Suicide and COVID-19: The time for suicide prevention is now
Highlighting an interview with the American Association of Suicidology (AAS), Beacon Health Options posted a blog in September about the potential impact of COVID-19 on suicide rates in the United States. The blog pointed out that suicide data from 2018 — the most recent we have on suicide trends — can tell us little about anything today, such as a reaction to the pandemic, making it difficult to inform prevention efforts.
Japan has made recent headlines regarding its suicide rate in October of this year: more people died from suicide in that month than from COVID-19 over the entire year to date. However, it’s more than a very high monthly suicide rate that makes Japan stand out. Japan is one of the few major countries to release timely suicide data, which means that this information could provide global insights on the pandemic’s effect on our mental health.
In the AAS interview, Colleen Creighton, CEO of AAS, stated: “We need to see trends before they happen. That means we need a coordinated national strategy to get that real-time data,” an important goal of the AAS. Here we have hard proof of those trends, and there’s no time to be lost in accelerating that national suicide prevention strategy.
More about suicide in Japan
Japan historically has had high suicide rates, often explained by long work days, social isolation, academic pressure, and the stigma associated with mental health. Consequently, some people might argue that Japan may not be the best barometer to gauge possible global suicide trends due to COVID-19. However, for the 10 years leading up to 2019, Japan’s suicide rate had gone down. Last year, the country recorded approximately 20,000 suicides, the lowest number since Japan started to track this data in 1978.
Interestingly, COVID-19 reversed that downward trend, with women disproportionately affected. Explanations include women holding more part-time hotel, food service and retail positions, positions most affected by layoffs. Additionally, childcare burdens and worry over their children’s wellbeing often fall on women.
Children in Japan are affected as well. Suicides among youth younger than 20 have been increasing since before the pandemic, and the pandemic has only increased pressure on youth. Many suffer abuse at home as they quarantine and feel the burden of falling behind in school work. Children as young as 5 are calling a crisis hotline started by a 21-year-old college student in March, which gets approximately 200 calls a day.
What can we learn from Japan?
Presumably, the United States has to wait until 2022 to understand the pandemic’s effect on suicide rates in this country. In the meantime, many lives will be lost. However, we can safely assume – based on Japan’s experience and the experience of past pandemics such as the Spanish Flu – that suicide rates will rise due to COVID-19.
Now is an opportunity to refocus our conversation around suicide. Below are a few thoughts to help jumpstart that conversation.
- Take a deeper look at the dynamics of suicide. We make a lot of assumptions about suicide, such as the long-established belief that there is a linear relationship between mental illness and suicide. Several years ago, the CDC released a report indicating that many people who had attempted or died by suicide did not have a known pre-existing mental health condition at the time of death. A similar dynamic is playing out during the pandemic. For example, there has been a rise in suicide ideation among youth but not a rise in suicide deaths for this age group. Youth are feeling particular stress during the pandemic, and anxiety is a realistic reaction to stress, stated Dr. Jonathan Singer of the AAS in Beacon’s September blog.
- Start collecting real-time data. Real-time data is critical to understanding people at suicide risk. Research is focusing on the role of technology to retrieve that real-time data, which is starting to challenge long-held assumptions about suicide, says Dr. Singer. For example, Ecological Momentary Assessment technology has helped us to learn that someone with a recent history of suicide attempt can fluctuate between no risk and high risk several times in a 24-hour period, important data that inform our efforts to understand the role of impulse and planning in suicidal behavior.
- Include all voices to understand suicide. Suicide ideation and impulse are not necessarily the same for all demographic groups. The reasons for suicide attempts and deaths among older White males may well be different than for young Black females. In order to understand the gaps in care and suicide prevention efforts, we need to understand the different trends as experienced by different groups of people, especially those people who have survived suicide attempts.
- Rethink how we deliver crisis services. Suicide by its very definition is a crisis. Communities must ensure they have a behavioral health crisis system that acts as more than a safety net. An effective crisis system supports individuals through all phases that lead up to and follow a crisis. The five phases of system involvement include prevention, early intervention, acute intervention, crisis treatment, and recovery and reintegration. (To learn more about a reimagined behavioral health crisis system, read Beacon’s blog on the topic here.)
We can’t let the two-year data lag stop our suicide prevention efforts. Japan is a current reminder of the urgency of those efforts during these unusual times.