COVID-19 and Suicide: Prioritizing Our Well-Being

This blog post was featured on MSU SciComm on April 29, 2020. The original post can be found here.

Over the last couple of months, COVID-19 has dramatically altered our norms and routines. As we each do our part to fight the spread of this virus by staying home and washing our hands, it is also an important time to focus on our social and emotional well-being. This was highlighted in a recent town hall about the pandemic in which President Trump suggested that continued social distancing would lead to “suicides by the thousands” in the U.S., due in part to economic distress. Though presented inaccurately, this comment raised concerns in the media and the public.

What the Data Say

When it comes to national suicide rates, two things are simultaneously true. First, data show that suicide rates can increase during times of economic distress (Chang et al., 2013; Reeves et al., 2012). For example, we saw increased rates of suicide during the Great Depression era and research shows that economic hardship and poverty are associated with increased suicide rates. Second, data also show that suicide rates can decrease during times of national crisis (Joiner, 2005; Lester, 1994). For example, we saw lower rates of suicide during World War II and immediately following the terrorist attacks on September 11, 2001. Recent news pieces across the political spectrum have attempted to compare the current pandemic situation to these times in order to forecast how suicide rates might be impacted. The short answer is we don’t know.

The COVID-19 pandemic cannot easily be compared to the economic instability of the Great Depression or the social connectedness of the World War II era. It is neither an economic crisis nor a social crisis. Rather, it is an unprecedented situation that lies somewhere in between. 

Suicide is multi-faceted, and two factors are relevant to discuss here: economic instability and social connectedness. Economically, we are in a similar situation to the Great Depression era with unemployment and financial insecurity soaring across the country. This can certainly contribute to suicide risk, and multiple studies demonstrate this. Socially, we are more connected as a society than ever before, and there is a sense of camaraderie that stems from a common crisis and shared experience of a crisis—both of which can reduce suicide risk. Many studies demonstrate this as well. 

What the Research Says

One way to view these seemingly incongruous findings is through the lens of the Interpersonal Theory of Suicide. This is the leading theory in the field of suicidology and was developed by Thomas Joiner in 2005. The theory posits that there are three factors that must converge in order for death by suicide to occur: 

• Thwarted belongingness (a lack of belonging or feeling alone)
• Perceived burdensomeness (feeling as though one is a burden to others), and
• The acquired capacity to enact self-harm (overcoming the inclination toward self-preservation in order to harm oneself). 

Times of economic instability can increase perceived burdensomeness by increasing reliance on social safety nets and loved ones and being unable to meet one’s basic needs. Not being able to provide for one’s family and overwhelming stress can also exacerbate these feelings. This likely explains increased rates during economic uncertainty. 

On the other hand, in times of national crisis such as wartime and natural disasters, thwarted belongingness tends to decrease due to a sense of camaraderie and feelings of being “in this together.” Many people feel a sense of duty for the common good (be it patriotism or public health), which adds to a sense of purpose and can decrease perceived burdensomeness in people. These likely explain reduced rates during national crises. 

Our current situation is unprecedented and there are no data on this particular situation to compare to. Some research suggests that suicide rates increased during the Great Influenza Epidemic in the United States between 1918 and 1920 (Wasserman, 1992). However, data are hard to come by, the global and national economy looked different, and the social landscape was different. 

What it Means

The main point takeaway from the research is that we simply do not know how the current pandemic might influence suicide rates. As such, stating that rates will either increase or decrease is inaccurate. In particular, though, stating that rates may increase in any sort of definitive way can be dangerous because it increases anxiety and stokes fear. In addition, research demonstrates that talking about suicide as something that is inevitable can normalize it and present it as an option for people, which could then increase rates.  

From an epidemiological perspective, returning to business as usual too soon to alleviate economic strain will prolong the duration of the virus, can create another uptick in cases, and therefore extend both the economic and social ramifications of COVID-19. Moreover, physicians have higher rates of burnout, depressive symptoms, and suicide risk than the general population. Therefore, it is more important than ever to follow the CDC’s guidelines for social distancing and hygiene in order to flatten the curve of infection and decrease the burden on our healthcare systems.

Suicide is a complex issue impacting tens of thousands of Americans each year. Therefore, it is imperative that we prioritize physical, social, and emotional health in these times. As a country, prioritizing economic stability over social and emotional well-being is dangerous. Prioritizing markets over people is dangerous. Our elected officials must promote the general welfare for everyone. Anything less is negligent and irresponsible.

If you or someone you know is struggling with thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text the word TALK to 741-741. Know that help and resources are available, and you are never alone. 

Corbin J. Standley is a Ph.D. Student in Ecological-Community Psychology. Read and learn more about his work at www.CorbinJStandley.com.

Master's Thesis

Social Support as a Protective Factor for Youth Suicide: An Intersectional and Socioecological Approach from Corbin J. Standley

SB228 Legislative Testimonies

April 11, 2019
Michigan Senate Health Policy and Human Services Committee

Corbin J. Standley - Senate Bill 228 Testimony

June 20, 2019
Michigan House Health Policy Committee

Corbin J. Standley - Senate Bill 228 Testimony

Reading More in 2019

One of my goals for 2019 is to read for leisure more. These are the books I read for leisure in 2018 (two of which are somewhat related to my work but were not read for classes or research specifically) and some of my thoughts on them. I welcome any book recommendations! I typically lean toward non-fiction but am open to any recommendations.

1. The New Jim Crow (Michelle Alexander): I started this in 2017 and finished it over the summer. I knew about many of these issues before, but I learned a lot more about the connections between Jim Crow-era laws, the War on Drugs, racism, and modern-day mass incarceration as a result of reading this book. I definitely recommend it!

2. Between the World and Me (Ta-Nehisi Coates): A collection of essays to his teenage son, Coates uses his prose to discuss the realities of being Black in the United States. This is a literary form I don't typically gravitate towards, but I really enjoyed this book. Coates brings a very personal lens to issues of race and inequity in a powerful and very compelling way.

3. Why People Die by Suicide (Thomas Joiner): This book was most relevant to my own research. One of the leading names in Suicidology, Dr. Joiner discusses his interpersonal theory of suicide. I reference and cite it often and recommend it for anyone interested in suicide prevention work.

4. iGen (Jean Twenge): This is the one I feel most conflicted about. Dr. Twenge's main argument is that the post-millennial generation is growing up more slowly, more depressed (and suicidal), and less prepared for adulthood due in large part to smart phones and social media. While I agree with some of her points, she cherry-picks studies supporting her pre-conceived viewpoints, overly relies on correlational research to draw causal conclusions, and comes to conclusions that tend to contradict each other. I would classify this as pop psychology and approach it with caution.

5. White Fragility (Robin DiAngelo): Dr. DiAngelo powerfully discusses privilege and the ways in which it inhibits us from confronting racism--particularly in ourselves--and does so with stunning clarity. I haven't quite finished the book yet as it's very stirring and requires a lot of self-reflection and introspection, but I have learned so much from it.

6. War on Peace (Ronan Farrow): As I've been increasingly interested in foreign policy and diplomacy, this book was a great way to start. Dr. Farrow discusses the increased militarization of American foreign policy and the decline of diplomacy. It was a fascinating read going back several administrations and his writing style kept me intrigued throughout.

Suicide Rates are Rising: Where Do We Go From Here?

Yesterday, the CDC released its annual mortality rates reports, including its report on suicide mortality for 2017. Overall, we've seen a 33% increase in suicide deaths in less than 20 years, and the increase from 2016 to 2017 was the sharpest increase in 50 years. Rates have increased across genders and ages, except for those over age 75. We also see that suicide rates in rural counties are 1.8 times those of urban counties. All of this is despite the fact that suicide rates are decreasing in most other places around the world.

What does this mean? It means that we're not doing NEARLY enough, and that the research, prevention, and advocacy fields have a long way to go. With this report and the USA TODAY series on suicide released on Wednesday, it's been a hectic week of news and reflection. Here are some of my thoughts on moving forward:

1. Suicide is not just a mental health issue. Most people with mental health conditions do not die by suicide, and recent data suggests that 54% of those who die by suicide did NOT have a known mental health condition. We need to go beyond the individual level and stop pathologizing suicide and suicidal behaviors. Multiple individual, social, and environmental factors (e.g. substance use, financial issues, relationship problems, etc.) have been shown to increase suicide risk, and that's where we need to increase our focus.
2. We need to move beyond examining risk factors. We know what the risk factors are, but comparatively little research has examined the role of protective factors in curbing rising suicide rates.
3. We need to be better at crisis intervention. We need to be proactive about prevention, train communities to recognize the warning signs and intervene safely and effectively, and place the responsibility on us. Those in crisis should be encouraged to reach out, but it's on us to reach out to others, listen, and take care of each other.
4. We need to better translate research into action. Recently, I received an email from a fellow suicide researcher via a listserv. In short, the email stated that researcher had some new findings related to a suicide intervention question that has long plagued the field of suicidology. The researcher was hesitant to post these findings in response to a specific question because the paper had not yet been published. The email troubled me, and it's one of the biggest issues I have with academia. Particularly in suicidology, research has very real potential to save lives, and thus should be shared widely. I don't fault the researcher, but rather the culture of academia and science in general. We need to use our research to inform practice to save lives, and we need to do so more quickly.
5. Researchers need to become advocates. In a recent piece I wrote for the American Foundation for Suicide Prevention, I mentioned the need for researchers to use their knowledge and their voice to inform change. For too long, researchers have stayed siloed in their fields without translating that research into meaningful policy. Over the last year, I've been very engaged in political advocacy. I've gone into these meetings with a clear, constructive message and specific, concrete next steps, all informed by my own research and research in the field of suicide prevention. While not every meeting results in support, I've found the strategy to be effective both in Lansing and in D.C., and it has resulted in increased partnerships and policy change for the better (the recent passage of the H.R. 2345 and the introduction of H.B. 6252 are two examples). I mention all of this to say that not only can we use our research and expertise to inform policy change, but I feel that we have an obligation to do so. The research and science are so much more impactful if they can be translated into policy that results in positive change for communities, though it may take a lot of work and time to make that change a reality.
6. We need to better fund suicide research. Suicide is currently the tenth leading cause of death
   nationally, yet we invest much more money into research for conditions with far lower mortality rates. The NIH spent $68 million on suicide research last year, but spent nearly five times that on sleep research alone. Only by actually investing in research and prevention can we make the strides needed to #StopSuicide.
7. We need to promote and support resources. Not only do we need to promote invaluable resources like the National Suicide Prevention Lifeline, the Crisis Text Line, and the Trevor Project, but we need to do more to support these resources. We also need to better promote the missions and visions of organizations like the American Foundation for Suicide Prevention and American Association of Suicidology, and continue donating money to these lifesaving organizations.

Along with a societal mindset shift, these are just a few of the things we need to do in order to make the change we want to see. Suicide prevention is a frustrating and exhausting field to be in at times, but I do know that we have the expertise and passion to make a difference. The next step is turning that into action.

If you or someone you know is struggling with thoughts of suicide, please call the National Suicide Prevention Lifeline at 1–800–273–8255 or text TALK to 741–741. If it is an immediate crisis, please dial 911. For more information and resources, visit www.afsp.org.