In the early days of the pandemic, there were fears that the anxiety, isolation and financial uncertainty would lead to a rise in suicide. Instead, after two decades of rising suicide rates in the U.S., the number of deaths by suicide declined in 2020 for the second year in a row, according to preliminary federal data published Wednesday.
While suicide deaths dropped overall in the U.S., there were increases among young adults, as well as American Indians and Alaska Natives, Black Americans and Hispanic Americans, the report from the Centers for Disease Control and Prevention found.
Suicide rates in the United States had increased by 35 percent between 1999 and 2018, before a slight dip of 2 percent in 2019.
The new CDC data, which included 99 percent of suicide deaths in 2020, showed an additional 3 percent decrease last year.
Drops in suicide deaths among white men and women were the main forces behind the declines in both 2019 and 2020. Rates for white Americans declined by 5 percent — the largest of any group — followed by a 4 percent drop for Asian Americans. White men saw a 3 percent decrease, while white women overall saw a 10 percent decrease.
The overall suicide rate among women declined 8 percent between 2019 and 2020 and 2 percent among men overall.
Among younger Americans, suicide rates increased slightly in all groups ages 10 to 34, although the only significant increase was a 5 percent uptick among 25- to 34-year-olds, the report said.
Suicide rates were by far the highest among American Indians and Alaska Natives, which increased by 5 percent in 2020, followed by white Americans. Black Americans and Hispanic Americans had similar rates of suicide. Black and Hispanic females had the lowest rates of suicide among any group, but those numbers don’t show the whole picture.
It's the first time the CDC has put together a report based on preliminary data.
“We knew from the initial quarterly data that what was going on for groups was different, and we wanted to look at those differences,” said Sally Curtin, a statistician at the CDC who led the study.
Curtin noted that although suicide rates among Black and Hispanic Americans remained much lower than suicide rates among American Indians and Alaska Native and white populations, overall, suicide rates were higher in 2020 than in 2019 for both Black Americans and Hispanic Americans.
The increase we’re seeing in minority populations is a concern, and it may not be related to the pandemic at all.
Dr. Maria Oquendo, Chairman of Psychiatry, Perelman School of Medicine, University of Pennsylvania
While suicide rates among Black girls and women ages 10 to 24 are low compared to other groups, deaths among this group increased more than 30 percent, from 1.6 to 2.1 per 100,000 people. Black boys and men of the same age saw a 23 percent increase, from 3.0 to 3.7 per 100,000.
Among Hispanic women in this age group, the rate increased by 40 percent, from 1.5 to 2.1 per 100,000 people. Hispanic men in this age group saw a 20 percent increase, from 2.0 to 2.4.
Asian women ages 15 to 24 also saw a nearly 30 percent increase in suicide deaths, from 4.9 to 6.2 per 100,000.
“The overall suicide rate decrease from 2018 to 2019 may be the beginning of a trend, and that’s a very welcome thing,” said Dr. Maria Oquendo, chairman of psychiatry at the University of Pennsylvania Perelman School of Medicine, who was not involved with the study. “What these data also tell us is that some of the increases we are seeing among minority groups also seem to be trending upward.”
The CDC report didn’t examine the reasons for suicide, only the numbers.
“The increase we’re seeing in minority populations is a concern, and it may not be related to the pandemic at all because we did see an increase already in 2019,” Oquendo said, noting that this wasn’t always the case. “Whatever is happening in these communities is very worrisome because historically they had been relatively protected from suicidal behavior.”
Oquendo also emphasized that suicide deaths among American Indians and Alaska Natives remain alarmingly high, with rates nearly three times that of Black or Hispanic Americans.
"I would underscore that the incredibly high rates among AIAN populations has been present for a long, long time," she said. "This is something that needs a tremendous amount of attention."
Some populations at high risk of suicide, such as LGBTQ Americans, aren’t accounted for in the CDC data, Oquendo said.
"We know from data collected on suicide elsewhere that sexual minorities are at a much higher risk for suicidal behavior," she said. "But because the CDC has not historically kept data on that information, we really don’t know what the suicide rates are in this population. It’s a gap in our knowledge."
Did the pandemic make things worse?
According to Craig Bryan, director of the Suicide Prevention Program at Ohio State University, the 2020 data follows a paradox long recognized by people who study suicide.
“Historically, we know that during times of crisis we tend to see reductions in suicide,” he told NBC News. “Did the pandemic make things worse? That’s what most people assumed would happen, and I expect the pandemic made things worse for some people and made things better for others.”
A study of 21 wealthy and upper-middle-income nations, published in April in The Lancet, found that suicide deaths during the early months of the pandemic either stayed the same or dropped below what pre-pandemic numbers predicted. The CDC’s preliminary data echoed that, reporting a 14 percent drop in U.S. suicide deaths in April 2020 compared to April 2019.
“This isn’t a magnitude of change we usually see year to year,” Curtin said, noting that this was also during the strictest lockdowns and a time when crisis hotlines saw a massive increase in calls.
Bryan attributed some of the progress to people being home with their families and expanded access to mental health care through telehealth.
"It’s quite possible that there were more family connections, but there are other possibilities, too," Bryan said. "When you are home with other people, you don’t have as much time by yourself, and there is more likely going to be someone around who can rescue or intervene in a suicide attempt."
Another key factor is that suicide is a complex event, and mental illness is not the only factor that plays a role.
“It may actually be much less of a factor than suicide prevention efforts suggest,” Bryan said.
There's an important difference between natural reactions to extreme stress and mental illness such as anxiety and depression, which may have been over-diagnosed during the pandemic, Bryan said.
"Increased strain or stress is not the same thing as mental illness," he said. "Many of us had increased stress during the pandemic, and these reactions are part of the human experience. We may have over-pathologized symptoms of depression and anxiety when in reality it was all of us reacting normally to a big change."