top of that it would have to be the case that sticking the link underneath an article makes people more likely to call it and benefit from it.

What harm does it do, materially, to post suicide prevention links?

What harm would it do to post some Bible passages under such posts? That might help someone. If we’re just doing everything that might help and wouldn’t seem to hurt.

Seems like a good study. Interesting result, I wonder if it will hold true for later periods, once the novelty has worn off...

Interesting to see the differences in the German cities.

Seems that the smaller the city, the lower the suicide rate.

Perhaps it is because you are more emotionally and socially connected to everyone near by to get better support and care?

I know in the US it's the opposite with higher suicide rates in more rural areas.

In U.S. rural areas can very be sparsely populated , the effect of neighbors and family nearby may not be as strong perhaps.

Or perhaps this could be because job losses have had heavier impact on industries based in the cities, like travel and tourism and less so in rural towns, which in turn kept the rates lower.

Tell this to the parent whose teenager committed suicide in the early or later months of the Covid-19 pandemic. No way that this study is an accurate picture of the Covid-19 pandemic. Perhaps suicides due to other causes reduced, while suicides due to lockdowns increased and the data just showed that the number is unchanged.

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