As we near the third anniversary of COVID-19, international suicide statistics reveal that the suicide epidemic that was widely predicted to ensue after the lockdown never happened.
Understanding how these predictions failed reveals the limitations of mental health modeling, challenges our assumptions about suicidality, and begs the question, “why wasn’t there a suicide epidemic?” A viewpoint article recently published in the Australian & New Zealand Journal of Psychiatry offers some answers.
The Australian authors, Nick Glozier, Richard Morris, and Stefanie Schurer, quote Nobel prize-winning economist Daniel Kahneman:
“People cannot be faulted for failing to predict the unpredictable, but they can be blamed for lack of predictive humility.”
In their Viewpoint, “What happened to the predicted COVID-19-induced suicide epidemic, and why?” the authors sought to stimulate the current scientific discourse on predicting human behavior and self-harm, articulating the limitations not only of public health modeling but also our societal understandings of suicide.
First, the authors outline why the suicide epidemic was predicted to transpire at the start of 2020. Lockdowns were to blame. Lockdowns were meant to increase a range of stressors associated with distress and suicidality, i.e., social disconnection, isolation, and loneliness. However reasonable this assumption may be, the authors note that people throughout the pandemic have been far more resilient than mental health professionals had initially thought. Indeed, in some countries, positive changes in mental health were observed.
The correlation between unemployment/economic hardship and suicidal behavior was also cited heavily in the 2020 predictions of a suicide epidemic. However, the authors noted that perhaps the most crucial reason the suicide pandemic did not happen is that “government intervention counterbalanced the economic and mental costs of lockdowns by increasing public expenditure.”
Despite the variability from country to country, it is undeniable that the stimulus checks early on in the pandemic proved to be lifesaving in more ways than one—especially in the USA, where the unemployment rate skyrocketed from “a few hundred thousand to over 6 million per week.”
Challenging the US-centric assumption that economic downturn causes suicide, the authors point out that although there is a nexus between unemployment to suicide in the United States, there is not one in other parts of the globe. In Germany and Australia, for example, suicides decline during spells of high unemployment.
Moreover, all kinds of public health modeling (predictive, machine learning, Bayesian) will be somewhat inaccurate.
“All predictive models in behavioral sciences are wrong to some extent, due to the impossibility of accurately predicting the future of complex human behavior, but some are useful. A recent systematic review of 64 unique mathematical prediction models found a predictive validity below 0.01 for suicide mortality in most models,” the authors write.
“This is not unique to mental health by any stretch of the imagination. As John Ioannidis and University of Sydney colleagues have shown, much of the COVID-19 forecasting modeling failed due to similar issues with poor data inputs, incorrect modeling assumptions, high sensitivity of estimates, lack of incorporation of appropriate epidemiological features, poor past evidence of the effects of available interventions and a lack of transparency, as well as consideration of only one or a few dimensions of the problem, compounded by groupthink and bandwagon effects. And this is an area where the data are far more robust and available in real-time than those struggling to provide mental health predictions.”
The authors invite us not to be too reliant on modeling for policy-relevant mental health and suicide predictions, as suicide is an incredibly complex behavior, and our societal assumptions concerning it are biased and, in many ways, polarized.
One of the significant limitations of the Viewpoint is that many countries, cultures, and populations of people are not included in the analysis. However, suicide statistics, both locally and globally, are imperfect and frequently underreported—leaving many suicide and mental health researchers and public health professionals guessing.
Indeed, suicide is a social justice issue, and the pandemic laid bare the lack of equal access to medical care across the globe. Due to these injustices, it was expected that suicide rates would rise, as we have seen them rise amongst indigenous communities, communities of color, and communities in poverty. However, even these assumptions of suicidality can create inaccurate models of one of the most complex human behaviors, and we ought to be humble in our ability to predict suicide and suicidal behavior.
Glozier, N., Morris, R., & Schurer, S. (2022). What happened to the predicted COVID-19- induced suicide epidemic, and why?. Australian & New Zealand Journal of Psychiatry, 00048674221131500. (Link)
Interesting that they went to people who have about as much chance of predicting suicide as the local windscreen cleaner at the traffic lights.
I guess putting yourself forward as an ‘expert’ and not mentioning your past failures makes it look like what your saying about the subject is valid.
When psychiatrists get better than the average Jo at predicting suicide, maybe then we should listen? At present, they are a flip of a coin in that regard.
“suicide is a social justice issue”
I agree 100%! Thank you!
Just read Max Fisher’s Chaos and the Machine, that conveys how the social platform created through Facebook, witnessed a rise in college students visiting the counseling centers. Might the role of learning how to stay attached, stay connected, being drawn into speech through fingertips, to the exclusion of realizing an audible response from those that surround one’s life be a part of the issues that shape wave perceptions. The spread of misinformation, or for any healthy mind wanting to be healthier, informative and of service, in shaping an economy brings the discussions into one of asking questions that generate collaboration? Does the speed of information transmitted also have degrees of humility attached? Tks much for the article.
Thanks for posting this — it’s so important. And for those of us in the USA, the real bombshell was this: Our patterns of suicide are DIFFERENT from those of other countries. In the USA, high unemployment is linked to more suicide — but not in the rest of the world!
Finding out about those differences could show us a lot about the kind of change that is needed in the Land of the Free (Markets). It also gently suggests that the problem is not primarily biological, since as far as I know we are biologically not all that different from Aussies (g).
I was so disappointed to find the actual paper behind a major-league paywall. Does anyone have a copy — and if so, could they at least tell us more about those figures? Thanks!
Johanna, here is a link to a copy of the article which is not behind a paywall: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9574530/
Probably not going to work and spending time with others “felt” safe in most people’s bodies regardless of feelings of being alone and/or lonely.
Anxiety is not from the bear in the forest but from others. It is social impact so perhaps everybody was relieved for a while.