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Tyler Black, MD Profile picture
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3 Feb, 6 tweets, 2 min read
1/ Suicidology 🧵, "why rates matter"

A news article in Bengaluru (Bangalore), India, shows that suicides have increased and "Experts blame COVID."

2,081 in 2019
2,162 in 2020
(up 3.8%)

The headline (with a disturbing "toe tag" graphic, not shared), is that suicides are up.
2/ However, Bengaluru has had an incredible population explosion, with an average yearly increase of 3.6-4% per year for over decade now.

The net result: the suicide rate is essentially unchanged. 17.5 per 100k (up about 0.16%)
3/ So while the headline is a toe tag graphic with a chilling statement about increasing rates, the actual news for the year is "suicides increased proportionally to the population growth, such that the rate is unchanged."

**Expertise matters to tell the right story**
4/ In truth, the population of Bengaluru in 2010 was 8,295,000, and there were 1778 suicides. (21.4 per 100,000)

In 2020, the population is ~12.3 million and there were 2162 suicides. (17.5 per 100,000)
5/ In other words, the actual story is that in the past decade, suicide rates in Bengaluru have declined.

Think about this again.

Headline: Suicides are up; COVID is to blame.

Truth: 📣📣Suicide Rates in Bengaluru India are the among the lowest they've been in a decade.📣📣
6/ Media, please talk to experts. Please do not be careless with your reporting. Please try to contextualize numbers. You can do better. Please reach out to me if I can be of help in that regard.

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More from @tylerblack32

Tyler Black, MD Profile picture
5 Feb
1/ My first estimate for USA Suicide Rates in 2020 is available. This scan represents my best effort to capture every reported number.

Though the final rate for 2020 will likely creep up due to lag, it is unlikely to go past 2019 levels.

*THE SUICIDE RATE HAS NOT INCREASED* Image
2/ Rather than reading this as proof of decrease, I would encourage all reporting/sharing this number to read this as "evidence that a significant increase across America is unlikely." I have done my best to estimate data lag, but it will likely head closer to even.
3/ This is an apples-to-apples comparison. Alaska 2019 Jan-Sep is compared to Alaska 2020 Jan-Sep. Because of this, as more data comes in, both the 2019 AND 2020 rates will change.
Read 20 tweets
Tyler Black, MD Profile picture
5 Feb
1/ My first estimate for USA Suicide Rates in 2020 is available. This scan represents my best effort to capture every reported number.

Though the final rate for 2020 will likely creep up due to lag, it is unlikely to go past 2019 levels.

*THE SUICIDE RATE HAS NOT INCREASED* Image
2/ Rather than reading this as proof of decrease, I would encourage all reporting/sharing this number to read this as "evidence that a significant increase across America is unlikely." I have done my best to estimate data lag, but it will likely head closer to even.
3/ This is an apples-to-apples comparison. Alaska 2019 Jan-Sep is compared to Alaska 2020 Jan-Sep. Because of this, as more data comes in, both the 2019 AND 2020 rates will change.
Read 20 tweets
Tyler Black, MD Profile picture
4 Feb
A parable on relative rates:

A man processes fruit. Each hour, he is presented with 100 oranges and apples each to package. He does this for years. He loves his job, and comes to expect the steady bags of similar oranges and apples.

100 apples. 100 oranges.
/1
The inspectors come to see the man work.
The suppliers come to take the bags of fruit.
The patrons of the markets buy apples and oranges.

They all see the balance between oranges and apples.

100 apples. 100 oranges.

/2
One day, conditions change, and the fruit is impacted. There are fewer apples and oranges, but for whatever reason, oranges are less impacted. Now, every hour, it's 60 less apples and 20 less oranges.

The man arrives to work and starts his first hour.

40 apples. 80 oranges.

/3
Read 8 tweets
Tyler Black, MD Profile picture
4 Feb
Have suicides increased in the pandemic?
(also a comment on kids below)

We have data for BC, AB, and SK... so far, and so far, so good. There have been fewer suicides in 2020 than in 2019.

Thank you everyone for the feedback, I've made this a lot cleaner and simpler now!

/1 Image
For people who saw this yesterday, I've changed things to become more confident.

For Alberta, this meant removing November #'s (they seem VERY low in 2020 and I will wait for confirmation). This raised Alberta's rate.

It doesn't change the message.

AB suicides are down.

/2
The other major change is giving a guess for how much the Saskatchewan number for 2020 may increase. In previous reports, a result reported the next year increases by ~20 suicides when the final count is done.

It doesn't change the message.

SK suicides are down. (by 25-36%)

/3
Read 14 tweets
Tyler Black, MD Profile picture
4 Feb
jamanetwork.com/journals/jamap…

From the suicide perspective, a great but nuanced study. It shows that presentations for suicide attempts overall dropped in the US (5300/week prior to the pandemic starting to 4944/week after the pandemic started).

/1
This figure here shows this... you can see the number (in thousands, take a sharp drop during covid and gradually restore (albeit not above pre-pandemic levels).

/2 Image
However, in terms of relativity to other presentations to the ER, that drop was much less, so the Rate (suicide attempts per 100,000 ER visits) increased.

/3 Image
Read 4 tweets
Tyler Black, MD Profile picture
1 Feb
Starting my day off with a bit of cleanup in Internet drama Aisle 9.

1) I do not support the public doxxing of anyone. In fact I call it out. It's wrong.

2) I do support someone, feeling harrassed, privately doing what they can to deal with it officially.
3) there are really really good reasons to be anonymous on the internet, for example, people who might be marginalized or victimized because of who they are can gain strength in anonymity. I support anonymity.

4) anonymity does not give someone a shield to violate rules
5) old man internet beard here: If you are anonymous, there is no way to hold you accountable for your words or phrases or identity and history is rife with faked siblings, stories, identities, genders, and even races. Anonymity comes at the cost of credibility.
Read 9 tweets

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