David Baxter PhD
Many assumed suicides would spike in 2020. So far, the data tells a different storyRobson Fletcher, CBC News
Feb 9, 2021
People who study suicide say it's a complex phenomenon that defies easy answers
Dr. Tyler Black is a psychiatrist who specializes in the study of suicide at the University of British Columbia. (Screenshot/Zoom)
Widespread assumptions that suicide rates would increase during the pandemic are not supported by the growing amount of evidence coming out of Canadian provinces and other jurisdictions around the world, say experts who study the topic.
"It's a good example of how sometimes the story we tell ourselves, we look for reasons to support it, and we don't always use the data," said Tyler Black, a psychiatrist and suicidologist with the University of British Columbia.
"When we look back at the numbers, it just doesn't pan out the way we thought."
Numerous public figures have claimed a link between public-health restrictions and increased suicide rates, without evidence to back it up. Some merely speculated about it early on in the pandemic, while others have made stronger claims more recently.
Ontario MPP Roman Baber was kicked out of the Progressive Conservative caucus in January after sending an open letter asserting public-health restrictions were "causing an avalanche of suicides," among other claims.
But Black pointed to recently released data out of Alberta, British Columbia and Saskatchewan that suggest suicide rates actually declined in 2020. He also noted coroners in Quebec and the chief medical examiner in Newfoundland and Labrador have recently said there were no increases in suicide in those provinces last year.
Data from Ontario and other provinces is still forthcoming, and Black cautions that counting suicide deaths always comes with some degree of uncertainty, as investigations into both cause of death and a person's intentions can take a long time.
What the early data tells usStill, Black said the data we have, so far, suggests the pandemic's arrival in 2020 didn't bring with it a surge in suicides.
"There might be small fluctuations because there are inquests and investigations ongoing," he said. "But they're likely not large enough to substantially change the results."
Alberta saw a particularly noticeable decline, according to preliminary data compiled by the province in late January, which shows 468 deaths by suicide in 2020.
That compares with more than 600 deaths in each of the previous four years.
Alberta considers the data for both 2019 and 2020 to be preliminary, as the office of the chief medical examiner may still make adjustments as death investigations continue.
Robert Olson, a research librarian with the Calgary-based Centre for Suicide Prevention, said the decline is striking, nonetheless.
"The difference between 2019 and 2020 is pretty large," he said. "So I can't see a big difference between the preliminary numbers now to the official numbers [later]."
Saskatchewan, too, saw a significant decline in suicides last year, according to provincial data with similar caveats. That province recorded 134 deaths by suicide in 2020, compared with an average of more than 200 over the previous four years.
B.C. hasn't released full data for 2020 yet but preliminary, year-to-date figures from January to August were lower last year than in 2019.
Researchers say this isn't out of line with what's been observed during past calamities.
Suicide is complicatedBlack said it's absolutely true that levels of distress have increased amid the pandemic and the public-health restrictions that have upended virtually everyone's life.
But he said suicide is nothing if not a complicated phenomenon, and some people were making "quite strong shortcuts" in believing that would necessarily result in more deaths by suicide.
"As someone who studies suicide a lot, I care about distress very much," he said. "But there's not a straight line between distress and suicide."
Various distress centres have reported increased call volumes during the pandemic, but Olson said that can actually have an upside.
"That suggests to us that people are reaching out," he said.
"And that helps offset suicide deaths."
Black said another factor is a "a well known phenomenon called the pull-together effect," which has been seen during disasters or other situations where an entire community is affected by a hardship that demands collective action.
"The pull-together is counter-intuitive," Black said. "When we're distressed and we're all trying to do something together for society for the benefit for others, it actually does significantly decrease suicide rates."
A third factor, in Olson's view, is the relatively strong financial and social supports governments in Canada have provided during the pandemic.
He said researchers who issued forecasts and warnings early in the pandemic about the risk of suicide increasing amid public-health restrictions that affect people's lives and livelihoods typically came with a big caveat.
"And the caveat they often often suggested was: 'unless the government intervened with social supports,'" he said.
"That was done, I think, really well in Canada. So I think that is a major reason why we have seen a decline in suicide rates."
Overdoses on the riseAt the same time, there has been a significant rise in the number of overdose-related deaths during the pandemic.
Black said some overdose deaths can end up being classified as suicides, but it's often quite difficult for investigators to determine the intent of a person who dies from opioid poisoning or other illicit substances.
"They could have been using it recreationally; they could have been using intentionally to hurt themselves; they could have been using it recklessly; or they could have been using it in a moment of despair," he said.
"You can't really be certain, because the person who could answer the question can't do it, so you have to try to piece it together. And, usually when they make a determination, they do it on the preponderance of all the evidence."
A 2018 study in Alberta suggested the increase in death accompanying the opioid crisis was primarily due to unintentional poisoning, rather than intentional self-harm.
Concerns have also been raised about an increasingly toxic supply of opioids in 2020, as the pandemic disrupted international supply chains of the drug.
What the future holdsIn general terms, Olson noted there has been relatively little study about the effect of pandemics, in particular, on suicide.
He said the decrease in suicide rates that has sometimes been observed after major disasters is not a "hard-and-fast rule," and the most robust studies on the topic have been on natural disasters such as hurricanes and earthquakes, not widespread outbreaks of disease.
He noted another name for the phenomenon is the "honeymoon" phase, because the decrease in suicide rates is usually not permanent.
Robert Olson is a research librarian with the Calgary-based Centre for Suicide Prevention. He says there has been relatively little study about the effect of pandemics on suicide rates. (Screenshot/Google Meet)
A recent paper in the scientific journal Nature Human Behaviour found evidence that the suicide rate in Japan declined in the early stages of the COVID-19 pandemic, but then rose again amid the second wave of the virus.
The authors note that "reliable empirical evidence regarding the link between the COVID-19 pandemic and suicide mortality remains scarce."
Black said there is always variance when looking at suicide rates around the world, but so far there doesn't appear to have been a major increase in suicides globally. If anything, he said the emerging data so far seems to suggest the opposite.
"We've seen some jurisdictions report higher rates. We've seen most report around average rates. And, if there's anything that's not normal, it's tended to be in the lower rates," he said.
It's something he said researchers, including himself, will continue to monitor closely.
But he believes the numbers we have, to date, for 2020 are worth noting because they run counter to a narrative that had developed about allegedly skyrocketing rates of suicide during the pandemic.
"People were able to say whatever they wanted about suicide, because we didn't have numbers for months. And there was a lot of political maneuvering around the use of suicide as a device, to either end lockdowns or end restrictions," Black said.
"So I hope it's a wake-up call that we need more real-time monitoring of cause of death."
If you are thinking of suicide or know someone who is, help is available nationwide by calling the Canada Suicide Prevention Service toll-free at 1-833-456-4566, 24 hours a day, or texting 45645. (The text service is available from 4 p.m. to midnight Eastern time).
If you feel your mental health or the mental health of a loved one is at risk of an immediate crisis, call 911.