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Tyler Black, MD

Feb 15 • 11 tweets • 3 min read

USA Suicidology Update, 2020-2021
********
I can now create a 2021 provisional estimate, with error, for the suicide rates for 2021. My method will be described at the end of the thread.

Contrary to the #moralpanic 2020-2021 suicide rates did NOT increase.

/1

The rate for both males and females in the United States will likely be within the expected fluctuation of the previous years, and still less than the "peak" of 2018 pre-pandemic.

/2

For Adults 61-84, likely a slight uptick for men but within 2019 levels, and for women no overall change.

/3

For adults 41-60, the significant drop seen in 2020 will likely continue for both men and women.

/4

For adults 25-40, no changes are significant but there seems to be a continuing and increase of about 2.5% per year in the male rate since 2009.

/5

For YOUNG ADULTS (18-24), **please note that neither change is outside of the error prediction so this is best described as** no significant differences. If the point estimates hold, they will both be highs. However, neither increase unprecedented or "A TSUNAMI" if they hold.

/6

For PEDIATRIC POPULATION (0-17), **please note that neither change is outside of the error prediction so this is best described as** no significant differences. Even if the point estimates hold, none of these increases unprecedented or "A TSUNAMI".

/7

All-in-all, its looking like 2021 will be a mundane year for final suicide numbers. In the coming days I will do my best to take a peek at the racial divides.

/8

"2021 ERROR SIZE"
I ran a model in which all the previous "Jan thru June" rates were compared to that year's final rate, to get the most conservative (largest) error in this prediction.

For the second year in a row, the "TSUNAMI OF SUICIDE" moral panic will not test true.

/9

"2021 Provisional Rate"

The 2021 rate is then displayed as the Jan-June rate (adjusted to to increase by 2.6% when provisional to final, based off of previous CDC Wonder updates), with the error bars above.

/10

@CDCgov

Source: @CDCgov WONDER

/done

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More from @tylerblack32

Tyler Black, MD

@tylerblack32

Feb 16

https://twitter.com/GregSimonKPWHRI/status/1493758284599152642

A disappointing (unfortunately not unexpected) result but good science; care management OR DBT skills did not decrease self harm (severe or broader definition), and in fact, DBT skills resulted in worse outcomes.

https://twitter.com/GregSimonKPWHRI/status/1493758284599152642

DBT is an important therapy for many reasons, but it is not magic. It is being hyped beyond its abilities in the management of suicidal patients, and most modern interpretations of its effect size are vanishingly small (0.15-0.25).

I still recommend DBT (not skills training, the full meal deal) for people who need gigantic containing therapies (multiple times per week, nighttime coaching, etc), and believe that many benefit from it.

Read 8 tweets

Tyler Black, MD

@tylerblack32

Feb 16

GUNS & SUICIDE & THE PANDEMIC

I took a quick look at suicide deaths by gun vs non-gun. A very bizarre pandemic shift has been observed in 2020-2021.

Here is the graph for Americans 19-29 years old (will explain why); showing a huge jump in gun suicides.

/1

This is the same graph for 8-18 years. while the lines didn't cross, you can clearly see a strong increase in gun suicides and no change in non-gun suicides.

/2

This is the same graph for 30-59 years. Again, a huge drop is seen in non-gun suicides whereas gun suicides lifted slightly in 2021 but not 2020.

/3

Read 14 tweets

Tyler Black, MD

@tylerblack32

Feb 15

@PandemicInfoIL

Alright so here's the scoop!

I published a chart earlier today that was a response to misinformation that has been spreading within antivaxx websites. This chart was summarized by the official Israeli Pandemic Info Center @PandemicInfoIL here. (flow of error drawn by me)

/1

https://twitter.com/tylerblack32/status/1493330378504880128

The OWID (Our World In Data) team imports from the JHU data repository, which connects to the Israeli MOH repository.

As of now, the information is correct, showing far less of a spike as the graph that is making the rounds.

/2

My understanding from the github provided by the JHU authors is that that the MOH in Israel had a duplication error, that led to days being "recounted" at the date of report, rather than the date of death. This type of duplication *was* not intentional.

/3

Read 18 tweets

Tyler Black, MD

@tylerblack32

Feb 12

Study out of southern switzerland. Measures of depression, anxiety, and stress varied as the pandemic went on, but overall numbers not particuarly high compared to other reported numbers. they did increase, however.

Interesting conclusion:

"anxiety and stress almost doubled over ten months following the end of the first pandemic wave. However... psychological distress may not be worse compared with pre-pandemic, and may in fact be less marked than in neighbouring countries in Europe."

super important, people who had chronic diseases far more impacted than those without.

Read 7 tweets

Tyler Black, MD

@tylerblack32

Feb 12

Reviewing a PUBLISHED PEER REVIEWED paper about anxiety prevalence during the pandemic in the UK, and the authors commented that because this funnel plot is symmetrical, publication bias is unlikely.

NONE OF THE STUDIES ARE IN THE FUNNEL!!!!!

Funnel plots are supposed to give you confidence that the estimate is not biased. Usually, it's to "show you if there is a bias around the mean."

In this case, the funnel plot serves to tell us to simply throw out the effect size.

As the error gets smaller, the certainty range is supposed to get smaller, that's the entire point of the funnel plot.

This is simply a metaanalysis of randomness.

Read 8 tweets

Tyler Black, MD

@tylerblack32

Feb 12

I really don't miss the hubris of old doctors who love to wax poetic about how great things were before modern ideas took over. It could be about some new technology or theory or idea. But it always goes back to "it was worse than we were before".

I dislike it so much.

/1

First, there are few things in healthcare that were better 100 years ago. Mortality rates were higher, life expectancy of his lower, outcomes were much worse, and treatments much more inhumane.

/2

Second, in almost always centers especially in the West around whiteness and ableism. There may be some who found it better earlier, but I promise you there are many groups who would never go back in time if given the chance.

/3

Read 9 tweets

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