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Tyler Black, MD Profile picture
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13 Jan, 13 tweets, 4 min read
/1 THREAD: I knew this day would come.

While pediatric societies & "hospital organizations" did "science by press release," breathlessly discussing a correlation on a parent survey or releasing a statement about 1 month of admissions in May 2021, I knew we would get REAL DATA.
/2 This day has arrived. We have the incredible article by Ray et al, showing that during the first 15 months of the pandemic, youth ER presentations of self harm, overdose, and hospital admissions of both decreased by ~18% in Ontario.

1.6 MILLION YOUTH

jamanetwork.com/journals/jaman…
/3 There is OTHER data out of Ontario showing that acute mental health ER and admission levels DID NOT INCREASE during the first 12 months of the pandemic. (broken down by age group)

THEY DECREASED.

pubmed.ncbi.nlm.nih.gov/34785528/
/4 We have data out of Paris showing pediatric suicide attempt presentations did not increase further during periods of school closure, rather decreased/same, but they increased significantly at times when lockdowns were lifted and pandemic was spreading.

/5 We have prescription data out of Manitoba showing that during the pandemic, prescriptions to youth for psychiatric medications decreased compared to previous years, not increased.

jamanetwork.com/journals/jamap…
/6 We have suicide data out of the United States showing that for the first time in history, when the pandemic hit, kids died of suicide during school months (mar-jun 2020) at the same rate as summer months.

/7 We have data showing that overall population suicide rates DECREASED BY 32% IN CANADA in 2020. 32%. The usual change is about 2.5% up or down.

journals.sagepub.com/doi/full/10.11…
/8 We have data out of CDC showing that heading in to may 2021, suicide rates for kids were within prepandemic levels (in press, embargoed, but coming!)
/9 I am working on pre-registered BC data comparing school & pandemic periods with respect to emergency mental health presentations, & we'll get it out as soon as its ready (& like a good scientist, I am still blinded as the statisticians do their thing)
/10 And yet, the narrative by LARGE public organizations has coopted mental health concerns for their political/moral panic messaging.
/11 Real data is going to be coming, and not all of it is going to support my thesis (my own study blinded to me at this point while the data analysis is going on!)
/12 But there is one promise to you: I am going to be reporting on ALL of it. Every single major study that comes out regarding mental health, our kids, and the pandemic, I'm going work hard to REPORT ON IT and tell you what it means and what it doesn't.
/13 Oh, and happy birthday to me :) On this day in the *cough* late seventies, at this exact time, I was brought, breech & premie, into this world, of course beating my amazing but never-winning-when-I'm-involved twin brother by 300 whole seconds.

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More from @tylerblack32

Tyler Black, MD Profile picture
13 Jan
My anger is so high. all I wanted when @CHEO and @SickKidsNews announced these breathless claims about skyrocketing admissions and self harm was DATA RELEASES.

Now, a large study shows that ON 14-24 admissions for self harm, OD, and deaths for same decreased by 20% to mid '21.
Science is not performed by press release. Science is not performed by large bold numbers presented without any historical context.

Science is performed by rigorous presentation analysis scrutiny and peer review of data.

Shame on everyone involved with this debacle.
I cannot express my gratitude enough to the authors who did the hard work to present this data and to get it published.
Read 5 tweets
Tyler Black, MD Profile picture
13 Jan
Hey remember all of the posturing and data free statements from major Ontario hospitals?

This is why I wanted data.

The pandemic associated with a SIGNIFICANT DECREASE in self harm and overdose for kids and young adults.

Thank you, authors!
jamanetwork.com/journals/jaman…
Among adolescents and young adults, the initial 15-month period of the COVID-19 pandemic was associated with a relative decline in hospital care for self-harm or overdose.
After 4M person-years of follow-up, 6224 14-24 experienced self-harm/ overdose during the pandemic (39.7 per 10 000 person-years) vs 12 970 (51.0 per 10 000 person-years) prepandemic, with an HR of 0.78 (95% CI 0.75-0.80)
Read 5 tweets
Tyler Black, MD Profile picture
12 Jan
1/ THREAD: Actual data (not claims):
Presentations of pediatric suicide attempts during the pandemic

A study out of Paris looking at suicide attempts in kids <16y, presenting to the Robert Debré. It has unsurprising (to me) results, but demonstrates some interesting things.
2/ Some context from a child emergency expert:

Children often present with suicide attempts when they are under duress. A surprising number of kids (5-8% per year) attempt suicide (by report), fortunately a much smaller fraction of kids (<0.01%) die of suicide.
3/ I couldn't find French data, but its neighbour Germany has an article out that shows the rate of suicide attempts in youth at 6.7% (no migration background) or 10% (with migration background).

bmcpediatr.biomedcentral.com/articles/10.11…
Read 22 tweets
Tyler Black, MD Profile picture
11 Jan
/1 Critically reading a paper
REMOTE/IN SCHOOL & KIDS BEHAVIOUR
*******
It took me ~40 (!!!) tweets to go through a paper critically and explain it and its strengths & limitations. This is how much work reading evidence is. Read (if you dare).

/2 But more importantly, look how much effort I put into it. I really wanted to show you what is required to read, integrate, extract, and analyze primary research.
/3 40 tweets was hard. I could have written MUCH more, and I did much more (like counting unlabelled n's, estimating cohen's d which is VERY challenging for in-person effects, etc)
Read 8 tweets
Tyler Black, MD Profile picture
11 Jan
THREAD: A look at a new study looking at school setting, pandemic, and behaviours in kids.

@JAMA_current article using a cohort design to look at the effects of the pandemic over time. They have an interesting statistical manipulation which I'll describe in a moment!

/1
Now very importantly, the authors acknowledge that the statistical manipulation wasnt enough! It falls short in a number of ways, so they caution very strongly against interpreting this as "causal evidence"

Let's look at what it shows and what its limitations are.

/2
First: what is this?

It is an ongoing survey that is being done of early learning that's been going since 2017. During the 2020-2021 school year, for kids 6-8, 405 parents were surveyed in 4 monthly surveys.

/3
Read 40 tweets
Tyler Black, MD Profile picture
10 Jan
Hey, is your BMI 20? congratulations. You have the same risk of dying as someone with a BMI of 35. BMI is a very imperfect, unscientific, pseudoscientific measure created by a Belgian astronomer. Pretty much everything most doctors know about BMI is wrong.

/1
BMI mortality depends very much on the thing that you are considering.

Many causes of death are associated with lower BMIs many with higher BMIs

/2
The use of archaic BMI's as a measure of health is unscientific and contributes to fatphobia, discrimination, and leads to people who should seek health care to avoiding health care.

/3
Read 6 tweets

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