CW: Suicide, Mental Health, Lockdowns. If this blog raises issues for you, here is a list of international helplines where you can get some help.
This year has been a hard one, there is no doubt. Usually, we get to December and I’m writing articles about Christmas cake and losing weight, or whether you’ll stick to your new year’s resolution, or perhaps summing up the fun and games of bad science reporting in the last 12 months.
Instead, we’re here talking about suicide. Not an easy topic.
There has been a common claim throughout this year, repeated endlessly by COVID-19 denialists and anti-regulation activists, that any form of government restriction will cause horrible waves of suicide. Many earlier in the year took to saying that there would be a “tsunami” of suicides due to lockdowns, as declines in mental health during COVID-19 began to become apparent.
Now, while suicide data often takes time to accumulate, a number of published studies and government reports are out looking at the question of whether lockdowns have been associated with an increase in the rate of suicide across the world.
And in general? They haven’t been.
A Heavy Topic
Right at the outset, I should make some things clear. Firstly, this data is aggregated at the population level, and by definition cannot speak to individual experience. What that means is that it is entirely possible that lockdowns have caused some people to die of suicide, even if on average there has not been an increase. If this is the case, however, then by definition lockdowns have also prevented some suicides, if the rates have not gone up.
This leads into the second important point, which is that anecdotes do not provide us with much data here. There are many people who die of suicide for many reasons, and the stories of individuals, while often heart-breaking, do not really tell us if the laws have had an impact overall.
Moreover, this piece is not about mental heath more broadly. We know that mental health has been impacted by COVID-19 and lockdowns alike — here we are just looking at one, specific question, which is whether there have been large increases in suicide due to lockdowns in 2020.
So, on to some evidence.
There have now been three studies published by states in Australia looking at suicidality during and after lockdowns and more broadly during COVID-19. In general, there has not been an increase in suicide in Queensland or New South Wales even during their lockdowns, which both lasted several months.
But what about Victoria? The state with the infamously long lockdown, that lasted 6 months of the year, and has been called the most severe lockdown in the world outside of Wuhan.
There was no increase in suicide rates in Victoria during 2020 at all. Even during lockdown, the numbers are remarkably similar to last 2019.
There is now some published research on Peru, which looks at suicides, homicides, and car accident deaths during their lockdown. Overall, mortality dropped for all three of these causes of death, with suicide rates dropping particularly fast for women during lockdown.
While there is limited data for the US, because the country takes a lot of time to record suicide deaths properly, there is some data trickling in from some states. One published study looked at Massachusetts, and found that the rate of suicide during the lockdown of that state, which was one of the toughest in the country, did not increase at all. It may have declined slightly.
Japan is actually a fascinating counterexample. While the country never officially locked down, schools closed down early on in the pandemic and there were quite a few restrictions at the time. Later on in the year, the government took a more relaxed approach to COVID-19, with fewer restrictions implemented in the second wave.
And suicide? Well, during the first wave rates fell by a reasonable percentage. As the second wave loomed, they climbed rapidly and have stayed high. Moreover, closing schools was associated with a statistically significant decrease in the rate of suicide in children. The authors speculated that this may have been due to the reduction in overwork for adults and children.
While data from England is somewhat patchy, a single study did look at suicide rates before and after lockdowns in the country. There did not appear to be a change in the rates of suicide in the 9 million or so people covered in this analysis during or after the country’s lockdown earlier this year.
The final example on this list is Norway. From the national lockdown’s beginning in March to end in May, there was a fairly large drop in the monthly suicide rate that was nevertheless not statistically significant. In other words, the lockdown may have actually prevented suicides when it was implemented.
Overall, there does not appear to be an immediate increase in the suicide rate associated with the implementation or continuation of government restrictions to control COVID-19. In some places, there may be a modest reduction associated with these lockdowns, although this is likely to be quite short-lived. As more data starts to come through early next year, we will get a better picture of the impact in other places in the world.
This does not mean that lockdowns don’t cause mental health problems. Suicide and mental health are of course very closely intertwined, but they are also both more complex than each other. It is not entirely surprising that suicide would not increase during lockdowns, because there are environmental and other factors that can impact suicide rates as well.
Moreover, this doesn’t mean that suicide rates will stay low. It’s possible that places which locked down harder will be hit at some point in the future with higher rates of suicide — we just don’t know. It’s important to remember that a big driver of suicidality in many places is economic downturns, and we may not see the impact of these for some time.
We also can’t discount the impact of the pandemic itself. The evidence from Japan indicates that a huge rise in COVID-19 cases may itself be associated with a large rise in suicides, even without substantial government action. This echoes evidence from the International Monetary Fund which found that the economic impacts of an out-of-control epidemic may substantially outpace the issues caused by government actions themselves.
Ultimately, what we can see so far appears to be quite good news. While mental health issues are certainly on the rise, government action itself does not appear, in the datasets published so far, to have resulted in a huge number of suicides yet, and given the evidence from Victoria there’s every reason to believe that this will continue into the future.
The tsunami of suicides that some were expecting has probably not happened.
Let’s hope it never does.