Study of COVID-19 deaths challenges claims, understanding of pandemic-era suicides
Narratives behind numbers point to need for better coordination, support by employers, communities, public health leaders in future crises, especially mental health
In what is believed to be the first study of its kind, University of Michigan researchers
dug deeper into the numbers-only data of COVID-19-era suicides and evaluated the narratives
contained in reports from coroners, medical examiners, police and vital statistics.
The researchers sought to understand how the crisis influenced suicide deaths in the
first year of the pandemic, how the response by governments, employers and others
influenced individuals, and if their handling could inform future public health responses.
"Our study adds much-needed context and meaning to the data that have assumed the
deaths are linked to the pandemic strictly because of when they occurred," said Briana Mezuk, professor of Epidemiology at the University of Michigan School of Public Health
and the Center for Social Epidemiology and Population Health.
"We felt it was important to delve into the narratives of these deaths, rather than
using numbers alone, to learn what roles the pandemic and the public health response
to the pandemic might have played in these lost lives."
In looking at the deaths of individuals 10 years old and above, the researchers found
that 6.8% of suicide deaths in 2020, representing 2,502 cases, described an aspect
of the pandemic, and 20% had no known circumstances described in death reports.
"Although many individuals experienced heightened emotional distress during that time,
and some had feared this would lead to greater suicide mortality in 2020, no overall
increase materialized in most countries, including the US," said Kara Zivin, professor of Psychiatry at Michigan Medicine and professor of Health Management
and Policy at the School of Public Health.
The study appeared in the PLoS One, Public Library for Science One, and was a collaboration
between the School of Public Health, Department of Psychiatry in U-M's Medical School,
School of Information and Institute for Social Research Population Studies Center.
"Scientific studies have just begun to explore this data and the consequences of the
pandemic using rigorous scientific studies, including population mental health," said
Mezuk, who is also co-director of Eisenberg Family Depression Center Data and Design Core.
"These narratives often contain information regarding circumstances in the decedent's
life that are salient to their death, including psychosocial factors such as recent
difficulties in relationships, work or school, as well as mental and physical problems."
In looking at the narratives, the researchers found that the reasons behind the suicides
are complex and that mental health may have been overlooked as the crisis unfolded.
"We were able to describe a variety of pandemic-related circumstances that were present
in the lives of suicide decedents at the time of their deaths," Zivin said. "Although
our study confirms prior work that the COVID-19 pandemic did not lead to an excess
in suicide mortality in 2020, that does not mean that the pandemic wasn't related,
in some way, to the deaths that did occur that year."
To unwind stories behind the deaths, the researchers used the CDC's National Violent
Death Reporting System, which compiles death reports and vital statistics and uses
that information to write text narratives that describe the circumstances in the person's
life at the time of their death.
The registry fills an information gap in suicide mortality research, which typically
has little access to information behind the numbers. The registry does not identify
individuals by name or include details that would reveal identities. A time-series
analyses examine how the timing of suicide deaths, over the calendar year, differed
in 2020 compared to the pre-pandemic period.
Suicide is the 11th leading cause of death in the US.
As the fifth anniversary of the official beginning of the pandemic in the US approaches,
Mezuk said she realizes that COVID fatigue may have caused the public to tune out.
"Maybe everyone has moved past COVID in some ways, myself included, but we still have
much more to learn, especially to know what to do differently in times of future public
health crises," she said. "What we learned signals a need for empathetic public health.
"What happened in 2020, people being told you can't go outside, you can't see people
outside your home, you can't work for some. We have no precedent in living memory
for this situation and how it affected people. What we do with that now and going
forward is important. I hope our study can help contextualize suicide mortality during
the acute phase of the COVID-19 pandemic and inform mental health promotion efforts
during future public health emergencies."
Study: “Psychosocial and pandemic-related circumstances of suicide deaths in 2020: Evidence from the National Violent Death Reporting System.” PLOS ONE. DOI:10.1371/journal.pone.0312027
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