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Tyler Black, MD Profile picture
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6 Feb, 6 tweets, 1 min read
A quick thread on being a suicidologist, and the absolutely humble knowledge that we can't predict anything yet with all the expertise, computing power, and variables in the world:

"Follow the data, do not get ahead of it."

/1
When the pandemic started, many of the interviewed experts only had 2018 data showing that rates of suicide were increasing. They used that information in March 2020 and April 2020 to say "it was increasing before and it will get worse now"

/2
Meanwhile the actual statistics for 2019 came out around December and guess what, 2019s rate had fallen. So every expert, opining on TV, online, print, even in scientific articles, didn't know that one of the foundations for their argument fall away.

/3
A real expert in suicide (there are some) will tell you flat out "I don't even know what happened in 2019 and we aren't very good at predicting figure suicide rates."

I know that's not headline grabbing, but it's true.

/4
Suicide rates change due to a host of factors that our expert brains have not yet understood. We do not have a model that even comes close to predicting suicide.

So experts, be humble, and when you as a physician are asked about suicide in the future, use the right answer:

/5
"I don't know what will happen in the future, but I know that if we work now to reduce risk factors and boost protective factors we can make a difference."

Follow the data, do not get ahead of it.

• • •

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Tyler Black, MD Profile picture
6 Feb
1/ **Canadian Update**

There is no evidence to support an increased rate of suicide during COVID.

Nova Scotia Added (trimmed to September for stability).
2/ The best way to interpret this is "in the provinces reported so far, with the months so far, it is unlikely there will be an increase in Canadian suicides, and a decrease is most likely."
3/ I know the 2020 numbers will creep up slightly, I strongly doubt the lag will overcome -12%, but its not impossible. It is, however, quite obvious that a significant increase is not going to occur in these provinces.
Read 5 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*
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*
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
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
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
Read 4 tweets

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