Suicide and C19

It only stands to reason...
Long-time readers may remember that this is one of the comments I red-flag when I read it in other people's writing.  It is my long experience that this is often where half-truths or even untruths hide. A very plausible theory ties two bits together, so we do not examine it closely.  It is one of those shortcuts that usually works, but doesn't always. It is related to "Everyone knows that..." or the various uses of obviously/undoubtedly/clearly. There is some social pressure in such statements, signalling to you to move along, there is nothing to see here.

So I am embarrassed to tell you that I have been vaguely thinking exactly that when skimming the sidebars and hyperlinks telling me that we are going to have more suicides from the shutdown than from C19 itself.  I didn't believe the numbers offered in the slightest. No one could have those numbers, and in fact the little blurbs around the links usually telegraphed that the article was about suicides that were going to happen, not ones that already had. I knew the estimates were going to be crap, but I assented to the general idea.  I will note in passing that specific writers who excoriate the "experts" about predictions of CoVid deaths that didn't pan out are linking to these other "experts" predicting suicide rates.

Yesterday I saw one of those links at a high-traffic site, from a person I believe is honorable, and wondered if it is now time to finally click on one of these, as some data might be coming in. Maybe someone has an early read on this. The article was very slender in data and had some poor reasoning.  I was not familiar with the author or the organisation he writes for.  I took a flier and started clicking around for the email address of both the author and the person who had linked to him.  As I was doing so, I was composing how I might phrase my criticism. In reassuring him that I believed the general premise was quite possible, I heard my own brain say "It only stands to reason..." I winced. I reread the article with even more skepticism and noted it was even worse than I thought.  It is still entirely in the realm of speculation, based on some general research about suicide.

To complete that part of the story, he wrote back, making it worse. He told me that he had spent countless hours talking people out of killing themselves, but that didn't show up in the data.  Which is complete bullshit.  The economic effects have been about two months, so "countless" is the sort of fevered exaggeration which makes everything else even more suspect.  I've been doing this for forty years and I think I could make a pretty good estimate of the number of hours I've spent. They aren't countless. The hours spent Mar-May talking people out of suicide would likely have made it into the article as well, even if only as personal supporting data. For people that have jobs and other responsibilities, the hours aren't likely to get out of the single digits either. Ridiculous. Drama queen.

There actual good numbers which tie economic stressors to suicide. Sociologists and economists like to try and arrive at formulas such as For every 0.1 rise in the unemployment rate, there will be an x% increase in suicides. Also, there is survey data of people who have attempted suicide or are contemplating suicide identifying what is driving their misery and hopelessness, and job loss or financial disasters do figure prominently in those lists.  I have certainly heard it myself many times over the years in my patients.  Men especially identify the collapse of their business, getting fired, or losing an expensive lawsuit as a precipitant to suicide. Does it matter whether the loss was sudden or long-expected?  How long does the effect last?

Economic stress can increase personal stresses as well.  It can cause people to kick you out of the house, especially if they were already looking for an excuse. Conversely, it can force people who don't like each other very much back into living together. Are those quite the same sort of economic effects? Does the tie-in to substance use and intentional vs. unintentional overdose matter - which is sometimes difficult to determine even when all the data is in.

So It Just Stands To Reason that there will be an increase in suicide due to the economic effects surrounding C19. There was a slow increase following the 2008 Recession.  Except...I hate that phrase, and it causes me to look a little harder at the whole affair. When one looks harder, there is no there, there.

The most basic numbers needed today would be what was the suicide rate in April last year and what was it this year. Only half of March would be in play, so that might be a little helpful, too.  May isn't finished yet, in case you haven't noticed, so we don't have those numbers.  Those numbers don't exist.  It's hard to even find 2019 numbers, let alone this year.  Other related numbers are interesting and helpful, but would be less conclusive.  Completed suicides sometimes don't make it to the ER, so those numbers are a little tricky. ER's are operating differently, so who comes in saying what might be apples-and-oranges compared to just a few months ago. The stress of having a relative die, or working in a place where people are dying might also precipitate suicidality. Many insecurities are heightened.  Isolation is a risk factor, while social support is a protective one. Which go in which columns? Putting out numbers of suicides "due to the lockdown" is a political rather than scientific at this point, and will be for some time.  None of those numbers exist.

I suppose I could make a few calls and ask "Dr. B?  Are we seeing a rise in suicides during CoVid?  Who in the BBH would know that?" or "Becky?  Is your husband's office recording more suicides these days?" But I already know the answer. "No one knows, and we won't know for months." There are as yet not even rumors of an increase large enough to excite comment.

The background numbers: Suicide rates have been rising nationally for at least two decades, about 25%, and even more sharply in NH, about 50%. The rate for the US in 2018 was 14.2 per 100,000 people, and in NH was 19.4 per 100K. There was an estimate for NH at 18.9 for the whole of 2020 so far  against a US number of 14.3, but I can't trust either one.

Hold it all at arm's length, and hold at even greater length people who try to sell you otherwise.