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Comment by timr | Hacker News Reader

Context: this is "surprising" (edit: mods changed title from "Surprisingly, suicide has become rarer during the pandemic") because suicidal ideation (and by some reports, attempts) were dramatically increased during our response to the pandemic. Deaths from alcohol and drug abuse are also up:

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.

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To add to the anecdata, I have friends who are therapists as well, and they're approaching burnout. The lockdowns and media hysteria are making latent, managable issues unmanageable. I would wonder if the lack of privacy for many people in vulnerable state is what keeps them from acting.

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...

Based on my looking at disposable cash flows available to the average American, I am curious if the pandemic assistance is perhaps allowing people to treat latent issues that they wouldn't have before - due to higher opportunity cost of consumption and also less cash flow.

My gut assumption would be that seeing a therapist virtually is now normalised due to COVID.

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.

To add more anecdata, I've heard of an increase in people seeking help for addiction issues (alcohol, weed). I imagine many of them perhaps were problematic in their use already, but the pandemic made things bad enough to seek help.

My guess would be that many of those excess overdoses are suicides.

I also know some therapists, and one surprising thing I learned is that they are very lonely - their jobs are literally to have face-time with customers, so there is zero time left for hanging out with coworkers; something that I have a lot of in the software sector. I guess director level managers may have a similar problem but I am not there yet :)

100% agree with others in this thread that my immediate thought was this headline and subheadline are misleading. It doesn't take a bunch of studies (although there are many and thanks for posting some of them) to know that lockdowns, social isolation, closing of public gathering spots, "death count tickers" on TV, reduced family visits, and when one does get out in the public, constant covering of everyone's facial expressions (no smiles) to know that there's going to be a public health impact. I don't think we'll know the extent of the impact for years.

That is conventional wisdom, yes. That's why it's interesting to see data that suggests the contrary.

As others have mentioned, this pandemic isn't actually over yet and even when it is there could be lagging effects.

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

> constant covering of everyone's facial expressions (no smiles)

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.

What's that joke about the extroverted and introverted engineer again?

I actually think that covering faces reduces stress. People ate able to have their boundaries and not feek pressured to smile for strangers when they don't want to.

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.

At least in normal people, the act of smiling releases some chemicals to make you feel better. Smiling at strangers therefore only feels oppressive to those who already have an underlying issue such as depression. I would therefore not say this is the general case: that it reduces stress.

Also, most people look more attractive wearing a mask. Leaves more room for fantasy. I kinda enjoy seeing masked people. But that’s just me.

So is this more of a "diagnosis of deaths as suicide has become rarer during the pandemic"?

I doubt the diagnostic criteria for suicide has changed dramatically during the pandemic.

Fascinating seeing how so many people do not want to accept the data as is because it doesn't fit their pre-conceptions.

> 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.

Pretty much every discussion of covid had multiple people claiming that suicides went up so much, that they probably turned lockdowns, masking etc contraproductive. Cause they supposedly drove more people to suicide then saved.

The suicides went down thing really goes against what significant part if HN wants to believe.

> 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.

It's valuing the hard statistics in the article over people asking other people how they are feeling, not cherrypicking. Trying to convince people that suicidal ideation and attempts are up without a corresponding increase in suicides is going to be a hard sell.

It's only a "hard sell" to people who refuse to change their minds when presented with statistics that contradict their preferred narrative.

Can you explain how you would reconcile this with what the Economist is reporting then?

Yes. The Economist is cherry picking data from one place, in one narrow period of time. All of the other studies (that you keep ignoring) cover much larger samples of people, over longer periods of time.

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!"

It's important to realise there's a lag with suicide statistics, and most of the research is looking at early days, and all of the researchers are saying that distress is up and we need to guard against a rise in future.

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.

Late to this, but this research included metrics going to October that showed the continued reduction in suicides.

If the data doesn't fit the preconceptions, then it's either something wrong with the data or with the preconceptions.

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.

What impacts what you consider "plausible" is your political preference.

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.

Or, maybe your preconception doesn't fit the facts? Suicidal ideation is up, which seems very likely to increase the number of suicides. How would you explain that?

I don't have a particularly strong preconception. It seems plausible to me that suicides would increase, but the world is a complex place and I can think of a number of factors that would have led to a decline. In general, economic declines are usually associated with decreased mortality.

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.

Unfortunately, no. There seems to be a lack of general population-based longitudinal studies on suicide and suicidal ideation. Most studies take place in the US or Europe, and almost all seem to be focused on particular subgroups like teenagers and young adults; combat veterans; or homeless people. This makes some sense, because one would expect people in these groups to have a higher risk of suicide than the general population. And, indeed, it is true, at least for teenagers and combat veterans; I'm not sure about homeless people.

Maybe someone more familiar with this area knows of something, but I haven't seen it.

> Suicidal ideation is up,

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.

Bezos has a point: https://twitter.com/dcancel/status/1065972003235119104?lang=...

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.

No, appealing to some billionaire's retold saying is not going to make me prioritize anecdote over data. I am not denying a mental health crisis, merely saying that it appears that suicides have declined. I understand that is counterintuitive.

Is this the level of sloppy reasoning we have fallen to?

It’s not sloppy reasoning. We should update our beliefs in light of new evidence in proportion to the strength of the evidence and the strength of our prior belief. How much would an equivalent study on the existence of ESP move your belief on that subject? A good answer would be not much if at all because a priori we expect the study being wrong is far more likely than the existence of ESP. For me, it would take more than an observational study to update my belief at all. This is prioritizing anecdotes over data - moreover, my belief (ESP doesn’t exist) wasn’t scientific in the first place!

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.

Little of what you've said is at odds with what I'm saying, it just is dressed up in the pop-Bayesian signifiers that seem to be popular right now.

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.

I honestly don't understand why this headline is at all counterintuitive.

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.

That's a good point. There is evidence that suicide rates sometimes decline during times of external crises, e.g. war.

If you don't deny a mental health crisis, then it's not sloppy reasoning to increase, in relative terms, your skepticism of studies which show a decrease in a logical consequence of a mental health crisis. This doesn't mean you reject the study. But counterintuitivity surfacing from contrary evidence in the form of both anecdotes and other data is a good as reason as any to be skeptical.

I believe that we had a mental health crisis that predated the pandemic.

I will be very frank here: it was much much less isolating then period I spent at home when kids were small. And that for me puts these complains into perspective.

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.

I would say that this is "surprising" because the AMA (and many other mental health groups) were predicting a huge increase in suicides, which never happened. Later on, the "people are killing themselves" narrative became the accepted dogma, sans evidence. I don't remember much talk about suicidal ideation, it was mainly (understandably) fixated on the suicide rate.

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.

Some more anecdata for you https://www.military.com/daily-news/2020/11/12/suicides-and-...

> 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.

That's fine, but seems to be making the same error as the article: numbers from the very beginning of the pandemic are perhaps not representative of the whole story. Particularly so when the numbers are taken from specific sub-populations.

The article numbers have comparative analysis of data dating to October.

We are really stretching the definition of "very beginning".

You have effectively repeated what I quoted VA leadership as saying in the article I linked.

Responses to this information are quite interesting.

What are"SI patients"?

Suicidal Ideation

I’ve always known SI to refer to Self Injury but I’m in Australia so this could be a regional difference.

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