In the early stages of the Covid-19 pandemic, mental health experts and members of the media predicted that the pandemic and its effects on society may lead to an uptick in suicides.
As many of these articles and viewpoints began to gain steam, some cautioned against jumping to conclusions. I wrote in a tweet that “Resilience during times of adversity is the more common human response,” and noted that some people would likely experience increased risk while others would likely experience decreased risk.
Those of us who posited that suicide rates may actually decline during the pandemic were either dismissed or criticized. But we were right: Provisional data released by the U.S. Centers for Disease Control and Prevention suggests that for the entire year of 2020 — when most lockdown procedures were put in place, many communities saw their highest rates of Covid-related deaths, and economic uncertainty was at its peak — suicide rates dropped by 3%.
When I suggested that the country might see a decline in suicides, I wasn’t just guessing. Here are some of the evidence-backed reasons I had in mind:
People tend to pull together in times of crisis
It may seem counterintuitive — and not every scenario is comparable — but suicide rates tend to decline during times of large-scale public crisis. That can include anything from terrorist attacks and war to natural disasters. It isn’t yet fully understood why, but one leading explanation is that people inherently want to pull together during turbulent times.
Think back to the early days of the pandemic. News stories focused on little victories and heartwarming tales of communities supporting one another, about businesses being propped up by their customers and others propping up their communities. In early- and mid-2020, it truly did feel like people in the U.S. were pulling together.
Months later, a divisive presidential election led to more harsh discourse and fracturing of communities. But that just meant our divisions and separations were due to sociopolitical reasons, not the pandemic.
Some pandemic changes lessened stress
Experts and others worried that unemployment and financial strain would put new burdens on many Americans. While that is certainly true for some, pandemic-related changes may have actually reduced stressors of a large portion of the population, particularly those who were already struggling with mental health issues.
Children were no longer at school with their bullies. Employees were no longer forced to work next to toxic coworkers. People who hated their jobs suddenly had a reason to stop working. Even if it made for challenging financial situations, that may have been preferable to many.
Unable to go to work, people started spending more time at home, typically with other family members, friends, and their support networks. With a little more time around the house, many started eating healthier, exercising more, and spending more time with loved ones. Lifestyle changes like these are protective factors against suicide.
And in a purely pragmatic way, spending more time at home may have made it harder to attempt suicide. In 2020, with many people stuck at home, there were far more people around to intervene. If someone did attempt suicide, there was a greater chance that someone would find and rescue them.
Pandemic stress was a different type of stress
People tend to lump all stress into the same basket. But the truth is that different forms of stress affect people differently.
In the case of the pandemic, increased stress related to Covid-19 is not necessarily pathological. Stress in response to a potentially life-threatening situation can actually be adaptive. In my view, the reported increases in anxiety and depression were a classic case of mental health professionals overpathologizing completely normal human emotional responses.
Of course, people were worrying more and not doing some of the enjoyable things they did before the pandemic. But concluding that this represented an increase in mental illness was a stretch. It lacked the context of why that stress was happening and how it would manifest itself.
Increased access to care
Although it wasn’t part of my prediction at the time, it’s clear to me now that telehealth and access to health care have played a major role in helping people through mental health issues amid the pandemic.
In an effort to keep doctors and patients safe, many states eased restrictions on telehealth, which made it significantly easier for people to access care and receive therapy — especially for mental health. But now that the pandemic is — hopefully — slowing, some states are beginning to undo some of the changes that made telehealth more accessible and return to a pre-pandemic status quo.
As expected, that’s coming with a lot of anxiety from patients and caregivers, especially in light of data that suggest patients strongly want to keep telehealth as a way to access treatment. The Ohio State Wexner Medical Center, where I work, is doing about 3,000 telehealth appointments per day, up from an estimated 50 such visits a month before the pandemic, and we really don’t see that changing. Returning to prepandemic restrictions on telehealth would mean closing a lot of patients out of treatment, especially those who cannot easily access in-person treatment, which could contribute to an increase in suicides.
How we return to “normal”
As the country tries to navigate its way out of the pandemic, cultural shifts and health care changes could have a drastic impact on whether it maintains the current rate of suicide or sees an increase in a post-Covid-19 world.
In the same way that people experienced changes in their stressors when they moved from work or school to home, people may experience increased stress and a reduction in some of their newfound healthy behaviors as they return to work or school. Hopefully the school or workplace landscape has changed, which would offset the return to the status quo.
For instance, reports indicate that companies and employers are having a hard time filling open positions, especially in the service industry, leading to higher salaries and benefits. Higher wages and improved access to health care are associated with reduced suicide risk, so that shift could help suppress suicide rates moving forward.
Suicide numbers in the future will depend on how much society attempts to return to the status quo. By simply restructuring our lives as they were before the pandemic, suicide rates will likely shift back to the previous patterns. But I’m hopeful that we can change certain facets of our lives as an adaptation to the pandemic and continue seeing declining suicide rates in the years to come.
Craig Bryan is a clinical psychologist at The Ohio State University Wexner Medical Center, director of the school’s Division of Recovery and Resilience, and director of trauma and suicide prevention programs at The Ohio State University College of Medicine.
If you or someone you know is considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (Español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.
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