The COVID-19 pandemic has been an incredibly trying time for societies around the world. From the to the healthcare tragedies of , the coronavirus has tested the limits of endurance, pain, fear, and uncertainty in the population. We know that distress has increased: have shown that indicators of distress are higher than previous baseline measurements.
Misleading Suicide Claims
However, early on in the pandemic, suicide claims were unfounded and, ultimately, untrue. As a suicidologist and emergency child and youth psychiatrist seeing children daily in the emergency department through the first year of the pandemic, it was distressing to see misinformation and fearmongering being popularized in my area of expertise. One idea emerged, without any supporting data; it turned into a moral panic, and soon, it was treated as an established truth without anyone ever actually establishing it in truth: suicide rates will increase.
It was trumpeted in the , as well as in medical literature. Worse, it was often hailed as a "tsunami," evoking imagery of an unstoppable, devastating force for which humanity has no recourse.
From one of the most powerful pulpits in the world, then-President Trump stated on March 23, 2020, "People get tremendous anxiety and depression, and you have suicides over things like this when you have terrible economies...Probably and -- I mean, definitely -- would be in far greater numbers than the numbers that we're talking about with regard to the virus." Of course, this was not just an esoteric concern for mental health, it was an argument for disregarding public health advice and "opening the economy." Later, in July 2020, Robert Redfield, MD, the CDC director at the time, stated, "...there has been another cost that we've seen, particularly in high schools. We're seeing, sadly, far greater suicides now than we are deaths from COVID." The wielding of suicide data to advance a political narrative has been, itself, distressing. Unfortunately, the issue has also been polarized; many who believe "lockdowns are harmful" have wielded the fabricated idea that suicide rates increased during lockdown periods to advocate for ending public health measures.
The moral panic went into full effect. The New York Times ran an article about the superintendent of schools in Clark County, Nevada in response to a "surge of suicides." It should be noted that Clark County had experienced similar increases of suicide rates in youth between March and December in the past 20 years: in 2003 (up 141% from 2002), 2011 (up 151% from 2010), and 2013 (up 100% from 2012). The context of the claim made in the New York Times report did not affect its uptake; due to the moral panic, television programs, local news agencies, and other news organizations were reporting the "increase in youth suicides" in one county as if it had national implications. Meanwhile, in Johnson County, Kansas, , and nobody noticed. In my jurisdiction, British Columbia, Canada, there were three fewer youth suicides (21) during the first 11 pandemic months compared to 2019, but people are surprised. This is how moral panics work: because of the pervasive belief, media and politicians promote the fear, and highlight data that seems to support it while ignoring the data against it.
The Data Show a Decrease, Not an Increase, in Suicide Rates for 2020
There were two missing data points at the time the moral panic began. The first was the overall rate of suicide in 2019. The U.S. was on a 13-year streak of increasing suicide rates, and most of the media/suicidology pundits assumed that the trend of increasing suicide rates would continue through the pandemic. Due to data lag, 2019's final numbers were not available until the end of 2020, and sure enough, 2019 demonstrated a decrease in suicide rates. The second set of data not available: the actual data for suicides during the pandemic. During the year, I did my best to keep a running spreadsheet of counties and states that released official figures in the , , and . Finally, the preliminary data was released: suicides did not increase during 2020, in fact, they .
For the U.S., we can now see the of the pandemic, and the predictions of "tsunami" are not validated. Generally, we see a decrease in suicides in the initial phase of the pandemic, with a "return to normal" over time. The net effect is still a decrease.
Lingering Areas of Concern in Suicide Figures
There are some indications of concern for suicide rates. We still do not have detailed age-breakdowns. The CDC released a just recently showing a subset of increase: ER presentations for girls with the combination of non-suicidal self-injury (a sign of distress, which by its name is not suicidal or dangerous, and often in fact a coping mechanism) and suicide attempts, but so far, we are not seeing large deviations of age and gender in the numbers of deaths by suicide. It will take time, but it will be clarifying to have state-by-state, gender, age, race, and urbanization breakdowns. However, multiple studies and data releases have shown a disproportionate bifurcation of suicide rate changes; suicide rates in white Americans decreased while suicide rates in non-white Americans either decreased less or in . There is significant evidence showing that across all areas of health, minoritized, racialized, and underprivileged people will bear the worst of a health crisis, and it seems that the COVID-19 pandemic is no exception.
Lessons From the Moral Panic of "Pandemic Suicide"
As someone who has always kept an eye on suicide data and works with people impacted by suicidal thinking and behaviors daily, I have many hopes coming out of the pandemic. I truly hope that we maintain the newfound focus on how mental health impacts our broader economic and personal health, and we maximize the benefits of changes during the pandemic (more work- and school-from-home options for those who benefit from it, wage support for those without, and so on). Also, we need better, real-time data collection on suicides. The nature of suicides is that they are both common (a leading cause of death in the first 40 years) and uncommon (occurring at a rate of about 14 per 100,000 people), such that large efforts to collect national data efficiently and comprehensively will be more helpful than small pockets of information. Finally, I have the optimistic hope that the next time we face an uncertain mental health situation, we try to resist listening to the warning cries of those who have not yet accepted the humble position that we cannot predict suicide rates to any degree of accuracy, and yet we know the societal, economic, and personal efforts we can make to reduce suicide rates.
is a child and adolescent psychiatrist and suicidologist based out of Vancouver, British Columbia. He is a clinical assistant professor at the University of British Columbia and the medical director of emergency psychiatry in a major pediatric hospital.