Tyler Black, MD Profile picture
Dec 14, 2021 18 tweets 6 min read Read on X
/1 Suicidology Update
"Kids during the Pandemic"

@CDCgov's full dataset, with every demographic.

TOP LINE:
Full lockdown phase: significant decrease (-15%)

SECOND HEADLINE:
Up but within expected for the remainder.

THIRD HEADLINE:
No change if the year taken in total.
/2 Note: GETH plot (my creation!). The previous months are actually TWO FULL pre-pandemic years (Mar-Feb 18-20), and all rates are standardized for population. Error bars are 95% CI for Proportions. All charts read MAR-FEB to capture a "full pandemic year."
/3 Can we break it down by sex? Sure can!

Boys: same pattern, suicides decreased significantly (-18%!) during the strictest school measures, and increased (nonsignificantly, 13%) during the second school year of the pandemic.

Take note of the FLAT March-July (more later)
/4 Girls: The decrease (8%) March-June and the increase (9%) Sept-Feb are well within normal historical changes year to year.
/5 What about the elementary school kids? No significant changes. Due to low #'s dying of suicide, the error bars are. Not even summing months creates significance.

Do you hear that, oh ye misinformation spreaders? YOUNG KIDS DID NOT DIE OF SUICIDE MORE DURING THE PANDEMIC.
/6 Now let's look at high-schoolers (13-17)

A huge difference based on phase of pandemic.
End of School year 2020: -16% and way lower than expected.

Next school year, within expected, slightly higher.
/7 The first school year of the pandemic (with full lockdowns) also represents the FIRST TIME IN 21 YEARS that March-June (school months) had the same low suicide rate as July (non school month). Typically, school months associated with 36-55% increase in HS kids.
/8 Yes, I will repeat that again.

EVERY SINGLE YEAR from 1999-2019, High School kids in the US died of suicide about 40% more frequently on March-Jun vs July. In 2020, when:

* all schools were shutdown
* during a new pandemic

the Mar-Jun rate equaled the lowest rate (July)!!
/9 We can also break it down by CDC Race (please note, CDC Race is clunky and I cannot do anything about that)

White kids in the US had a significant decrease (-18%) in suicide rates in the inital phase, and no significant change in the subsequent year.
/10 Hispanic kids, and non-white kids in the US showed similar patterns. I personally feel its simply underpowered to detect it, but I think white kids did better. There is no statistically significant difference racially for RATE changes, but do keep note of the overall rates.
/11 Especially as it pertains to Indigenous children in the US. While, fortunately, there was no pandemic effect, it's very important to note how ridiculously high the rate of suicide is amongst Indigenous Youth (close to the adult white rate).
/12 I have all the data 8-24 for every group, so I'm happy to answer any questions people may have for this, the best I can. I do have provisional data heading into the 2nd pandemic year (mar-may) at high reliability and the general message is "it settled down"
/13 This puts a final pin in the notion that kids were overall "more likely to die of suicide" during the pandemic. The net effect on suicides of kids in the first year of the pandemic was COMPLETELY FLAT:

Mar-Feb 2019-2020 - 4.1/100k
Mar-Feb 2020-2021 - 4.1/100k

...]
/14 The data is also entirely consistent with a very data-backed position I have been stating for quite some time: when lockdowns were strongest (least amount of school), suicide rates amongst kids were lowest. School is a well established risk-factor for suicide.
/15 For a preview into what we're seeing so far in 2021, I can say from preliminary CDC and embargoed data that I have access to that after around April-ish, things settled back into expected #'s for the remainder of the year.
/16 As always, if you follow me you will find data-driven answers, not speculation. Only a few suicidologists chose the correct path of NOT PREDICTING an increase in suicides in young people. Media, take note. It is always foolish to PREDICT suicide rates, we ain't that good yet.
/17 Data is from CDC:

Provisional Multiple Cause of Death on CDC WONDER Online Database, released 2021. Accessed at wonder.cdc.gov/mcd-icd10-prov… on Dec 14, 2021
/18 Media: please contact me via DM if you would like to discuss, interview, or get more information. Please help me correct the wrong narrative that DOMINATED the pandemic.

All visualizations are mine; media have full permission to use, if using please credit me.

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More from @tylerblack32

May 5
RFK is no better at psychiatric medications than he is about vaccines.

RFK's "overmedicalization crisis" thread is a master class in using true-ish numbers to imply a false conclusion. Let's go through it. 🧵

/1
The core trick: he treats prescription prevalence as self-evidently bad. But high rates only signal a problem if the meds don't work, are given to people who don't need them, or cause net harm. He establishes none of this. He just gestures at numbers.

/2
The same rhetorical structure would indict insulin prescribing, or asthma inhalers. Prevalence is not pathology. The question is whether treatment matches need — and whether the alternative (untreated illness) is better or worse.

/3
Read 20 tweets
May 4
Disabled people should not live in poverty.

It makes no sense the way we treat our people with disabilities in Canada. Canada has the full apparatus to implement adjusted payments, yet we typically support disabled people WELL under the poverty line.

/1 Image
Canada has an official poverty line: the Market Basket Measure. It's regionally calibrated, methodologically sound, and updated by StatCan.



A single person on BC PWD receives ~$18.4k/year. The Vancouver MBM is ~$29k.

/2www150.statcan.gc.ca/t1/tbl1/en/tv.…
That's not a rounding error. It's a structural choice.

PWD recipients in Vancouver sit at roughly 47% of the poverty line and below the Deep Income Poverty threshold (75% of MBM), which is the level StatCan uses to flag the worst material deprivation in the country.

/3
Read 10 tweets
May 2
Quick thread: "How do SSRI's work" 🧵

I've had a few patients ask me how SSRI's work.

To be clear, my first answer is "well we know they are supposed to block serotonin reuptake, but it's not that simple and we don't really know."

But, if you want the best 2026 science...

/1Image
For a few particularly science-interested patients, I walk them through what we currently have for the 'best evidence' even though we're still not sure.

This is the "best story" I can tell about SSRI's right now.

(nb, this is NOT locked in, this is MY best synthesis)

/2
1) SSRIs BLOCK the Serotonin Transporter
The protein that pulls serotonin back into the neuron after its released is blocked. Serotonin lingers longer in the synapse, the gap where neurons signal each other.

This is very well established, & how SSRIs were designed.

/3Image
Read 15 tweets
May 2
The Ihben story is making the rounds. "Judge forced 18 vaccines, child got autism." It's being treated as a smoking gun. It is not a smoking gun. It is barely a story.

/1
Sourcing: one father, one advocacy org (CHD), one GiveSendGo. Records sealed. No filings. No named physicians. Every outlet repeating it cites the same Defender article. This is a closed loop, not corroboration.

/2
"18 vaccines in one day" is not a thing. That number counts antigens as doses to make the headline scream. Real catch-up schedules don't work this way and you can verify that in five minutes on the CDC site.

/3
Read 10 tweets
Apr 30
🧵Borderline Personality Disorder (BPD) 🧵

Ask any person who has been even suggested to have BPD; they will uniformly tell you that they have been told to try DBT (Dialectical Behavioural Therapy). Reflexively recommended. "Gold standard."

This is not science-supported.

/1Image
Quick history: Marsha Linehan developed DBT in the late 1980s, published the foundational manual in 1993. She drew on CBT, Zen Buddhism, and dialectical philosophy. Brilliant clinician, brilliant marketer. Her institute has trained tens of thousands of therapists worldwide.

/2 Image
That marketing machine is the reason DBT is "the BPD treatment." It is not the reason DBT works better than alternatives, because it does not.

The faint superiority signals in older trials evaporate once you adjust for allegiance bias (DBT researchers studying DBT).

/3
Read 16 tweets
Apr 30
The McCullough Foundation's @NicHulscher — who posts garbage medical misinformation — styles himself an "independent epidemiologist."

His entire career has been spent publishing with, and working for, McCullough. Image
No academic post, no health agency, no clinical role, no pre-Foundation experience. Hired straight out of his 2024 MPH by the senior author on nearly every paper bearing his name.

/2
He publishes almost exclusively with McCullough, overwhelmingly in predatory or fringe journals, and has already been retracted twice — plus an Expression of Concern — in a career that's barely two years old.

/3
Read 7 tweets

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