A Thread with Nuance!!

Because the media is obsessed with Japanese suicide data ("suicidal" Japan is a lazy, one-sided trope in Western news), I'd like to add nuance.

First, here are the graphs for who suicides in Japan for the past 5 years, to February 2021! /1 A graph showing suicides for men and women in Japan (approxi
If we zoom into the men, we can see that there was a decrease in early 2020, an increase at the end, and things are back to normal-ish for 2021. In fact, 2021 is a record low for January and 2nd lowest for February. /2 As described in the tweet.
If we zoom into the women, we can see that there is again an early mild decrease followed by a SUBSTANTIAL increase at the end of 2020. Though things are still elevated in Jan-Feb 2021, much less so and hopefully on the way to normalizing. /3 As described in the tweet.
This is going to, unfortunately, lead to some misreporting. For the men, even though Feb was very low in 2020 and feb 2021 is still lower than 2017-2019, the INCREASE is going to be reported with fearmongering by a media obsessed with year-over-year scary numbers. /4
And though there still is a story of increased suicides in Japanese women, this is going to be greatly exaggerated by the *drop* of suicides in 2020. Compared to 2020, February is 24% increase. Compared to 2019, a 7% increase. Guess which number you'll see? /5
It will also not be reported that in Japan male and female suicide rates are not necessarily linked. In the past 20 years, rate changes have been better for men 9 times, women 9 times, and have been the same twice.

2020 IS STILL an anomaly, an unprecedented shift. /6 As described in the tweet.
The story on 2021 is unknown, of course, but it could be like 2011, when men had a 6% decrease and women a 3% increase, for a "change gap" of 9%, or we could see a continuation of the trend prior to 2020 of more and more decrease. /7
Most importantly, the media will report Japan suicide numbers to the NORTH AMERICAN public as if they predict/say something about North America. /8
In the past 10 years, I have not seen a single article ever do this, except this year, where there was a substantial increase in Japan. /9
For the past 10 years, Japanese rates have plummeted (2020 excluded, of course). This has been completely linked to SIGNIFICANT NO CHANGE in Canadian rates and (until 2019), increases in America. /10
Plummeted, you say? Yes, plummeted. Even for women, who experienced a large increase in 2020, the rate (10.7 per 100,000) is FAR LESS than 2021 (14.8 per 100,000, a 28% decrease). Even moreso for men (32% decrease). /11
The idea that one nation's complexities will translate to another for suicide is not evidence based. /12
There are SO MANY cultural, economic, demographic, and social differences between nations (even in how suicides are coded), that making comparisons (especially as if they are predictions) is rarely helpful. /13
I'm BRACING for the next 5 months of articles in American media about how Japanese suicide rates have SOARED in 2011, completely oblivious to the dip in the first 6 months of 2020.

There is a MEDIA MORAL PANIC about "skyrocketing suicide rates." Please fight against it. /14
And though there still is a story of increased suicides in Japanese women, this is going to be greatly exaggerated by the *drop* of suicides in 2020. Compared to 2020, February is 24% increase. Compared to 2019, a 7% increase. Guess which number you'll see? /5 /15
It will also not be reported that in Japan male and female suicide rates are not necessarily linked. In the past 20 years, rate changes have been better for men 9 times, women 9 times, and have been the same twice.

2020 IS STILL an anomaly, an unprecedented shift. /6 /16

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More from @tylerblack32

6 Jun
1/ CW: abuse (please read only if you feel in a good space to, this stuff is tough, but it's important data). Statistics from #TX don't show the predicted "major spike" in child abuse fatalities during the pandemic.

Contd: Graph showing the # of child abuse/maltreatment fatalities i
2/ Every child death by abuse, neglect, and wrongful supervision is a tragedy. In no way am I underplaying the importance of these deaths. I'm simply pointing out that the increase is not some kind of previously-unseen thing. It's definitely no tsunami.
3/ evidence:

a) as evidenced, the number is quite "noisy" (standard deviation is 35), and the # of deaths falls between the min (151, 2014) and the max (280, 2009)

b) the rate change is lower than most recent years (its lower than 6 and higher than 8 of the past 14 years) I created this Excel graph to demonstrate the years for whic
Read 6 tweets
5 Jun
Data Update: Suicide Subpopulations in 2020

Colorado Subgroup Data is out, so I can focus on demographic groups in a major US State. Colorado has ~5.8 million people.

Let's look overall at the state first. The suicide rate decreased* in 2020 by a small amount (2.3%).

/1
It should be noted that this rate of suicide is quite high. Colorado ranks 6th among states for suicide.

Let's break it down by gender:

In Colorado, suicide rates for men were essentially unchanged, and there was a minor decrease* in the rates for women.

/2
By CDC Race categories*:

We see it was only white Coloradans that overall had a suicide rate decrease*. All non-white Coloradans displayed an increased* rate in 2020 by varying degrees. Indigenous suicides by # are smaller and show variance but by rate dwarf the others.

/3
Read 7 tweets
31 May
1/ Thread (and it's a big'un!):

Issues with Psychotherapy Research

It is 2021 and virtually none of following major issues have been largely addressed, which severely undermines the practical value of the research.
2/ As a psychiatrist, I am trained in both pharmacotherapy and psychotherapy. I care deeply about evidence in both areas and am a strong proponent of "as many useful tools as I can have to help my patients."
3/ I support, <3, and provide psychotherapy. This is NOT a debunking of it, nor would I dissuade a single soul from taking it or providing it. For children and adolescents, psychotherapy is essential and should be considered first line in most situations.
Read 32 tweets
31 May
Just in pre-print and quite rough, this study looks at 🇨🇦kids & tries to find an association between (in person, hybrid, and online class) & mental health difficulties.

It finds none.

601 kids surveyed.
23.5% online (ON, AB, NB)
35% in person (BC, maritimes)
41% hybrid (var.)
Very difficult for me to assess the quality of this study - it's not long and if I were a reviewer I would want to see more descriptive statistics.

/2
It is consistent with other studies of kids during the pandemic, however, and there is growing evidence that kids' stress is related to the pandemic writ large, and not largely "are they in school or not.".

/3
Read 4 tweets
30 May
Great paper out of Ontario - showing a number of things.

* Drug overdoses went up significantly during the pandemic period

* Fentanyl overdoses went up very significantly (76% detected in deaths prior to the pandemic, 86% after)

/1
* the drug overdose increase was much worse for men than women

* it affected rural areas and urban centers alike

* improvements in drug overdose deaths in 2019 disappeared completely

/2
Though I'm really not a fan of the younger age grouping (15-34) because it will be misintrepreted. I am quite certain that the rates of 15-19 year olds are 1-3% of the 20-34 group, and this subset should have been removed/isolated.
/3
Read 5 tweets
28 May
1/ Report analysis:
Adolescent Boys vs Girls during the Pandemic

A new article is out comparing Suicide Attempt frequency (12-18y) in Catalonia during the pandemic.

It's a succinct article that presents data from the population-level registry that was in place prior to COVID. Image
2/ Unfortunately (I really wish they would not do this), it only compares one pre-pandemic year to 2020-21, but this is also a very interesting study because, famously, Catalonia had a devastating early first wave, significant lockdown, then reopening of schools. Image
3/ What did they do?

They used the CSRC (a database of suicide attempts estbalished in a suicide prevention effort) to look at # of attempts in the year prior to, and the first year of, the pandemic.
Read 21 tweets

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