Mental Health, Suicide, and COVID-19

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By: Amy Marschall, Psy.D., Freelance Columnist

Content note: this article discusses suicide in general terms. “Suicide behavior” refers to a deliberate action to end one’s own life; commonly, this is often referred to as a “suicide attempt.” In my writing, I choose to use the term “behavior” rather than “attempt” because “attempt” implies that surviving is somehow a failure. Of course, individuals (especially suicide survivors) can use the terminology that is most comfortable for them.

Throughout various stages of lockdown around the world, many have expressed concern about the impact of long-term self-isolation on mental health. This is an important consideration, and I have spoken to many people about finding ways to maintain physical safety without compromising psychological well-being. Families quarantining together can experience higher levels of conflict, at best leading to fewer positive interactions and at worse higher rates of domestic violence and child abuse. This is not to mention individuals who live alone, for whom quarantine means little or no in-person human interaction for weeks or longer.

I have written before about the importance of prioritizing mental health during a pandemic. Although technology and the availability of telehealth services have made therapy more convenient, providers are stretched thin, and it can be challenging to find someone who is available to meet with you. Therapy might theoretically be more readily available as providers can literally meet you where you are, but increased demand for services has made getting an appointment more difficult. This makes attending to people’s mental health needs even more vital during a difficult time.

One specific concern amid discussion of how long lockdowns should continue is whether we will face an increase in suicide behaviors as a result of isolation. This concern has been raised during discussions of when or how to open schools in particular. Parents, educators, pediatricians and mental health professionals have expressed concern about the effect of virtual learning on social skills as well as mental health. There is also worry that adults with preexisting mental illness or addiction might experience relapses leading to suicide behavior if lockdowns seem to never end. Does this mean we need to lift restrictions for the sake of our mental health?

It is important to acknowledge that rates of depression, anxiety, substance use, suicidal thoughts, and trauma were significantly higher in 2020 than in 2019; however, we cannot know for sure that lockdowns and quarantines are the reason for this increase. If you have ever taken a statistics class, you know the phrase, “Correlation does not imply causation.” Basically, just because two things happen together does not mean they are related. This wonderful website shares some cases when unrelated things have correlated. As you can see, the “data” showed that, from 1999 until 2009, there was an increase in drownings when Nicolas Cage starred in more films. Is Nicolas Cage killing people with his movies?

In the same way, we do not know that lockdowns increase depression. Absolutely, long-term isolation takes a toll on mental health, but so does unemployment (or threat of unemployment), anxiety about getting sick, and uncertainty about the future. It is quite possible that we would have seen similar rates for depression and anxiety in 2020 had there been no lockdown procedures at all due to other stressors that occurred last year.

Some have been sharing concerning statistics about increased suicide behavior in the last year. Although there is a lot of data available about mental health in 2020, we actually have not finished calculating suicide rates, so we do not know at this point whether those numbers are accurate. Basically, at this point, we do not know if suicide rates in 2020 are higher than they were in 2019 in the United States. However, preliminary findings actually showed a decrease in suicide behavior from March to July of 2020. (Again, these findings are still being evaluated and are not finalized.)

Let’s say a peer review of the data ends up showing that suicide behavior did increase in 2020 over 2019. Again, we do not know for sure that this increase was due to lockdowns. For young adults in the United States, rates of mental illness and suicidal ideation have been increasing for years, predating the COVID-19 pandemic and lockdowns. So, we do not know for sure that lockdown has caused an increase in suicide behavior, and there is a good amount of evidence to suggest that it hasn’t.

Furthermore, when it comes to debates about COVID-19 restrictions and lockdowns, we seem to be falling into the trap of all-or-nothing thinking. In psychology, this is known as a cognitive distortion – basically, the way we are approaching the problem is flawed because we are viewing it as an either/or situation. In other words, we’re thinking about it wrong.

The approach seems to be something like this: “Either we end all lockdown restrictions immediately, or people will die from suicide.” We need a more nuanced approach: “How can we care for people’s mental well-being while also keeping them physically safe?” If someone is burned out on video calls but needs human connection, how can they follow the CDC’s considerations for events and gatherings, maintaining a low risk of spreading COVID-19 but still experiencing human connection? With the weather getting warmer, are there options for masked, spaced out gatherings? What about “quarantine bubbles,” where two or three households isolate together so that they can feel more connected?

Mental health and suicide prevention are important. Protecting people from contracting COVID-19 is important. Both of these statements are equally true and do not cancel each other out, and we can cater to our mental health without disregarding COVID-19 precautions.

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