Narratives behind numbers point to need for better coordination, support by employers, communities, public health leaders in future crises, especially mental health

In what is believed to be the first study of its kind, University of Michigan researchers dug deeper into the numbers-only data of COVID-19-era suicides and evaluated the narratives contained in reports from coroners, medical examiners, police and vital statistics.

The researchers sought to understand how the crisis influenced suicide deaths in the first year of the pandemic, how the response by governments, employers and others influenced individuals, and if their handling could inform future public health responses.

“Our study adds much-needed context and meaning to the data that have assumed the deaths are linked to the pandemic strictly because of when they occurred,” said Briana Mezuk, professor of epidemiology at U-M’s School of Public Health and its Center for Social Epidemiology and Population Health.

“We felt it was important to delve into the narratives of these deaths, rather than using numbers alone, to learn what roles the pandemic and the public health response to the pandemic might have played in these lost lives.”

In looking at the deaths of individuals 10 years old and above, the researchers found that 6.8% of suicide deaths in 2020, representing 2,502 cases, described an aspect of the pandemic, and 20% had no known circumstances described in death reports.

“Although many individuals experienced heightened emotional distress during that time, and some had feared this would lead to greater suicide mortality in 2020, no overall increase materialized in most countries, including the U.S.,” said Kara Zivin, professor of psychiatry at Michigan Medicine and professor of health management and policy at the School of Public Health.

The study appeared in the PLoS One, Public Library for Science One, and was a collaboration between the School of Public Health, Department of Psychiatry in U-M’s Medical School, School of Information and Institute for Social Research Population Studies Center.

“Scientific studies have just begun to explore this data and the consequences of the pandemic using rigorous scientific studies, including population mental health,” said Mezuk, who is also co-director of Eisenberg Family Depression Center Data and Design Core.

“These narratives often contain information regarding circumstances in the decedent’s life that are salient to their death, including psychosocial factors such as recent difficulties in relationships, work or school, as well as mental and physical problems.”

In looking at the narratives, the researchers found that the reasons behind the suicides are complex and that mental health may have been overlooked as the crisis unfolded.

“We were able to describe a variety of pandemic-related circumstances that were present in the lives of suicide decedents at the time of their deaths,” Zivin said. “Although our study confirms prior work that the COVID-19 pandemic did not lead to an excess in suicide mortality in 2020, that does not mean that the pandemic wasn’t related, in some way, to the deaths that did occur that year.”

To unwind stories behind the deaths, the researchers used the CDC’s National Violent Death Reporting System, which compiles death reports and vital statistics and uses that information to write text narratives that describe the circumstances in the person’s life at the time of their death.

The registry fills an information gap in suicide mortality research, which typically has little access to information behind the numbers. The registry does not identify individuals by name or include details that would reveal identities. A time-series analyses examine how the timing of suicide deaths, over the calendar year, differed in 2020 compared to the pre-pandemic period.

Suicide is the 11th leading cause of death in the U.S.

As the fifth anniversary of the official beginning of the pandemic in the U.S. approaches, Mezuk said she realizes that COVID fatigue may have caused the public to tune out.

“Maybe everyone has moved past COVID in some ways, myself included, but we still have much more to learn, especially to know what to do differently in times of future public health crises,” she said. “What we learned signals a need for empathetic public health.

“What happened in 2020, people being told you can’t go outside, you can’t see people outside your home, you can’t work for some. We have no precedent in living memory for this situation and how it affected people. What we do with that now and going forward is important. I hope our study can help contextualize suicide mortality during the acute phase of the COVID-19 pandemic and inform mental health promotion efforts during future public health emergencies.”