Although we don’t know exactly what has led to the overall reported declines and increases in suicide rates, experts believe the COVID-19 pandemic may have played a part. “It’s been clear throughout the pandemic that the overall impact on the population’s mental health has been significant,” says Christine Moutier, MD, Chief Medical Officer at the American Foundation for Suicide Prevention (AFSP).
A Mental Health Pandemic
During the pandemic, about 4 in 10 adults in the US have reported symptoms of anxiety or depression, compared to one in 10 adults who reported between January and June 2019. “Experiences such as depression, anxiety, and suicidal thoughts have been more prevalent during the COVID-19 pandemic, particularly for youth and young adults, caregivers, frontline workers, and Black, Indigenous, and People of Color (BIPOC) populations,” says Dr. Moutier. But when it comes to suicide death rates, the situation is complex. “Suicide rates are greatly impacted during times of national tragedies or major world events,” says Julian Lagoy, MD, a psychiatrist with Community Psychiatry and MindPath Care Centers. For instance, four years after the 9/11 terrorist attacks in New York City analyses of death records showed there was no increase in suicide rates. “This may be because there was a general sense among the population of ‘we are all in this together,’ " Dr. Lagoy says. Dr. Moutier adds that even when distress is high, suicide isn’t a foregone conclusion, because help seeking can also rise, and during periods of community-wide distress, cohesion and interpersonal connectedness increase, which can mitigate against suicide risk. She also stresses that it’s important to understand that COVID-19 and associated mitigation efforts such as physical distancing alone don’t cause suicide. “An individual’s personal risk factors combined with precipitants such as evolving experiences with isolation, depression, anxiety, economic stress, suicidal ideation, and access to lethal means may lead to periods of increased risk of suicide,” she explains. We may not understand the entire impact of COVID-19 on suicide deaths for the long-term, because suicide mortality data takes time to collect and analyze. Plus, the pandemic is not yet over. Another consideration is the time lag that often occurs in the manifestation of distress—this can be months after a traumatic or stressful period is over, says Dr. Moutier.
Customizing Suicide Prevention Efforts
The increase in suicide rates among BIPOC populations can be linked to the fact that they face more challenges and stressors compared to white people. “BIPOC individuals were also more likely to lose their jobs and be financially disadvantaged by COVID-19 than the general population,” says Dr. Lagoy. He adds that it’s important to recognize that suicide prevention shouldn’t be a one-size-fits-all approach. “Everybody is different and suicide prevention strategies and tactics must be unique for each person,” he says. “Although there are shared characteristics and risk factors, anybody who has attempted or died by suicide should not be treated like a number but as an individual.” Dr. Moutier agrees that customized suicide prevention efforts are critically important, and points out that these are more likely to be effective if they are based on and reflect the specific needs as well as beliefs of the demographic groups they are trying to reach. When implementing suicide prevention efforts, it’s important to consider various aspects of an individual’s identity, such as race, ethnicity, education, physical and mental health, gender/sexual identity, and religion. “More research is needed to better understand the specific risk factors and prevention strategies that work for each community,” Dr. Moutier says. “Partnerships should include diverse representation of mental health care providers and community stakeholders including people and family members with lived experience.” As we plan for post-pandemic times, Dr. Moutier hopes the new CDC data will encourage initiatives such as the American Foundation for Suicide Prevention’s (AFSP) Project 2025 to embrace stronger evidence-based suicide prevention practices. “For example, primary, behavioral care, and emergency departments are critical settings where coordinated suicide prevention strategies can have a dramatic impact on saving lives,” she says. “Basic screening and suicide risk reducing care steps, educating providers about suicide prevention, and collaborating with key accrediting professional organizations, can improve the acceptance and adoption of screening and preventative intervention as the standard of care.”
See our National Helpline Database for more mental health resources.
