Early Insights on COVID-19’s Impact on Mental Health and Suicide Risk

This story was originally published in Spanish.
Lea la versión española aquí.

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President Trump’s comments about the likelihood of suicide during the COVID-19 crisis distressed many mental health professionals.

For mental health professionals, in times of crisis like those we are experiencing now, how people talk about suicide is as important as what they say about it. That is why mental-health experts were repelled by the dismissive manner Trump exhibited on March 24 when he said that if the U.S. economy remained closed and isolated, suicides would increase by thousands.

For Katherine M. Keyes, associate professor of epidemiology at the Columbia University Mailman School of Public Health, this was a terrible mistake because “it is these kinds of statements” from public figures that can lead to a real “increase in the number of suicides as people lose hope,” and these statements have no real basis.

Shortly after the president said at a Fox News town hall that suicides “probably and — I mean, definitely — would be in far greater numbers than the numbers that we’re talking about with regard to the virus,” the Associated Press ran a fact check report denying the veracity of these claims, saying there “is no evidence that suicides will rise dramatically, let alone surpass potential coronavirus deaths. Historically in a crisis, suicides tend to diminish as society pulls together for a common purpose.

“We often think about economics as driving suicide, because unemployment has such a strong correlation with suicide rates,” says Seth Abrutyn, associate professor of Sociology at the University of British Columbia, but “it isn’t as clear as ‘poor people die by suicide disproportionately more than employed people.’ In fact, poorer people are less likely to die by suicide.”

There is no evidence that suicides are increasing dramatically, all the experts consulted by City Limits said. While most suicide prevention hotlines so far indicate an increase in the number of calls, this does not necessarily indicate increased risks of suicide.

Rising anxiety

Organizations like the National Alliance on Mental Illness of New York City, NAMI-NYC, have noticed an increase in phone calls and emails to helplines since March 1, when the first case of coronavirus was detected in New York.

“Yes, the volume has increased significantly —we set an all-time high last week for the number of people contacting the NAMI HelpLine on a given day,”  acknowledges Dawn Brown, director of community engagement at the National Alliance on Mental Illness, “with a 45 percent increase.” 

“Of the callers who mention COVID-19,” Brown says, “more than 20 percent have reported experiencing a high level of anxiety. Among the myriad problems, callers seek support and peace of mind, seek where they can find a testing center, alternatives to access treatment, financial assistance, and information about social services in their area.”

The volume of calls, text messages, and chats with NYC Well, the city’s mental health hotline, has also increased. For its part, the New York City Department of Health and Mental Hygiene (DOHMH) has noted as a general trend that “in recent years, call volume has increased from February to March” and the department via email added that “this year’s increase is larger than previous years and is likely a result of the city promoting NYC Well for people in many communications about COVID-19.  It may also be due to the stress and anxiety many individuals are feeling related to this outbreak.”

In 2019 the average number of contacts per day to the NYC Well program was 932. During the week of March 22, 2020 to March 28, 2020, the daily contact volume was in the range of 1,100 to 1,300, DOHMH says.

The American Association of Suicidology (AAS), which among other things accredits crisis centers around the country, tells City Limits that many of the nation’s crisis centers “are experiencing dramatic increases in calls.”

“Some [of these centers] are taking over their state’s hotline specific to coronavirus and COVID-19 concerns, as well as dealing with increased volume of suicide and mental health crisis calls. And many of them are totally worn out, but they’re continuing to do the work,” the organization says. 

“So yes, people are worried, confused, overwhelmed, and scared, and the folks on the crisis lines are doing everything in their power to offer a little hope and solace to those in need,” responded AAS via email.

Springtime and suicides

So far, the National Suicide Prevention Lifeline and the Trevor Project, a suicide prevention and crisis intervention organization for LGBTQ young people, have not seen significant changes in call volume in New York.

In regards to how the crisis triggered by the coronavirus is affecting the mental health of New Yorkers, Keyes replied that “it will take some time to get that data.” Regina Miranda, a professor of psychology, and Ana Ortin, a research associate, both from Hunter College at CUNY, responded by e-mail that “we don’t know exactly how the risk of suicide will be impacted by COVID-19, and some of the consequences may not be seen for months or even years.”

“Research has shown talking about suicide with those who are or might be feeling suicidal is preferable to avoiding it,” said Abrutyn. “It isn’t easy, but people should know raising the subject and talking about it (and listening closely) does not make a suicidal person more suicidal or make someone not suicide suicidal.”

“Spring,” Miranda and Ortin say, is usually “a season when we see an increase in suicide attempts and increased visits to emergency departments. But as far as we know we still don’t have exact data on suicide attempts in March, or if there has been an increase compared to previous years.”

DOHMH says that as of “March 26, 2020, there has been no increase in emergency room visits for suicide-related issues since the COVID-19 outbreak in New York City.”

“In New York,” Miranda and Ortin say, “the majority of visits to emergency departments for suicide ideation, attempts, or self-harm tend to be among teenagers, more often girls. Many of these referrals to emergency departments for assessment of suicide risk come from schools. With school closings, it will be more difficult for teachers and school counselors who might have identified youth at risk and made referrals to do so.”

The suicide profile

New York City saw 565 suicides in 2017. According to Miranda and Ortin, “across the U.S., 48,344 people died by suicide in 2018, and New York state has the lowest suicide rate at just over 8 per 100,000 (compared to the national average of just over 14 per 100,000).”

Nationally, “men are at higher risk of suicide deaths than women. At the same time, women more often think about and attempt suicide.  The highest risk period of life for suicide deaths tends to be in middle age, but the highest risk period for making a suicide attempt is in adolescence,” Miranda and Ortin explained. 

Experts also recognized that the Latino community, as well as the immigrant community, faces specific problems such as language barriers, lack of health insurance, fear of deportation, misdiagnosis, discrepancies in access to treatment and in the quality of treatment they receive.

However, comparatively, those at greatest risk among the different groups (Asians, Blacks, Latinos and Native Americans) are Native Americans, Miranda and Ortin specify. 

Experts also point out that some adolescents whose suicidal thoughts are triggered by social stressors may initially experience a buffering effect from not being in school. Yet “for those in homes with high levels of interpersonal conflict, not being able to go out or receive social support from peers may increase risk. At the same time, an increasing reliance on social media for communication will necessitate monitoring of cyberbullying. Parents should be attentive to their children’s overall signs of distress and offer support,” say Miranda and Ortin.

“Job loss, financial instability, depression, anxiety, among others, can be factors that increase the risk of suicide,” says Keyes. In addition, he acknowledged that social isolation may not help people who have been facing problems with depression or anxiety.

Currently, many mental health providers have switched to telemedicine, “which will present challenges and opportunities: challenges for low-income (usually minority) communities with limited access to the internet and technology, and opportunity because people who have difficulty traveling to see their mental health provider might be more likely to attend a telehealth session from home,” Miranda and Ortin add.

Don’t talk about suicide without talking about prevention 

Another problem noted by some experts about the president’s comments is that it is never a good idea to talk about mental health and suicide without mentioning the resources available to prevent suicide. All of the experts emphasized the importance of the entire community knowing that there are professionals available to help. 

The NAMI has a guide to mental health specifically for the Latino community and the NAMI helpline, (800) 950 6264, is open Monday through Friday from 10 am to 6 pm (Eastern Time).

The National Suicide Prevention Hotline shared with City Limits this link for communicating with someone who may be suicidal. 1 (800) 273 8255.

New York’s NY Well program offers a number of resources to emotionally support people whose symptoms of stress are overwhelming. There is also this link where you can find a list of support resources for those who must stay at home, as well as resources for housing, employment and unemployment, and food. 1 (888) NYC WELL

New York State’s recently created a Covid-19 emotional support helpline at 1 (844) 863 9314.

For LGBTQ youth, The Trevor Project has a crisis hotline at 1 (866) 488 7386 and Chat/Text services at TheTrevorProject.org/Help

The Samaritans also have a 24-hour suicide prevention hotline that offers help at (212) 673 3000 and this guide that offers resources and services for suicide prevention (in English).

Finally, Keyes recommended that “if you feel you are not getting the help and service you deserve, seek the advice of a mental health professional to ensure that you receive appropriate care.”

Risks and possibilities

Even for those who do not call a hotline or contemplate suicide, there can be long-term effects from something as harrowing as the COVID-19 crisis. Some will have to deal with the harmful effects of post-traumatic stress disorder (PTSD).

“These circumstances that we are experiencing now might lead to PTSD,” says Denise Varela, mental health counselor and certified national counselor. “Symptoms include flashbacks, avoidance (not wanting to hear news about it, fear of walking in front of a hospital, etc.), hypervigilance and reactivity (being ‘super alert’ and aware that ‘something is about to happen’), and cognition and mood swings (feeling sad, anxious, angry, guilty, etc.).”

There is also the possibility that some people will eventually be stronger as a result of COVID-19. At this juncture, DOHMH says, it is important “to build upon our strengths and foster resiliency, and to be aware that research shows that people who go through extremely difficult life events can experience significant positive outcomes including improved resiliency, deeper and more meaningful relationships, and awareness of personal strengths.”