Nothing to do with the content of your essay, but I was initially confused by the title of the magazine "Works in Progress". I was thinking that, like your recent "Peer Review Request", you were posting an actual work in progress and was asking for feedback on it before it is finalized, and the Works in Progress website was just a space for authors to release drafts of their essays. However, the About page for Works in Progress makes it clear that publication venue for complete pieces. Sharing this in case other readers were confused in the same way.
(Also why was the essay published on Works in Progress? I think it would have been more convenient for us commenters to have published it on Substack. Maybe it's some kind of social status thing.)
I simply want to Nth this remark. Looking at the site, I know I've read pieces on Works in Progress before, but didn't recall it by name. I made the same initial assumption about it, based on name, as Itai Bar-Natan.
Same. I was going to ignore this until you posted it here, except that I happened glance down and to see this comment. Super confusing title for a publication.
I agree. When I hear "There were more black suicides in 2020 than in 2019, and this phenomenon was unique to black people" my assumption is that it isn't COVID-19, but another emotionally significant happening of 2020 that led to this occurrence, rather than the pandemic.
A common theme that I find in a lot of analyses is that factors that seem obviously important fall apart on a closer look. You do that with multiple factors here. I also get the same feeling when I listen to historical podcasts by Mike Duncan, like the Revolutions podcast on the French Revolution. Factors that seem important and fundamentally causal in an almost common-sensical way almost always fall apart on closer inspection.
This sometimes leads me to suspect that causality is mostly a mirage in the social sciences, and that any and every factor will fall apart on a "really" close look. Events happen not because of any overarching causal patterns, but only because of sheer dumb chance. This lack of any causal relations has also been stretched to science by Stephen Wolfram in his recent article- https://writings.stephenwolfram.com/2021/03/what-is-consciousness-some-new-perspectives-from-our-physics-project/
Wolfram says that any causal factors that we may find for events are only a result of our limited cognition, and not an inherent description of the universe itself. Although I am apprehensive about stretching the metaphor to that extent, do you also agree that any kind of causality, at least in the social sciences, is mostly illusory?
I don't agree or disagree because I am not sure how one could really falsify the claim, but Ragnar Frisch had an interesting take on this, outlined in his Econ Nobel Prize lecture. In section 2, he basically says "you can't rule out the possibility that reality is chaos and we are just impose order on it via our sense organs". https://www.nobelprize.org/uploads/2018/06/frisch-lecture-1.pdf
Thanks! I really enjoyed reading that section. I do have a couple of questions that also confused me when I read Wolfram's article:
1. Why is perceiving regularity in an ultimately chaotic universe an evolutionary advantage? For instance, I might see a pattern between going into the forest at night unarmed, and getting killed/maimed. Spotting this pattern is indeed evolutionary advantage, as this is a "true" causation/correlation relationship. However, if I see a correlation between rainy weather and my left knew throbbing, this will ultimately not be an evolutionary advantage as this is false causation/correlation. Hence, why is spotting potentially false patterns supposed to make me a fitter mate?
2. When I hit a ball, it goes flying in that direction. This is clear-cut causation. How is this pattern of causation made manifest only through my senses, and not in "reality"?
Presumably, if something is truly random, it doesn't really matter whet your response is, but if there is a pattern, it's very useful to exploit it. So it makes sense that we might be biased toward finding patterns because we have less to lose by finding a pattern where there is none than by failing to find one where there is one. This heuristic falls appart when trying to do science, but maybe it's good for life generally.
I would generally disagree with this. For instance, if I see a correlation between me having sex and an earthquake hitting the neighboring village, this can obviously be disadvantageous for me (and my genes). However, I remember reading an old SSC post in which Scott posits how spotting patterns in random data was advantageous in things like agriculture, etc.
It's not realistic that people would link sex to earthquakes, because the latter are far rarer than the former.
That you have difficulty coming up with a good example, is weak evidence in favor of the claim.
Note that superstitions are very good examples of overzealous pattern-finding, but they rarely seem to have the kind of negative impact that would be significant in a pre-science society.
Another argument you could make in favor of overzealous pattern-finding: It might help in convincing other people. I might have my own selfish motif why I want my tribe/company to do X, but maybe I can convince them that it would also prevent disaster Y. Doesn't matter if there is no correlation between X and Y if I can tell the story convincingly enough.
I think you raise some excellent questions, and ones that I myself share. By combining this with some of the predictive processing stuff Scott has alluded to before I can imagine an explanation that might be something like:
"Perceiving patterns, even when reality is in truth pure chaos, permits prediction which in turn permits (purposive?) action. Action can be useful insofar as it counteracts the depletion of resources needed for successful replication, either by moving to a new locale or 'stirring up the sediment' so to speak, in the vicinity, making more resources available for replication. In this way perceiving regularity in a reality of ultimate chaos is adaptive."
I'm not totally sold on the above explanation -- it seems rather hand-wavy, and raises some obvious questions. However, I think it does have one real strong point as an explanation: if true, then by acting on perceived patterns in chaos, the action itself converts chaos into order, making reality more amenable to use by (including for reproduction) of the actor (for instance, even the exhausting of resources locally creates a bubble of regularity in a sea of chaos, albeit a sterile bubble).
We are part of reality. So, to say that "we just impose order via our sense organs" is already to grant that reality contains highly ordered structures. Those very sense organs, and the order-imposing entity to which they belong, embody a tremendous amount of order.
I wonder if it would help to be more specific. It seems likely that events and policies can affect society and the actions of individuals, but the analysis falls apart because people rarely act for a single obvious reason. To simplify, there are causal effects in society but we are extremely limited in finding them or describing them because everything is happening all at once.
I suppose that is how most history books proceed. "The Second World War was caused by a mix of economic, geopolitical and historical factors". This is broad enough to be unhelpful, and is mostly used to mask ignorance about the actual causes of an event.
I also concede the point that multiple factors lead to events, and not one single factor. However, there is generally one or a handful of triggers that actually precipitates events. For instance, it is possible to imagine Europe not going to war had Hitler not invaded Poland. Hence, Hitler invading Poland could be called the trigger that actually caused the Second World War, although there were other contributing factors. It is these "triggers" that I'm referring to. It is almost impossible to isolate them.
It could also be said that Hitler invading Poland need not have been a trigger. It is possible to imagine Europe not reprimanding Hitler for only "innocently flexing the German war machinery a little bit". Hence, maybe the Second World War was a truly random event started by England on a whim, when it is equally likely that it would not have gone that route and attacked Germany
Wolfram is like the biggest premature ejaculator ever in terms of what he says in science. It always sounds like it'll be something amazing, then always turns out to be piffle only slightly above Deepak Chopra.
This makes sense to me. There is an easy way to tell whether you are right about identifying the causal factors. Can you predict the future? No one has a consistently above-chance record of predicting the future when it comes to human action, just like no one can consistently beat the index funds in investing. There is only one conclusion I feel I can draw from this. The world is indeterminate. And the world is especially indeterminate when it comes to people.
We predict human action quite well. Either this a big case of selection bias (like, focusing on index funds is almost like saying "we can´t easily improve on our current best predictions, therefore, we can´t predict") or you mean something more nuanced than what I understood you meant.
> No one has a consistently above-chance record of predicting the future when it comes to human action
I think this is overstating the case. I can predict with a high degree of accuracy that adults within a certain age range will be at their day jobs, and that children within a certain age range will be at their school, and that a certain number of adults above 70 years of age will die tomorrow.
Perhaps you mean we cannot predict the outcomes of *collective action* of many people when we have very little information or context, but somehow that doesn't sound surprising.
Sorry, but how can someone research suicide and not have "G-d", "morality", "religion", "value system" come into play? I am not saying that those thing would explain everything, of course not - but excluding them from the picture is beyond pale... Yes, many had a chance to reexamine their convictions and their views on acceptability of suicide.
That doesn’t seem obvious to me. Don’t modern people generally have less free time, fewer available cycles? I’m prettysure I’ve seen that reported a bunch of times over the years. We work longer hours and plug into media when we aren’t.
Besides, some people contemplating suicide, are wondering about what does this transition entails, so when they have more time, they might go deeper to try and answer this question.
Maybe so, but the flip side is that many churches have been closed or online only, and so there might be a countervailing phenomenon of people losing their faith (or realizing that they'd lost it already and that they were just going to church out of habit).
I'd think the people had more time on their hands to explore, and might have become more religious/conservative. I know a few people whose views have changed that way (not about suicide, but from agnostic to religious light)
I'd assume that more time on my hands means more people are reconsidering their lifes and worldview more than ever. Therefore you will have more conversions *and* more apostecies (and more people going from one religion to the other). But because in our times apostecies are more common, i'd expect the net effect to be against religions, not for towards them.
BUT! There is virtually no effect of the sort in Sweden or Japan according to the above link, and they had the same suidice pattern, so religion can hardly be the causal factor here.
I agree that it's probably not causal, but I'm not surprised that religion is winning. All of the evangelicals I know have the story of "I was sad before I converted, but am very happy now that I have Jesus" (they appear to be sincere). It's not hard to see how this would be very appealing to people who are more depressed than normal during COVID, especially if they weren't used to some degree of depression
There are definite psychological benefits to religion, specifically Christianity.
The idea of a loving God watching over you and a wonderful afterlife to look forward to are obviously comforting. This might not actually prevent you from suffering right now, but at least you're not alone and have hope that it will improve. More concretely there's the community, which is especially welcoming to recent converts and offers you a new social support network.
Some people complain that religion makes you feel guilty, but since everyone with a functioning conscience has regrets, the idea that God will forgive you if you repent is probably comforting on net.
I mean, Scott says he doesn't have good subgroup breakdowns to go on aside from US black/white. Without any data on X he can't do much analysis on X.
Kinda streetlighty, but he says he doesn't have a good explanation and maybe he'll be able to do better with more data in the future, so hard to fault that.
> Could it be that people have trouble getting the means to commit suicide? For example, maybe they would like to shoot themselves, but all the gun shops are closed?
You already reject this argument in the essay, but another bit of relevant evidence here is that gun sales shot to record highs in 2020, so it doesn't seem like suicidal people would have had much difficulty buying a gun last year.
How much of that was sales to new gun owners as opposed to existing gun owners buying more? One possibility is that the change was driven by people who were concerned about government overreach and wanted to buy guns now in anticipation of either 1) gun sales being made more difficult or 2) a potential revolt against the government.
"When COVID started spreading, life got more depressing, people became more depressed, but suicide rates went down. Why?
"First, are we sure all of that is true? I won’t waste your time listing the evidence that life got more depressing, but what about the other two?"
Maybe you should waste our time with point one. At least in my case, after about the first month when I became sure I'd still be able to get groceries (more or less) without issue, my life took a profoundly positive turn. Since the pandemic started, I finally bought my first house, got a dog, and realized my career-long dream of working from home. I know many people have had great emotional struggles during this time, but how many others like myself have had the opposite happen? Is it a large enough group to be meaningful?
Since my employer announce their return-to-office plan, I've noticed a steep rise in my anxiety levels—and not from fear of COVID, against which I'm now vaccinated.
Could it be that for a large fraction of suicidal people, their anxiety stems from (unwanted) social interactions, and that the lockdown was on the whole better for them than other non-suicidal people, who may have gotten slightly more depressed but not suicidal?
Even if this was true for a lot of people, I don't find it convincing.
Think of it like this: there is a distribution of happiness. Some people are more happy, some are less happy. When you become unhappy enough, you commit suicide. Only a tiny fraction of 0.01 % ever reach this point. (I know that it doesn't work like this, but the argument still makes sense.)
I think a fair description of the pandemic is that is massively increased the variance. Some people became much more happy, some much unhappy. But *everything* that increases the variance should massively increase the fraction that reaches the bottom level.
So it should be a good rule of thumb that everything which completely overthrows many people's life should increase all kind of extremal things. The positive things in your example, but suicide, too. So I am on Scott's side to find it very surprising that this did not happen.
"Massively increased the variance" sounds incorrect in this context for some reason, although I am of course biased by my previous assessment. In my book, Covid might have shifted the "mean" of the mental health spectrum to the "more depressed" side, but perhaps pushed the "very depressed" people onto the "happier" side. Hence, I see the probability distribution function of "mental health" as becoming more concentrated around the mean, and not really spreading out more at the extremes.
Since the lump depression rate increased, it must be that your anectdotal scenario isn't holding up to the majority of people. Perhaps you are unusually introverted?
Life feels better for some people (myself very much included), worse for others.
[Epistemic status - Idle/inebriated speculation]: Perhaps there's some correlation between "is the sort of person who would find life more tolerable during covid" and "is the sort of person who, if depressed, would commit suicide"?
If there are certain kinds of people who are more likely to commit suicide when depressed, and those are also the kind of people who (contrary to the broader trend) are less depressed during lockdown, that might go some way towards explaining things.
Nthed. With the additional point that I was in fact depressed before the pandemic started, and one of the things that did not help my depression was feeling guilty about my depressed-person lifestyle.
There's a vicious circle here: depressed -> hard to get things done -> feel bad about yourself -> get more depressed. For me, the lockdown interrupted the third link: hard to get things done -> feel bad about yourself. Everyone was suddenly living like a depressed person! I didn't have to worry about why I was continually failing to carpe the damn diem. Lockdown massively lowered the expectations I was putting on myself and I started feeling better. My mental health remains considerably better than it was pre-pandemic.
Life got significantly worse for me – being in home office reduced my work motivation to maybe 1/3, and not getting anything done during the day strongly impacts the energy I have to pursue productive pastimes afterwards. Food choices are much worse and have led me to waste copious hours on cooking. Lack of commute means I'm not getting any exercise unless I explicitly try to. Visiting friends is a multi-hour project of researching travel restrictions and quarantine requirements and often yields the result "it's currently not possible". It got super hard to meet new people, with all activities happening online or not at all – and for this purpose online mostly feels equivalent to not at all.
I'm curious (I had independent life developments that meant that I cook at home slightly less and do takeout slightly more) -- is takeout not available where you live, or are you concerned about its safety, or is it less convenient now that you're not commuting to work and it's not on your way, or did you previously end up going out to eat (perhaps with other people) in person and takeout isn't a good replacement for that? My impression here in (the suburbs of) Minneapolis has been that takeout was always pretty available, since it was the best way for restaurants to stay afloat -- but I don't depend on it much, so it could be that my perception was skewed.
I've been quite lucky with lunch arrangements at work so far: 2 of 3 places had an in-house cafeteria (one subsidized via the employer providing the kitchen (+maybe some staff? idk), the other one providing free food. The third place I worked at had a very cheap supermarket just around the corner and food trucks not too far away on some days of the week. So food has been affordable, healthy, varied, social (with colleagues) and generally low effort.
There is takeout available around where I live and I occasionally use it – mostly when I eat on my own. Usually I want to eat with my vegetarian flat mate, and only one of the restaurants offering a daily lunch menu regularly has a vegetarian option. They publish the menu on the same day, so it is a bit of a coordination problem to decide on time what we want. Cooking is faster (or at least has a more predicable timeline) than ordering food, so that's the default. But yeah, overall I guess we've been under-utilizing takeaway food for shared meals and I could improve that.
"I won’t waste your time listing the evidence that life got more depressing" is too dismissive - in exactly what way did things become more depressing and what relationship would you expect these individual factors to have to suicide?
I'm not sure "scoring high on a depression index" is the same as actually being depressed. I went and took the depression questionnaire used by Ettman et al. - the Patient Health Questionnaire–9 - and it would have reported me as depressed even when I definitely wasn't depressed. Back when covid first got to my country of residence, I experienced some anxiety which resulted in taking what I called "anxiety naps" where it felt like I would just shut down and sleep for an extra four hours most every day after work. I was also stress-eating a lot more than I usually did. I also had trouble concentrating on things - my mind would keep drifting back to the horror stories I'd read from hospitals in countries where the pandemic was hitting the hardest. All of these were specific responses to stress and anxiety over the threat of coronavirus - related, probably, to my history of respiratory illness and my specific fears about how my young children would fare if I died. At no point in the pandemic did I consider myself "depressed", and over time I built up better coping mechanisms.
But of course the nature of those specific problems - extreme but somewhat rational fear of dying horribly and leaving my kids without a father - contraindicates suicide. Put another way, while fear of death might lead you to sleep more, or overeat, or lose focus on your work, or fail to take joy in things that you otherwise would have enjoyed, you wouldn't expect someone to commit suicide out of a fear of dying.
In fact it might be worth looking at whether fear of death decreases suicide in general - do people who live more dangerous lives kill themselves with less frequency? Or something like that.
Also, I wonder if being stuck inside with your family members brought more people closer together and reduced the kind of isolation that sometimes precipitates suicide.
This comment resonates with me. I wonder if covid made depression questionnaires less valid in measuring depression. A question like "I feel isolated from my family" might be an indication for depression in normal times (when it attests to your chosen relationship with your family) but during covid is the forced normal.
I'm particularly sympathetic to the "change of pace" line of thinking. On Twitter @PaulSkallas always talks about how people desire a certain amount of volatility in their lives. They get bored going to work every day, the same routine, following a traditional life trajectory, etc...sometimes they secretly hope for something radical to happen, even if it's objectively "bad" for them. I've certainly felt this way myself at times. It similar to a joke made by one of the hosts of the Red Scare podcast. "Don't kill yourself because something retarded might happen and you'd miss it". Obviously not a super polite articulation of the point. But I think the insight is the same as above.
The pandemic was something new. What if it's the apocalypse? What if society emerges from the crisis totally remade? Maybe you're depressed in your email-office job, but you'll be happy in your new post-apocalyptic role as a community garden tender. Maybe UFOs show up tomorrow and show us the wonders of the universe. Gee, maybe suicide can wait for another day, at least until the conclusion of the most recent species-wide narrative arc. You never know!
Yes, this rung true to me as well. I won't pretend to be an expert on suicide, but from what I've seen of it (unfortunately too much), it's not a sudden shock that drives it most of the time. It's the ongoing sad, boring drudgery from a series of setbacks that does it.
From what I've seen of this world, a person normally doesn't commit suicide the day he unexpectedly loses a job that he valued, even though that's a day that would probably yield very negative results on psychological tests of stress and distress and sadness and self-esteem. Because for all that, somewhere in the mix of emotions there's also a feeling of excitement and novelty -- what's next? The suicide comes months later, after realizing your prior career plans are permanently screwed up due to something on your record and you can't get an interview and eventually stop trying and your girlfriend leaves you and you realize you're broke and about to be evicted and you see no end in sight.
Is there data about "location of suicide" ? That might explain the suicide drop and also the drug-overdose increase data-point ... if more people are committing suicide at home, then that appears as drug-overdoses
I wonder if part of the decrease is because people are less likely to commit suicide when another one of their family members is physically present in the same home. This doesn't explain the black/white divergence though.
On the black/white divergence: I wonder it the reported increase in gun sales during the pandemic varied by race?
My understanding is that a decent proportion of suicides are committed in hotels, in part because of the suicidal person trying to spare their loved ones the experience of finding their bodies if they succeed, and also of causing the suicide to fail by finding them in time to save them. I wonder if you just "added back" the number of hotel-based suicides there normally are, if that would get you to the expected depression:suicide ratio....
> Second, one pillar of Aaron Beck’s triad of depression is “this is endless.” A sense that nothing can ever change, so why bother to wait and see? The pandemic was the opposite of that.
This is strongly, strongly, strongly inconsistent with the lived experiences of literally every person I know. I cannot think of a single person who was like "yeah this is totally temporary it's only two weeks then it's back to normal".
We very quickly realized it wasn't just going to be over in a matter of weeks, but it was always obvious that this state of affairs would not be permanent - eventually there'd be a vaccine and life would go more or less back to normal, with maybe the only change being that there are a more countries than before where masks are a common sight in public places. So it never felt truly "endless" in the sense of a truly intractable problem with your life.
Yeah, as someone who was suicidal during the pandemic, the big thing that helped me get through it was the knowledge that stuff would eventually go back to normal (or something close to it at least).
One thing I noticed was this line "Second, the US has a waiting period on guns, so most gun suicides are by people who already owned the gun when they became suicidal.". While some places do have waiting periods, some don't. For example my state has no waiting period, I walk in wanting a gun, I walk out with a gun.
Besides that one question I would have is around the kind of people who would be more prone to committing suicide. I mean if you are depressed and everything shuts down, does that impact you that much? If you were depressed were you going out to bars partying and visiting family? Maybe now that everyone is a shut in you feel some sort of kinship, "Hey welcome to my world normies, enjoy the ride". All the newly depressed people know it is temporary and rally around beating covid.
As of this moment, the majority of US states and US population have no waiting period for firearms. From that quote, this continued misunderstanding - purposeful or otherwise - regarding guns and suicide is really getting quite old. Huge numbers of people in India are committing suicide by throwing themselves under trains and lighting themselves on fire with flammables (the videos are everywhere) because those are the means most available to them, just like throwing yourself off tall buildings or hanging yourself with a rope would take a guns place if those were less available.
The method has no bearing on suicide, and people are quite creative regarding the methods available (in industrialized countries we have an entire right-to-die industry using helium tanks or fancy drugs). Period. Just stop it with this.
Based on some cursory preliminary reading, research consensus seems to be that restricting access to effective and culturally established suicide methods is fairly effective at reducing suicides. If you have some strong evidence that this is false, does not obtain for firearms specifically, or otherwise skewed/missing something, I'd be interested in learning about it, but right now, this just sounds like ideological bias.
(oh, and I assume you were comparing the 2 story building to waiting periods for firearms? a more accurate analogy might be physical structures that make it more difficult to jump)
Actually no, but that's an interesting take. I didn't think of that. "Physical structures that make it more difficult to jump" seems really really tough...let's just ban gravity.
"Thomas and colleagues23 described the large increase in suicides in the UK, first in men and later in women, after carbon monoxide gas from coalmines became widely available in the first half of the 20th century. Gas rose to become the primary national method of suicide. The replacement of coal gas with natural gas from North Sea wells between the late 1950s and early 1970s led to a gradual reduction in the carbon monoxide content of domestic gas, which in turn was followed by a steady and prominent decrease in fatal gassing and the overall suicide rate in the UK.23,24 This decline in the overall rate was directly caused by the reduction in suicide with domestic gas. Thomas and colleagues23 showed that the number of fatal gas poisonings in the UK rose in the early 1980s, but it later fell after the introduction of catalytic converters into car exhaust systems"
I'm genuinely interested in whether there's evidence supporting your argument, not just trying to justify a position. This just seems like what is true to me; if it's not, I'd be happy to update.
This has been investigated for suicides off the Golden Gate Bridge[1] and led to the long-awaited decision to install a suicide net on the bridge (although current intervention teams supposedly catch and stop 80-90% of attempts). A fascinating statistic I remember from the study was that only 1 of every 10 people who were prevented from jumping later committed suicide by another method. Of the very few survivors (I think just 34) if I recall correctly only 1 actually went on to kill himself. Accordingly to a very interesting New Yorker article on the subject[2], supposedly for many survivors the jump was shockingly life-affirming. There's a famous quote from one of them, recounted in the New Yorker article: "As he crossed the chord in flight, Baldwin recalls, 'I instantly realized that everything in my life that I'd thought was unfixable was totally fixable -- except for having just jumped.'" That man got a second chance, and used it. The idea of the net is to give that chance to the 30-40 other people who jump from that bridge yearly.
The most common suicide method in India (and the world) is drinking pesticide. There's evidence that banning the most lethal pesticides reduces the rate. See here:
"reduces the rate"...of drinking pesticide. They are now throwing themselves under trains, trucks, electrocuting themselves on exposed wires, and dousing themselves in gasoline and lighting a match.
"We found two observational time series analyses in Sri Lanka, which find a substantial decline in suicide rates following pesticide bans aimed at reducing suicides."
I can't claim there's no displacement to other methods, but the researchers aren't idiots and did actually measure the overall suicide rate, since that's what we actually care about. For some reason, people don't just switch to another method once the easiest is taken away from them.
...ok...extrapolating "people" using data from Sri Lanka as a statement on worldwide methods of choice for suicide is using a rather big tent don't you think?
No. I remain unconvinced that seriously suicidal people with constant suicidal ideation and the will power to end their own lives are deterred by the removal of one particularly popular method for committing suicide. As if removing bug spray or train tracks suddenly convinced these deadly serious people that they had every reason to live when no one else, themselves included, could.
I was talking about one specific context since that was what started the conversation, but I believe a reduction in suicides was also seen when carbon monoxide was decreased in coal gas in the United Kingdom, and that bridge barriers decrease suicide at specific locations without increasing it elsewhere (no significant effects on overall rates were detect though). It's very difficult to study of course, since suicide is relatively rare (so changes in one city are hard to measure) and can increase or decrease over time for any number of different reasons.
I understand your objection, and sure, maybe "seriously suicidal people with constant suicidal ideation" won't be deterred by any inconvenience, so for that reason I suspect the benefits of means reduction come from preventing people who are less committed to ending their own lives and really just need to think it through some more or just survive a temporary but extreme mental health crisis. I've gone through periods of suicidal ideation in the past, while I was never seriously suicidal I think it's a good thing I didn't have a massive tub of toxic pesticides lying around.
Some types of suicide are indistinguishable from accidents and such. I think that it is extremely likely that if you go after obvious suicidal methods, people will seek out other methods that more often look like accidents.
My state has waiting periods for semi-automatic rifles and handguns. If you want a shotgun or bolt-action rifle you can buy it and walk out with it in one transaction.
Another non-obvious source of gun suicides are rental guns at ranges. All of the ranges I've been to have a policy to mitigate this: if you're by yourself you cannot rent a gun unless you brought a gun with you. However, that's not a law, and I don't know how widely such a policy has been adopted. Maybe it's just a quirk of the area I live in.
My area you can rent a gun if you don't bring one, but I do know they have some extra requirements for that same reason. Good catch on that I completely forgot that happens.
From what I can tell, that's a pretty common policy everywhere in the nation, with the addition that you can rent a firearm if you have another person with you.
Is going out to buy a gun and killing yourself with it a thing? Choosing a gun and learning enough to use it correctly might be quite an obstacle for someone thinking to kill themselves out of depression. Conversely, if you already own a gun, you probably know how to use it, and you don't have the trouble of buying one. (Obviously this is not relevant to someone who is used to guns but doesn't have one at the moment.)
I feel like most people that don't know how to use guns would assume it's pretty easy, especially if you only want to shoot yourself. That's probably not true since there are definitely times when people botch it and just hurt themselves without dying, but this is more about what people think than the reality.
Me too. Because drug addiction is mostly categorized as clinical pathology now, it creates a huge gray zone for many addicts (and their caregivers) as to where an addiction ceases to become an addiction and becomes suicide, albeit on purpose or not, and regardless of how slowly or quickly it happens. You meet these people all the time, the ones that know deep down their addiction will kill them, and they'll tell you too. Some of them will have varying degrees of acknowledgement of their power or powerlessness to stop it, and others that have made peace with the knowledge they could stop and choose not to knowing that it is a death sentence. And they're fine with that.
If you know something will kill you and you know you have the power to stop and you do it anyway, consider me old fashioned, but I consider that suicide, even if it takes 5 or 10 years. There are tons of these kinds of addicts out there, but for the reason I mention above, they will never be added to official suicide numbers.
I always go into this with the thought: "yeah, but I wonder if he's thought of THIS!", and I always find out you have. I have to appreciate how thoroughly you consider things. Here are the two ideas that I thought of, and my thoughts on your points:
1. Overdoes vs. suicide. I've had one sad personal experience with a young man where the question as to whether this was an overdose or a suicide was unclear. My feeling was that we all agreed it was an overdose out of kindness for the surviving family, and maybe to lessen the shock. I wonder if, in this pandemic, there was either less investigation of these deaths happening, or whether there was just an unconscious nudge that way.
2. Meaning. I have never seriously considered suicide, but when I'm at my most dark points, it's because of the bleak expanse of unchanging, bland, dreary life ahead. The pandemic was at least interesting and engaging in a lot of ways, as grim as that is. I think people are itching to fight for something meaningful, or work for something meaningful. Most of our careers aren't very meaningful: for example, my job is helping big companies track how you behave online so they can market to you more effectively. Kind of depressing. So you've got this pandemic, and we've got the kind of existential moment, and we can all kind of "fight" for something.
At least at first. Then it starts to get political, with your mask adherence becoming a tribal thing, and everyone back to the same routines, but with social distancing. So there's that initial interesting time of the crisis (that Zunin and Myers graphic is awesome), but then it's back to the usual slog of meaninglessness. And it might be that we come out into a weird economic period that doesn't rebound into "reconstruction" the way a different crisis might, because the crisis of the pandemic was so odd, and we've already kind of been "reconstructing" through the whole thing, and now we'll have the bill to pay for the unemployment and supply chain problems and kids having just terrible school years, so they're practically a year behind. . .
Anyway, the Durkheim/"meaning" thing seems most likely to me based on my own observations.
Yeah, that part resonates with my experience. E.g. reading science-adjacent blogs and arguing on the Internet suddenly went from "mostly harmless but mostly useless way to kill your time" to a way to get (or share) actually relevant and important information.
as a person with medium to severe depression before the pandemic and very severe depression including suicidal ideation during the pandemic, I would be a data point for your last two hypotheses - the change of pace and making the whole shebang feel at least a bit different (before it turned into endless hopelessness again) + not ever being alone to actually do anything. and the reason I would more likely feel inclined to kill myself in April-ish is easy: between October and March you can (in the northern hemisphere) blame it on winter and tell yourself that it'll get better in spring, because sunshine. Then spring comes around, and it doesn't actually get better... then it definitely must be forever this bad, so what's the point. At least that's always been my reasoning. Hooray for anti depressant medication.
I remember when it first started and millions were losing there jobs my firm did a few layoffs. Ordinarily that would make me anxious and depressed. But somehow the thought that millions of other facing the same thing made it much easier to deal with. Maybe part of suicidal depression is the idea that bad things are happening just to you. You've been singled out.
On the other side of it, having a job, when everyone else has a job, doesn't feel amazing. But having a job when millions are losing theirs makes it feel special and like a real accomplishment.
Did suicide attempts fall too? Are people just less successful since there is a greater proximity to people at home?. I also wonder if people who couldnt handle the situation might have just decided to ignore the pandemic as a way of coping instead of Suicidal behavior.
> So it’s weird to see drug overdose deaths follow such a different trend from suicide. I’m tempted to wonder if people are misclassifying suicides as overdoses, but I don’t see any evidence of this or any reason why it would happen.
One theory: we always misclassify some drug-related suicides as overdoses, and the pandemic caused some suicidal people to shift their suicide method to drug-related, and as a result we increased the number of suicides misclassified as overdoses.
We could check this theory by checking if the increase in overdose deaths cancels out the decrease in suicides.
If you can't go to the Golden Gate Bridge and the trains aren't running as frequently, then you might turn to your medicine cabinet rather than just taking a detour from your commute that you aren't doing either.
A slightly different take: I used to work in drowning prevention - albeit in Australia - and there is a weak coronial presumption against ruling a death as suicide in the absence of clear evidence to the contrary.
Saying someone took their own life is much more likely to upset family members, etc, so you want to be right if you say it.
In a pandemic in presumably gets harder to gather the necessary evidence, and some deaths might move from provably suicide to assumed-to-be unintentional.
"But most people stayed home even in places without legally mandated lockdowns"
-Citation needed.
One observation of possible relevance to apparent difference in the black/white suicide directionality gap: I live in a majority-black neighborhood, and I found that for the first several months of the pandemic, almost *nobody* in my neighborhood observed basic safety measures outside the home. People would wear masks in stores once it became legally mandatory, but outdoors, only a fraction of people wore masks, and only a fraction of those people wore them properly covering their noses and mouths. I constantly saw people approaching each other within distances of 2 feet or so (this is a small personal space bubble neighborhood) and taking their masks off to talk to each other, often touching each other on the shoulders, sometimes even each other's faces in the process.
I noticed practically no difference in terms of outdoor socialization during the pandemic versus pre-pandemic, until around last Winter, after the election. People actually wear masks outdoors now, and wear them properly, and fewer people socialize at physical contact distance, but it took a *long* time for this change to take.
It seems Americans started social distancing even before governors ordered it. I don't know the exact effect the lockdowns had, but their is evidence that Americans were reacting even before the orders.
On a population level, in terms of behaviors like avoiding restaurants and bars, I find that easy to believe. On average, social distancing measures like "don't gather in crowds, wear masks, keep at least six feet apart from others," etc. may have been observed even without government mandate.
In my experience though, my neighborhood was very much a high-contact, small personal space bubble community prior to the pandemic, and it remained so for a very long time into the pandemic, and while shopping-related safety measures were mostly observed, socialization-related safety measures were mostly, not willfully defied, but blindly disregarded.
However people here weathered the experience emotionally, I suspect that this was likely a relevant factor.
Was there any state that in the US that never had mandated lockdowns? Everyone's definition of a lockdown is different, but even in Texas the bars and indoor dining was illegal for a long time. Perhaps the Dakotas never had that. But where else?
It was only about 6-8 weeks that bars and restaurants were closed in most of Texas. I recall that Memorial Day was when bars re-opened, and I'm pretty sure they never closed again (though there might be have been periods when they were legally required to sell you a $4 bag of chips with your $0.50 beer).
"Also, this explanation implies that people were financially better off with the coronavirus and relief package than they were with neither, which doesn’t really seem to match reality."
Why not? CARES was uncharacteristically generous in that many people actually did end up better off financially. Someone who worked a shitty service job slinging popcorn at a movie theater for minimum wage and got laid off by their employer probably wasn't that invested in concessions as a career and would've been quite happy to get more money for less effort.
"Third, maybe people became more worried about the effect that suicide attempts would have on their family. Part of this is increasing social closeness—people suddenly had to spend every waking moment with family members, or else bubbled together with people they had previously lived apart from. Another part is that their family members were also suffering, and depressed people decided it was unfair to ask them to bear the burden of a family member’s suicide at the same time as everything else. Or what if you just literally don’t have the personal space, out of earshot of your family, to attempt suicide without someone else noticing?"
This was also my theory upon first hearing that suicides went down during the pandemic, and before I looked at further data. More specifically, I predicted:
(a) that the drop in suicides was due to fewer suicides among young people, who were newly forced back into their parents' home
(b) that deaths of despair among adults had increased.
I don't really know how to verify my predictions -- is there an age-breakdown of the suicides anywhere? I consider the increase in overdoses to be weak confirmation of (b) for now.
When you use phrases like “studies from Norway, England, Germany, Sweden, and New Zealand” it is unclear what this means. My best guess just, like, grammatically, would be studies from research institutions in those countries; whereas my best guess based on what information would actually be relevant to the reader is studies whose study populations were from those countries. Maybe it happens to be both simultaneously for these examples.
Anecdotally, my therapist friend had the exact same observation of anxiety patients. All of a sudden, it's like they were in their element, or like their life outlook had suddenly been vindicated.
Re drug overdoses: there are two plausible explanations I've heard:
1. More people doing drugs alone, with no one to call an ambulance or administer Naloxone
2. Erratic supply causes people to buy drugs in bulk, which leads to overdose.
It should actually be easy to figure out if 1. is true, just based on the details of individual overdoses.
I think the "two types of depression" is on the correct track. There's the 'normal' type of depression, which is the depression in the other post. That's not going to change very much during Covid-19 and may even, weirdly, become slightly better. Those are the people who, if they're going to kill themselves, are going to kill themselves whether or which.
The second type is "kinda down, kinda blue, kinda not feeling good" which happens when people not suffering from the first type of depression have their usual "go out and enjoy myself" activities curtailed, along with worries about the pandemic, maybe laid off from their job, etc. Ordinarily they're not thinking about killing themselves and things have to get really, really bad to push them to that stage. When the restrictions are limited, life goes back to normal, they'll bounce back.
What I mean for the first set of people, those who are suffering from depression before, "weirdly become slightly better" is that now *everyone* is in the same boat. I'm introverted, I don't like people, and I think I might be mildly agoraphobic. That means currently I *love* the lockdown conditions, because this is normal life for me *plus* bonus "working from home? no interaction with other people? can slob around in my night clothes all the day? oh yeah baby!"
Also having to wear a mask is great when you have (a) plain to ugly features and (b) really can't be bother slapping on makeup. When three-quarters of your face is covered between mask and glasses, it's really liberating.
Nobody can travel, nobody can socialise, everyone is confined to the same restrictions. This is awful for people who have social lives and like going out and mixing in the world. For depressed people who already have the tendency to stay inside, avoid people, and have lost interest in formerly pleasurable activities, suddenly this state of affairs is the new normal and now they're virtuous for not doing any of the "just go out, have fun, meet people, force yourself to interact" activities. This is a sort of relief of pressure, funnily enough.
Drug use (and as a result of that overdoses) going up? Yeah, I'd expect that too, the same way alcohol consumption goes up. People can't go out and do their normal activities, they get bored with being confined indoors with TV and games, they consume their usual fun substances to cheer themselves up, but now they're doing more of them, regularly, and possibly upping doses as well. They don't intend to kill themselves, it's not suicide, it's just a bit too much of your usual fun substance/mixing several recreational substances together and then - oops.
I too think the "two types of depression" hypothesis is probably the best explanation here. At any rate, it's the simplest.
A lot of focus in the in article is on people stuck living close to their families, but a lot of people live alone and were stuck hanging out alone much more than they are used to. That should introduce a lot of situational mild depression.
My first thought was to look at suicide during war. You gave a link saying that suicide in Britain went up during WW2, but the linked article only said that suicides in Scotland declined less during the war years than one would predict given a longer-term data sample.
I say, look for more data on this. "Suicides went down less than predicted" probably depends critically on what window you use to set your "background effect". Also, the Scots weren't uniting against a threat so much as they were fulfilling military obligations imposed on them by a foreign nation (England) which many of them (like, maybe half) saw as their oppressors.
I applaud and appreciate your methodical refusal to come to any conclusion. Measured rationalism, while less than satisfying as a narrative, is a refreshing approach to potentially torture-prone statistics. It’s like the rhetorical equivalent to publishing negative studies to insure against publication bias. Thanks for sharing your still-baking thought process. The world needs more out-loud examples of such things.
One of my kids (M 20) is a front line worker and was therefore not locked down. He has bipolar disorder, which is managed with Aripiprazole and psychotherapy. He experienced an episode of suicidal ideation over the winter that seemed to come from nowhere. He explained to his therapist (and me) that what was depressing him was his failure to progress at work, the sense of "same shit, different day" and that he didn't see a way to get back to being a college student (which he currently can't handle). So, N = 1 but I go along with the "hopelessness" theory.
Overall, very well written and helpful - as always.
It would be interestingly, probably in a stressful kind of way, to restrict the analysis to healthcare people, e.g. RNs and med techs and RTs in the inpatient setting. Those people had a very rough year.
Scott you're at your strongest when you discuss about stuff related to your job and I wish you'd continue doing it instead of reviewing books or hinting about HBD
Just as an anecdotal counter to comments like this, I personally enjoy Scott's writings on a wide range of subjects. Psychiatry posts are the ones I find least interesting (nothing wrong with the posts I'm sure, it's just not a subject that I'm interested in).
I love the "much more than you wanted to know" and book reviews posts, whatever the subject.* I feel Scott is weaker in his discussions of history (outside of the USA).
Yeah basically when talking about psychiatry related subject his professional experience really shows, when he talks about other subject he's just a random dude
Since most of the death statistics are going to be based on CDC death certificate data, I suspect that who completes the death certificate is somehow a factor. Death certificates of violent suicides or completed overdoses found in the field with an accompanying note are going to be completed by the local coroner or an emergency personnel trained in and certified in death pronouncement. Most overdoses of the kind you describe here, "There’s a thin line between a drug overdose death and a suicide. Something really terrible happens, you can’t stand the thought of dealing with it, so you take ten times your normal dose of painkiller in order to fall into a warm, pleasant sleep. At some level of misery, “but what if you take too much and never wake up?” stops feeling like a flaw in this plan. For some people, it’s a bonus—all the oblivion of suicide, with none of the guilt—after all, you weren’t trying to kill yourself, not exactly.", they will be managed in an ICU somewhere by a critical care physician, and unless there is an accompanying clear suicide note found at the scene that was transported with the patient and makes its way into the ICU and the patient's chart, those deaths are not likely to be classified as suicide at all and will instead be accidental overdoses with the death certificate being completed by the attending physician at the time of the patient's death. I have taken care of many of such ICU overdose admits and completed many death certificates concerning those cases and have rarely indicated suicide on the death certificate. It is very important to be accurate when completing death certificates because they do have life insurance implications etc. It does not surprise me that overdoses increased during those early months of lock downs, and I suspect that a fair number of those overdoses were also suicides of the type you describe.
Hypothesis on drug overdoses: with borders largely closed, it's getting more difficult to get certain foreign-made drugs, so addicts are switching to other even worse drugs; e.g. if you can't get heroin you try fentanyl.
My understanding of the situation is that drug dealers frequently sell diluted fentanyl as heroin, because 50kg of heroin are more expensive and harder to smuggle than 1kg of fentanyl (and truth-in-advertising laws have no power over people selling an illegal product).
Or to put it another way: you know some people who are opiate addicts, but do they really know which opiate they're taking?
Did I misunderstand something, or does the CDC say that 2020 10.7% of Americans considered suicide? This number seems absurdly large... Or does "thinking about suicide" mean something different?
Pretty sure 10% of people suffer from depression. Plenty of people think about suicide, even those who aren't depressed. The question is usually how seriously you are thinking about it. That number sounds about right to me for a normal year.
I notice you are not too fond of the Durkheimian "during a crisis people seek together" hypothesis. A reflection here:
A test of Durkheim's theory should probably use something else than suicide rates as an operationalisation/indicator. Since (if you follow Durkheim) there are different suicide motivations, and not all of them are of the type that is influenced by "getting closer together/becoming more distant from each other".
...A better operational indicator to test the Durkheimian thesis is probably to check the rates of marriage/co-habitation break-up. The Durkheimian thesis straightforwardly leads to the assumption that the breakup rate will go down during an epidemic/disaster.
...I have not checked if that has been the case during the present pandemic (worth doing!), but here is an old article finding this effect after the 1995 Oklahoma bombing: Nakonezny et. al. (2004): Did divorces decline after the Oklahoma city bombing? Journal of Marriage and the Family vol 66 (1) p. 90-100.
Ok, I know that checking if Durkheim was on to something is not what you are interested in here: you are interested in theories that can explain variation over time in suicide rates, regardless of where these theories come from. But let me offer an elaboration that might be relevant, although admittedly speculative:
There are two types of suicide that are dominant in modern societies, if one follows Durkheim: Egoistical/self-interested suicide (calculating that the costs of continued living are higher than the benefits: Gary Becker’s & Richard Posner's rational choice theory of suicide is in this mould); and anomic suicide/"existential" suicide (Seeing/finding no meaning/purpose in life; acute Weltschmerz; that Kirkegaardian/Nietszchean stimmung).
Durkheim arguably claims that the odds of committing egoistic suicide is influenced by having friends and relatives that cares about you (and hence this type of suicide should go down during a crisis that brings people closer together, similar to breakup rates); while anomic suicide results from a deeper-level cultural ennui that is not necessarily influenced by how distant/close you feel to others.
Which might explain why drug overdoses have gone up; they may be related to the feeling "life is meaningless anyway, and it feels even more meaningless these days", rather than to "I thought no-one cared about me, but in this present crisis I somehow feel that I was wrong".
Ok, perhaps egoistical versus anomic seems like a hair-splitting difference in suicide motivations. But the distinction may potentially at least explain why suicide rates and drug overdoses move in different directions during the present covid crisis. And it might perhaps also explain why meta-studies on suicide do not find consistent results supporting an assumed Durkheimian approach (since such studies can hardly distinguish between Durkheim's different types of suicide motivations, and hence different types of suicides).
….The above is perhaps a bit rambling and disorganised, but I'll post it anyway.
Great piece! Summary: Suicides declined possibly cuz a) misery loves company, b) curiosity, c) and responsibility towards others. And we don't know why drug overdoses rose when suicides declined.
Curious what’s the story behind posting this there and not on your own blog? Is this a business/partnership/commeercial arrangement thing? (i.e. you’re posting it there it helps giving their website more exposure?)
Dostoyevski's notion of finding "happiness in the midst of despair" is distinct from "people pull together during a crisis" although at times it looks similar. Under Dostoyevski's formulation it's the crisis itself -- which may be personal -- which, although causing one to feel bad, also causes one to feel like they are *supposed* to feel bad. If feeling bad at least makes sense it's easier to tolerate.
I think of this idea as similar to Adam Smith's observation that people suffer from small embarrassments more than big ones.
To amplify, big embarrassments can force you to make sense of them. You're naked on the street on Christmas Day and you look your staring neighbors in the eye and say "What are you looking at?". You become your own ally in those situations, whereas the paranoia your neighbors saw you masturbating because you didn't close the blinds all the way has no defense you can provide.
Random thought that I have no emotional attachment to...a lot of people who commit suicide are "Zoom class" or "affluenza" types whose lives actually got better during this period since they still made money, got to stay at home, and could actually do all the stuff they normally want to do?
The increase in overdoses might not necessarily reflect an increase in suicidality/indifference to death. I think hard drug use in a social setting might actually be safer than solitary hard drug use. This would be due to having help on hand to administer antidotes or call an ambulance if someone takes too much. I think it could also be due to social pressures leading to people using less drug overall. The two biggest ones would be avoiding the shame/stigma of taking a way higher dose than anyone else and wanting to remain lucid enough to socialize.
I don't use opiates and I don't know anyone that does, but I do see the same pattern of people using lower doses in social settings and higher doses alone across all sorts of other types of alcohol and drug users.
Isn't overdose risk context specific, so you have higher risk from the same dose in an unfamiliar context? My source for this being my wife, a psychology graduate. If it still stands, this might be a pertinent factor here.
"Also, there were slightly more black suicides in the months just before and after the crisis, so that if you look at total black suicides during 2020, it’s about the same as any other year—in fact, lower than two years ago."
This passage was opaque to me. Did you mean slightly *fewer* black suicides? There are two small bumps on the chart that might be the ones you're referring to, but I don't see how slightly more suicides before and after the crisis, added onto high suicides during the crisis, could lead to the year being normal in total.
> Also, [the 'increased welfare' explanation] implies that people were financially better off with the coronavirus and relief package than they were with neither, which doesn’t really seem to match reality.
For what it's worth, real personal income per person shot up sharply during the pandemic: https://fred.stlouisfed.org/graph/?g=EiOd (sorry for weird units, don't know how to fix that). The worst month throughout the entire pandemic on that metric, March 2020, was only as bad as July 2019, at around ≈$51,000. April 2020 it shot up to ≈$58,000 (going by the trendline, that wouldn't have happened for ≈5 years by default) and hasn't come back down to pre-pandemic levels since. This March was even more, at ≈$65000.
But this doesn't address your counterargument that suicides dropped off in March, before the stimulus.
Also, personal consumption expenditures per person went down even more drastically, from February 2020's $45,000 to March's $37,000, only fully recovering recently, and I guess that's a better measure of well-being overall: https://fred.stlouisfed.org/graph/?g=EiOr. (Though, question for econ people: does personal consumption include paying off debt? Does it depend on what you're paying off debt *for*? I'm trying to get a sense of where people's stimulus checks went if not on consumption — sitting in their bank account with everything closed, paying off debt, or what?)
Overall I'm pretty unclear on what people were going through financially during the pandemic outside of my bubble (and since everyone in the news media and in my social media bubbles is talking about zoom calls and whatnot, I can't really expect them to inform me).
Followup: someone on another form said that debt payments count as savings, not consumption. If someone could get me a link to where the FRED defines their terms, or a reasonably authoritative textbook or something, I'd appreciate it.
All these mindblowing statistics, from suicides to savings, just continue to leave me confused as to what the breadth of human experience was like during the pandemic. (Also, this is only US data; I'm even more ignorant outside of that.)
On the differential suicide rate for black people in the US, we're not in an all else being equal scenario here. There's the issue that if you are black in the US there's a dominant media narrative that you are a victim of a racist society. That's going to have an effect on people, increasing feelings of helplessness and isolation (if this makes people more conscious of their perceived differences), and there seems no reason this could not be as big an effect as COVID.
We also had an explicitly racist president in the USA in 2020 as well as the video of the George Floyd murder by the police. Perhaps that had an even greater effect than the media narrative.
The "racist president" was a media narrative (Scott has had a bit to say on this), and a video being repeatedly broadcast and transmitted is clearly part of a media narrative, even if the narrative is focussed on the video. A media narrative is not in itself a bad or wrong thing; it's just a reflection of human tendencies to coalesce our thoughts, and probably a reflection that most people in media and on social media don't have the time to think about the evidence so much as use and adapt already existing narratives. A media narrative might even be correct on occasion (I'd nominate the Rudy Giuliani is clearly going mad one for this award...)!
The endless focus on George Floyd's race was also part of a media narrative; there's no evidence whatsoever that his race was any kind of factor in what happened to him.
How about the simpler explanation that COVID, both the disease itself and the economic carnage of jobs lost, foreclosures, and evictions, hit black people generally harder?
Did it? That would require three things to make a convincing case:
1. Evidence that this was the case. I have no reason to doubt this, but from my external viewpoint I don't know the relevant statistics and suspect that any narrative at the moment is likely to take a social-justice slant and look for structural inequalities. That said, my prior would be to believe this will be the case.
2. Evidence that there is a direct link between the economic effects of COVID and suicide. This might be problematic though since I don't think the statistics exist for this, but since the whole US population suffered increased jobs lost, foreclosure and evictions and the aggregate suicide rate dropped, I'm not sure we can say that is the case here (if we accept the sense of community here as a reason for the decreased suicides, Scott's provisos noted, then you might have an argument if black people could be seen to be alienated from the community, but then that would play into my suggestion anyway...).
3. Simply becausrbmy idea was first on the table, a way of discounting the alienation and othering induced by a narrative of victimhood (often ironically deriving from already distant political, media and business elites who are predominately white) as a factor, since it is pretty clear the possibility exists that being repeatedly told your skin colour makes you different and less capable of achieving what you want than the average US citizen may have an effect on people.
To be reasonable about this though, lets try the same exercise about what we need to substantiate the suggestion with my suggestion that the anomalous suicide rate amongst the black population in the US may be (there should be a partially here: life is never that simple!) a factor of a narrative reinforcing alienation and helplessnes. What would we need to make a plausible hypothesis here?
a. A mechanism. Currently I am correlating a media message (without consideration of cut-through to the target population) to a statistical variation. Whilst I'm using nice-sounding words (othering, alienation) note I am not suggesting how this actually works. My underlying prior here though would be the relationship between bullying and suicide, which I believe is accepted as causal (although it wouldn't shock me if this hadn't replicated).
b. Evidence that perceived or real oppression on the basis of identity can cause variation in suicide rates. This data probably exists (I'd look at South Africa, and maybe the history of gay communities) but by its nature might be difficult to use or simply a culture war minefield.
c. Ideally some anecdata that this is a plausible case, as the best hypotheses ever have minimal value if they can't be seen to actually apply. Since I believe humans to be rational actors, I have to believe a hypothesis applied to people can at least match people's behaviour rather than positing an invisible hand in action. If the actual case evidence all points in a different direction from what you are suggesting, then you should probably listen to that evidence.
So my original idea needs work to even become a hypothesis. I still favour this over economic determinism though, simply because if this was a factor I wouldn't expect the whole population drop then normalisation of suicide rates. There's lots of other possibilities of course: the role of organised religion in averting suicide and the effects of COVID on this for example. I'm just very tempted by that lovely correlation between narrative and statistics...
Keep in mind, the underlying suicide rate for whites is two and a half times that of blacks (that's per 100k people, not total; total is even starker because of whites being more common). The effect being discussed isn't "black people commit suicide more during 2020", it's "the racial disparity in suicides wasn't as big as expected in 2020".
All else is not equal, but one of the unequal things is "whatever makes white people so much more suicidal than black people", and the most obvious guesses at this factor seem like things COVID could plausibly interfere with.
Are you saying that the differing base rates of suicide here mean we cannot assume different patterns have particular significance? I'd be inclined to agree, but I don't known that the racial disparity is real. In the UK suicide is most common in poor rural environments (I lost two former schoolmates that way), and the US has a hell of a lot more rural poverty than we do and that rural population is much more white than the urban population. If a high rate of rural suicide maps across, it might explain a lot of that racial difference. Is the suicide rate for socio-economic groups in cities in the US consistent or varied across racial sub-populations? To come over all Marxist here, the focus on race can hide real similarities between races, and before accepting that black people do have less chance of committing suicide than a white person in the same socio-economic situation I'd need to see data saying just that.
Oh, I'm not saying it's something innate. I'm saying a) race correlates with a bunch of things (wealth, culture, day-to-day danger level, physical activity, etc.), b) at least one of those things is presumably responsible for the stark gap in suicide rates, c) COVID could plausibly be hitting some of those things (e.g. black neighbourhoods are generally more dangerous, COVID makes every neighbourhood dangerous).
When you write "there are two types of depression" I think you mean "there are two modes of depression". The statements that follow support a change in mode for those who are already in one, whereas two types could exist simultaneously.
Best practice for spelling Māori these days either has a macron over the ā or uses two as - Maaori. Both are more accurate, which one is used depends on the tradition/preference of the local iwi (Māori traditional group).
I'm not saying that the ā or aa spellings are best practice when writing in the Māori language, I'm saying that they've become best practice when writing in English. It's routine for news outlets, advertising and government and business reports these days.
Perhaps that is best practice in New Zealand, where they have reason to be frequently referring to the Maori.
Though I thought the push was on to refer to the country as Aotearoa, given that I have seen a finger-wagging piece about that elsewhere.
And even *that* is susceptible to the "more woke than thou" creep, as those patting themselves on the back for using the 'correct' name can now be corrected by even more correct types: https://www.newsroom.co.nz/aotearoa-whats-in-a-name
"The Māori version of New Zealand is ‘Nu Tereni’, a Māori pronunciation of the English name. Aotearoa is not used."
However, since this is not New Zealand/Aotearoa/Nu Tereni and the majority of us are neither Pakeha nor indigenous, then "Maori" is good enough for general use.
While I hope I am sensitive to cultural nuances, given that right now there is NO "local iwi" around me, I'd stick with Maori. Finger-wagging uselessness of this type does move to make people annoyed and less eager to co-operate or try to be correct than any amount of "structural racism".
Now, if ever I move to New Zealand (something less likely than the Second Coming happening in the next ten minutes) or I am communicating with Maori people or groups and that is the spelling they use, sure, I'll go along with it for the sake of courtesy.
Someone from God knows where who could be a dog for all we know telling us all - who do not live, work or have dealings with New Zealand, New Zealanders, or the Maori peoples - off in schoolmarm tones of "I know better"? Go away and reflect on your life choices.
Mate, Scott was explicitly asking for feedback from us on a piece of text, I think it's a reasonable editorial comment. I don't just go around randomly interjecting to insist on everybody doing things my way or slag anyone off for not keeping up with the latest woke signalling, you can check my post history.
A chara, Scott was asking for feedback on a post about Covid, suicides and depression. Completely incidental to that, he made one (1) mention of "Maori".
Instead of addressing the topic of Covid, suicides and depression, you came back with a Tumblr woke madam comment "Ackshully" about the "best practice spelling". While you're at it, why not remind us that "Gypsy" and "Berber" are horrible awful slurs and if we use them we're all racist white supremacists?
Also, if we're going to indulge in preciousness about "correct forms" and "best practice", don't refer to me as "mate" as that is not in conjunction with *my* cultural norms and is an inaccurate form of address. If you need to address me, use the formal, gender-neutral term as instanced above. I do not invite you to use a more direct form of address, but if you really desire to do so, then it would be "A Dheisigh". Certainly *not* "mate" which is not even the correct language!
Or you could come down off that high horse and stick to common usage in English where and when we are not discussing the Maori in general, particular, or in any more depth than a passing reference.
I've lost a lot of respect for you today Deiseach. I don't come here to be attacked. I came here to add information that I had reasonable cause to believe Scott might not have known and could appreciate, I think you're being pretty mean to rake me over the coals for it.
Were your good opinion something I cared to have, doubtless this would wound me. Since, however, the question we are debating is one where a wokescold is annoyed that their performative virtue signalled was criticised, hence denying them the thrill of the enjoyment of conscious virtue, this means nothing to me.
I don't comment here for ego-stroking or to show off how very much up on the latest correctness of the most correct that I am. The information you wanted to wave in our faces was irrelevant to the actual topic for which Scott was eliciting feedback. I don't know your personal circumstances nor do I wish to know, as I very much dislike the current trend on social media to demand name, rank, and serial number before anyone can dare offer an opinion. Richard Dawkins has every right to give an ignorant opinion on The Troubles and then try to pass it off as a joke when he gets pushback. I have every right to say that it is an ignorant opinion and he was being a privileged Brit.
To address the meat of the matter: there is no correct way to spell Maori, Māori, Maaori, Mayawhooarooa, or whatever "current best practice" for the term may be (one that changes with fashion), there is only the preferred version (as you yourself admit, though you seem not to realise it, when referring us to whatever "the local iwi" may use. That one iwi may pick a version different from another means there is no one, single, "Best Practice").
"It's routine for news outlets, advertising and government and business reports these days."
It's routine *in New Zealand*. This is not New Zealand, as I have pointed out several times. By the way, I note that you continue to address me as "Deiseach" despite my request that you use the correct terms. Did you think I was not serious? If you insist that non-New Zealanders use "Maaori", I am within my rights to insist you use "A Dhéisigh" when addressing me. That is "best practice" and "tradition/preference" of the First Official Language of my country, and if you are being so precious over indigenous language usage about your (presumed) own nation, then you should extend the same courtesy to others.
Unlike yourself, I have not insisted that people on here use "Déiseach" or "A Dhéisigh" or "A Chara" when addressing me, because unlike yourself I recognise that we are using English, with an audience of English-speakers, from many countries, and that I don't get to police their language conventions.
The problem we are dealing with is one common to every attempt at Romanisation of non-European languages, where since the Maori language(s) had no formal written system, one had to be invented - as was the case with Sequoyah and his creation of the Cherokee syllabary where no native writing system existed.
Since the language of orthography is English, this is another problem: in English, long vowels are not specially marked. Were this another European language which used diacritical marks (note the síneadh fada in the Gaelic version of my username), we would not have this problem; everyone would be spelling it "Māori" or "Máori" or the preferred usage in their tongue.
However, we are dealing with English. Usage of the macron is a specialist, not a general, use. The double a vowel may be more 'natural' in a usage sense, but it is not an habitual usage and thus is an orthographical innovation for most people. And if we were reduced to phonetic spelling, we enter into the wilds; then it would not be "Maori" or "Maaori" at all, but "Mowree".
Now, were I writing a formal letter or otherwise dealing with any of these bodies http://www.tkm.govt.nz/omo/ then yes, I would use the spelling on their letterhead. I do the same for all other bodies I deal with, where there is such a difference. This is something in my own country, where there would be a difference between whether I was writing to the Department of Health or An Roinn Turasóireachta, Cultúir, Ealaíon, Gaeltachta, Spóirt agus Meán. And betimes, there would also be a difference whether I was communicating with the Department of Health or An Roinn Sláinte.
On the other hand, if an English-speaker living 5,000 miles away from me refers to "the Irish health service", I am not going to sniff and correct them that "Ackshully, you should use Feidhmeannacht na Seirbhíse Sláinte" because while I hope that I am a patriot, I also hope I am not a complete idiot.
My concluding counsel, and you are perfectly free to dump it in the bin, is not to cry out before you are hurt. When and if Scott, or one of the commenters, starts talking about the Maori peoples in particular, then you are entitled to jump in with your "best practice, tradition/preference" spelling correction. Until then, my rejoinder to such tut-tutting is, regrettably, the vulgar vernacular "who asked you?"
Do you have access to international overdose data? If the suicide dip/overdose surge pattern does not appear in other countries, that would be strong evidence against the cause of death misclassification hypothesis.
Well, the last explanation certainly rings most true to my experience. The chronically mildly -- and I emphasize "mildly" -- depressed people I know perk right up when a genuine existential crisis comes along, when it's root, hog, or die. Maybe there's even some weird bit of pride in there, as in, I may well kill myself but I'm damned if I'll just let this stupid hurricane/mugger/scary skin cancer kill me. But I have zero experience with severely depressed people, and an intution is worth bupkis when assessing broad social trends.
One thing I didn't see addressed there is the precision of the "depressed" categorization. Is it possible people who were stressed and scared were lumped in?
"War experiences are brutal, painful and tragic, but sometimes they call up the best in human beings. And after the war is over, the survivors eventually began to yearn for that time when they surpassed themselves, when during better and worse they lived at their peak." -Roger Ebert
>But I have zero experience with severely depressed people, and an intution is worth bupkis when assessing broad social trends.
I tried to off myself a few years back - I think that qualifies as severely depressed. Got thrown in mental hospital, mental hospital had insufficient security and scary people talking about how they were going to kill/rape people. Bounced back to peak performance in days.
what portion of suicide is attention seeking? if you are motivated by attention, this may have been absent during covid. i dont know how much of this is true or a myth however.
Probably only teenagers think of suicide as attention seeking, and most who actually do it are probably pretty fucking depressed and beyond caring about attention seeking.
No adult wants to be known as a suicide. Fear of attention probably prevents more suicides than the desire for attention causes.
As Scott says, a breakdown of who committed suicide last year might be telling, but I doubt teenagers make up a large proportion of suicides in general.
This article makes me wonder how many suicidal people died of COVID-19 before they managed to commit suicide. Something can technically reduce suicide... by killing people another way.
Notice from Figure 2 the highest suicide rate is men 75+ (40 per 100,000), followedly closely by men aged 45-64 at 31 per 100,000. These would be the #1 and #2 risk groups for COVID death as well, and I believe suicides in those age groups are often tied to infirmity and ill health -- which of course would also enhance one's vulnerability to COVID.
Thank you. I spent the last couple hours wondering about the potential overlap between high-suicide-risk groups and high-covid-risk groups. That makes a lot of sense.
There's also the fact that severely depressed people tend to give up on self care. I wonder if that raises their risk of respiratory illness.
It also occurred to me that COVID-19 could be stealing people from all the other categories of death, but the loss shows up more in small categories (suicide) than big ones (car accidents). I wonder if any other small-ish death categories showed some shrinkage in the last year (shootings? drowning? falling down stairs? animal attacks?).
It would be pretty funny if, by claiming half a million death certificates, COVID-19 significantly reduced the number of deaths by animal attacks.
Excellent, thank you. Highlighting the slipperiness of statistics and their danger in the hands of most people, is so important these days. I really like your conclusions on this one.
Haven't seen what seems like the intuitive answer to me. Committing suicide generally means you are not only miserable in the present but expect to be miserable in the future. I have never considered suicide when I had food poisoning, but if I were diagnosed with "chronic food poisoning" with a 0% chance of recovery, suicide might become more compelling.
Depression often arises with the belief that one is irredeemably worthless, unlovable, etc. and suicide may appear to be the best decision in light of this distorted view. When someone's depression is clearly caused or heavily influenced by an event they perceive to be temporary, I would speculate they would be far more likely to wait and see how things go before making such a permanent decision.
In fact, I would not be surprised if this "wait and see how things go" effect even applies to people who were already depressed before the pandemic. When your life gets shaken up in drastic and unforeseen ways, there is a sense that the cards might land in your favor once the dust settles. You can't just end on a cliffhanger.
It looks like his second sympathetic argument does touch on it - I think I missed it because he ends up taking in a bit of a different direction. I don’t see how this doesn’t qualify as a satisfying explanation though. Obviously there’s no data on it, but in light of it, I really would be surprised if suicides had gone up.
My dear friend Kieran Latty, who is an economist working on subjective well-being, has always told me that recessions are associated with a paradoxical fall in the suicide rate. If this is true it would seem to explain it (while opening up another mystery- why do recessions reduce suicide). However a brief Google turns up a number of papers alleging the opposite- that recessions in fact cause suicide- which would just compound the mystery here. No idea what the truth is.
Kieran's explanation for the purported phenomena of recessions reducing suicide was that when many people are down and out economically, being down and out economically feels less bad.
Yeah, I think it is a matter of comparison. Everyone around you - family, friends, people you went to school with - are thriving and have (outwardly) great lives, you don't; the fault is in me, I'm worthless trash, I should kill myself.
It's a recession, everyone is doing badly - this is not something I can control, this is not my fault, I'm no worse than anyone else.
I think you gave up on the overdose explanation too early, and am confused as to why you treated it as you did. It seemed like the one place where you had concrete numbers that could provide an explanation. You move on from it and instead focus on more speculative theories. While those theories sound anywhere from plausible to accurate, they are not data-driven. Ignoring the data driven answer is out of line with my expectations of your approach (and of the rationalist sphere approach in general). I also had a previous expectation that the line between what is reported as a suicide vs an overdose is a moving target subject to much personal judgment, weak circumstantial evidence, and policy directives. While I think that prior expectation made the change in approach stand out more starkly to me, upon reflection I do still think that the approach you took is surprising.
A (quite possibly wrong) hypothesis that has enough of a chance of being right I'll register it now for gloating rights.
What if internet, video calls, and to some degree improved phone service, were the drivers of the low suicide rates.
First up, why would we expect this to be the case? Well, most of the depressed people were probably otherwise healthy people whose social lives got destroyed by COVID and quarantining. However, access to communication allowed them to maintain some degree of a support network. Eating every meal alone for a year might still be depressing, but when you feel suicidal you still have your weekly zoom calls with each of your friends. Most of this is anecdotal, but I'll do why this might match the evidence next.
Firstly, any hypothesis should at least comment on the US racial disparity. This actually does that. According to wikipedia, the US has 80% access for whites, and only 60-65% for blacks and Hispanics. Considering that Hispanic suicide rates didn't appear to go up, it's hard to call this a victory, but whatever.
Secondly, this would help distinguish between past pandemics/really bad stuff and COVID. Widespread internet, and even free long distance calling, are relatively new things.
Thirdly, it explains why we see the same results across multiple studied countries; what do Germany, Sweden, Japan and the US all have in common? We're rich and we have good internet (by global standards).
Fourth, this helps with ODs. From what I've read (but mostly I read about it casually because it's depressing so I freely accept the possibility of me being wrong) the opiate epidemic is hitting rural america a lot harder. Anyone who's ever lived in a serious rural area knows that it's very hard to get decent unlimited internet. Then we might suspect that opiate ODs are a substitute for suicides in rural regions.
So, falsifiable predictions? Basically, we should see results that depend upon internet access, even when we control for both race and income. Once we get suicide rates for less developed countries, we should expect them to have rates drop less than in the US, or possibly even rise. I guess we'll see how this holds up once data comes out.
It is brutally, incredibly weird to me that it didn't occur to you to question the difference between "people say they are depressed" and "people are depressed" here. Not that you didn't settle on that as an explanation, or that you didn't dismiss it as silly - it just doesn't come up at all.
Indeed. I expect a lot of people who are sad because they can't party and who normally have a very high quality of life, to report themselves as depressed.
“this explanation implies that people were financially better off with the coronavirus and relief package than they were with neither”
The numbers certainly bear this out. Spending was way down, savings were way up, debt was way down, markets were way up, and stimulus on top of all of it. For many low wage workers enhanced unemployment paid better than working, and millions who lives in debt were able to wipe it away via net savings and/or by taking advantage of rates going to zero.
I do think personal financial insecurity is a well documented motivator of suicide. 2020 solved many more financial problems than it created — so far, at least.
What about esteem dynamics? One notion I have seen floated in relation to the curiously high suicide rate in Australia is that a factor driving people over the edge is the humiliating thought that "I live in the Lucky Country, so I have no excuse for my personal inadequacy." In a pandemic, everyone has an excuse for failing, so depressed people do not also have to cope with (their subjective perception of) humiliation.
When I have thought about suicide (never very seriously, in case someone I know is reading), it's never just about my being depressed. It's about disappointing people I care about.
My guess is that the pandemic actually provided a sort of life raft to depressed people... sure I'm letting my family down, but I don't feel as personally responsable.
Related to: why people kill themselves at all, instead of running away.
Perhaps killing oneself over "that stupid virus" is perceived as a status loss in a way that killing oneself over more personal troubles isn't. It's about the story you want told. Not every suicide is a storytelling act, but I assume many are.
And yes, yes I do think people often care more about status than survival.
I have difficulty believing that status seeking is a big part of suicide.
On the other hand, what the heck would I know? The main thing I'm learning from this article is that my intuitions around suicidal-level depression are totally wrong.
Oh thank goodness. I'd already read the one on Works in Progress and when I saw this email come in I thought "aw, man, he's written it up for ACX too? Now I'm gonna have to read basically the same thing again just in case there are any differences!"
So I was relieved to find this was just a link to the one I'd already read. Maybe I need to get a life...
“Make enough comparisons like this and eventually you have” -- here I thought you were going to say "two subgroups which differ from each other just because of a statistical fluctuation".
I'm curious to see the data by age. Per Wikipedia, men over the age of sixty five are the highest risk for suicide. With them being in the higher risk for covid-19, is it possible that covid-19 was directly competing with the suicide numbers?
There is one point you make that really spoke to my circumstance:
"I’ve seen surprisingly many instances of depressed or anxious people, who can’t cope with everyday life, cope perfectly well with emergencies. Finally there’s something obvious and worthwhile they need to do that breaks through the fog of meaninglessness, and finally they have the motivation to try to handle it (because they could die if they don’t). But also, I’ve seen a weird number of anxiety patients who are completely calm in an emergency. Or maybe they have the same level of anxiety as usual, but it finally feels completely appropriate to the situation and so they can respond as reasonably as anyone else would, plus they have more experience with it. "
I have been battling what I was say is moderate depression for about 3 years. In 2017 I took a job on the road that required I leave behind everything I loved to hop around rather miserable rural towns in return for ALL of my financial concerns being handled (the "golden handcuffs" as they've been described to me). I knew I had to get out of the job but couldn't muster my exit and it was causing me great grief. My greatest concerns were the loneliness and boredom I was experiencing being away from friends and loved ones.
Fast forward to March 2020, I get let go from work due to their workload decrease and it completely changed my life for the better. I moved back to the city that I felt I belonged in, and suddenly everyone around me was now experiencing the feeling of isolation and loneliness that I had been going through for years. I very much fall in that bucket of people who were moderately depressed before COVID but found great comfort in the disaster.
I don't believe I would ever have considered myself contemplative of suicide, but can certainly agree with the idea that some function better in crisis. No longer were those I observed around me having the times of their life while I was locked away working in some random town (FOMO), and now I watch people I would normally look to as strong and brave in good times begin to crack under the pressure of the new status quo.
> Or what if you just literally don’t have the personal space, out of earshot of your family, to attempt suicide without someone else noticing?
Aren't suicide attempts tracked as well? This possibility should be discernable if attempts stayed constant but successes fell.
Although I admit thie "dissonance" hypothesis has some intuitive appeal. Feeling depressed in depressing circumstances feels appropriate, but being depressed when everyone else is happy and moving on seems like it would be more distressing. Dissonance seems to be a common theme with mental health problems.
Yet another hypothesis is that people weren't necessarily staying home with family and friends, but they were more frequently *staying in touch*. Depressed people might hear more stories of sadness, fear and depression from family and friends, and the external awareness of other people's circumstances might make them feel less lonely, and they might have shared in turn. Shared misery and all. I could see that helping.
Black people are disproportionately represented among the poor, so maybe they didn't have internet or phone access after losing their jobs, so many of them perhaps didn't see those benefits and possibly that's why suicides didn't fall or even went up.
Something that felt missing to me was more details about the profile of a typical person who commits suicide (or better - a distribution). Are they young or old? Do they have families or roommates or neither? Are they rural/urban, religious/not, educated/not? In what circumstances do they commit suicide (after a long fight with depression as measured by questionnaires?)? Where and how do they do it (e.g. hotel suicides mentioned in another comment. Guns/pills/...)?
I think this would help zero in on what might have changed for them. Ideally we would want the change in suicide rate for each group, like there is for race. But absent that, a change of 10% is pretty large, so can't come from a small group of suicide victims.
Anecdotally, the idea that people with high anxiety do well in crises rings true. I am chronically depressed and anxious, and experienced a large increase in well being during the pandemic (which I mostly kept to myself). The way I thought about it was that a lot of my anxiety comes from feeling like my internal models/interpretations are out of whack with the outside world. I get alarmed by the sense of "why isn't everyone as worried about this as I am?" because it feels like the two options are that most people are misperceiving dangerous situations as safe or that I'm uniquely broken, both of which are frightening in their own ways. When the pandemic hit, it was like the outside world lined up with my emotional state for the first time in memory, and I felt hope that I was relatively sane as a result. I experienced something similar when people started worrying about Trump trying to steal the election a few months before it happened, because I'd had a growing fear for months before that that I might just be paranoid about the prospect.
Seems almost no effect there to explain. I suspect natural disasters in general don't have any consistent effect on suicide because they're both obviously temporary and obviously not your fault. Being born into poverty in some third world country also doesn't seem to have any effect on suicide rates (the only consistent effect I see on the map is a HUGE effect in favor of muslim countries regardless of their wealth or lack thereof.)
I see an obvious explanation that unifies all the weird things about suicidality, that I've never seen proposed before. Someone feel free to tell me what's obviously wrong with it:
1. Committing suicide requires depression _plus motivation_. You need to both think everything sucks and won't get better, and _also_ to exert some momentary burst of willpower to get you from "do nothing about it" to "commit suicide about it."
2. Things that give people more motivation (i.e. increase dopamine) — like certain antidepressants, or like the bright-light-therapy analogue of getting more sunlight in spring, or like Christmas in the middle of winter — increase suicidal ideation in depressed people. Because — at least at first — having more undirected motivation doesn't make depressed people any less depressed (they still think everything is pointless and there's no way to fix anything), but it _does_ allow them to get over the big energy-cost hurdle that was preventing them from committing suicide.
3. The opposite is likely true as well: things that take away people's motivation decrease their likelihood to commit suicide. Anti-psychotics. Winter. Stress (the kind that makes you too tired to do anything at the end of the day.) Eating poorly. Being forced to stay in your house where you experience no novel sensory/social stimuli, and potentially get little sunlight even in summer.
4. Different suicide methods require different amounts of willpower. If there are "easy" methods of suicide available — especially those that don't require _making a decision_ to commit suicide (like drug overdose!) then you'll expect unmotivated depressed people to preferentially enact those forms of suicide, while motivated depressed people don't prefer them over-and-above any other method of suicide. As people get more motivated/manic during depression, more difficult, choice-requiring, and novel methods of suicide will "come into scope" for them — much like how having more motivation left in the day when choosing dinner will lead to being willing to try cooking a new dish.
(This all seems obvious to me, as someone who got diagnosed with ADHD as an adult, and so has experienced both long periods with/without motivation in my life, and sees the contrast in my own thinking every day as my medication kicks in and then later wears off. Modelling depressed people who _don't_ commit suicide, as having the same problem I have when I'm hungry but have run dry of the willpower to decide _what_ to eat, seems pretty intuitive.)
Depression and, at times, suicidal thoughts are no strangers to me.
The concept that there may be two types of depression, one correlating more strongly with suicidality and the other more with "current and presumably transient adverse events", for lack of a better description, resonates strongly with me. A chronic versus a more "acute" one, so to speak, for a definition of "acute" that would run from maybe months to single-digit years.
I would have made a similar self-diagnosis some years ago, and on my odyssey to figure myself out I finally came across the concept of cPTSD; and 'depression' as one of its common symptoms.
Complex Post-Traumatic Stress Disorder in a nutshell means that people, in childhood formation, were conditioned that certain adverse events and situations are things they can do nothing about, and as such severely stunts autonomy and self-efficacy. At the same time, those individuals will have learned incredibly complex coping and survival strategies, so that they will often present as highly functioning even to a trained psychiatrist / neuropsychologist.
Here, I'd like to invite you all, as you feel drawn, to take a look at these concepts. I'll leave a few starting points that got me into it:
* Bessel van der Kolk's book, "The Body Keeps the Score: Brain, Mind, and Body in the Treatment of Trauma"
... from an "I don't care if it is methodically complete and sufficient, it leads to a workable model for everyday dealings with one's emotional undulations" viewpoint, as in the Polyvagal Ladder:
My take on the COVID situation (shituation?) is: It sucks, doubly so for people with fragile psyche or a fragile social support network in the first place. But at the same time, while it will present as an external factor the individual can do very little about, at also presents as something with a lot of change and movement - there are bouts of "we're going to be stuck in this forever", but then there's with some regularity some change happening that again directly affects everyone's everyday life to some degree, so it doesn't feel completely stuck. There continue to be 'surprises', one prime antidote to the cPTSD stuck loop.
Of course, I have a lot of perception bias with all this - once you have a hammer, every problem starts to look like a nail. Going through town, interacting with people, I see trauma and fragmentation and hints of cPTSD everywhere.
I agree with your conclusion. I had multiple patients state outright that they felt better because everyone else was going through the same thing and they finally felt justified in their negative feelings. Social anxiety patients and OCD patients did especially well (and are now doing worse that things are opening up). Even the borderlines improved. Young women with garden-variety depression and anxiety did especially poorly. There was a lot of talk about wasted time in finding a mate and falling behind where they perceived they should be in their lives. Also mothers did terribly for all the obvious reasons. I got a lot of new patients who had no history of previous depression in these categories. Maybe these are reasons why the dip is not reflected as much for women.
I would ask that you research and comment on depression and suicide rates in children and teens. My mother patients frequently expressed that their child was going through depression for the first time. My nanny said over 1/2 of the students in her daughter's class were depressed and the guidance counsellors were reaching out to all students for wellness checks. The first article that comes up from the APA suggests high increases in suicide attempts among teens.
"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."
similar to your theory that some suicides were still happening but masked/categorized as accidental overdoses, I wonder if the they same thing happened with traffic deaths? Because those were up quite a bit in the US. Which is at first counterintuitive, since there were so many less miles driven in 2020. The explanation I've heard, is that with less traffic, people were able to drive faster, and thus deadlier. Makes sense. And given the drop in suicides, I wonder if also some of that fast/reckless driving was suicidal
There’s one point that feels missing from the final speculation section. Suicide is inherently an act of hopelessness, which you hit on with the Aaron beck “this is endless” point. On the other hand, the pandemic was expected to end, as interminable as it felt in any given moment. When people have a point of light in the horizon, something to really hang hope of improvement on for the long term, it can provide so much fuel to continue because people can plausibly believe life will improve when the bad situation ends.
As someone who lives with someone who is chronically depressed (who, btw, has never felt as comfortable or as satisfied with life as she has during the pandemic), the "this is endless" dynamic I see as a substantial contributor to depressing leading to suicide, and conversely why pandemic depression doesn't lead to as many suicides.
Depression due to the pandemic was a different kind of psychic pain... it was a shared pain, and a pain that by definition has some kind of begin-and-end time period. And, importantly, pandemic depression has an identifiable reason.
I know we can't do exit interviews, but I do wonder if suicides from depression are driven more by the dual factors of not knowing why they feel this way (nothing to point to) and therefore grow convinced that there's no hope in ever getting relief.
Maybe potential suicides were covered by excess mortality eg people who had no will to live succumbed to Corona more by seeking help late and responding much worse to placebo etc.
That would entirely hide suicides in all countries that had excess mortality but not in the ones that had not. Someone looked it up?
I've skimmed through all the comments here but didn't see my pet theory offered as an explanation: misery loves company.
In a normal year you are expected to earn a living, maintain a social circle and have fun hobbies. If you are seriously depressed and failing (or just believe you're failing) to live up to those expectations, you feel like a major fuck-up.
Contrast that to our COVID year. Lost your job? So has everyone else, to the extent that the government has started handing out mass relief without the usual judgmental chatter about the lazy poors. Don't have any friends? Everyone's stuck inside, so it's not like you're missing out. No fun hobbies? Anything worth doing has been cancelled, anyway.
Life may have gotten worse for most people, so depression rates have gone up. But if you're _already_ feeling useless or socially isolated, lockdowns don't change your situation! And at least now there's no pressure to act like everything's fine!
> I won’t waste your time listing the evidence that life got more depressing
I don't know, life got *significantly* better for me, being able to work from home. I know my experience doesn't generalize, but it also doesn't seem like an insignificant factor across the board. Increased unemployment too, applying especially to those with the most shitty jobs.
There's also some thing about covid representing a tangible threat (vs the malaise and ennui of modern life) while at the same time not actually hurting all that many people.
In effect, many ended up safe and comfy at home, and never got sick.
What if COVID and suicides are competing hazards and strongly so for a certain subset of people?
Two of those correlates are age and trait:anxiety. Both are positively correlated (age much stronger than anxiety and anxiety is early research, still seems to be valid and has a large effect) with worse covid outcomes - hospital stays, long covid, death and with suicide in other years.
May be covid took away more of the people who would have otherwise committed suicide.
1) why most suicides in spring? My understanding (personal theory) is this: human bodies do have a built in hibernation program as many other species. This program is controlled by daily sunlight exposure. In preparation for the coming winter our serotonine level and our drive decreases, we eat more and build up fat storage to survive hard winter. Reduced drive (depression?) helped our ancestors (both human and animal) to look for a cave and just sleep there over the winter with least fuel consumption possible. In spring light exposure increases and with it serotonine levels. Drive (and sex drive) and motivation come back. In some individuals the depression stays longer and then they suddenly have the drive to kill themselves. Starting giving Antidepressants (SSRI) is always combined with the warning to tightly monitor the patient the first weeks so that it not kills itself due to this process.
2) why less depressed after a natural crisis or desaster? You mentioned "sense of meaning" and I guess this could be a key. Why there are so many people depressed and suicidal in "happy countries" (I guess you mean western wealthy countries)? Because these sociaties removed a lot of meaning of the lives of their people which were the norm for millions of years for our ancestors: tight daily human connections and interactions with close and loose family members, purposeful activities all the day around like feeding the family, the children, growing food, hunting food, building purposeful things like houses, tools, everything else, singing and dancing together and so on. A lot of these things are gone in the everyday lifes of a lot of western people. Instead they often life alone in anonymous apartments, doing a long daily commute to stupid companies sitting in boring and stupid meetings, producing useless things or services ("what would happen to the world if I, my job or this company would suddenly not exist anymore - nothing - nobody would take notice"). So they feel depressed. Now let's happen a natural desaster Like a flood or a hurricane or a pandemic. Suddenly all the stupid things are not porta to anymore but to help each other. No cracy meetings anymore, a lot of cooperation with formerly strangers from the neighborhood, suddenly a lot of purpose, humankind, success, self realisation asf.
I think it could have to do with jobs. Richer individuals got to work from home while poorer ones were stuck going into work during the pandemic. Race and job/income correlate such that you might see more suicides among essential workers than people at home. When you're constantly surrounded by family and never leave the house you may be depressed but find it harder to plan and execute a suicide.
I read it a couple of days ago (it was posted in the subreddit). Excellent analysis as usual.
Nothing to do with the content of your essay, but I was initially confused by the title of the magazine "Works in Progress". I was thinking that, like your recent "Peer Review Request", you were posting an actual work in progress and was asking for feedback on it before it is finalized, and the Works in Progress website was just a space for authors to release drafts of their essays. However, the About page for Works in Progress makes it clear that publication venue for complete pieces. Sharing this in case other readers were confused in the same way.
It is a rather confusing title for a publication.
I was confused about this too.
Ditto.
Me too.
(Also why was the essay published on Works in Progress? I think it would have been more convenient for us commenters to have published it on Substack. Maybe it's some kind of social status thing.)
I simply want to Nth this remark. Looking at the site, I know I've read pieces on Works in Progress before, but didn't recall it by name. I made the same initial assumption about it, based on name, as Itai Bar-Natan.
Same. I was going to ignore this until you posted it here, except that I happened glance down and to see this comment. Super confusing title for a publication.
One more - this is even more confusing than a book review by Scott in the middle of reader-submitted book reviews.
Yeah, whoever wrote this article on COVID suicides should take the confusion into account.
Same.
Is it going for a pun along the lines of "Works *on* Progress"?
Me too
Might be some confounding variables in the case of black suicides.
I agree. When I hear "There were more black suicides in 2020 than in 2019, and this phenomenon was unique to black people" my assumption is that it isn't COVID-19, but another emotionally significant happening of 2020 that led to this occurrence, rather than the pandemic.
Always suprised that the most widely accepted theory of suicide comes from a 19th century sociologist and that it still seems to fit the data.
Well, the most widely accepted theory of how species develop comes from a 19th century biologist.
It gets worse. The most widely accepted theory of mechanics comes from a 17th century natural philosopher.
the most widely accepted theological doctrine comes from a guy who lived 2000 years ago
A common theme that I find in a lot of analyses is that factors that seem obviously important fall apart on a closer look. You do that with multiple factors here. I also get the same feeling when I listen to historical podcasts by Mike Duncan, like the Revolutions podcast on the French Revolution. Factors that seem important and fundamentally causal in an almost common-sensical way almost always fall apart on closer inspection.
This sometimes leads me to suspect that causality is mostly a mirage in the social sciences, and that any and every factor will fall apart on a "really" close look. Events happen not because of any overarching causal patterns, but only because of sheer dumb chance. This lack of any causal relations has also been stretched to science by Stephen Wolfram in his recent article- https://writings.stephenwolfram.com/2021/03/what-is-consciousness-some-new-perspectives-from-our-physics-project/
Wolfram says that any causal factors that we may find for events are only a result of our limited cognition, and not an inherent description of the universe itself. Although I am apprehensive about stretching the metaphor to that extent, do you also agree that any kind of causality, at least in the social sciences, is mostly illusory?
I don't agree or disagree because I am not sure how one could really falsify the claim, but Ragnar Frisch had an interesting take on this, outlined in his Econ Nobel Prize lecture. In section 2, he basically says "you can't rule out the possibility that reality is chaos and we are just impose order on it via our sense organs". https://www.nobelprize.org/uploads/2018/06/frisch-lecture-1.pdf
Thanks! I really enjoyed reading that section. I do have a couple of questions that also confused me when I read Wolfram's article:
1. Why is perceiving regularity in an ultimately chaotic universe an evolutionary advantage? For instance, I might see a pattern between going into the forest at night unarmed, and getting killed/maimed. Spotting this pattern is indeed evolutionary advantage, as this is a "true" causation/correlation relationship. However, if I see a correlation between rainy weather and my left knew throbbing, this will ultimately not be an evolutionary advantage as this is false causation/correlation. Hence, why is spotting potentially false patterns supposed to make me a fitter mate?
2. When I hit a ball, it goes flying in that direction. This is clear-cut causation. How is this pattern of causation made manifest only through my senses, and not in "reality"?
Presumably, if something is truly random, it doesn't really matter whet your response is, but if there is a pattern, it's very useful to exploit it. So it makes sense that we might be biased toward finding patterns because we have less to lose by finding a pattern where there is none than by failing to find one where there is one. This heuristic falls appart when trying to do science, but maybe it's good for life generally.
I would generally disagree with this. For instance, if I see a correlation between me having sex and an earthquake hitting the neighboring village, this can obviously be disadvantageous for me (and my genes). However, I remember reading an old SSC post in which Scott posits how spotting patterns in random data was advantageous in things like agriculture, etc.
This is the post- https://slatestarcodex.com/2019/06/04/book-review-the-secret-of-our-success/
I wonder if religion/superstition is also this act of spotting patterns in random noise, and maybe it is somehow evolutionarily advantageous for us?
It's not realistic that people would link sex to earthquakes, because the latter are far rarer than the former.
That you have difficulty coming up with a good example, is weak evidence in favor of the claim.
Note that superstitions are very good examples of overzealous pattern-finding, but they rarely seem to have the kind of negative impact that would be significant in a pre-science society.
Another argument you could make in favor of overzealous pattern-finding: It might help in convincing other people. I might have my own selfish motif why I want my tribe/company to do X, but maybe I can convince them that it would also prevent disaster Y. Doesn't matter if there is no correlation between X and Y if I can tell the story convincingly enough.
I think you raise some excellent questions, and ones that I myself share. By combining this with some of the predictive processing stuff Scott has alluded to before I can imagine an explanation that might be something like:
"Perceiving patterns, even when reality is in truth pure chaos, permits prediction which in turn permits (purposive?) action. Action can be useful insofar as it counteracts the depletion of resources needed for successful replication, either by moving to a new locale or 'stirring up the sediment' so to speak, in the vicinity, making more resources available for replication. In this way perceiving regularity in a reality of ultimate chaos is adaptive."
I'm not totally sold on the above explanation -- it seems rather hand-wavy, and raises some obvious questions. However, I think it does have one real strong point as an explanation: if true, then by acting on perceived patterns in chaos, the action itself converts chaos into order, making reality more amenable to use by (including for reproduction) of the actor (for instance, even the exhausting of resources locally creates a bubble of regularity in a sea of chaos, albeit a sterile bubble).
We are part of reality. So, to say that "we just impose order via our sense organs" is already to grant that reality contains highly ordered structures. Those very sense organs, and the order-imposing entity to which they belong, embody a tremendous amount of order.
I wonder if it would help to be more specific. It seems likely that events and policies can affect society and the actions of individuals, but the analysis falls apart because people rarely act for a single obvious reason. To simplify, there are causal effects in society but we are extremely limited in finding them or describing them because everything is happening all at once.
I suppose that is how most history books proceed. "The Second World War was caused by a mix of economic, geopolitical and historical factors". This is broad enough to be unhelpful, and is mostly used to mask ignorance about the actual causes of an event.
I also concede the point that multiple factors lead to events, and not one single factor. However, there is generally one or a handful of triggers that actually precipitates events. For instance, it is possible to imagine Europe not going to war had Hitler not invaded Poland. Hence, Hitler invading Poland could be called the trigger that actually caused the Second World War, although there were other contributing factors. It is these "triggers" that I'm referring to. It is almost impossible to isolate them.
It could also be said that Hitler invading Poland need not have been a trigger. It is possible to imagine Europe not reprimanding Hitler for only "innocently flexing the German war machinery a little bit". Hence, maybe the Second World War was a truly random event started by England on a whim, when it is equally likely that it would not have gone that route and attacked Germany
Wolfram is like the biggest premature ejaculator ever in terms of what he says in science. It always sounds like it'll be something amazing, then always turns out to be piffle only slightly above Deepak Chopra.
That's true, but not kind nor necessary. It did make me laugh, though.
This makes sense to me. There is an easy way to tell whether you are right about identifying the causal factors. Can you predict the future? No one has a consistently above-chance record of predicting the future when it comes to human action, just like no one can consistently beat the index funds in investing. There is only one conclusion I feel I can draw from this. The world is indeterminate. And the world is especially indeterminate when it comes to people.
Interesting. Would you say anyone has a consistently below-chance record of predicting future human action?
We predict human action quite well. Either this a big case of selection bias (like, focusing on index funds is almost like saying "we can´t easily improve on our current best predictions, therefore, we can´t predict") or you mean something more nuanced than what I understood you meant.
> No one has a consistently above-chance record of predicting the future when it comes to human action
I think this is overstating the case. I can predict with a high degree of accuracy that adults within a certain age range will be at their day jobs, and that children within a certain age range will be at their school, and that a certain number of adults above 70 years of age will die tomorrow.
Perhaps you mean we cannot predict the outcomes of *collective action* of many people when we have very little information or context, but somehow that doesn't sound surprising.
Relevant: https://www.gwern.net/Causality#what-a-tangled-net-we-weave-when-first-we-practice-to-believe
Sorry, but how can someone research suicide and not have "G-d", "morality", "religion", "value system" come into play? I am not saying that those thing would explain everything, of course not - but excluding them from the picture is beyond pale... Yes, many had a chance to reexamine their convictions and their views on acceptability of suicide.
Have people become significantly less religious during the pandemic in up and above the rate that people are getting less religious all the time?
I think they'd have to have become significantly more religious during the pandemic, not less, to explain the lower suicides.
That'd be caunterintuitive. The more time people have to think, the less religious they become. (see the last 100 years).
Either way, have they?
That doesn’t seem obvious to me. Don’t modern people generally have less free time, fewer available cycles? I’m prettysure I’ve seen that reported a bunch of times over the years. We work longer hours and plug into media when we aren’t.
https://en.wikipedia.org/wiki/Working_time#/media/File:Heures_travaillees_OCDE.png
I was thinking more like 1870’s than 1970’s
Besides, some people contemplating suicide, are wondering about what does this transition entails, so when they have more time, they might go deeper to try and answer this question.
anecdotally, the church I go to is evangelical (~150 members) and they say it’s been a good year for conversions
I am not surprised!
See my comment to Irishkha
Maybe so, but the flip side is that many churches have been closed or online only, and so there might be a countervailing phenomenon of people losing their faith (or realizing that they'd lost it already and that they were just going to church out of habit).
I'd think the people had more time on their hands to explore, and might have become more religious/conservative. I know a few people whose views have changed that way (not about suicide, but from agnostic to religious light)
I'd assume that more time on my hands means more people are reconsidering their lifes and worldview more than ever. Therefore you will have more conversions *and* more apostecies (and more people going from one religion to the other). But because in our times apostecies are more common, i'd expect the net effect to be against religions, not for towards them.
whoops! apperenly not, at least not in the US:
https://www.pewforum.org/2021/01/27/more-americans-than-people-in-other-advanced-economies-say-covid-19-has-strengthened-religious-faith/
BUT! There is virtually no effect of the sort in Sweden or Japan according to the above link, and they had the same suidice pattern, so religion can hardly be the causal factor here.
Well, suicide is a moral issue, so not looking at this aspect of it is not doing a thorough research, as far as I am concerned.
I agree that it's probably not causal, but I'm not surprised that religion is winning. All of the evangelicals I know have the story of "I was sad before I converted, but am very happy now that I have Jesus" (they appear to be sincere). It's not hard to see how this would be very appealing to people who are more depressed than normal during COVID, especially if they weren't used to some degree of depression
There are definite psychological benefits to religion, specifically Christianity.
The idea of a loving God watching over you and a wonderful afterlife to look forward to are obviously comforting. This might not actually prevent you from suffering right now, but at least you're not alone and have hope that it will improve. More concretely there's the community, which is especially welcoming to recent converts and offers you a new social support network.
Some people complain that religion makes you feel guilty, but since everyone with a functioning conscience has regrets, the idea that God will forgive you if you repent is probably comforting on net.
Suicide is inversely correlated with religious practice.
I mean, Scott says he doesn't have good subgroup breakdowns to go on aside from US black/white. Without any data on X he can't do much analysis on X.
Kinda streetlighty, but he says he doesn't have a good explanation and maybe he'll be able to do better with more data in the future, so hard to fault that.
> Could it be that people have trouble getting the means to commit suicide? For example, maybe they would like to shoot themselves, but all the gun shops are closed?
You already reject this argument in the essay, but another bit of relevant evidence here is that gun sales shot to record highs in 2020, so it doesn't seem like suicidal people would have had much difficulty buying a gun last year.
What about during March and April?
Looks like US gun sales moved up substantially starting in march 2020, i.e. precisely when the pandemic reached the US.
How much of that was sales to new gun owners as opposed to existing gun owners buying more? One possibility is that the change was driven by people who were concerned about government overreach and wanted to buy guns now in anticipation of either 1) gun sales being made more difficult or 2) a potential revolt against the government.
Lots and lots of first time buyers. On moble but this was covered in both mainstream and redtribe press
"When COVID started spreading, life got more depressing, people became more depressed, but suicide rates went down. Why?
"First, are we sure all of that is true? I won’t waste your time listing the evidence that life got more depressing, but what about the other two?"
Maybe you should waste our time with point one. At least in my case, after about the first month when I became sure I'd still be able to get groceries (more or less) without issue, my life took a profoundly positive turn. Since the pandemic started, I finally bought my first house, got a dog, and realized my career-long dream of working from home. I know many people have had great emotional struggles during this time, but how many others like myself have had the opposite happen? Is it a large enough group to be meaningful?
Since my employer announce their return-to-office plan, I've noticed a steep rise in my anxiety levels—and not from fear of COVID, against which I'm now vaccinated.
This rings true for me as well.
Could it be that for a large fraction of suicidal people, their anxiety stems from (unwanted) social interactions, and that the lockdown was on the whole better for them than other non-suicidal people, who may have gotten slightly more depressed but not suicidal?
Even if this was true for a lot of people, I don't find it convincing.
Think of it like this: there is a distribution of happiness. Some people are more happy, some are less happy. When you become unhappy enough, you commit suicide. Only a tiny fraction of 0.01 % ever reach this point. (I know that it doesn't work like this, but the argument still makes sense.)
I think a fair description of the pandemic is that is massively increased the variance. Some people became much more happy, some much unhappy. But *everything* that increases the variance should massively increase the fraction that reaches the bottom level.
So it should be a good rule of thumb that everything which completely overthrows many people's life should increase all kind of extremal things. The positive things in your example, but suicide, too. So I am on Scott's side to find it very surprising that this did not happen.
"Massively increased the variance" sounds incorrect in this context for some reason, although I am of course biased by my previous assessment. In my book, Covid might have shifted the "mean" of the mental health spectrum to the "more depressed" side, but perhaps pushed the "very depressed" people onto the "happier" side. Hence, I see the probability distribution function of "mental health" as becoming more concentrated around the mean, and not really spreading out more at the extremes.
Ditto. Life improved.
Since the lump depression rate increased, it must be that your anectdotal scenario isn't holding up to the majority of people. Perhaps you are unusually introverted?
Life feels better for some people (myself very much included), worse for others.
[Epistemic status - Idle/inebriated speculation]: Perhaps there's some correlation between "is the sort of person who would find life more tolerable during covid" and "is the sort of person who, if depressed, would commit suicide"?
If there are certain kinds of people who are more likely to commit suicide when depressed, and those are also the kind of people who (contrary to the broader trend) are less depressed during lockdown, that might go some way towards explaining things.
Nthed. With the additional point that I was in fact depressed before the pandemic started, and one of the things that did not help my depression was feeling guilty about my depressed-person lifestyle.
There's a vicious circle here: depressed -> hard to get things done -> feel bad about yourself -> get more depressed. For me, the lockdown interrupted the third link: hard to get things done -> feel bad about yourself. Everyone was suddenly living like a depressed person! I didn't have to worry about why I was continually failing to carpe the damn diem. Lockdown massively lowered the expectations I was putting on myself and I started feeling better. My mental health remains considerably better than it was pre-pandemic.
There's definitely a significant fraction of people who had this response, including myself to some extent.
Life got significantly worse for me – being in home office reduced my work motivation to maybe 1/3, and not getting anything done during the day strongly impacts the energy I have to pursue productive pastimes afterwards. Food choices are much worse and have led me to waste copious hours on cooking. Lack of commute means I'm not getting any exercise unless I explicitly try to. Visiting friends is a multi-hour project of researching travel restrictions and quarantine requirements and often yields the result "it's currently not possible". It got super hard to meet new people, with all activities happening online or not at all – and for this purpose online mostly feels equivalent to not at all.
I'm curious (I had independent life developments that meant that I cook at home slightly less and do takeout slightly more) -- is takeout not available where you live, or are you concerned about its safety, or is it less convenient now that you're not commuting to work and it's not on your way, or did you previously end up going out to eat (perhaps with other people) in person and takeout isn't a good replacement for that? My impression here in (the suburbs of) Minneapolis has been that takeout was always pretty available, since it was the best way for restaurants to stay afloat -- but I don't depend on it much, so it could be that my perception was skewed.
I've been quite lucky with lunch arrangements at work so far: 2 of 3 places had an in-house cafeteria (one subsidized via the employer providing the kitchen (+maybe some staff? idk), the other one providing free food. The third place I worked at had a very cheap supermarket just around the corner and food trucks not too far away on some days of the week. So food has been affordable, healthy, varied, social (with colleagues) and generally low effort.
There is takeout available around where I live and I occasionally use it – mostly when I eat on my own. Usually I want to eat with my vegetarian flat mate, and only one of the restaurants offering a daily lunch menu regularly has a vegetarian option. They publish the menu on the same day, so it is a bit of a coordination problem to decide on time what we want. Cooking is faster (or at least has a more predicable timeline) than ordering food, so that's the default. But yeah, overall I guess we've been under-utilizing takeaway food for shared meals and I could improve that.
"I won’t waste your time listing the evidence that life got more depressing" is too dismissive - in exactly what way did things become more depressing and what relationship would you expect these individual factors to have to suicide?
I'm not sure "scoring high on a depression index" is the same as actually being depressed. I went and took the depression questionnaire used by Ettman et al. - the Patient Health Questionnaire–9 - and it would have reported me as depressed even when I definitely wasn't depressed. Back when covid first got to my country of residence, I experienced some anxiety which resulted in taking what I called "anxiety naps" where it felt like I would just shut down and sleep for an extra four hours most every day after work. I was also stress-eating a lot more than I usually did. I also had trouble concentrating on things - my mind would keep drifting back to the horror stories I'd read from hospitals in countries where the pandemic was hitting the hardest. All of these were specific responses to stress and anxiety over the threat of coronavirus - related, probably, to my history of respiratory illness and my specific fears about how my young children would fare if I died. At no point in the pandemic did I consider myself "depressed", and over time I built up better coping mechanisms.
But of course the nature of those specific problems - extreme but somewhat rational fear of dying horribly and leaving my kids without a father - contraindicates suicide. Put another way, while fear of death might lead you to sleep more, or overeat, or lose focus on your work, or fail to take joy in things that you otherwise would have enjoyed, you wouldn't expect someone to commit suicide out of a fear of dying.
In fact it might be worth looking at whether fear of death decreases suicide in general - do people who live more dangerous lives kill themselves with less frequency? Or something like that.
Also, I wonder if being stuck inside with your family members brought more people closer together and reduced the kind of isolation that sometimes precipitates suicide.
This comment resonates with me. I wonder if covid made depression questionnaires less valid in measuring depression. A question like "I feel isolated from my family" might be an indication for depression in normal times (when it attests to your chosen relationship with your family) but during covid is the forced normal.
I'm particularly sympathetic to the "change of pace" line of thinking. On Twitter @PaulSkallas always talks about how people desire a certain amount of volatility in their lives. They get bored going to work every day, the same routine, following a traditional life trajectory, etc...sometimes they secretly hope for something radical to happen, even if it's objectively "bad" for them. I've certainly felt this way myself at times. It similar to a joke made by one of the hosts of the Red Scare podcast. "Don't kill yourself because something retarded might happen and you'd miss it". Obviously not a super polite articulation of the point. But I think the insight is the same as above.
The pandemic was something new. What if it's the apocalypse? What if society emerges from the crisis totally remade? Maybe you're depressed in your email-office job, but you'll be happy in your new post-apocalyptic role as a community garden tender. Maybe UFOs show up tomorrow and show us the wonders of the universe. Gee, maybe suicide can wait for another day, at least until the conclusion of the most recent species-wide narrative arc. You never know!
Yes, this rung true to me as well. I won't pretend to be an expert on suicide, but from what I've seen of it (unfortunately too much), it's not a sudden shock that drives it most of the time. It's the ongoing sad, boring drudgery from a series of setbacks that does it.
From what I've seen of this world, a person normally doesn't commit suicide the day he unexpectedly loses a job that he valued, even though that's a day that would probably yield very negative results on psychological tests of stress and distress and sadness and self-esteem. Because for all that, somewhere in the mix of emotions there's also a feeling of excitement and novelty -- what's next? The suicide comes months later, after realizing your prior career plans are permanently screwed up due to something on your record and you can't get an interview and eventually stop trying and your girlfriend leaves you and you realize you're broke and about to be evicted and you see no end in sight.
Is there data about "location of suicide" ? That might explain the suicide drop and also the drug-overdose increase data-point ... if more people are committing suicide at home, then that appears as drug-overdoses
I wonder if part of the decrease is because people are less likely to commit suicide when another one of their family members is physically present in the same home. This doesn't explain the black/white divergence though.
On the black/white divergence: I wonder it the reported increase in gun sales during the pandemic varied by race?
My understanding is that a decent proportion of suicides are committed in hotels, in part because of the suicidal person trying to spare their loved ones the experience of finding their bodies if they succeed, and also of causing the suicide to fail by finding them in time to save them. I wonder if you just "added back" the number of hotel-based suicides there normally are, if that would get you to the expected depression:suicide ratio....
> Second, one pillar of Aaron Beck’s triad of depression is “this is endless.” A sense that nothing can ever change, so why bother to wait and see? The pandemic was the opposite of that.
This is strongly, strongly, strongly inconsistent with the lived experiences of literally every person I know. I cannot think of a single person who was like "yeah this is totally temporary it's only two weeks then it's back to normal".
We very quickly realized it wasn't just going to be over in a matter of weeks, but it was always obvious that this state of affairs would not be permanent - eventually there'd be a vaccine and life would go more or less back to normal, with maybe the only change being that there are a more countries than before where masks are a common sight in public places. So it never felt truly "endless" in the sense of a truly intractable problem with your life.
Yeah, as someone who was suicidal during the pandemic, the big thing that helped me get through it was the knowledge that stuff would eventually go back to normal (or something close to it at least).
I predicted three months if it ran wild and six months if we beat it (I underestimated the length of time it'd take before vaccine deployment).
< had depressive relapse from COVID.
One thing I noticed was this line "Second, the US has a waiting period on guns, so most gun suicides are by people who already owned the gun when they became suicidal.". While some places do have waiting periods, some don't. For example my state has no waiting period, I walk in wanting a gun, I walk out with a gun.
Besides that one question I would have is around the kind of people who would be more prone to committing suicide. I mean if you are depressed and everything shuts down, does that impact you that much? If you were depressed were you going out to bars partying and visiting family? Maybe now that everyone is a shut in you feel some sort of kinship, "Hey welcome to my world normies, enjoy the ride". All the newly depressed people know it is temporary and rally around beating covid.
As of this moment, the majority of US states and US population have no waiting period for firearms. From that quote, this continued misunderstanding - purposeful or otherwise - regarding guns and suicide is really getting quite old. Huge numbers of people in India are committing suicide by throwing themselves under trains and lighting themselves on fire with flammables (the videos are everywhere) because those are the means most available to them, just like throwing yourself off tall buildings or hanging yourself with a rope would take a guns place if those were less available.
The method has no bearing on suicide, and people are quite creative regarding the methods available (in industrialized countries we have an entire right-to-die industry using helium tanks or fancy drugs). Period. Just stop it with this.
>The method has no bearing on suicide
The method has a strong bearing on success rates, which is one of the most important factors to consider.
I agree. I said as much in my last letter to my congressman about why no building should be higher than 2 stories.
Don't get me started on my missives regarding Home Depot...
Based on some cursory preliminary reading, research consensus seems to be that restricting access to effective and culturally established suicide methods is fairly effective at reducing suicides. If you have some strong evidence that this is false, does not obtain for firearms specifically, or otherwise skewed/missing something, I'd be interested in learning about it, but right now, this just sounds like ideological bias.
(oh, and I assume you were comparing the 2 story building to waiting periods for firearms? a more accurate analogy might be physical structures that make it more difficult to jump)
Actually no, but that's an interesting take. I didn't think of that. "Physical structures that make it more difficult to jump" seems really really tough...let's just ban gravity.
I will be happy to consider your cursory and preliminary findings on any 'research consensus' you care to provide.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191653/
Relevant bit:
"Thomas and colleagues23 described the large increase in suicides in the UK, first in men and later in women, after carbon monoxide gas from coalmines became widely available in the first half of the 20th century. Gas rose to become the primary national method of suicide. The replacement of coal gas with natural gas from North Sea wells between the late 1950s and early 1970s led to a gradual reduction in the carbon monoxide content of domestic gas, which in turn was followed by a steady and prominent decrease in fatal gassing and the overall suicide rate in the UK.23,24 This decline in the overall rate was directly caused by the reduction in suicide with domestic gas. Thomas and colleagues23 showed that the number of fatal gas poisonings in the UK rose in the early 1980s, but it later fell after the introduction of catalytic converters into car exhaust systems"
Also, obviously a flawed source, but https://en.wikipedia.org/wiki/Suicide_methods#cite_note-:3-6
I'm genuinely interested in whether there's evidence supporting your argument, not just trying to justify a position. This just seems like what is true to me; if it's not, I'd be happy to update.
This has been investigated for suicides off the Golden Gate Bridge[1] and led to the long-awaited decision to install a suicide net on the bridge (although current intervention teams supposedly catch and stop 80-90% of attempts). A fascinating statistic I remember from the study was that only 1 of every 10 people who were prevented from jumping later committed suicide by another method. Of the very few survivors (I think just 34) if I recall correctly only 1 actually went on to kill himself. Accordingly to a very interesting New Yorker article on the subject[2], supposedly for many survivors the jump was shockingly life-affirming. There's a famous quote from one of them, recounted in the New Yorker article: "As he crossed the chord in flight, Baldwin recalls, 'I instantly realized that everything in my life that I'd thought was unfixable was totally fixable -- except for having just jumped.'" That man got a second chance, and used it. The idea of the net is to give that chance to the 30-40 other people who jump from that bridge yearly.
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[1] E.g. https://www.sfchronicle.com/bayarea/article/Golden-Gate-Bridge-suicide-nets-delayed-two-14900278.php
[2] https://www.newyorker.com/magazine/2003/10/13/jumpers
It's always fascinating how near death experiences can have a positive effect on people, kind of difficult to use clinically though.
The most common suicide method in India (and the world) is drinking pesticide. There's evidence that banning the most lethal pesticides reduces the rate. See here:
https://www.givewell.org/research/incubation-grants/centre-pesticide-suicide-prevention/august-2017-grant#Evidence_from_Sri_Lanka
"reduces the rate"...of drinking pesticide. They are now throwing themselves under trains, trucks, electrocuting themselves on exposed wires, and dousing themselves in gasoline and lighting a match.
"We found two observational time series analyses in Sri Lanka, which find a substantial decline in suicide rates following pesticide bans aimed at reducing suicides."
I can't claim there's no displacement to other methods, but the researchers aren't idiots and did actually measure the overall suicide rate, since that's what we actually care about. For some reason, people don't just switch to another method once the easiest is taken away from them.
"For some reason, people don't just switch..."
...ok...extrapolating "people" using data from Sri Lanka as a statement on worldwide methods of choice for suicide is using a rather big tent don't you think?
No. I remain unconvinced that seriously suicidal people with constant suicidal ideation and the will power to end their own lives are deterred by the removal of one particularly popular method for committing suicide. As if removing bug spray or train tracks suddenly convinced these deadly serious people that they had every reason to live when no one else, themselves included, could.
I was talking about one specific context since that was what started the conversation, but I believe a reduction in suicides was also seen when carbon monoxide was decreased in coal gas in the United Kingdom, and that bridge barriers decrease suicide at specific locations without increasing it elsewhere (no significant effects on overall rates were detect though). It's very difficult to study of course, since suicide is relatively rare (so changes in one city are hard to measure) and can increase or decrease over time for any number of different reasons.
Don't rely on a single source of course, but https://www.hsph.harvard.edu/means-matter/means-matter/saves-lives/ and https://en.wikipedia.org/wiki/Suicide_barrier#Efficacy_of_suicide_barriers_for_saving_lives
I understand your objection, and sure, maybe "seriously suicidal people with constant suicidal ideation" won't be deterred by any inconvenience, so for that reason I suspect the benefits of means reduction come from preventing people who are less committed to ending their own lives and really just need to think it through some more or just survive a temporary but extreme mental health crisis. I've gone through periods of suicidal ideation in the past, while I was never seriously suicidal I think it's a good thing I didn't have a massive tub of toxic pesticides lying around.
Some types of suicide are indistinguishable from accidents and such. I think that it is extremely likely that if you go after obvious suicidal methods, people will seek out other methods that more often look like accidents.
...and hanging and throwing themselves off water towers. I forgot about those too.
My state has waiting periods for semi-automatic rifles and handguns. If you want a shotgun or bolt-action rifle you can buy it and walk out with it in one transaction.
Another non-obvious source of gun suicides are rental guns at ranges. All of the ranges I've been to have a policy to mitigate this: if you're by yourself you cannot rent a gun unless you brought a gun with you. However, that's not a law, and I don't know how widely such a policy has been adopted. Maybe it's just a quirk of the area I live in.
My area you can rent a gun if you don't bring one, but I do know they have some extra requirements for that same reason. Good catch on that I completely forgot that happens.
From what I can tell, that's a pretty common policy everywhere in the nation, with the addition that you can rent a firearm if you have another person with you.
Is going out to buy a gun and killing yourself with it a thing? Choosing a gun and learning enough to use it correctly might be quite an obstacle for someone thinking to kill themselves out of depression. Conversely, if you already own a gun, you probably know how to use it, and you don't have the trouble of buying one. (Obviously this is not relevant to someone who is used to guns but doesn't have one at the moment.)
I feel like most people that don't know how to use guns would assume it's pretty easy, especially if you only want to shoot yourself. That's probably not true since there are definitely times when people botch it and just hurt themselves without dying, but this is more about what people think than the reality.
I would have loved to see more analysis on the overdose angle. If we add those to the suicides, does the counterintuitive effect mostly disappear?
Me too. Because drug addiction is mostly categorized as clinical pathology now, it creates a huge gray zone for many addicts (and their caregivers) as to where an addiction ceases to become an addiction and becomes suicide, albeit on purpose or not, and regardless of how slowly or quickly it happens. You meet these people all the time, the ones that know deep down their addiction will kill them, and they'll tell you too. Some of them will have varying degrees of acknowledgement of their power or powerlessness to stop it, and others that have made peace with the knowledge they could stop and choose not to knowing that it is a death sentence. And they're fine with that.
If you know something will kill you and you know you have the power to stop and you do it anyway, consider me old fashioned, but I consider that suicide, even if it takes 5 or 10 years. There are tons of these kinds of addicts out there, but for the reason I mention above, they will never be added to official suicide numbers.
One thing I've wondered is how many solo-driver collisions (with, e.g., a tree or a cliff) on empty highways might be suicides.
I met a (recovered) long-term alcoholic once who said he tried it many times, but always chickened out at the last moment.
Yes, the drug overdose rise is much larger when you look at the absolute numbers.
I always go into this with the thought: "yeah, but I wonder if he's thought of THIS!", and I always find out you have. I have to appreciate how thoroughly you consider things. Here are the two ideas that I thought of, and my thoughts on your points:
1. Overdoes vs. suicide. I've had one sad personal experience with a young man where the question as to whether this was an overdose or a suicide was unclear. My feeling was that we all agreed it was an overdose out of kindness for the surviving family, and maybe to lessen the shock. I wonder if, in this pandemic, there was either less investigation of these deaths happening, or whether there was just an unconscious nudge that way.
2. Meaning. I have never seriously considered suicide, but when I'm at my most dark points, it's because of the bleak expanse of unchanging, bland, dreary life ahead. The pandemic was at least interesting and engaging in a lot of ways, as grim as that is. I think people are itching to fight for something meaningful, or work for something meaningful. Most of our careers aren't very meaningful: for example, my job is helping big companies track how you behave online so they can market to you more effectively. Kind of depressing. So you've got this pandemic, and we've got the kind of existential moment, and we can all kind of "fight" for something.
At least at first. Then it starts to get political, with your mask adherence becoming a tribal thing, and everyone back to the same routines, but with social distancing. So there's that initial interesting time of the crisis (that Zunin and Myers graphic is awesome), but then it's back to the usual slog of meaninglessness. And it might be that we come out into a weird economic period that doesn't rebound into "reconstruction" the way a different crisis might, because the crisis of the pandemic was so odd, and we've already kind of been "reconstructing" through the whole thing, and now we'll have the bill to pay for the unemployment and supply chain problems and kids having just terrible school years, so they're practically a year behind. . .
Anyway, the Durkheim/"meaning" thing seems most likely to me based on my own observations.
> 2. Meaning.
Yeah, that part resonates with my experience. E.g. reading science-adjacent blogs and arguing on the Internet suddenly went from "mostly harmless but mostly useless way to kill your time" to a way to get (or share) actually relevant and important information.
as a person with medium to severe depression before the pandemic and very severe depression including suicidal ideation during the pandemic, I would be a data point for your last two hypotheses - the change of pace and making the whole shebang feel at least a bit different (before it turned into endless hopelessness again) + not ever being alone to actually do anything. and the reason I would more likely feel inclined to kill myself in April-ish is easy: between October and March you can (in the northern hemisphere) blame it on winter and tell yourself that it'll get better in spring, because sunshine. Then spring comes around, and it doesn't actually get better... then it definitely must be forever this bad, so what's the point. At least that's always been my reasoning. Hooray for anti depressant medication.
I remember when it first started and millions were losing there jobs my firm did a few layoffs. Ordinarily that would make me anxious and depressed. But somehow the thought that millions of other facing the same thing made it much easier to deal with. Maybe part of suicidal depression is the idea that bad things are happening just to you. You've been singled out.
On the other side of it, having a job, when everyone else has a job, doesn't feel amazing. But having a job when millions are losing theirs makes it feel special and like a real accomplishment.
is that not copverd by the Durkheim hypothesis?
I don't think so. It doesn't involve any coming together. It's more of a reframing of ones situation.
Did suicide attempts fall too? Are people just less successful since there is a greater proximity to people at home?. I also wonder if people who couldnt handle the situation might have just decided to ignore the pandemic as a way of coping instead of Suicidal behavior.
> So it’s weird to see drug overdose deaths follow such a different trend from suicide. I’m tempted to wonder if people are misclassifying suicides as overdoses, but I don’t see any evidence of this or any reason why it would happen.
One theory: we always misclassify some drug-related suicides as overdoses, and the pandemic caused some suicidal people to shift their suicide method to drug-related, and as a result we increased the number of suicides misclassified as overdoses.
We could check this theory by checking if the increase in overdose deaths cancels out the decrease in suicides.
> some suicidal people to shift their suicide method to drug-related,
Why would they?
If you can't go to the Golden Gate Bridge and the trains aren't running as frequently, then you might turn to your medicine cabinet rather than just taking a detour from your commute that you aren't doing either.
A slightly different take: I used to work in drowning prevention - albeit in Australia - and there is a weak coronial presumption against ruling a death as suicide in the absence of clear evidence to the contrary.
Saying someone took their own life is much more likely to upset family members, etc, so you want to be right if you say it.
In a pandemic in presumably gets harder to gather the necessary evidence, and some deaths might move from provably suicide to assumed-to-be unintentional.
I like this theory.
"But most people stayed home even in places without legally mandated lockdowns"
-Citation needed.
One observation of possible relevance to apparent difference in the black/white suicide directionality gap: I live in a majority-black neighborhood, and I found that for the first several months of the pandemic, almost *nobody* in my neighborhood observed basic safety measures outside the home. People would wear masks in stores once it became legally mandatory, but outdoors, only a fraction of people wore masks, and only a fraction of those people wore them properly covering their noses and mouths. I constantly saw people approaching each other within distances of 2 feet or so (this is a small personal space bubble neighborhood) and taking their masks off to talk to each other, often touching each other on the shoulders, sometimes even each other's faces in the process.
I noticed practically no difference in terms of outdoor socialization during the pandemic versus pre-pandemic, until around last Winter, after the election. People actually wear masks outdoors now, and wear them properly, and fewer people socialize at physical contact distance, but it took a *long* time for this change to take.
https://fivethirtyeight.com/features/americans-didnt-wait-for-their-governors-to-tell-them-to-stay-home-because-of-covid-19/
It seems Americans started social distancing even before governors ordered it. I don't know the exact effect the lockdowns had, but their is evidence that Americans were reacting even before the orders.
On a population level, in terms of behaviors like avoiding restaurants and bars, I find that easy to believe. On average, social distancing measures like "don't gather in crowds, wear masks, keep at least six feet apart from others," etc. may have been observed even without government mandate.
In my experience though, my neighborhood was very much a high-contact, small personal space bubble community prior to the pandemic, and it remained so for a very long time into the pandemic, and while shopping-related safety measures were mostly observed, socialization-related safety measures were mostly, not willfully defied, but blindly disregarded.
However people here weathered the experience emotionally, I suspect that this was likely a relevant factor.
Was there any state that in the US that never had mandated lockdowns? Everyone's definition of a lockdown is different, but even in Texas the bars and indoor dining was illegal for a long time. Perhaps the Dakotas never had that. But where else?
It was only about 6-8 weeks that bars and restaurants were closed in most of Texas. I recall that Memorial Day was when bars re-opened, and I'm pretty sure they never closed again (though there might be have been periods when they were legally required to sell you a $4 bag of chips with your $0.50 beer).
"Also, this explanation implies that people were financially better off with the coronavirus and relief package than they were with neither, which doesn’t really seem to match reality."
Why not? CARES was uncharacteristically generous in that many people actually did end up better off financially. Someone who worked a shitty service job slinging popcorn at a movie theater for minimum wage and got laid off by their employer probably wasn't that invested in concessions as a career and would've been quite happy to get more money for less effort.
I thought that was addressed in the next sentence, since CARES was passed several weeks after the decrease in suicides began.
"Third, maybe people became more worried about the effect that suicide attempts would have on their family. Part of this is increasing social closeness—people suddenly had to spend every waking moment with family members, or else bubbled together with people they had previously lived apart from. Another part is that their family members were also suffering, and depressed people decided it was unfair to ask them to bear the burden of a family member’s suicide at the same time as everything else. Or what if you just literally don’t have the personal space, out of earshot of your family, to attempt suicide without someone else noticing?"
This was also my theory upon first hearing that suicides went down during the pandemic, and before I looked at further data. More specifically, I predicted:
(a) that the drop in suicides was due to fewer suicides among young people, who were newly forced back into their parents' home
(b) that deaths of despair among adults had increased.
I don't really know how to verify my predictions -- is there an age-breakdown of the suicides anywhere? I consider the increase in overdoses to be weak confirmation of (b) for now.
When you use phrases like “studies from Norway, England, Germany, Sweden, and New Zealand” it is unclear what this means. My best guess just, like, grammatically, would be studies from research institutions in those countries; whereas my best guess based on what information would actually be relevant to the reader is studies whose study populations were from those countries. Maybe it happens to be both simultaneously for these examples.
Anecdotally, my therapist friend had the exact same observation of anxiety patients. All of a sudden, it's like they were in their element, or like their life outlook had suddenly been vindicated.
Re drug overdoses: there are two plausible explanations I've heard:
1. More people doing drugs alone, with no one to call an ambulance or administer Naloxone
2. Erratic supply causes people to buy drugs in bulk, which leads to overdose.
It should actually be easy to figure out if 1. is true, just based on the details of individual overdoses.
I think the "two types of depression" is on the correct track. There's the 'normal' type of depression, which is the depression in the other post. That's not going to change very much during Covid-19 and may even, weirdly, become slightly better. Those are the people who, if they're going to kill themselves, are going to kill themselves whether or which.
The second type is "kinda down, kinda blue, kinda not feeling good" which happens when people not suffering from the first type of depression have their usual "go out and enjoy myself" activities curtailed, along with worries about the pandemic, maybe laid off from their job, etc. Ordinarily they're not thinking about killing themselves and things have to get really, really bad to push them to that stage. When the restrictions are limited, life goes back to normal, they'll bounce back.
What I mean for the first set of people, those who are suffering from depression before, "weirdly become slightly better" is that now *everyone* is in the same boat. I'm introverted, I don't like people, and I think I might be mildly agoraphobic. That means currently I *love* the lockdown conditions, because this is normal life for me *plus* bonus "working from home? no interaction with other people? can slob around in my night clothes all the day? oh yeah baby!"
Also having to wear a mask is great when you have (a) plain to ugly features and (b) really can't be bother slapping on makeup. When three-quarters of your face is covered between mask and glasses, it's really liberating.
Nobody can travel, nobody can socialise, everyone is confined to the same restrictions. This is awful for people who have social lives and like going out and mixing in the world. For depressed people who already have the tendency to stay inside, avoid people, and have lost interest in formerly pleasurable activities, suddenly this state of affairs is the new normal and now they're virtuous for not doing any of the "just go out, have fun, meet people, force yourself to interact" activities. This is a sort of relief of pressure, funnily enough.
Drug use (and as a result of that overdoses) going up? Yeah, I'd expect that too, the same way alcohol consumption goes up. People can't go out and do their normal activities, they get bored with being confined indoors with TV and games, they consume their usual fun substances to cheer themselves up, but now they're doing more of them, regularly, and possibly upping doses as well. They don't intend to kill themselves, it's not suicide, it's just a bit too much of your usual fun substance/mixing several recreational substances together and then - oops.
I too think the "two types of depression" hypothesis is probably the best explanation here. At any rate, it's the simplest.
A lot of focus in the in article is on people stuck living close to their families, but a lot of people live alone and were stuck hanging out alone much more than they are used to. That should introduce a lot of situational mild depression.
My first thought was to look at suicide during war. You gave a link saying that suicide in Britain went up during WW2, but the linked article only said that suicides in Scotland declined less during the war years than one would predict given a longer-term data sample.
I say, look for more data on this. "Suicides went down less than predicted" probably depends critically on what window you use to set your "background effect". Also, the Scots weren't uniting against a threat so much as they were fulfilling military obligations imposed on them by a foreign nation (England) which many of them (like, maybe half) saw as their oppressors.
I applaud and appreciate your methodical refusal to come to any conclusion. Measured rationalism, while less than satisfying as a narrative, is a refreshing approach to potentially torture-prone statistics. It’s like the rhetorical equivalent to publishing negative studies to insure against publication bias. Thanks for sharing your still-baking thought process. The world needs more out-loud examples of such things.
One of my kids (M 20) is a front line worker and was therefore not locked down. He has bipolar disorder, which is managed with Aripiprazole and psychotherapy. He experienced an episode of suicidal ideation over the winter that seemed to come from nowhere. He explained to his therapist (and me) that what was depressing him was his failure to progress at work, the sense of "same shit, different day" and that he didn't see a way to get back to being a college student (which he currently can't handle). So, N = 1 but I go along with the "hopelessness" theory.
Overall, very well written and helpful - as always.
It would be interestingly, probably in a stressful kind of way, to restrict the analysis to healthcare people, e.g. RNs and med techs and RTs in the inpatient setting. Those people had a very rough year.
Scott you're at your strongest when you discuss about stuff related to your job and I wish you'd continue doing it instead of reviewing books or hinting about HBD
with you on HBD, but I loved the Arabian Nights review.
I love the book reviews he does!
Just as an anecdotal counter to comments like this, I personally enjoy Scott's writings on a wide range of subjects. Psychiatry posts are the ones I find least interesting (nothing wrong with the posts I'm sure, it's just not a subject that I'm interested in).
I love the "much more than you wanted to know" and book reviews posts, whatever the subject.* I feel Scott is weaker in his discussions of history (outside of the USA).
Yeah basically when talking about psychiatry related subject his professional experience really shows, when he talks about other subject he's just a random dude
Since most of the death statistics are going to be based on CDC death certificate data, I suspect that who completes the death certificate is somehow a factor. Death certificates of violent suicides or completed overdoses found in the field with an accompanying note are going to be completed by the local coroner or an emergency personnel trained in and certified in death pronouncement. Most overdoses of the kind you describe here, "There’s a thin line between a drug overdose death and a suicide. Something really terrible happens, you can’t stand the thought of dealing with it, so you take ten times your normal dose of painkiller in order to fall into a warm, pleasant sleep. At some level of misery, “but what if you take too much and never wake up?” stops feeling like a flaw in this plan. For some people, it’s a bonus—all the oblivion of suicide, with none of the guilt—after all, you weren’t trying to kill yourself, not exactly.", they will be managed in an ICU somewhere by a critical care physician, and unless there is an accompanying clear suicide note found at the scene that was transported with the patient and makes its way into the ICU and the patient's chart, those deaths are not likely to be classified as suicide at all and will instead be accidental overdoses with the death certificate being completed by the attending physician at the time of the patient's death. I have taken care of many of such ICU overdose admits and completed many death certificates concerning those cases and have rarely indicated suicide on the death certificate. It is very important to be accurate when completing death certificates because they do have life insurance implications etc. It does not surprise me that overdoses increased during those early months of lock downs, and I suspect that a fair number of those overdoses were also suicides of the type you describe.
Hypothesis on drug overdoses: with borders largely closed, it's getting more difficult to get certain foreign-made drugs, so addicts are switching to other even worse drugs; e.g. if you can't get heroin you try fentanyl.
Seems plausible. Interesting hypothesis.
I thought fentanyl had displaced heroin a while ago.
I don't think so. I don't know any fentanyl addicts. I do know some heroin addicts.
My understanding of the situation is that drug dealers frequently sell diluted fentanyl as heroin, because 50kg of heroin are more expensive and harder to smuggle than 1kg of fentanyl (and truth-in-advertising laws have no power over people selling an illegal product).
Or to put it another way: you know some people who are opiate addicts, but do they really know which opiate they're taking?
Comparison photo of how much fentanyl is deadly and some stats on fentanyl overdose deaths: https://www.drugabuse.gov/about-nida/noras-blog/2017/04/addressing-americas-fentanyl-crisis
This is how we get headlines like "Boston police seize enough fentanyl to kill over 2 million people" (https://www.bostonherald.com/2019/11/09/boston-police-seize-enough-fentanyl-to-kill-over-2-million-people/).
I think that drug dealers who sell fentanyl to unknowing drug addicts should be charged with murder if the drug user dies from it.
Did I misunderstand something, or does the CDC say that 2020 10.7% of Americans considered suicide? This number seems absurdly large... Or does "thinking about suicide" mean something different?
Pretty sure 10% of people suffer from depression. Plenty of people think about suicide, even those who aren't depressed. The question is usually how seriously you are thinking about it. That number sounds about right to me for a normal year.
I think you mean to cite "Daly, Oswald, and Wilson" rather than "Daly, Oswald, and Wu".
I notice you are not too fond of the Durkheimian "during a crisis people seek together" hypothesis. A reflection here:
A test of Durkheim's theory should probably use something else than suicide rates as an operationalisation/indicator. Since (if you follow Durkheim) there are different suicide motivations, and not all of them are of the type that is influenced by "getting closer together/becoming more distant from each other".
...A better operational indicator to test the Durkheimian thesis is probably to check the rates of marriage/co-habitation break-up. The Durkheimian thesis straightforwardly leads to the assumption that the breakup rate will go down during an epidemic/disaster.
...I have not checked if that has been the case during the present pandemic (worth doing!), but here is an old article finding this effect after the 1995 Oklahoma bombing: Nakonezny et. al. (2004): Did divorces decline after the Oklahoma city bombing? Journal of Marriage and the Family vol 66 (1) p. 90-100.
Ok, I know that checking if Durkheim was on to something is not what you are interested in here: you are interested in theories that can explain variation over time in suicide rates, regardless of where these theories come from. But let me offer an elaboration that might be relevant, although admittedly speculative:
There are two types of suicide that are dominant in modern societies, if one follows Durkheim: Egoistical/self-interested suicide (calculating that the costs of continued living are higher than the benefits: Gary Becker’s & Richard Posner's rational choice theory of suicide is in this mould); and anomic suicide/"existential" suicide (Seeing/finding no meaning/purpose in life; acute Weltschmerz; that Kirkegaardian/Nietszchean stimmung).
Durkheim arguably claims that the odds of committing egoistic suicide is influenced by having friends and relatives that cares about you (and hence this type of suicide should go down during a crisis that brings people closer together, similar to breakup rates); while anomic suicide results from a deeper-level cultural ennui that is not necessarily influenced by how distant/close you feel to others.
Which might explain why drug overdoses have gone up; they may be related to the feeling "life is meaningless anyway, and it feels even more meaningless these days", rather than to "I thought no-one cared about me, but in this present crisis I somehow feel that I was wrong".
Ok, perhaps egoistical versus anomic seems like a hair-splitting difference in suicide motivations. But the distinction may potentially at least explain why suicide rates and drug overdoses move in different directions during the present covid crisis. And it might perhaps also explain why meta-studies on suicide do not find consistent results supporting an assumed Durkheimian approach (since such studies can hardly distinguish between Durkheim's different types of suicide motivations, and hence different types of suicides).
….The above is perhaps a bit rambling and disorganised, but I'll post it anyway.
Great piece! Summary: Suicides declined possibly cuz a) misery loves company, b) curiosity, c) and responsibility towards others. And we don't know why drug overdoses rose when suicides declined.
Curious what’s the story behind posting this there and not on your own blog? Is this a business/partnership/commeercial arrangement thing? (i.e. you’re posting it there it helps giving their website more exposure?)
He may have submitted it there before AST was up and running.
Re: "The US has a waiting period to buy guns"
No it doesn't. A few individual states, including California, have waiting periods, but most of the country does not.
Dostoyevski's notion of finding "happiness in the midst of despair" is distinct from "people pull together during a crisis" although at times it looks similar. Under Dostoyevski's formulation it's the crisis itself -- which may be personal -- which, although causing one to feel bad, also causes one to feel like they are *supposed* to feel bad. If feeling bad at least makes sense it's easier to tolerate.
I think of this idea as similar to Adam Smith's observation that people suffer from small embarrassments more than big ones.
To amplify, big embarrassments can force you to make sense of them. You're naked on the street on Christmas Day and you look your staring neighbors in the eye and say "What are you looking at?". You become your own ally in those situations, whereas the paranoia your neighbors saw you masturbating because you didn't close the blinds all the way has no defense you can provide.
Random thought that I have no emotional attachment to...a lot of people who commit suicide are "Zoom class" or "affluenza" types whose lives actually got better during this period since they still made money, got to stay at home, and could actually do all the stuff they normally want to do?
The increase in overdoses might not necessarily reflect an increase in suicidality/indifference to death. I think hard drug use in a social setting might actually be safer than solitary hard drug use. This would be due to having help on hand to administer antidotes or call an ambulance if someone takes too much. I think it could also be due to social pressures leading to people using less drug overall. The two biggest ones would be avoiding the shame/stigma of taking a way higher dose than anyone else and wanting to remain lucid enough to socialize.
I don't use opiates and I don't know anyone that does, but I do see the same pattern of people using lower doses in social settings and higher doses alone across all sorts of other types of alcohol and drug users.
Isn't overdose risk context specific, so you have higher risk from the same dose in an unfamiliar context? My source for this being my wife, a psychology graduate. If it still stands, this might be a pertinent factor here.
"Also, there were slightly more black suicides in the months just before and after the crisis, so that if you look at total black suicides during 2020, it’s about the same as any other year—in fact, lower than two years ago."
This passage was opaque to me. Did you mean slightly *fewer* black suicides? There are two small bumps on the chart that might be the ones you're referring to, but I don't see how slightly more suicides before and after the crisis, added onto high suicides during the crisis, could lead to the year being normal in total.
> Also, [the 'increased welfare' explanation] implies that people were financially better off with the coronavirus and relief package than they were with neither, which doesn’t really seem to match reality.
For what it's worth, real personal income per person shot up sharply during the pandemic: https://fred.stlouisfed.org/graph/?g=EiOd (sorry for weird units, don't know how to fix that). The worst month throughout the entire pandemic on that metric, March 2020, was only as bad as July 2019, at around ≈$51,000. April 2020 it shot up to ≈$58,000 (going by the trendline, that wouldn't have happened for ≈5 years by default) and hasn't come back down to pre-pandemic levels since. This March was even more, at ≈$65000.
But this doesn't address your counterargument that suicides dropped off in March, before the stimulus.
Also, personal consumption expenditures per person went down even more drastically, from February 2020's $45,000 to March's $37,000, only fully recovering recently, and I guess that's a better measure of well-being overall: https://fred.stlouisfed.org/graph/?g=EiOr. (Though, question for econ people: does personal consumption include paying off debt? Does it depend on what you're paying off debt *for*? I'm trying to get a sense of where people's stimulus checks went if not on consumption — sitting in their bank account with everything closed, paying off debt, or what?)
Overall I'm pretty unclear on what people were going through financially during the pandemic outside of my bubble (and since everyone in the news media and in my social media bubbles is talking about zoom calls and whatnot, I can't really expect them to inform me).
Followup: someone on another form said that debt payments count as savings, not consumption. If someone could get me a link to where the FRED defines their terms, or a reasonably authoritative textbook or something, I'd appreciate it.
Also, they pointed me towards the personal savings graph...: https://fred.stlouisfed.org/graph/?g=EiOR 👀
All these mindblowing statistics, from suicides to savings, just continue to leave me confused as to what the breadth of human experience was like during the pandemic. (Also, this is only US data; I'm even more ignorant outside of that.)
*forum
[give me an edit button substack, i am unable to type, nor am i able to think of everything i want to say until after i click "post"]
[* Third paragraph should read "from February 2020's ≈$45,000 to April's ≈$37,000" (March was between the two). Sorry for my clutter of comments.]
On the differential suicide rate for black people in the US, we're not in an all else being equal scenario here. There's the issue that if you are black in the US there's a dominant media narrative that you are a victim of a racist society. That's going to have an effect on people, increasing feelings of helplessness and isolation (if this makes people more conscious of their perceived differences), and there seems no reason this could not be as big an effect as COVID.
We also had an explicitly racist president in the USA in 2020 as well as the video of the George Floyd murder by the police. Perhaps that had an even greater effect than the media narrative.
The "racist president" was a media narrative (Scott has had a bit to say on this), and a video being repeatedly broadcast and transmitted is clearly part of a media narrative, even if the narrative is focussed on the video. A media narrative is not in itself a bad or wrong thing; it's just a reflection of human tendencies to coalesce our thoughts, and probably a reflection that most people in media and on social media don't have the time to think about the evidence so much as use and adapt already existing narratives. A media narrative might even be correct on occasion (I'd nominate the Rudy Giuliani is clearly going mad one for this award...)!
The endless focus on George Floyd's race was also part of a media narrative; there's no evidence whatsoever that his race was any kind of factor in what happened to him.
Not a relevant debate here though since the narrative did exist, regardless of Derek Chauvin's motivation.
How about the simpler explanation that COVID, both the disease itself and the economic carnage of jobs lost, foreclosures, and evictions, hit black people generally harder?
Did it? That would require three things to make a convincing case:
1. Evidence that this was the case. I have no reason to doubt this, but from my external viewpoint I don't know the relevant statistics and suspect that any narrative at the moment is likely to take a social-justice slant and look for structural inequalities. That said, my prior would be to believe this will be the case.
2. Evidence that there is a direct link between the economic effects of COVID and suicide. This might be problematic though since I don't think the statistics exist for this, but since the whole US population suffered increased jobs lost, foreclosure and evictions and the aggregate suicide rate dropped, I'm not sure we can say that is the case here (if we accept the sense of community here as a reason for the decreased suicides, Scott's provisos noted, then you might have an argument if black people could be seen to be alienated from the community, but then that would play into my suggestion anyway...).
3. Simply becausrbmy idea was first on the table, a way of discounting the alienation and othering induced by a narrative of victimhood (often ironically deriving from already distant political, media and business elites who are predominately white) as a factor, since it is pretty clear the possibility exists that being repeatedly told your skin colour makes you different and less capable of achieving what you want than the average US citizen may have an effect on people.
To be reasonable about this though, lets try the same exercise about what we need to substantiate the suggestion with my suggestion that the anomalous suicide rate amongst the black population in the US may be (there should be a partially here: life is never that simple!) a factor of a narrative reinforcing alienation and helplessnes. What would we need to make a plausible hypothesis here?
a. A mechanism. Currently I am correlating a media message (without consideration of cut-through to the target population) to a statistical variation. Whilst I'm using nice-sounding words (othering, alienation) note I am not suggesting how this actually works. My underlying prior here though would be the relationship between bullying and suicide, which I believe is accepted as causal (although it wouldn't shock me if this hadn't replicated).
b. Evidence that perceived or real oppression on the basis of identity can cause variation in suicide rates. This data probably exists (I'd look at South Africa, and maybe the history of gay communities) but by its nature might be difficult to use or simply a culture war minefield.
c. Ideally some anecdata that this is a plausible case, as the best hypotheses ever have minimal value if they can't be seen to actually apply. Since I believe humans to be rational actors, I have to believe a hypothesis applied to people can at least match people's behaviour rather than positing an invisible hand in action. If the actual case evidence all points in a different direction from what you are suggesting, then you should probably listen to that evidence.
So my original idea needs work to even become a hypothesis. I still favour this over economic determinism though, simply because if this was a factor I wouldn't expect the whole population drop then normalisation of suicide rates. There's lots of other possibilities of course: the role of organised religion in averting suicide and the effects of COVID on this for example. I'm just very tempted by that lovely correlation between narrative and statistics...
Well OK. Here is the evidence on the disparity of illness and death rates:
https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/disparities-deaths.html
Here's the evidence on disparity of economic impact:
https://www.stlouisfed.org/open-vault/2021/april/how-covid-19-economic-impact-varies-by-geography-and-race
There are tons of lists of risk factors for suicide which note financial reverses, job loses, and the death of family members are among them:
https://www.psychiatry.org/patients-families/suicide-prevention
Here's some more data on the connection between job loss and suicide:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3423193/
Keep in mind, the underlying suicide rate for whites is two and a half times that of blacks (that's per 100k people, not total; total is even starker because of whites being more common). The effect being discussed isn't "black people commit suicide more during 2020", it's "the racial disparity in suicides wasn't as big as expected in 2020".
All else is not equal, but one of the unequal things is "whatever makes white people so much more suicidal than black people", and the most obvious guesses at this factor seem like things COVID could plausibly interfere with.
Are you saying that the differing base rates of suicide here mean we cannot assume different patterns have particular significance? I'd be inclined to agree, but I don't known that the racial disparity is real. In the UK suicide is most common in poor rural environments (I lost two former schoolmates that way), and the US has a hell of a lot more rural poverty than we do and that rural population is much more white than the urban population. If a high rate of rural suicide maps across, it might explain a lot of that racial difference. Is the suicide rate for socio-economic groups in cities in the US consistent or varied across racial sub-populations? To come over all Marxist here, the focus on race can hide real similarities between races, and before accepting that black people do have less chance of committing suicide than a white person in the same socio-economic situation I'd need to see data saying just that.
Oh, I'm not saying it's something innate. I'm saying a) race correlates with a bunch of things (wealth, culture, day-to-day danger level, physical activity, etc.), b) at least one of those things is presumably responsible for the stark gap in suicide rates, c) COVID could plausibly be hitting some of those things (e.g. black neighbourhoods are generally more dangerous, COVID makes every neighbourhood dangerous).
When you write "there are two types of depression" I think you mean "there are two modes of depression". The statements that follow support a change in mode for those who are already in one, whereas two types could exist simultaneously.
Best practice for spelling Māori these days either has a macron over the ā or uses two as - Maaori. Both are more accurate, which one is used depends on the tradition/preference of the local iwi (Māori traditional group).
Sure, if you also refer to Germans as Deutsche, the French as Francais, and the Japanese as 日本人.
But if you're speaking in English you get to call them by the English name (Germans, French, Japanese, Maori).
I'm not saying that the ā or aa spellings are best practice when writing in the Māori language, I'm saying that they've become best practice when writing in English. It's routine for news outlets, advertising and government and business reports these days.
Perhaps that is best practice in New Zealand, where they have reason to be frequently referring to the Maori.
Though I thought the push was on to refer to the country as Aotearoa, given that I have seen a finger-wagging piece about that elsewhere.
And even *that* is susceptible to the "more woke than thou" creep, as those patting themselves on the back for using the 'correct' name can now be corrected by even more correct types: https://www.newsroom.co.nz/aotearoa-whats-in-a-name
"The Māori version of New Zealand is ‘Nu Tereni’, a Māori pronunciation of the English name. Aotearoa is not used."
However, since this is not New Zealand/Aotearoa/Nu Tereni and the majority of us are neither Pakeha nor indigenous, then "Maori" is good enough for general use.
While I hope I am sensitive to cultural nuances, given that right now there is NO "local iwi" around me, I'd stick with Maori. Finger-wagging uselessness of this type does move to make people annoyed and less eager to co-operate or try to be correct than any amount of "structural racism".
Now, if ever I move to New Zealand (something less likely than the Second Coming happening in the next ten minutes) or I am communicating with Maori people or groups and that is the spelling they use, sure, I'll go along with it for the sake of courtesy.
Someone from God knows where who could be a dog for all we know telling us all - who do not live, work or have dealings with New Zealand, New Zealanders, or the Maori peoples - off in schoolmarm tones of "I know better"? Go away and reflect on your life choices.
Mate, Scott was explicitly asking for feedback from us on a piece of text, I think it's a reasonable editorial comment. I don't just go around randomly interjecting to insist on everybody doing things my way or slag anyone off for not keeping up with the latest woke signalling, you can check my post history.
A chara, Scott was asking for feedback on a post about Covid, suicides and depression. Completely incidental to that, he made one (1) mention of "Maori".
Instead of addressing the topic of Covid, suicides and depression, you came back with a Tumblr woke madam comment "Ackshully" about the "best practice spelling". While you're at it, why not remind us that "Gypsy" and "Berber" are horrible awful slurs and if we use them we're all racist white supremacists?
Also, if we're going to indulge in preciousness about "correct forms" and "best practice", don't refer to me as "mate" as that is not in conjunction with *my* cultural norms and is an inaccurate form of address. If you need to address me, use the formal, gender-neutral term as instanced above. I do not invite you to use a more direct form of address, but if you really desire to do so, then it would be "A Dheisigh". Certainly *not* "mate" which is not even the correct language!
You may go further into this by perusing this 2017 version of the Caighdeán Oifigiúil which for my nation is at least as authoritative as "the local iwi" is for yours. https://data.oireachtas.ie/ie/oireachtas/caighdeanOifigiul/2017/2017-08-03_an-caighdean-oifigiuil-2017_en.pdf
Or you could come down off that high horse and stick to common usage in English where and when we are not discussing the Maori in general, particular, or in any more depth than a passing reference.
I've lost a lot of respect for you today Deiseach. I don't come here to be attacked. I came here to add information that I had reasonable cause to believe Scott might not have known and could appreciate, I think you're being pretty mean to rake me over the coals for it.
Were your good opinion something I cared to have, doubtless this would wound me. Since, however, the question we are debating is one where a wokescold is annoyed that their performative virtue signalled was criticised, hence denying them the thrill of the enjoyment of conscious virtue, this means nothing to me.
I don't comment here for ego-stroking or to show off how very much up on the latest correctness of the most correct that I am. The information you wanted to wave in our faces was irrelevant to the actual topic for which Scott was eliciting feedback. I don't know your personal circumstances nor do I wish to know, as I very much dislike the current trend on social media to demand name, rank, and serial number before anyone can dare offer an opinion. Richard Dawkins has every right to give an ignorant opinion on The Troubles and then try to pass it off as a joke when he gets pushback. I have every right to say that it is an ignorant opinion and he was being a privileged Brit.
To address the meat of the matter: there is no correct way to spell Maori, Māori, Maaori, Mayawhooarooa, or whatever "current best practice" for the term may be (one that changes with fashion), there is only the preferred version (as you yourself admit, though you seem not to realise it, when referring us to whatever "the local iwi" may use. That one iwi may pick a version different from another means there is no one, single, "Best Practice").
"It's routine for news outlets, advertising and government and business reports these days."
It's routine *in New Zealand*. This is not New Zealand, as I have pointed out several times. By the way, I note that you continue to address me as "Deiseach" despite my request that you use the correct terms. Did you think I was not serious? If you insist that non-New Zealanders use "Maaori", I am within my rights to insist you use "A Dhéisigh" when addressing me. That is "best practice" and "tradition/preference" of the First Official Language of my country, and if you are being so precious over indigenous language usage about your (presumed) own nation, then you should extend the same courtesy to others.
Unlike yourself, I have not insisted that people on here use "Déiseach" or "A Dhéisigh" or "A Chara" when addressing me, because unlike yourself I recognise that we are using English, with an audience of English-speakers, from many countries, and that I don't get to police their language conventions.
The problem we are dealing with is one common to every attempt at Romanisation of non-European languages, where since the Maori language(s) had no formal written system, one had to be invented - as was the case with Sequoyah and his creation of the Cherokee syllabary where no native writing system existed.
Since the language of orthography is English, this is another problem: in English, long vowels are not specially marked. Were this another European language which used diacritical marks (note the síneadh fada in the Gaelic version of my username), we would not have this problem; everyone would be spelling it "Māori" or "Máori" or the preferred usage in their tongue.
However, we are dealing with English. Usage of the macron is a specialist, not a general, use. The double a vowel may be more 'natural' in a usage sense, but it is not an habitual usage and thus is an orthographical innovation for most people. And if we were reduced to phonetic spelling, we enter into the wilds; then it would not be "Maori" or "Maaori" at all, but "Mowree".
Now, were I writing a formal letter or otherwise dealing with any of these bodies http://www.tkm.govt.nz/omo/ then yes, I would use the spelling on their letterhead. I do the same for all other bodies I deal with, where there is such a difference. This is something in my own country, where there would be a difference between whether I was writing to the Department of Health or An Roinn Turasóireachta, Cultúir, Ealaíon, Gaeltachta, Spóirt agus Meán. And betimes, there would also be a difference whether I was communicating with the Department of Health or An Roinn Sláinte.
On the other hand, if an English-speaker living 5,000 miles away from me refers to "the Irish health service", I am not going to sniff and correct them that "Ackshully, you should use Feidhmeannacht na Seirbhíse Sláinte" because while I hope that I am a patriot, I also hope I am not a complete idiot.
My concluding counsel, and you are perfectly free to dump it in the bin, is not to cry out before you are hurt. When and if Scott, or one of the commenters, starts talking about the Maori peoples in particular, then you are entitled to jump in with your "best practice, tradition/preference" spelling correction. Until then, my rejoinder to such tut-tutting is, regrettably, the vulgar vernacular "who asked you?"
Do you have access to international overdose data? If the suicide dip/overdose surge pattern does not appear in other countries, that would be strong evidence against the cause of death misclassification hypothesis.
Well, the last explanation certainly rings most true to my experience. The chronically mildly -- and I emphasize "mildly" -- depressed people I know perk right up when a genuine existential crisis comes along, when it's root, hog, or die. Maybe there's even some weird bit of pride in there, as in, I may well kill myself but I'm damned if I'll just let this stupid hurricane/mugger/scary skin cancer kill me. But I have zero experience with severely depressed people, and an intution is worth bupkis when assessing broad social trends.
One thing I didn't see addressed there is the precision of the "depressed" categorization. Is it possible people who were stressed and scared were lumped in?
"War experiences are brutal, painful and tragic, but sometimes they call up the best in human beings. And after the war is over, the survivors eventually began to yearn for that time when they surpassed themselves, when during better and worse they lived at their peak." -Roger Ebert
>But I have zero experience with severely depressed people, and an intution is worth bupkis when assessing broad social trends.
I tried to off myself a few years back - I think that qualifies as severely depressed. Got thrown in mental hospital, mental hospital had insufficient security and scary people talking about how they were going to kill/rape people. Bounced back to peak performance in days.
what portion of suicide is attention seeking? if you are motivated by attention, this may have been absent during covid. i dont know how much of this is true or a myth however.
Probably only teenagers think of suicide as attention seeking, and most who actually do it are probably pretty fucking depressed and beyond caring about attention seeking.
No adult wants to be known as a suicide. Fear of attention probably prevents more suicides than the desire for attention causes.
As Scott says, a breakdown of who committed suicide last year might be telling, but I doubt teenagers make up a large proportion of suicides in general.
Also considered this. If suicide is a social act, and covid makes life less social...
This article makes me wonder how many suicidal people died of COVID-19 before they managed to commit suicide. Something can technically reduce suicide... by killing people another way.
Not entirely unreasonable:
https://www.nimh.nih.gov/health/statistics/suicide
Notice from Figure 2 the highest suicide rate is men 75+ (40 per 100,000), followedly closely by men aged 45-64 at 31 per 100,000. These would be the #1 and #2 risk groups for COVID death as well, and I believe suicides in those age groups are often tied to infirmity and ill health -- which of course would also enhance one's vulnerability to COVID.
Thank you. I spent the last couple hours wondering about the potential overlap between high-suicide-risk groups and high-covid-risk groups. That makes a lot of sense.
There's also the fact that severely depressed people tend to give up on self care. I wonder if that raises their risk of respiratory illness.
It also occurred to me that COVID-19 could be stealing people from all the other categories of death, but the loss shows up more in small categories (suicide) than big ones (car accidents). I wonder if any other small-ish death categories showed some shrinkage in the last year (shootings? drowning? falling down stairs? animal attacks?).
It would be pretty funny if, by claiming half a million death certificates, COVID-19 significantly reduced the number of deaths by animal attacks.
Excellent, thank you. Highlighting the slipperiness of statistics and their danger in the hands of most people, is so important these days. I really like your conclusions on this one.
Haven't seen what seems like the intuitive answer to me. Committing suicide generally means you are not only miserable in the present but expect to be miserable in the future. I have never considered suicide when I had food poisoning, but if I were diagnosed with "chronic food poisoning" with a 0% chance of recovery, suicide might become more compelling.
Depression often arises with the belief that one is irredeemably worthless, unlovable, etc. and suicide may appear to be the best decision in light of this distorted view. When someone's depression is clearly caused or heavily influenced by an event they perceive to be temporary, I would speculate they would be far more likely to wait and see how things go before making such a permanent decision.
In fact, I would not be surprised if this "wait and see how things go" effect even applies to people who were already depressed before the pandemic. When your life gets shaken up in drastic and unforeseen ways, there is a sense that the cards might land in your favor once the dust settles. You can't just end on a cliffhanger.
Isn't this basically one of the hypothesis he goes over at the end?
It looks like his second sympathetic argument does touch on it - I think I missed it because he ends up taking in a bit of a different direction. I don’t see how this doesn’t qualify as a satisfying explanation though. Obviously there’s no data on it, but in light of it, I really would be surprised if suicides had gone up.
My dear friend Kieran Latty, who is an economist working on subjective well-being, has always told me that recessions are associated with a paradoxical fall in the suicide rate. If this is true it would seem to explain it (while opening up another mystery- why do recessions reduce suicide). However a brief Google turns up a number of papers alleging the opposite- that recessions in fact cause suicide- which would just compound the mystery here. No idea what the truth is.
Kieran's explanation for the purported phenomena of recessions reducing suicide was that when many people are down and out economically, being down and out economically feels less bad.
Yeah, I think it is a matter of comparison. Everyone around you - family, friends, people you went to school with - are thriving and have (outwardly) great lives, you don't; the fault is in me, I'm worthless trash, I should kill myself.
It's a recession, everyone is doing badly - this is not something I can control, this is not my fault, I'm no worse than anyone else.
I think you gave up on the overdose explanation too early, and am confused as to why you treated it as you did. It seemed like the one place where you had concrete numbers that could provide an explanation. You move on from it and instead focus on more speculative theories. While those theories sound anywhere from plausible to accurate, they are not data-driven. Ignoring the data driven answer is out of line with my expectations of your approach (and of the rationalist sphere approach in general). I also had a previous expectation that the line between what is reported as a suicide vs an overdose is a moving target subject to much personal judgment, weak circumstantial evidence, and policy directives. While I think that prior expectation made the change in approach stand out more starkly to me, upon reflection I do still think that the approach you took is surprising.
A (quite possibly wrong) hypothesis that has enough of a chance of being right I'll register it now for gloating rights.
What if internet, video calls, and to some degree improved phone service, were the drivers of the low suicide rates.
First up, why would we expect this to be the case? Well, most of the depressed people were probably otherwise healthy people whose social lives got destroyed by COVID and quarantining. However, access to communication allowed them to maintain some degree of a support network. Eating every meal alone for a year might still be depressing, but when you feel suicidal you still have your weekly zoom calls with each of your friends. Most of this is anecdotal, but I'll do why this might match the evidence next.
Firstly, any hypothesis should at least comment on the US racial disparity. This actually does that. According to wikipedia, the US has 80% access for whites, and only 60-65% for blacks and Hispanics. Considering that Hispanic suicide rates didn't appear to go up, it's hard to call this a victory, but whatever.
Secondly, this would help distinguish between past pandemics/really bad stuff and COVID. Widespread internet, and even free long distance calling, are relatively new things.
Thirdly, it explains why we see the same results across multiple studied countries; what do Germany, Sweden, Japan and the US all have in common? We're rich and we have good internet (by global standards).
Fourth, this helps with ODs. From what I've read (but mostly I read about it casually because it's depressing so I freely accept the possibility of me being wrong) the opiate epidemic is hitting rural america a lot harder. Anyone who's ever lived in a serious rural area knows that it's very hard to get decent unlimited internet. Then we might suspect that opiate ODs are a substitute for suicides in rural regions.
So, falsifiable predictions? Basically, we should see results that depend upon internet access, even when we control for both race and income. Once we get suicide rates for less developed countries, we should expect them to have rates drop less than in the US, or possibly even rise. I guess we'll see how this holds up once data comes out.
Yo decent theory
It is brutally, incredibly weird to me that it didn't occur to you to question the difference between "people say they are depressed" and "people are depressed" here. Not that you didn't settle on that as an explanation, or that you didn't dismiss it as silly - it just doesn't come up at all.
This!!
Indeed. I expect a lot of people who are sad because they can't party and who normally have a very high quality of life, to report themselves as depressed.
“this explanation implies that people were financially better off with the coronavirus and relief package than they were with neither”
The numbers certainly bear this out. Spending was way down, savings were way up, debt was way down, markets were way up, and stimulus on top of all of it. For many low wage workers enhanced unemployment paid better than working, and millions who lives in debt were able to wipe it away via net savings and/or by taking advantage of rates going to zero.
I do think personal financial insecurity is a well documented motivator of suicide. 2020 solved many more financial problems than it created — so far, at least.
https://www.nytimes.com/2021/01/01/upshot/why-markets-boomed-2020.html
Oh and also evictions were suspended!
What about esteem dynamics? One notion I have seen floated in relation to the curiously high suicide rate in Australia is that a factor driving people over the edge is the humiliating thought that "I live in the Lucky Country, so I have no excuse for my personal inadequacy." In a pandemic, everyone has an excuse for failing, so depressed people do not also have to cope with (their subjective perception of) humiliation.
BLM movement may be relevant, although according to google trends it didn't really pick up until June 1 2020
Makes sense - George Floyd died May 25 2020
When I have thought about suicide (never very seriously, in case someone I know is reading), it's never just about my being depressed. It's about disappointing people I care about.
My guess is that the pandemic actually provided a sort of life raft to depressed people... sure I'm letting my family down, but I don't feel as personally responsable.
Related to: why people kill themselves at all, instead of running away.
Perhaps killing oneself over "that stupid virus" is perceived as a status loss in a way that killing oneself over more personal troubles isn't. It's about the story you want told. Not every suicide is a storytelling act, but I assume many are.
And yes, yes I do think people often care more about status than survival.
I have difficulty believing that status seeking is a big part of suicide.
On the other hand, what the heck would I know? The main thing I'm learning from this article is that my intuitions around suicidal-level depression are totally wrong.
Oh thank goodness. I'd already read the one on Works in Progress and when I saw this email come in I thought "aw, man, he's written it up for ACX too? Now I'm gonna have to read basically the same thing again just in case there are any differences!"
So I was relieved to find this was just a link to the one I'd already read. Maybe I need to get a life...
“Make enough comparisons like this and eventually you have” -- here I thought you were going to say "two subgroups which differ from each other just because of a statistical fluctuation".
;-)
"anxiety patients who are completely calm in an emergency": similia similibus curentur?
Guess as the "two types/axes of depression":
- The world is [negative affect].
- I am [negative affect].
>Britain came together a lot during World War II, but if anything, suicides went up.
For years I'd heard that suicide rates in the UK fell during the Blitz. It's not true?
Another data point: heard a news story on the radio that suicides had not increased during the pandemic in Ireland, the most recent coverage online is here: https://www.irishtimes.com/life-and-style/health-family/suicides-have-not-increased-during-pandemic-figures-indicate-1.4492985
I'm curious to see the data by age. Per Wikipedia, men over the age of sixty five are the highest risk for suicide. With them being in the higher risk for covid-19, is it possible that covid-19 was directly competing with the suicide numbers?
There is one point you make that really spoke to my circumstance:
"I’ve seen surprisingly many instances of depressed or anxious people, who can’t cope with everyday life, cope perfectly well with emergencies. Finally there’s something obvious and worthwhile they need to do that breaks through the fog of meaninglessness, and finally they have the motivation to try to handle it (because they could die if they don’t). But also, I’ve seen a weird number of anxiety patients who are completely calm in an emergency. Or maybe they have the same level of anxiety as usual, but it finally feels completely appropriate to the situation and so they can respond as reasonably as anyone else would, plus they have more experience with it. "
I have been battling what I was say is moderate depression for about 3 years. In 2017 I took a job on the road that required I leave behind everything I loved to hop around rather miserable rural towns in return for ALL of my financial concerns being handled (the "golden handcuffs" as they've been described to me). I knew I had to get out of the job but couldn't muster my exit and it was causing me great grief. My greatest concerns were the loneliness and boredom I was experiencing being away from friends and loved ones.
Fast forward to March 2020, I get let go from work due to their workload decrease and it completely changed my life for the better. I moved back to the city that I felt I belonged in, and suddenly everyone around me was now experiencing the feeling of isolation and loneliness that I had been going through for years. I very much fall in that bucket of people who were moderately depressed before COVID but found great comfort in the disaster.
I don't believe I would ever have considered myself contemplative of suicide, but can certainly agree with the idea that some function better in crisis. No longer were those I observed around me having the times of their life while I was locked away working in some random town (FOMO), and now I watch people I would normally look to as strong and brave in good times begin to crack under the pressure of the new status quo.
> Or what if you just literally don’t have the personal space, out of earshot of your family, to attempt suicide without someone else noticing?
Aren't suicide attempts tracked as well? This possibility should be discernable if attempts stayed constant but successes fell.
Although I admit thie "dissonance" hypothesis has some intuitive appeal. Feeling depressed in depressing circumstances feels appropriate, but being depressed when everyone else is happy and moving on seems like it would be more distressing. Dissonance seems to be a common theme with mental health problems.
Yet another hypothesis is that people weren't necessarily staying home with family and friends, but they were more frequently *staying in touch*. Depressed people might hear more stories of sadness, fear and depression from family and friends, and the external awareness of other people's circumstances might make them feel less lonely, and they might have shared in turn. Shared misery and all. I could see that helping.
Black people are disproportionately represented among the poor, so maybe they didn't have internet or phone access after losing their jobs, so many of them perhaps didn't see those benefits and possibly that's why suicides didn't fall or even went up.
Very interesting data nonetheless.
Interesting and in depth as always.
Something that felt missing to me was more details about the profile of a typical person who commits suicide (or better - a distribution). Are they young or old? Do they have families or roommates or neither? Are they rural/urban, religious/not, educated/not? In what circumstances do they commit suicide (after a long fight with depression as measured by questionnaires?)? Where and how do they do it (e.g. hotel suicides mentioned in another comment. Guns/pills/...)?
I think this would help zero in on what might have changed for them. Ideally we would want the change in suicide rate for each group, like there is for race. But absent that, a change of 10% is pretty large, so can't come from a small group of suicide victims.
For example it's possible (though don't think it's likely) that older people who would have committed suicide died from covid instead, just by chance.
Anecdotally, the idea that people with high anxiety do well in crises rings true. I am chronically depressed and anxious, and experienced a large increase in well being during the pandemic (which I mostly kept to myself). The way I thought about it was that a lot of my anxiety comes from feeling like my internal models/interpretations are out of whack with the outside world. I get alarmed by the sense of "why isn't everyone as worried about this as I am?" because it feels like the two options are that most people are misperceiving dangerous situations as safe or that I'm uniquely broken, both of which are frightening in their own ways. When the pandemic hit, it was like the outside world lined up with my emotional state for the first time in memory, and I felt hope that I was relatively sane as a result. I experienced something similar when people started worrying about Trump trying to steal the election a few months before it happened, because I'd had a growing fear for months before that that I might just be paranoid about the prospect.
Seems almost no effect there to explain. I suspect natural disasters in general don't have any consistent effect on suicide because they're both obviously temporary and obviously not your fault. Being born into poverty in some third world country also doesn't seem to have any effect on suicide rates (the only consistent effect I see on the map is a HUGE effect in favor of muslim countries regardless of their wealth or lack thereof.)
https://www.undispatch.com/map-day-suicide-global-health-priority/
I see an obvious explanation that unifies all the weird things about suicidality, that I've never seen proposed before. Someone feel free to tell me what's obviously wrong with it:
1. Committing suicide requires depression _plus motivation_. You need to both think everything sucks and won't get better, and _also_ to exert some momentary burst of willpower to get you from "do nothing about it" to "commit suicide about it."
2. Things that give people more motivation (i.e. increase dopamine) — like certain antidepressants, or like the bright-light-therapy analogue of getting more sunlight in spring, or like Christmas in the middle of winter — increase suicidal ideation in depressed people. Because — at least at first — having more undirected motivation doesn't make depressed people any less depressed (they still think everything is pointless and there's no way to fix anything), but it _does_ allow them to get over the big energy-cost hurdle that was preventing them from committing suicide.
3. The opposite is likely true as well: things that take away people's motivation decrease their likelihood to commit suicide. Anti-psychotics. Winter. Stress (the kind that makes you too tired to do anything at the end of the day.) Eating poorly. Being forced to stay in your house where you experience no novel sensory/social stimuli, and potentially get little sunlight even in summer.
4. Different suicide methods require different amounts of willpower. If there are "easy" methods of suicide available — especially those that don't require _making a decision_ to commit suicide (like drug overdose!) then you'll expect unmotivated depressed people to preferentially enact those forms of suicide, while motivated depressed people don't prefer them over-and-above any other method of suicide. As people get more motivated/manic during depression, more difficult, choice-requiring, and novel methods of suicide will "come into scope" for them — much like how having more motivation left in the day when choosing dinner will lead to being willing to try cooking a new dish.
(This all seems obvious to me, as someone who got diagnosed with ADHD as an adult, and so has experienced both long periods with/without motivation in my life, and sees the contrast in my own thinking every day as my medication kicks in and then later wears off. Modelling depressed people who _don't_ commit suicide, as having the same problem I have when I'm hungry but have run dry of the willpower to decide _what_ to eat, seems pretty intuitive.)
I read this with great interest.
Depression and, at times, suicidal thoughts are no strangers to me.
The concept that there may be two types of depression, one correlating more strongly with suicidality and the other more with "current and presumably transient adverse events", for lack of a better description, resonates strongly with me. A chronic versus a more "acute" one, so to speak, for a definition of "acute" that would run from maybe months to single-digit years.
I would have made a similar self-diagnosis some years ago, and on my odyssey to figure myself out I finally came across the concept of cPTSD; and 'depression' as one of its common symptoms.
Complex Post-Traumatic Stress Disorder in a nutshell means that people, in childhood formation, were conditioned that certain adverse events and situations are things they can do nothing about, and as such severely stunts autonomy and self-efficacy. At the same time, those individuals will have learned incredibly complex coping and survival strategies, so that they will often present as highly functioning even to a trained psychiatrist / neuropsychologist.
Here, I'd like to invite you all, as you feel drawn, to take a look at these concepts. I'll leave a few starting points that got me into it:
* Bessel van der Kolk's book, "The Body Keeps the Score: Brain, Mind, and Body in the Treatment of Trauma"
There's an enganging summary:
https://fortelabs.co/blog/the-body-keeps-the-score-summary/
* Polyvagal Theory
https://en.wikipedia.org/wiki/Polyvagal_theory
... from an "I don't care if it is methodically complete and sufficient, it leads to a workable model for everyday dealings with one's emotional undulations" viewpoint, as in the Polyvagal Ladder:
https://medium.com/age-of-awareness/how-to-use-the-polyvagal-ladder-c68835f0fe19
* The work and perspectives of Dr Gabor Maté
https://youtu.be/H9B5mYfBPlY
My take on the COVID situation (shituation?) is: It sucks, doubly so for people with fragile psyche or a fragile social support network in the first place. But at the same time, while it will present as an external factor the individual can do very little about, at also presents as something with a lot of change and movement - there are bouts of "we're going to be stuck in this forever", but then there's with some regularity some change happening that again directly affects everyone's everyday life to some degree, so it doesn't feel completely stuck. There continue to be 'surprises', one prime antidote to the cPTSD stuck loop.
Of course, I have a lot of perception bias with all this - once you have a hammer, every problem starts to look like a nail. Going through town, interacting with people, I see trauma and fragmentation and hints of cPTSD everywhere.
An excellent piece.
The strange disparity between black and white suicide rates is easy to explain:
Whites couldn't get a moments peace to off themselves because everybody was cooped up at home.
Blacks couldn't satisfy the urge to kill in the usual way because, see above, and had to off themselves.
Any questions?
I'm confused. You're saying that because black people couldn't murder other people, they murdered themselves?
This is obvious;y not a site for satire. forgive me.
I agree with your conclusion. I had multiple patients state outright that they felt better because everyone else was going through the same thing and they finally felt justified in their negative feelings. Social anxiety patients and OCD patients did especially well (and are now doing worse that things are opening up). Even the borderlines improved. Young women with garden-variety depression and anxiety did especially poorly. There was a lot of talk about wasted time in finding a mate and falling behind where they perceived they should be in their lives. Also mothers did terribly for all the obvious reasons. I got a lot of new patients who had no history of previous depression in these categories. Maybe these are reasons why the dip is not reflected as much for women.
I would ask that you research and comment on depression and suicide rates in children and teens. My mother patients frequently expressed that their child was going through depression for the first time. My nanny said over 1/2 of the students in her daughter's class were depressed and the guidance counsellors were reaching out to all students for wellness checks. The first article that comes up from the APA suggests high increases in suicide attempts among teens.
"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."
Good post. I think it's the end in sight and reduced depression/anxiety in 'emergency' type situations.
similar to your theory that some suicides were still happening but masked/categorized as accidental overdoses, I wonder if the they same thing happened with traffic deaths? Because those were up quite a bit in the US. Which is at first counterintuitive, since there were so many less miles driven in 2020. The explanation I've heard, is that with less traffic, people were able to drive faster, and thus deadlier. Makes sense. And given the drop in suicides, I wonder if also some of that fast/reckless driving was suicidal
Hell is other people. Not having to deal with other people has improved my mood. Surely that explains a lot?
There’s one point that feels missing from the final speculation section. Suicide is inherently an act of hopelessness, which you hit on with the Aaron beck “this is endless” point. On the other hand, the pandemic was expected to end, as interminable as it felt in any given moment. When people have a point of light in the horizon, something to really hang hope of improvement on for the long term, it can provide so much fuel to continue because people can plausibly believe life will improve when the bad situation ends.
As someone who lives with someone who is chronically depressed (who, btw, has never felt as comfortable or as satisfied with life as she has during the pandemic), the "this is endless" dynamic I see as a substantial contributor to depressing leading to suicide, and conversely why pandemic depression doesn't lead to as many suicides.
Depression due to the pandemic was a different kind of psychic pain... it was a shared pain, and a pain that by definition has some kind of begin-and-end time period. And, importantly, pandemic depression has an identifiable reason.
I know we can't do exit interviews, but I do wonder if suicides from depression are driven more by the dual factors of not knowing why they feel this way (nothing to point to) and therefore grow convinced that there's no hope in ever getting relief.
Maybe potential suicides were covered by excess mortality eg people who had no will to live succumbed to Corona more by seeking help late and responding much worse to placebo etc.
That would entirely hide suicides in all countries that had excess mortality but not in the ones that had not. Someone looked it up?
I've skimmed through all the comments here but didn't see my pet theory offered as an explanation: misery loves company.
In a normal year you are expected to earn a living, maintain a social circle and have fun hobbies. If you are seriously depressed and failing (or just believe you're failing) to live up to those expectations, you feel like a major fuck-up.
Contrast that to our COVID year. Lost your job? So has everyone else, to the extent that the government has started handing out mass relief without the usual judgmental chatter about the lazy poors. Don't have any friends? Everyone's stuck inside, so it's not like you're missing out. No fun hobbies? Anything worth doing has been cancelled, anyway.
Life may have gotten worse for most people, so depression rates have gone up. But if you're _already_ feeling useless or socially isolated, lockdowns don't change your situation! And at least now there's no pressure to act like everything's fine!
> I won’t waste your time listing the evidence that life got more depressing
I don't know, life got *significantly* better for me, being able to work from home. I know my experience doesn't generalize, but it also doesn't seem like an insignificant factor across the board. Increased unemployment too, applying especially to those with the most shitty jobs.
There's also some thing about covid representing a tangible threat (vs the malaise and ennui of modern life) while at the same time not actually hurting all that many people.
In effect, many ended up safe and comfy at home, and never got sick.
What if COVID and suicides are competing hazards and strongly so for a certain subset of people?
Two of those correlates are age and trait:anxiety. Both are positively correlated (age much stronger than anxiety and anxiety is early research, still seems to be valid and has a large effect) with worse covid outcomes - hospital stays, long covid, death and with suicide in other years.
May be covid took away more of the people who would have otherwise committed suicide.
@Scott: some comments on your Covid suicide article on work in progress (https://worksinprogress.co/issue/why-didnt-suicides-rise-during-covid/)
1) why most suicides in spring? My understanding (personal theory) is this: human bodies do have a built in hibernation program as many other species. This program is controlled by daily sunlight exposure. In preparation for the coming winter our serotonine level and our drive decreases, we eat more and build up fat storage to survive hard winter. Reduced drive (depression?) helped our ancestors (both human and animal) to look for a cave and just sleep there over the winter with least fuel consumption possible. In spring light exposure increases and with it serotonine levels. Drive (and sex drive) and motivation come back. In some individuals the depression stays longer and then they suddenly have the drive to kill themselves. Starting giving Antidepressants (SSRI) is always combined with the warning to tightly monitor the patient the first weeks so that it not kills itself due to this process.
2) why less depressed after a natural crisis or desaster? You mentioned "sense of meaning" and I guess this could be a key. Why there are so many people depressed and suicidal in "happy countries" (I guess you mean western wealthy countries)? Because these sociaties removed a lot of meaning of the lives of their people which were the norm for millions of years for our ancestors: tight daily human connections and interactions with close and loose family members, purposeful activities all the day around like feeding the family, the children, growing food, hunting food, building purposeful things like houses, tools, everything else, singing and dancing together and so on. A lot of these things are gone in the everyday lifes of a lot of western people. Instead they often life alone in anonymous apartments, doing a long daily commute to stupid companies sitting in boring and stupid meetings, producing useless things or services ("what would happen to the world if I, my job or this company would suddenly not exist anymore - nothing - nobody would take notice"). So they feel depressed. Now let's happen a natural desaster Like a flood or a hurricane or a pandemic. Suddenly all the stupid things are not porta to anymore but to help each other. No cracy meetings anymore, a lot of cooperation with formerly strangers from the neighborhood, suddenly a lot of purpose, humankind, success, self realisation asf.
PS: I was confused about Works in Progress too...
I think it could have to do with jobs. Richer individuals got to work from home while poorer ones were stuck going into work during the pandemic. Race and job/income correlate such that you might see more suicides among essential workers than people at home. When you're constantly surrounded by family and never leave the house you may be depressed but find it harder to plan and execute a suicide.