Tyler Black, MD Profile picture
Dec 3, 2021 11 tweets 4 min read Read on X
Suicidology during the Pandemic (US)
=-=-=-=-=-=-=-=-=-=-=-=-=-==-=
(and a quick lesson in visualization)

Suicide rates decreased significantly when the pandemic started, and remained lower than 2019 for the remainder of the year. This is the monthly breakdown.

#COVID19 /1
This is the best way to visualize yearly changes, and media types/communication types, please take note. This graph contains all of the necessary information to put a yearly change into context.

This graph is my invention, called the "GETH"

Why is it the best, you ask? /2
FIRST: it standardizes each month and year to "per 100,000 per year". Populations change over time and months have 28-31 days. This variation matters and without controlling, introduces error. /3
SECOND: it shows the historical context. the years prior to the previous year are in grey, and the most recent year is more prominent and highlighted in blue. /4
THIRD: it shows error bars for the "target year" (2020). Error bars are not necessary for the fact, but they ARE necessary to determine whether or not a change is outside of expectations. See how clearly April and May are lower than previous years? /5
By combining all these things together, you can get a sense of year-on-year change, as well as the historical context, as well as the variation one would expect. /6
The GETH is also useful for subgroups.

Here we can see the 2020 changes for Men in the United States. April was significantly lower, and every month following was either lower than or the same as 2019. /7
Women fared even better, with many of the months being lower (and 5 significantly so) than previous years. /8
Unless you're a real estate board trying to pump your industry, you should always include:

1) population & time adjustment
(not just "# of deaths")

2) historical information for context
(not just year-over-year change)

3) uncertainty measure (i use 95% CI for proportion) /9
The GETH does all of that, and in one graph, you can convey all of the information necessary to understand the larger picture.

Be a good science communicator! Follow these principles. /10
(and yes, by the way, GETH is inspired by @masseffect, because I am a geek. To make the acronym work, it's short for "Graphical Envisioning of Temporal Happenstances", because it can be used for any time frame and any occurrence, not just suicide)

with <3 to @bioware /11

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More from @tylerblack32

Sep 3
🚨COVID-19 Vaccination saves lives and improves outcomes 🚨

In this UK study of >3 MILLION PEOPLE who vaccinated, the incidence of mental health problems was significantly reduced when a subsequent COVID-19 infection occurred.

/1Image
Looking at the totals who were infected with COVID-19, it is clear that COVID-19 diagnosis was associated with a ROBUST increase in mental health problems after the diagnosis.

/2 Image
This adds to the massive and still growing body of evidence that Covid 19 Vaccination was safe, effective, and extremely important especially considering that after this study, virtually everyone was infetcted with COVID-19.

/3
Read 5 tweets
Aug 29
Yet another study finding differential impacts (mostly with decrease of symptoms) on the mental health of youth comparing prepandemic to pandemic times.

The media far far far less likely to report on these now common findings.

/1


jamanetwork.com/journals/jaman…
My colleagues and I talked about this at length, that there were many reasons to be cautious about the early "expert predictions" and in fact when good evidence was considered, many so-called evidence based scientists were wrong: dire outcomes on mental health harder to find.

/2


Our '23 peer-reviewed commentary here, g despite many professionals who attacked my us for daring to suggest we interpret evidence cautiously rather than childishly reducing issues & acting like sensationalists, I am certain our publciation holds up well.ncbi.nlm.nih.gov/pmc/articles/P…
Read 4 tweets
Aug 4
❌Mythbusting❌
Youth suicide & COVID

❌Myth:
responses to COVID "caused" 🔼youth suicides

✅Reality:
We now have 4 years of pandemic data showing that school-aged youth did NOT have an increase in suicides; in fact, rates decreased 18.3% from recent trends AND averages.

/1Image
This is true for girls in the US (pretty much right on the 3-year average (-0.8%), and 16.3% less than expected from the 10-year trend).

/2Image
This is true for boys in the US (10% less than the 3-year average and 18.9% less than expected from the ten-year trend)

/3Image
Read 22 tweets
Jan 31
Talking to kids when they're struggling🧵
For parents (or anyone who cares for kids!)

It can be really scary to notice something in your kid & be worried suicidality/self-harm.

How do you approach kids?

I've had this conversation >10000 times so I have some tips!

Be CALM

/1Image
CALM is a memory-trick to remember the key concepts of communicating to a struggling kid but also to remind you to be in control of your own emotions. If you are prepared, you will defeat your initial instinct, which will be to FREAK THE BLEEP OUT!

/2Image
First, COOPERATE!

You & your kid are a team, and you have a common goal: their present & future wellbeing. Don't set yourself up as the security guard, jailor, punisher, or antagonist. Don't push. Don't pull. Be alongside them, tell them you're willing to walk with them.

/3Image
Read 17 tweets
Jan 30
Suicidology
Predicting Suicide Death

A recent study looking at >2M Americans presenting to ERs with MH concern shows the difficulty of "predicting suicide" - we can't predict suicide to help guide important clinical decisions.

The problem: Sensitivity vs PPV

/1Image
They used machine learning EMR-coded variables (outpatient visits, medications, previous appointments, age, etc etc) - you can see the entire dictionary used to "predict" here (word doc):

They had 2,069,170 ER visits and 899 suicides within 90 days.

/2ars.els-cdn.com/content/image/…Image
After running the model and letting machine learning do its thing, the best fit had the following predictive properties at the 95% percentile cutoff of risk:

Sensitivity: 34.8% (deaths/positive predictions)

Is this helpful?

/3
Read 18 tweets
Jan 20
Debunking Antivaxxer Tropes:
"Antivaxxer is a slur" 🧵

Many many many accuse me of using a "slur" when I say "antivaxxer". It is a twitter shorthand for sure, but it is not a "slur", and I use it without regret or remorse.

/1


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I certainly believe that if one is an "anti-vaxxer", they are not using science, reason, or reality to understand vaccines.

& I note a distrubing trend in antivax and some concerning other beliefs.

That being said, when I say antivax, I only mean "antivaccine belief holder"

/2


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Check out my "antivax misinfo" threads. Someday take a look at the "hidden replies" & note that the antivax profiles are quite.. well.. recognizable.

Note: Do not assume every "Antivaxxer" is, I just notice the trend. As do many of my colleagues here space fighting misinfo.

/3
Read 10 tweets

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