Despite isolating lockdowns and a sharp rise in unemployment, suicides fell by 32 per cent in the first year of the pandemic compared with the year before it, according to a new report.
This is the lowest suicide mortality rate in Canada in more than a decade, says the study, published in the Journal of the Royal Society of Medicine.
“It’s a remarkable finding, that during this awful time, we saw a decrease,” said the report’s lead author, Roger McIntyre, a University of Toronto professor of psychiatry and pharmacology.
“This tells us there are things that we can do,” Dr. McIntyre said. “We don’t need to accept suicide rates, we need to rethink how we’re approaching this from a policy perspective.”
Dr. McIntyre and his co-authors credited government-funded financial benefits and an increase in mental-health support with creating a sense of security in this country.
“Our results suggest that government interventions that broadly aim to reduce measures of insecurity (economic, housing, health), and timely psychiatric services should be prioritized as part of a national suicide reduction strategy, not only during but after termination of the COVID-19 pandemic,” reads the report, which drew from Statistics Canada data on suicide rates over nearly 11 years.
The study noted that after the Great Recession, economies in Europe that provided programs to help people affected by unemployment and financial insecurity demonstrated significant mitigation of suicide risk.
While experts stress that suicide risk is highly complex and never caused or reduced by one factor alone, sudden and abrupt economic insecurity has been associated with mental-health decline and suicide, Dr. McIntyre explained.
“When you are faced with economic duress or shock – and this was an economic shock in the first degree – it does significantly worsen measures of security, including financial, housing and food. That leads to distress,” Dr. McIntyre said.
Government provisions deployed early in the pandemic softened the blow, the study authors say. Dr. McIntyre cited the Canada Emergency Response Benefit, which offered employed people $2,000 a month for up to 28 weeks; the Canada Emergency Student Benefit, which provided $1,250 a month for 16 weeks, as well as provisions for small business, mortgage leniency for homeowners and eviction bans for renters.
Besides financial help, the report also noted a boost in regional funding for psychotherapy and counselling services, and 24/7 crisis lines.
The report noted that while mental distress and people’s thoughts about suicide rose, this did not translate into more deaths.
“Mental health has a relationship to suicide rate, but it’s not the be-all-end-all,” said Tyler Black, a Vancouver psychiatrist and suicidologist who was not involved in the current paper. “Many people who die of suicide … they’re having real-world problems, whether it’s relationship problems or financial problems or health problems.
“There is not this strong relationship between thinking about it and dying, on the individual level,” Dr. Black said.
Canada’s suicide rate decreased from 10.82 deaths per 100,000 population in the period of March, 2019, to February, 2020, down to 7.34 deaths per 100,000 in the first 12 months of the pandemic. This, as the country’s average monthly unemployment rate rose from 5.7 per cent in 2019 to 9.5 per cent in 2020.
Canada’s decrease in suicide rates mirrors that of other middle-to-high income countries, Dr. Black said. A meta-analysis published in April in The Lancet examined suicide trends in 21 countries during the early months of the pandemic. The report found no evidence of heightened suicide rates, with drops recorded in nine regions, from South Korea to Leipzig, Germany, to New South Wales, Australia.
“Controlling the pandemic is the best thing we can do for our economy, our mental health, our children. It means less suffering and death. It looks like this maxim is holding true. The countries that have done the best against COVID are the ones that are suffering the least economically, and in health measures,” said Dr. Black, who, along with Senator Stan Kutcher, co-authored the spring report Suicide during COVID-19: Myths, realities and lessons learned, which questioned the likelihood of a widely projected “tsunami of mental health” in the pandemic.
Mental-health experts also noted the positive influence of stronger social cohesion, which can emerge in crisis.
“Some people have been saying that for the first time, they discovered they have neighbours and a sense of collective community. This is also playing some role,” Dr. McIntyre said. “It’s not only about the financials.”
Dr. Black referred to it as the “pulling-together effect.”
“During times of hardship – whether it’s wartime or a natural disaster or this pandemic – people pull together,” he said. “There’s an added connectedness during times of common calamity where we work for each other and do our part.”
Even with the declines in suicide during the global health crisis, Dr. McIntyre urged caution. Ongoing surges in infections are causing “chronic, unpredictable stress,” which is especially toxic, the psychiatrist warned.
“The longer this goes on with an unpredictable end point, the literature says this carries with it greater hazard for people’s mental health,” Dr. McIntyre said.
He added that some people get sick after a major crisis passes and they’re out of survival mode: “We’re wired for fight or flight in battle. It’s not until after the battle that we realize we’re covered in scars. When it’s over, that’s when the consequences, the wear and tear and the battle fatigue manifest.”
Experts sometimes see an uptick in suicides after a large-scale crisis ends because this is when social services and financial support tend to disappear.
The report pointed to Japan, where suicide rates decreased by 14 per cent in the first five months of the pandemic, only to rise and then exceed prepandemic levels last fall, when the government clawed back financial provisions. Youth and women were hardest hit. For women, employment insecurity, the burden of juggling many personal and professional roles, and a surge in intimate-partner violence during lockdowns likely contributed, Dr. McIntyre said.
It is this level of detail that Dr. Black found lacking in the optimistic figures emerging out of the pandemic in Canada.
“My biggest worry about the large data … presented in this article, is that it misses granular things. It’s missing the effect on Indigenous populations. It’s missing the effect on young women,” he said. “The overall statement can hide much disparity and unfairness inside it.”
Dr. McIntyre acknowledged that opioid deaths have skyrocketed in Canada during the pandemic, and that a fraction are likely intentional. Statistics Canada does not include fatal, intentional opioid overdoses in its suicide rates, codifying such deaths as poisoning.
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The Globe and Mail
Editor’s note: The March 2020 to Feb 2021 suicide data reported in the study is provisional. Lengthy investigations by coroners and medical examiners mean suicides can take longer to be reported to Statistics Canada. The 2020 data referenced in the study was 93 per cent complete.
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Zosia Bielski