U.S. Suicides Declined Over All in 2020 but May Have Risen Among People of Color

Ever since the pandemic started, mental health experts have worried that grief, financial strain and social isolation may take an unbearable toll on American psyches. Some warned that the coronavirus had created the “perfect storm” for a rise in suicides.

The concern was seized on by lawmakers who were eager to reopen the economy. In March 2020, Donald J. Trump predicted a surge in suicides resulting from statewide lockdowns. A provisional tally of last year’s deaths, however, contains a surprising nugget of good news.

While nearly 350,000 Americans died from Covid-19, the number of suicides dropped by 5 percent, to 44,834 deaths in 2020 from 47,511 in 2019. It is the second year in a row that the number has fallen, after cresting in 2018.

The decline came even as the number of unintentional overdose deaths rose dramatically during the pandemic. Some overdoses are classified as suicides; there is debate among researchers as to how many ought to be included.

But while the number of suicides may have declined over all, preliminary studies of local communities in states like Illinois, Maryland and Connecticut found a rise in suicides among Black Americans and other people of color when compared with previous years.

Whether that is the case nationally is not known. Federal health officials have yet to release a detailed breakdown of the race and ethnicity of last year’s suicide victims, and some experts have cautioned against making generalizations based on trends in a few localities.

“We can’t make any bold statements until we have more national data,” said Arielle Sheftall, a principal investigator at the Center for Suicide Prevention and Research at Nationwide Children’s Hospital in Columbus, Ohio. “It may be that only certain areas or certain cities have experienced these increases” among people of color, she added.

Suicides are comparatively rare events, and it is hard to know how to interpret changes in small numbers and whether they represent statistical hiccups or broad trends. Rates usually fall off during times of war or natural disasters, when people feel drawn together to fight for survival against a common enemy. But the effect can peter out over time, and fatigue and despair may follow, experts say.

In the early days of the pandemic, families posted colorful drawings of rainbows in their windows and children stuck their heads out each day at 7 p.m. to ring bells and cheer for health care workers.

“During the early phase of a natural disaster, there’s a sense of community building, a feeling that we’re all in this together,” said Dr. Christine Moutier, chief medical officer for the American Foundation for Suicide Prevention. “The survival instinct can really kick in front and center.”

The initial sense of crisis and purpose may have been a source of strength for people around the world. A new study of suicide trends among residents of 10 countries and 11 states or regions with higher incomes found that the number remained largely unchanged or had even declined during the early months of the pandemic, though there were increases in suicide later in the year in some areas. (Another study that has not yet been peer reviewed reported sharp increases in suicide from July to November in Japan, with a greater increase in suicides among women during that time period.)

In the United States, the pandemic has taken a starkly disproportionate toll on communities of color: Hispanic, Black and Native Americans, as well as Alaska Natives, are more likely than white Americans to be hospitalized with Covid-19 and to die from it. Two in five Black and Hispanic Americans have lost a close friend or family member to the virus, compared with one in four white adults.

People of color have also been pummeled financially, particularly low-wage earners who have lost their jobs and had few resources on which to fall back. Many who remain employed hold jobs that put them at risk of contracting the virus on a daily basis.

Anxiety and depression have risen across the board, and many Americans are consumed with worry about their health and that of their families. A recent study found that one in 12 adults has had thoughts of suicide; Hispanic Americans in particular said they were depressed and stressed about keeping a roof over their heads and having enough food to eat.

Some Americans plunged into poverty for the first time, shattering their sense of identity and self, said Dr. Brandi Jackson, a psychiatrist who is director of integrative behavioral health at Howard Brown Health in Chicago.

News reports about the killings of Black people, from Breonna Taylor and Ahmaud Arbery to the shocking death of George Floyd in May, added to the trauma for Black Americans, Dr. Jackson said.

“It’s one stressor on top of another stressor on top of another stressor,” Dr. Sheftall said. “You’ve lost your job. You’ve lost people in your family. Then there’s George Floyd. At one point, I had to shut the TV off.”

Researchers who study the racial trends said increases in suicide among people of color were consistent across the cities and regions that they examined — and all the more striking because suicide rates among Black and Hispanic Americans had always been comparatively low, about one-third the rate among white Americans.

Rodney Moore Sr., of Anaheim, Calif., lost his 14-year-old son, Rodney Jr., to suicide in January. Mr. Moore believes that his son despaired when his school did not reopen as expected earlier this year.

Mr. Moore urged parents to be on the lookout for any changes in behavior or mood in their children that could indicate hopelessness about the future. “Look out for anything that is different in their sleeping, their eating, a change in attitudes, a personality change,” he said.

Public health officials in Chicago were among the first to notice that even though overall suicide numbers remained stable during the first eight months of 2020, the number of suicides among Black residents had increased.

Officials were particularly concerned about a rise in suicides among young Black adults in their 20s, as well as by an increase among older people of all races, issuing a health alert in November and taking steps to beef up funding for crisis hotlines and mental health services.

The state’s Department of Health in January reported a similarly lopsided trend, saying suicides in the state had dropped by 6.8 percent over all, but they had risen by 27.7 percent among Black residents and by 6 percent among Hispanic individuals.

“It’s important to not just be monitoring the topline numbers, because we know that Covid has impacted different communities in disparate ways,” said Matthew Richards, the deputy commissioner for behavior health at Chicago Department of Public Health.

“When we talk about Covid and the amount of trauma, grief and stress at the community level — we should not underestimate how significant a public health issue that has the potential to be.”

A similar trend appeared in Maryland, where researchers analyzed suicide deaths from March 5, 2020, when a statewide emergency was declared, to May 7, when public spaces started to reopen, and then compared them with the same periods during previous years.

The study found that suicides fell by almost half among white Americans — but doubled among Black residents of the state after the emergency declaration in March. (There was no change in suicide trends from Jan. 1 to March 4 of last year.)

“It’s clear the pandemic has hit African-Americans a lot harder than it has whites,” said Dr. Paul Nestadt, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins who was the senior author of the study, which was published in JAMA Psychiatry in December.

“The pandemic may have been a perfect storm, but we’ve all been in very different boats in that storm,” he added.

He and a colleague, Michael Bray, have continued to investigate and say there is preliminary evidence that suicide rates have also increased among Hispanics in Maryland last year.

In Connecticut, Yale University scientists who studied death rates during the period of strict stay-at-home measures in that state, between March 10 and May 20 of last year, were also at first surprised to find that the overall suicide rate in the state had plummeted by 20 percent, when compared with the same period in 2019.

But a closer look revealed that while suicide among white residents had plunged to a six-year low, the rate among the nonwhite population had risen.

Of 74 Connecticut residents who died by suicide during the lockdown period, 23 percent identified as nonwhite, nearly double the percentage of suicide deaths compared with the previous six years, the researchers found. Neither the average age of suicide death (50) nor the sex ratio (three-quarters were men) had changed.

“It was deeply disturbing,” said Dr. Thomas O. Mitchell, a psychiatrist and one of the authors of the paper, which was published in the journal Psychiatry Research in December. He said that financial strain — known to be strongly linked to suicide — might have played a critical role in the deaths.

“People in minority groups already face unique economic challenges, so the financial crisis from losing a job during the pandemic might be felt even more intensely by these communities,” Dr. Mitchell said, adding that those who continued to work in public-facing jobs “are putting their life on the line every day — a stressful thing to do.”

Jasmin Pierre, a Black woman is now a mental health advocate, narrowly survived a suicide attempt seven years ago after a number of setbacks, including a job loss and the death of her sister.

Many friends and relatives responded with disbelief. “They said, ‘Black people don’t do that,’ or, ‘Girl, go and pray,’” recalled Ms. Pierre, who has developed an educational app called The Safe Place. “But actually, we do do that. We just don’t talk about it. It’s taboo.”

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.


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