Why the US Suicide Rate Decreased During the Pandemic

While mental health worsened during the pandemic and suicide 'ideation,' or communication about it from distressed people increased, actual suicide declined. 

Mental health professionals believe the reason for the decline was the sense of common purpose that the pandemic engendered and, despite fears of the impact of loneliness during quarantines, social media and telephonic communication did a lot to enhance the sense of community, thereby reducing suicidal desire. JL

Kathryn Gordon reports in Psychology Today:

Mental health worsened for many people in the U.S. during 2020—especially for those facing health- and financial-related distress.  (But) the number of suicides decreased by 5.6%. The decline may feel counterintuitive in the context of the rising U.S. suicide rates in recent years and the social, economic, and political stresses faced by many people in 2020. While some people became more isolated during the pandemic, others grew closer to their families and friends. Many shared their struggles privately, via social media and popular press. Stress can feel more bearable when they are not the only ones going through it.

Preliminary 2020 data for U.S. mortality causes were published last week. A startling statistic revealed an estimated 17.7 percent increase in deaths from 2019 to 2020. Approximately 344,323 (10.3 percent) of those lives were lost directly due to COVID-19.

While deaths related to heart disease, unintentional injury, diabetes, stroke, and Alzheimer's disease reportedly increased from 2019 to 2020, the number of suicides seemed to decrease by 5.6 percent. The decline in suicides may feel counterintuitive in the context of the rising U.S. suicide rates in recent years (with the exception of a decrease from 2018 to 2019) and the significant social, economic, and political stresses faced by many people in 2020. 

Suicide Rates Decreased but Suicidal Ideation Increased

Despite the apparent decrease in suicides, heightened stress took a toll on mental health. A CDC survey conducted in June 2020 found that 40.9 percent of participants reported at least one mental health issue, including symptoms of depression, anxiety, or trauma- and stress-related disorders. Participants also reported greater use of substances to cope with stress, which may have contributed to the increase in drug overdose deaths from 2019 to 2020. Self-reported anxiety and depression symptoms were three to four times higher in 2020 than in 2018.

Additionally, 10.7 percent of participants reported that they had seriously considered suicide in the past 30 days. Rates varied by demographics and occupational group, with 25.5 percent of young adults, 18.6 percent of Hispanic respondents, and 15.1 percent of Black respondents reporting seriously considering suicide in the past 30 days. Unpaid caregivers of adults and essential workers also reported higher levels of suicidal ideation, 30.7 percent and 21.7 percent respectively. This is approximately twice the rate of self-reported past-year suicidal ideation in 2018. Data collected from Gallup and Pew Research painted similar pictures: Mental health worsened for many people in the U.S. during 2020—especially for those facing health- and financial-related distress.

How can the prevalence of suicide desire go up while the number of suicide deaths goes down? Klonsky and May’s (2015) Three-Step Theory (3ST) offers a framework for understanding the conditions under which suicidal desire transitions to suicidal action. According to the first step of the 3ST, people desire suicide when they experience both pain and hopelessness. This could explain why increased distress, anxiety, and depression symptoms do not lead to suicidal desire for everyone. People with hope that conditions will improve are not as likely to want to end their life—even in the face of suffering. 

 

The second step proposes that people who experience pain and hopelessness will develop strong suicidal desire if their pain exceeds their connections to life (e.g., relationships or other sources of meaning). Consequently, people with pain and hopelessness may tend to have more moderate levels of suicidal desire if they have connections drawing them toward life, and more severe levels of suicidal desire if they do not.

The last step of the 3ST proposes that suicidal desire leads to suicide attempts for people who have the capacity to attempt suicide. The 3ST, building on the interpersonal theory of suicide, claims that a strong survival instinct may prevent people who desire suicide from ending their lives. People who have the capacity to inflict lethal self-harm due to lower fear of death, higher pain tolerance, and access and knowledge of suicidal methods are thought to be at elevated risk for suicide attempts. Accordingly, suicide prevention strategies tend to focus on alleviating pain, building hope, strengthening connections, and restricting access to lethal means to mitigate the conditions that may increase suicide risk.

Hope and Connections Through Common Causes

Suicidologists highlighted several factors that they worried would contribute to higher rates of suicide in 2020 (e.g., reduced interpersonal contact due to physical distancing, health problems, loss). Reger, Stanley, and Joiner (2020) also noted potential reasons for optimism: a pulling-together effect “whereby individuals undergoing a shared experience might support one another, thus strengthening social connectedness.” They also suggested that the pandemic could change some people’s “views on health and mortality, making life more precious, death more fearsome, and suicide less likely.” Currently, there are no clear data available to directly test these hypotheses. However, there are some vivid examples of people connecting alongside hardships that may support the ‘pulling together’ hypothesis.

While some people have become more isolated during the pandemic, others have grown closer to their families, partners, or roommates as they spent more time at home. Many people openly shared their struggles with their friends privately and via social media. Popular press articles and news coverage about common mental health struggles also reached the public. Stress can feel more bearable to people when they know they are not the only ones going through it. 

Meaning found within hardship can also reduce suffering (e.g., physical distancing for the purpose of preventing COVID-19 spread in one's community). In addition, there were rapid changes in the availability of mental health services delivered virtually and covered by insurance, including across state lines where it had not been before. Greater therapy accessibility may have helped some people through mental health crises. Finally, a sense of hope may have emerged for some people after learning about the development of COVID-19 vaccines and some financial help from the government.

Activism

Other major stressors in 2020 included multiple types of political strife. In the face of polarized politics, there were strong activist movements pushing for change. Organizers paved paths for people to connect and take meaningful action together. This engagement around common causes is evident in the record-high voter turnout in 2020.

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It is also evident in the popularity of the Black Lives Matter movement, which strengthened following tragic killings of Black people by law enforcement officers, including Breonna Taylor and George Floyd. An estimated 15 to 26 million people in the U.S. participated in protests in response to George Floyd’s death, making it one of the largest protest movements in U.S. history. John Lewis expressed his sentiments in an op-ed published after his death, “You filled me with hope about the next chapter of the great American story when you used your power to make a difference in our society. Millions of people motivated simply by human compassion laid down the burdens of division.”

Conclusions

The 3ST ideation-to-action framework and "pulling together" hypothesis may offer a partial explanation for the discrepancy in the rise in suicidal desire and apparent decline in suicide deaths for 2020. Alongside the pain people experienced, some retained hope—perhaps bolstered by social connections, news of vaccine efficacy, and some financial support from the government.

Tragically, this was not enough to save the lives of the estimated 44,834 people who died by suicide in 2020. Interpersonal connections, meaning, hope, support for healthcare and housing needs, and social equity continue to be of the utmost importance for suicide prevention in 2021 and beyond.