Suicide has become rarer during the pandemic
economist.com
economist.com
https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
https://pediatrics.aappublications.org/content/147/3/e202002...
https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm
https://www.bmj.com/content/371/bmj.m4095
https://pubmed.ncbi.nlm.nih.gov/33533876/
https://www.kff.org/coronavirus-covid-19/issue-brief/the-imp...
On a more anecdotal note, I'm personally close to a therapist, and they're busier with SI patients than ever. They're also overwhelmed with demand, in general, having seen a significant increase in both patients and patients with SI over the course of 2020.
Given the viral property of suicides[1] in communities, a sudden mean reversion on those stats concievably risks turning into a cascade effect as well, which would manifest just on our way out of this mess.
[1] https://www.hhs.gov/answers/mental-health-and-substance-abus...
Prior to 2020, my insurer would've laughed me off if I tried to claim a psychotherapy visit that wasn't done in person. Now it seems they're bending over backwards to let me know they are allowing it.
Something as small as physically going to an appointment is enough of a barrier to access, sometimes.
Similar to celebrating how the economy is doing better than ever during covid, but the actual bill for unprecedented government spending hasn't come due.
edit: typo
I have noticed little sympathy for this here on HN, as well as in interviews with scientific advisors to my own government (who tell the journalist things like "masks are just a thin little layer of fabric, they have no drawbacks whatsoever!"). Often people point to Asia as a reason people should not feel any unease in a mask, but the smile famously plays a rather different role in Asian body language than in the West.
In 2021, a person having a bad mental health day can wrap their face up and not have to deal with anyone. Possibly taking a lot of pressure out of a critical tipping point of mental distress.
Fascinating seeing how so many people do not want to accept the data as is because it doesn't fit their pre-conceptions.
Not sure exactly what you're implying here, but cherry-picking data to fit pre-conceptions has definitely been an epidemic of its own throughout the Covid situation.
The suicides went down thing really goes against what significant part if HN wants to believe.
And I just provided half a dozen links to better research that shows that this "suicides went down thing" is misleading.
So yes, let's have a conversation about people cherry-picking the data they'd prefer to believe.
Here's Prof Louis Appleby, clinical lead for suicide prevention in England.
https://blogs.bmj.com/bmj/2021/03/10/louis-appleby-what-has-...
> A year into the pandemic, what is the evidence? The short answer is that there has been little effect. But it’s more complex than that, as it always is with suicide statistics.
> First though, it’s important to stress that the graphs and figures that are used to answer this question are not dry data. They represent real lives lost, real families devastated. No suicide rate, whether high or low, rising or falling, is acceptable. Even before covid-19, there were over 6000 deaths by suicide per year in the UK, an estimated 800,000 worldwide.
[...]
> Our conclusions at this stage, however, should be cautious. These are early findings and may change. Beneath the overall numbers there may be variations between demographic groups or geographical areas. After all, the impact of covid-19 itself has not been uniform across communities.
Also, "number of successful suicides" is an extreme, myopic metric for mental health. Ignoring all of the upstream signs of decreased mental well-being, and focusing only on successful suicides, is like measuring societal well-being exclusively by homicide rate.
"Sure, people are depressed, anxious, isolated and panicked, have increased suicidal ideation, and are seeking therapy in greater numbers than ever before...but they're not successfully killing themselves! All is well!"
At this point doubt is healthy, especially since similar data from different sources shows different results.
I would really like to see an attempt to critically examine all the available data and try to give a plausible scientifical explanation, leaving aside political prejudices and sides.
Can I see the source of data indicating that there has been an increase in suicide deaths in the US? So far, nobody in the thread has actually posted such "similar data."
Nebulous references to what is "plausible" and "similar data" that never appears is, of course, exactly what we don't want.
It doesn't take a genius to look at the immense, obvious damage to our mental health from excessive isolation to think perhaps there's something wrong with the way we are measuring this.
Is this the level of sloppy reasoning we have fallen to?
People are currently unhappy because of the pandemic, and people can point at that and understand that there's an exogenous cause right in all of our faces causing the problem and everyone is affected.
People are much more likely to commit suicide when they just believe that everyone else is doing fine and they're the only ones whose lives are shit.
Epistemology is impossibly hard. Determining the strength of evidence is hard. In the places that a paper contradicts our mental model of the world, the only sane approach is to question the paper.
To put it in that context, what I am contending is that people seem to have unreasonably high priors about the impact of this pandemic on suicides that don't seem to be based on much at all, and I believe underestimate the fundamental complexity of the world, that cause and effect are often difficult to trace.
The fact that you are comparing the idea that suicides have decreased during the pandemic with the existence of ESP is, I think, emblematic of exactly this sort of false overconfidence.
Anecdotes should have some, but marginal, impact on our posterior when coming head to head with data.
> Epistemology is impossibly hard. Determining the strength of evidence is hard. In the places that a paper contradicts our mental model of the world, the only sane approach is to question the paper.
References to the sanity of one approach over the other aside, I do not see how this follows from what you said before. I agree that determining the strength of evidence is hard. I would suggest that creating a causal model of the world from anecdata might be a bit harder.
e: As a sort of meta-point, I really do find it interesting the increasing currency of Bayesian concepts in pop imagination, often combined with arguments against good inference. It seems almost like pop-Bayesianism is the sophistry of the 21st century, both in the sort of argumentation that characterizes it and as a sociological phenomenon, who it appeals to.
Which is why a lot of people don't take these complains so seriously. Because of was much less isolating, everyone was going through the same thing, you was still member of same team.
How could we possibly know this? Reports of suicidal ideation is up, would be a more honest claim.
Increased reporting of/willingness to report ideation and reduced rate of suicide might both be explained by people accessing mental health support.
It's an interesting question and something to explore. I don't think the relationship between suicidal ideation and successful suicides is strictly linear, there are a lot of variables on the path from one to the other.
That said, I think the evidence is relatively strong for a decline in successful suicide, for whatever reason. Multiple comparative studies have shown this effect.
I'm curious - have you seen a nation-wide comparative/longitudinal study of suicidal ideation? All I can find are news reports about a specific hospital or two.
Maybe someone more familiar with this area knows of something, but I haven't seen it.
An increase in actual suicide attempts is different from an increase in self-reported suicide attempts, and I'm not sure how you would reconcile the former with a decrease/stagnation in the suicide rate. If more people are deciding to reach out/ask for help I would expect a similar pattern.
> According to the report, about 30 fewer veterans died by suicide in the five months after the start of the pandemic, compared with the same time frame before the outbreak.
> Known suicide attempts dropped sharply. They had fluctuated between 300 and nearly 600 each week before the pandemic, but numbered between 230 and 340 each week after.
> On-campus suicide attempts also dropped sharply in the early weeks of the pandemic, but they rose in July. However, the number was still small, with 24 attempts that month.
Are "on-campus" attempts tracked by any other organization?
Also,
> VA officials cautioned, however, that it is too early to tell how the closure of VA clinics and hospitals, as well as restrictions on medical services during the pandemic, play into the findings.
We are really stretching the definition of "very beginning".
Responses to this information are quite interesting.
Speaking as someone who heard testimonials of what it's like to WFH with kids, this part doesn't surprise me as much.
On a more serious note, I wonder what the mix was of existing abusers just having more contact with the child vs additional stressors causing the abuse (& whether there was abuse that started as a result of the stress).
I am not sure that it is misleading, but agree it isn't the full picture. Naturally, I think the primary focus should be on decreasing successful suicide attempts, then on decreasing suicide attempts writ large.
I wouldn't, those are vastly different outcomes. I would like a separate stat that lumps suicides and overdoses (and maybe deaths from alcoholism) together. They are all sort of death from despair, and it's hard to say weather an O.D. was deliberate or not.
I don't think an increase in suicides a priori means the pandemic is handled poorly if it is the best we could do while stopping the 600k virus deaths from becoming 1.2 mill or whatever.
Person A is very likely still depressed and in mental pain. Person B is not. Now, if person A "recovers" and goes on to experience many good years of life, maybe then they're better off, but right now, they may believe that they are worse off than person B.
There is certainly a question, I merely find myself falling pretty heavily on one side of that question, and I think that is generally the side that people would fall on if it were put up to a vote. Dying from suicide worse than surviving suicide.
Badly. People dying to suicide is not good, but like any cause of death, it's going to happen. I think the bigger picture of overall degradation in mental health is a worse indicator than the deaths of people's quality of life. Personally I think you address the overall underlying issues, which would lead to lower death rates.
If we heard that deaths from car accidents was down but the number of accidents was way up, we'd want to do something to address it because clearly there's a problem.
Yes, but it would be much better than the flip side scenario of way more people dying but fewer accidents, no?
Indeed, I would argue it's better than the same number of people dying as before and the same number of accidents.
But that's not the only thing that matters. I don't want to keep going down the car rabbit hole, so to bring it back to suicide: increased rates of mental distress (as indicated by higher incidences of suicidal ideation) is very bad. This would likely mean several other things which are damaging to both the individuals and society (loss of income, additional expenses from medical treatment, possible run ins with criminal or psychological incarceration)
As with most things, there's no "magic metric" when it comes to mental health relating to suicide that we could say "if we can get this down to 0 everything is fixed".
Perhaps also an increase in the mix of suicide attempts that are unlikely to be successful, for instance, perhaps more women attempting suicide due to IPV, and generally women who attempt suicide are less likely to die.
Suicides among Black people doubled during COVID-19 lockdowns, while suicides in white individuals were cut in half during the same period.
I also think it is interesting that the article doesn't mention what the actual suicide rates are/were. Prior to the pandemic white suicide rates were more than twice that of black suicide rates.
In 2017 suicide rates were:
- White Men: 28.2 per 100,000
- Black Men: 11.4 per 100,000
- White Women: 8 per 100,000
- Black Women: 3 per 100,000
https://www.usnews.com/news/healthiest-communities/articles/...
We have to be really cautious about multiple comparison bias when analyzing results like these.
The part where it's a race issue is farther up the causality chain, where "urban living + poor" becomes correlated with "black" in the first place.
I suspect that the study took place in Maryland is why the effect is so pronounced. I wouldn't be a bit surprised to find that their race-demographics are even more skewed in terms of geographic distribution and SES than is typical nationwide.
Anyway I just don't see the data from which the original conclusion is made. According to CDC WISQARS the suicide rate in Baltimore MD was 9 per 100k, whereas in nearby rural Cecil County MD it was 24 per 100k.
"And Veralyn Williams reports on places where there’s a paucity of suicides: African-American communities. As it happens, blacks are only about half as likely to kill themselves as whites. (When it comes to murder, meanwhile, blacks are nearly six times more likely than whites to die.) There are just three places in the U.S. where the overall homicide rate is higher than the suicide rate: Louisiana, Maryland and the District of Columbia. It’s not a coincidence that these are also places with large African-American populations. Donna Barnes, who founded the National Organization for People of Color Against Suicide, tries to explain why there’s such a huge black-white suicide gap:
BARNES: Okay, it’s very easy when you are stressed and you don’t want to live anymore and put yourself in harm’s way and somebody will take you out. We get angry. We get irritable. We do things, we engage in reckless behavior more so than say, the dominant culture. And those are signs of depression. And many times we will externalize our frustration meaning that we’re going to take it out on other people. And then you might have more folks maybe from the dominant culture who internalize their frustration and take it out on themselves. We have been socialized to believe that a lot of our disadvantages are based on our surroundings — racism, discrimination and all of that. So it’s really easy, for us, when we become frustrated and we look at what’s going on around us, to take it out on the environment and other people rather than ourselves."
https://freakonomics.com/podcast/new-freakonomics-radio-podc...
I would also like to see this broken down by income.
There is a huge economic disparity between the average black person and the average white person. That means that race is intertwined with almost every class issue in America.
We now know the answers to the above (both births and murders went down during the past year), but as far as I know we can't prove the precise reason it happened the way it did.
It reminds me of the big debates we had right here on Hacker News about why Americans were slim in the 1950s -- just look at photos of crowds from the 1950s -- but are overweight today. We know what happened but we can't prove the precise reason.
That is because people who claim to be using the logic to the most tend to correlate with people why have astonishingly little knowledge about the topic at hand. They create over simplified model and ignore wast amount of studies and evidence that says their model is not conforming with real life.
> I heard arguments that birth rates would go up (couples at home with plenty of time for sex) or that they would go down (not a good time to have a baby with hospitals overflowing and an uncertain future). Which was right?
Sociologists were right, births went down, as pretty much always when there is large uncertainty and threat.People in the past did not made more babies when facing economic or health issues. People dont have babies when there is war. People dont have babies when they fear future.
Plus, the other claim does not even makes logical sense. Anti-contraception exists, people can have sex without making babies, lack of time for sex is not why people don't have kids. Plus, videogames and netflix exists, it is not like there would be nothing to do.
The point here is that the logical argument was not logical and ignored pretty much all what sociologists know about human behavior.
As well my ems friends say that suicide ideation and suicide attempts are way way up. As well as alcohol and drug poisoning cases (which are not marked as suicides usually)
---
I wonder if some booking of psychologists & therapists might have to do with people now having liquid cash they can use to address things they couldn't in the past and a relative absence of other things to spend money on.
which has the UK's latest suicide data which is published quarterly and one stand-out that is very much relevant to suicide statistics globally during this pandemic and I quote:
"The increase in registered suicides during the third quarter of 2020 likely reflects the resuming of coroner’s inquests"
That right there is a huge factor and why I really don't feel we will know the true extent upon suicide until later this year, and few years after.
"Results showed recent suicidal ideation was 1.60 and 1.45 times higher in March and July 2020, respectively, than in March and July 2019. Odds of recent suicide attempt were 1.58, 2.34, 1.75 and 1.77 times higher in February, March, April and July 2020 than the same months in 2019, respectively."
Ideation and attempt is not the same as death, but it is pretty alarming on its own.
Additionally, I would expect that the longer lockdown gets, the higher suicide rate. Social isolation may take time to "kick in", in the meantime more people got out of business (or run in other serious troubles), and (likely) there was more hope in the first months for things to be over soon.
With the pandemic you can find someone else going through the same sort of thing, they will have empathy about their shared experience. For most people this level of isolation is temporary however, for the disabled this is their every day and they also on a day to day before the pandemic they didn't have this empathy from anyone, from their family nor their doctors. It is about the best it has ever been for the chronically ill, people for once have some empathy for what they are going through but I suspect it wont last.
I suspect pretty much every "mental health" issue will at some point finally be tracked to a physical condition, potentially something we could have been treating decades beforehand if they had bothered to look.
I don't know what underpins PTSD, I just know I wouldn't jump to any conclusion. I would want researchers to never stopping looking for answers until we genuinely understand what physically is going on in those individuals bodies. Talk therapy has too long been used to paper over that understanding and tried to tell people they are really just well if they thought differently and I am not convinced that Psychology should be funded as medicine given how it gets it wrong more than it gets it right and can't even get its diagnoses straight. Gulf war syndrome is a physical condition, it is basically PVCS/ME/Fybromylgia but for decades it was considered Psychological. I am constantly appalled by medicines practices.
Self-isolation meant they are subject to less stress because much fewer social interactions are forced upon them, and they feel good about themselves - as requirement to self-isolate suddenly turned them from "weirdos" to "exemplary citizens". In a way, everyone is forced to become an introvert these days, except for actual introverts, it's effortless and the world works in a lot more "their way" today.
Personally i relate to this 100%. Another lockdown was announced hours ago and i suddenly feel i'm happy. I literally missed the lockdown days.
[ADD] I looked and in the UK the rate has increased and been noted that that the aspect that coroner’s inquests initially at the start of the pandemic had been suspended due to caution in contamination and spread as we was still learning about the virus. An aspect that I'm sure mirror's in many countries globally.
https://www.theatlantic.com/health/archive/2021/04/pandemic-...
Apologies if you get paywalled.
Usually a combination of reporter being told to "find story on this thing" and multiple comparison bias.
e: and I'm downvoted why?
I dont understand pretending to argue against the science -- of which i'll just point to rosemary kennedys expert medical advice and move on.
(I'm not a denier or downplayer)
Again, it was just a thought that crossed my mind and I decided at best it didn't account for the whole drop.
Suicide is rarely about true despair, I would say it is more about loss of purpose. When you are scrounging to get by or have bigger fish to fry than some existential demons, suicide falls to the back of your mind. When there is time to ponder bigger questions it returns.
Suicide rates are strongly linked to socioeconomic status. Being in the 1st decile for income gives you a more than double risk than being in the 10th decile (and the risk is still higher among even poorer people).
Article: https://www.sciencedirect.com/science/article/pii/S091750401...
Most relevant graph: https://ars.els-cdn.com/content/image/1-s2.0-S09175040173003...
Suicide rates fluctuate wildly over time though, so trying to understand suicide by looking at relative rates within a given year is going to give you at best an incomplete picture.
Take a look at all countries: https://en.wikipedia.org/wiki/List_of_countries_by_suicide_r...
Suicide is not mainly determined by absolute poverty. That doesn't mean that socioeconomic factors or financial ruin are irrelevant but it questions the idea that suicide is mainly about material circumstances.
Science is imperfect. If you don't like the results that science has told us, you can claim the opposite and you can believe the opposite, citing exceptions, as you have done.
But, that doesn't make the opposite true. You can provide your evidence also (in my personal opinion, a link to Wikipedia doesn't count as evidence).
It's plausible that absolute poverty would be the main factor in suicide, i.e. privation and resulting suffering would drive people to suicide. Though plausible, that doesn't seem to be the case, which is interesting.
Glancing at the data on wikipedia, there seem to be cultural and religious factors at play here that dwarf economic factors (not to mention sex...). Muslim countries have low rates of suicide. Japan and Korea have high rates of suicide. It's totally fine to look for correlations along economic lines but that's a lot more to the story and it isn't wrong to bring that up.
As far as poverty goes, I don't see any reason at all that absolute poverty should mean anything. Again, my buying power isn't materially affected by that of people in Europe, for instance, but my buying power certainly has a huge absolute effect on my quality of life. I would expect the effect of poverty on suicide rates to be stronger per country than worldwide for this reason, and also that what is considered poor in the United States would be unimaginably rich in some countries.
And, those cultural factors are precisely what makes it difficult to compare across countries. The amount of statistical adjustment you'd have to do to compare across even 10 countries would probably swamp most of the non-cultural effects is my guess.
Uh, they're all humans?
> As far as poverty goes, I don't see any reason at all that absolute poverty should mean anything. Again, my buying power isn't materially affected by that of people in Europe, for instance, but my buying power certainly has a huge absolute effect on my quality of life. I would expect the effect of poverty on suicide rates to be stronger per country than worldwide for this reason, and also that what is considered poor in the United States would be unimaginably rich in some countries.
If you don't think it's plausible that abject suffering would lead someone to suicide I don't know what to say.
You only want to talk about "purchasing power" but my whole point is that there are lots of other factors. You can talk about purchasing power but you shouldn't dismiss people talking about those other factors.
> And, those cultural factors are precisely what makes it difficult to compare across countries. The amount of statistical adjustment you'd have to do to compare across even 10 countries would probably swamp most of the non-cultural effects is my guess.
...and personality differences make it difficult to compare across individual humans. None of these studies are controlling for all relevant factors, most of which are probably unknown or at least unmeasured.
As far as abject suffering goes, I agree, that probably doesn't help the suicide rate. But, what I've been getting at is this: you keep referring to "absolute poverty," and I'm telling you I don't think "absolute poverty" is it. I think it's plain old poverty, which is relative poverty, which has to do with what one's local purchasing power is.
"Abject suffering" is relative, too. What you might call "abject suffering," someone in another country might just call "Tuesday." Conversely, someone used to living very well who ends up losing everything financially might feel extreme despair. Think 2008, or 1929.
In other words, add all those cultural factors on, and what an American might want to end it all over, a Pakistani (to pick a random example) might not. If you did a study with 10 countries, then you'd have 45 pairs to consider, and, like I said, that gets messy quickly.
This is roughly why I suspect there aren't any good studies that do what you suggest. Almost all the studies of this nature concentrate on a single country, and I suspect it's because the research itself would be difficult, but, also that it would be extremely tough to make any cross-cultural conclusions, which is what you want to do if you want to know what makes "humans" want to kill themselves.
I don't agree that all suffering is relative. I don't believe that Pakistanis experience starvation less severely than Americans. Maybe human suffering is relative to being a human.
I understand that you think relative poverty causes suicide. That's not important to my argument which (following from the original commenter's) is "there are other interesting variables that affect suicide besides relative poverty".
You keep bringing up how culture is hard to control for. But a study of only South Korea doesn't control for culture. The correlation between relative poverty and suicide is probably higher in SK for cultural reasons (which is, of course, why SK was chosen). My point is that culture (among other things) is an interesting factor in suicide. It could be studied too. It's fine to look for the effect of relative poverty within a country but it's also interesting to look for other things, like culture and absolute poverty and levels of industrialization.
https://www.medicalnewstoday.com/articles/financial-hardship...
I'm sure there are many other factors and it's hard to point at any one as a real, root cause, but I don't think that existential dread or ennui or whatever you name it is the root cause either.
As an aside, if I were a poor, suicidal person, I'd probably take extreme issue with your comment as somehow implying that I'm not 'doing being suicidal right' or something like that, since I'm apparently being suicidal when I should be thinking about my three part-time jobs. (I'm not, I don't take personal offense, I'm just expressing how I suppose someone might see this mentality, and how it could be seen as insensitive. Although, these people do have bigger problems than internet comments, and any kind of correction here wouldn't fix that.)
Maybe they’re not?
It doesn't matter if it is "rarely associated"... Among millions of people, do you think the association will be positive or negative?