Suicides

Our lockdown response to COVID-19 has produced unprecedented social isolation and loneliness, unprecedented levels of clinical depression, and unemployment for 16% of U.S. workers.  Those factors all lead to deaths of despair, defined as deaths due to suicides and drug and alcohol misuse.  By our COVID response we are trying to reduce deaths due to COVID, but we knew, or should have known, that the response would cause other deaths.  In other words, to be blunt, we decided to kill some people by driving them to suicide and drug and alcohol overdose in order to try to save others from COVID death. Was it worth it?  Are we killing fewer people than we are saving?

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The Well Being Trust, a nonprofit devoted to promoting mental, social, and spiritual health, estimated that our response to COVID will cause 27,644 to 154,000 excess deaths of despair, with a midpoint estimate of 68,000 (reference 1).  This was based solely on the unemployment from our COVID response, because there was good previous research showing that a 1% increase in unemployment causes a certain number of increased suicides and deaths of despair.  The estimate of 68,000 did not include the effect of the unprecedented social isolation  from closing churches, restaurants, bars, and health clubs and mandated mask wearing that makes it harder to meet and emotionally connect with others.  My guess would be those factors would cause more deaths of despair than the unemployment alone, so it is very likely the 68,000 estimate is an underestimate.

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We have to use estimates since we do not know how many people have died from suicides or drug or alcohol overdoses during the pandemic because the CDC and the state health departments, although they tell us literally every day how many people died of COVID in the previous day, have not told us yet how many died of suicide even for 2019.  You can make of that what you will.  It suggests to me that they consider deaths from COVID to be of much greater consequence than deaths from suicide.

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For 2018 though, there were 67,386 drug overdose deaths, 48,344 suicides, and over 95,000 alcohol caused deaths, of which over 40,000 were classified as “100% alcohol attributable” (references 2, 3, 4).   That is a total of 210,000 deaths of despair per year, or 155,000 if you exclude indirect alcohol-related deaths such as liver cancer and cirrhosis of the liver.  Taking the lower 155,000 figure, an increase of 68,000 would require an increase of only 22% per year for two years. I find it hard to believe that we will not have at least a 22% increase in suicides and other deaths of despair for 2 years because of our COVID response.

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The CDC has not released total numbers of suicides or other deaths of despair for 2019 or 2020, but they did put out a press release saying that for the 12-months ending at the end of May 2020 there were 81,000 drug overdose deaths and this was a 18.2% increase over the prior 12 month period, which had been a 4% decline from the year before that (reference 5).  Since drug overdoses had been declining, my guess would be the 18% annual increase for the 12 months ending in May 2020 occurred entirely in the three months of March-May 2020, during COVID after the unemployment and social isolation hit.  If so, then it was a 72% increase during those 3 months.  This again suggests to me that we will have at least a 22% increase in deaths of despair for two years and indeed have at least 68,000 excess suicides and other deaths of despair as a result of our COVID lockdown response.

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The median age of a person dying by suicide is about age 42 (reference 6).  A person aged 42 has about 38 years of life expectancy remaining in the U.S.  So 68,000 excess deaths of despair x 38 years life expectancy = 2.58 million person-years of life lost from excess deaths of despair caused by our COVID lockdown response.  That is more than 3 times the 800,000 person-years of life COVID Sanity is estimating our lockdown response is saving in averted COVID deaths.

These findings are summarized in the figure above.  While it is true that we are estimating that our COVID lockdown response is killing fewer people by driving them to suicide or de facto suicide by drug or alcohol abuse than we are saving by preventing COVID deaths, the deaths of despair we are causing are in far younger people with far more years of life remaining than those whose lives we are saving by preventing COVID deaths, so we wind up causing more than 3 times more person-years of life lost due to deaths of despair than we are saving in prevented COVID deaths.