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Tyler Black, MD

@tylerblack32

11 Jun

https://twitter.com/CDCMMWR/status/1403384138175033346?s=19

Thread:

The CDC made a large mistake in their recent publication. It took data from "nonsuicidal self injury" and "suicide attempts" and combined them to create a metric "suspected suicide attempts."

This is stigmatizing and wrong. I will explain why.

https://twitter.com/CDCMMWR/status/1403384138175033346?s=19

Non-suicidal self injury is a phenomenon that happens in adolescence at a high rate. About 12 to 20% of adolescents and young adults engage in non-suicidal self-injury yearly.

It is **not** suicidal. It differs from suicide in many ways.

/2

Non-suicidal self-injury (NSSI):
* Is recruited for therapeutic purpose
* usually involves superficial injuries that do not threaten life
* usually provides relief (as reported by those who do it)
* When we ask kids, they are clear. "IT MAKES ME FEEL BETTER*

/3

Read 6 tweets

Tyler Black, MD

@tylerblack32

11 Jun

https://twitter.com/CDCMMWR/status/1403384138175033346

Hey CDC if your article is about suicide attempts why did you present data about nonsuicidal self harm?

Shocked to see the CDC make such an elementary mistake in its titles and headlines, and it was a great opportunity to separate the two **very different** phenomena.

https://twitter.com/CDCMMWR/status/1403384138175033346

Nonsuicidal self harm is a coping mechanism. It's intent is to feel better, not die. It's a sign of distress and ineffective/failing coping mechanisms and usually people with it are suffering but want to live. It's very common in adolescence. (10 to 22% depending on survey).

Suicide attempts are gestures or actions intentionally taken with the purpose to die. They are signs of hopelessness and overwhelming distress, and represent a much smaller group of kids. By survey, about 6 to 8%, by ER presentation about 2%.

Read 5 tweets

Tyler Black, MD

@tylerblack32

10 Jun

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

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

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

Read 16 tweets

Tyler Black, MD

@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:

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)

Read 6 tweets

Tyler Black, MD

@tylerblack32

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

Tyler Black, MD

@tylerblack32

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.

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