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Tyler Black, MD Profile picture
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13 Apr, 7 tweets, 2 min read
1/ **thread: Mental Health and COVID**

Few things annoy me more than "experts" making claims and headline-horny academics publishing surveys about mental health and Covid-19 doing so with complete lack of nuance and scientific humility.
2/ Most of our studies show associations with "a cross section now" and some change to mental health (many worse, some better, some no change)
3/ Yet if a study shows a negative result, it's always "effects of lockdown restrictions" or "effects of school changes."

What about the effing effect of a WORLDWIDE PANDEMIC that's now claimed 3 million people (millions more seriously ill), entering its 16th month?
4/ Suicides are down.
Cross sections of studies of kids are mixed.
Drug overdoses are up.

And fact, using higher quality studies (not just those that reinforce the moral panic), the most reliable answer is "we are doing well, all things considered."

depressd.ca/research-quest…
5/ Ask yourself though: how can I know what's due to pandemic itself, pandemic response, pandemic length, or other things that happened during that time?
6/ The truth is, we can't. We have very poor studies... Especially in Mental Health... To answer that question.

The gold rush of every clinician to publish something has led to a million observational studies that don't point to cause.
7/ Many people, many checkmarks on twitter, many big researchers, are selfishly building their careers off of the poorest of evidence. Be wary of ANYONE who claims to know WHY measures changed. They are almost certainly full of shit.

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More from @tylerblack32

Tyler Black, MD Profile picture
13 Apr
Oh look, I recognize this data! Great publication showing what (if you followed me) you already know: suicide rates generally declined or stayed the same across the world in 2020. Mostly these countries are middle to high income.
Personally, it's a citable vindication of the work I did to independently collect the data myself:

docs.google.com/spreadsheets/d…

docs.google.com/spreadsheets/d…

docs.google.com/spreadsheets/d…

(I didn't have a team of 40+ researchers! Just me and spreadsheets!)
Because I'm still collecting the data, there is a stronger signal for increase in Asia (Phillipines, japan, some parts of China) than in the rest of the world.

Malawi had an unofficial report (a health official to a radio station) of a strong increase in suicides.
Read 5 tweets
Tyler Black, MD Profile picture
7 Apr
To any survivors of those who died by suicide:

The incorrect and stigmatizing messages of "warning signs" & mental illness made you feel guilt you shouldn't bear.

You did nothing wrong.
You didn't miss anything.
The death you grieve was complex and unpredictable.

/1
Our brains do terrible things to us when we know someone dies of suicide: straight line cause connections (always wrong), fantasies of rescue (rarely possible), and imagined hindsight-driven redoing (never testable).

You did your best with your knowledge, skills, and position.
The best advice I can give about "warning signs": they are over-broad and useless to you.

Instead:
1) check in on people you care about
2) express your concerns when you see it
3) let people you know your willingness to help them
4) be genuinely kind and compassionate to people
Read 4 tweets
Tyler Black, MD Profile picture
19 Mar
In America, every day, about 7800 people die, during that day's events.

Some of these events (driving without a seatbelt, kissing a possum) will be related to their death, some (watching Judge Judy, choosing marmalade over strawberry jam) will be unrelated.

/1
In the past 95 days in America, 77 million people have received one COVID-19 vaccine and 44 million have received a second dose.

That makes 121 million worth of days in which a covid vaccine was given (1.2 million doses per day).

/2
1335 deaths have been recorded in VAERS.
14 deaths per day. 1 death per 90,000 "days events" worth of vaccines.

In these 95 days, we would expect about 743k deaths. 1335 are in the system "possibly" associated with vaccine.

/3
Read 5 tweets
Tyler Black, MD Profile picture
17 Mar
More of X means don't care about Y is a really really really bad argument.

There is no signal yet in the various pockets of youth suicide information that has been published to suggest that 2020 has had an increase in suicides, despite the media panic.

/1
Unsurprisingly, AIER has libertarian and right-leaning economic policies. Like many with such a political bend, they use the fear/headline-grabbing of "suicide" to advance their political agenda, which is beyond shitty.

Even worse when it's a "what about the children?" thing.
/2
I have done a survey of american counties and states, and though there isn't enough for me to say anything definitively, I can say that in North America so far, suicide rates in kids were right around 2019 levels. No fantastic increase or decrease has been seen.

/3
Read 5 tweets
Tyler Black, MD Profile picture
13 Mar
1/ Me: a thread about the importance of getting to know your patient, respect them, and create spaces for appropriate clinical care when rote guidelines would introduce harm.

An "expert":
Cruel, pedantic, and thoughtless.

The worst of people can beleive they're righteous.
2/ In case you're wondering about my thread which prompted it, it was this one.



I created it specifically to outline an example of when "going through the checklist" would be cruel and heartless.
3/ Please, if you take care of patients, never forget this important lesson.. you will always have rigid academics and administrators telling you that X, Y, and Z are required. And truly, a majority of the time you should do X, Y, and Z. Guidelines can be very helpful.
Read 4 tweets
Tyler Black, MD Profile picture
12 Mar
/1 Thread: Do better, American Suicide Organizations.
(content warning, obviously!)

If @afspnational incorrectly states "White middle age" as the peak rate of suicide, ignoring the Indigenous youth/young adult suicide crisis, that's a fail. Part of systemic racism.

4 Pics: American Foundation for Suicide Prevention "statistics Incorrectly states that the peak rate of suicide is in "I go to the CDC Wonder database and search for 2019....And 'lo and behold! The peak suicide rate in 2019 is for In
/2 LOOK AT THIS! AHHHHH! How could a major national organization not put this front and center about statistics?!?!

The rate of 15-19 year old Indigenous males is as high as almost EVERY white age bracket! As described in the text.
/3 For the past 21 years, the highest rate of suicide is Indigenous males, by 7%. The peak rate is between 18-27y at 33.6/100k

For White males, the "middle age peak" between 48-57 is 31.5/100k.

Since I've looked, I've not seen the AFSP mention this in their statistics page. Graph as described in the tweet.
Read 12 tweets

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