Medical Examiner

Fear and Isolation May Not Actually Bring a Rise in Suicides

There might actually be a protective effect of weathering a pandemic together.

Donald Trump at a podium outside the White House.
President Donald Trump at the March 29 briefing at the White House when he said he thinks there could be higher numbers of deaths stemming from shutting down the economy than from COVID-19. Tasos Katopodis/Getty Images

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One of the pervading worries about the current attempt to contain the coronavirus is the idea that the cure might be worse than the underlying problem—that everyone staying indoors might inadvertently end up being costlier than the coronavirus itself. This has been a chief concern of President Donald Trump’s in particular. During a March 29 press conference, a journalist asked the president to clarify his previous statements on why he thinks there could be higher numbers of deaths stemming from shutting down the economy than from COVID-19. He responded, “It’s common sense. You’re going to have massive depression … you’re going to have large numbers of suicides, take a look at what happens in a really horrible recession or worse, so you’re going to have tremendous suicides, but you know what you’re going to have more than anything else? Drug addiction.”

As experts in mental health and suicide prevention, we disagree. There is no evidence to suggest that suicide will increase as a result of the global pandemic. Though some newspaper headlines report suicide hotlines throughout the country are fielding higher volumes of calls, that fails to tell the whole story.

Yes, people are anxious and distressed and, as a result, reaching out for help. The national hotline providing support for emotional distress has seen call volume increase by nearly nine times from this same time last year and the Crisis Text Line has had a doubling in volume, with 1 in 5 people mentioning the coronavirus in conversation. But the fact that we are living through a pandemic may be all the heightened volume represents. Even before the coronavirus, the majority of callers to crisis lines are not suicidal at the time of their call.

The narrative seems to be that someone who is home alone, facing financial stressors and family stressors, will turn to substance use, anxiety, or depression, and eventually suicide. This seems believable, especially to those not well versed in the nuances of mental health.

It is easy to create a narrative to push an agenda—the agenda, in this case, being that we need to restart the economy and end isolation. It is also easy to once again distract from public health needs by putting the spotlight—and blame—on mental illness. We see this frequently after mass shootings, when mental illness is often blamed as a way to deflect attention away from debate about firearm policies. In the case of the coronavirus, it makes sense to many people that depression might arise due to lack of jobs and social isolation, and indeed, for many, that might be a more tangible target than a microscopic virus. But again, mental illness becomes a scapegoat in crisis.

We do know financial strain might be correlated to depression and suicide, and that some cope with stress by turning to substances, which is also a risk factor for suicide. But we don’t yet have data about whether these associations are true during COVID-19. Anecdotally, it might actually be the opposite.

Some people have anecdotally been doing better in self-isolation. They have been able to take time for self-care, to manage their own schedule and sleep, and to get back to exercise. Some who were isolated before have even said they are getting checked on more than they ever have before. And, with medication assisted therapies for opioid addiction more easily available at home, and virtual Alcoholics Anonymous meetings, perhaps others will enter or remain in recovery despite the stress.

Feeling united responding to a threat might even have a protective effect. Some previous data indicates that during wartime or crises, population suicide rates may decrease because of social cohesion. In the current situation, initially focusing on disease prevention (rather than economic recovery) may have the greatest benefit. That is because most anxiety right now is grounded in the lowest part of the Maslow hierarchy of needs: safety.

We are worried about our friends, our family, and ourselves dying from COVID-19, and that is causing the distress. But allowing people to prematurely enter back into their jobs—and thereby increasing fear of additional deaths or exposures—might only worsen these feelings. Conversely, having people work to protect one another collectively may reduce anxiety. Even if people are anxious or depressed right now, it might not create negative outcomes (like suicide) because we are united in our anxiety.

None of this means we should ignore mental health and wellness completely. More than a third of Americans told the American Psychiatric Association that the coronavirus is having a serious impact on their mental health. Gun sales have reportedly gone up during the pandemic, which is worrisome because easier availability of guns at home could increase the risk of death from suicide. People are also in homes where they might not be safe (due to abuse or domestic violence, for example). Loneliness and social isolation can lead to increased depression and suicide, especially in older adults. (Though, we know that this generally happens when isolation is long-lasting, and there are techniques we can use to alleviate the problem, if we can work proactively.) And, if the data from SARS and Wuhan, China, is correct, we also know the strain may be particularly great on front-line workers.

Talking about mental health openly normalizes the fact that we are all anxious, and rightly so. Proactively focusing on coping techniques will likely lead to better outcomes. We can also address potential risk factors like isolation or substance use by minimizing them and naming them out loud. We can work to get people the help they need proactively and preventively, and not only during crisis. The COVID-19–induced shifts to telemedicine and online counseling may help people connect with needed resources even after the epidemic has waned and reduce some of the barriers and access to care.

The narrative needs to shift from one of despair to one of hope. We can advocate for optimal mental health by investing financially in infrastructure, staffing, and systemic change while also emphasizing that we can and will get through this together and come out stronger. The message should be that staying home can save lives—and perhaps even just that little bit of altruism and collectivism could help us all get through this, together.