SIO323: Did COVID Precautions Increase Adolescent Suicide Risk?

Transcript

This transcript was generated automatically and may contain errors — the audio is the record.

0:00:12 Thomas: And welcome to Serious Inquiries Only. This is episode 323. I'm Thomas and I'm joined by Lindsey. I want to leave a little suspense like just if maybe they thought I was gonna say and Lindsey's gone. But no, you're here.

0:00:18 Lindsey: Oh, boy. Oh, yeah. No, I'm not gone.

0:00:27 Thomas: No, it's good because you're not gone. So been good suspense. But anyway, I'm so glad you're back because science thingy. Science thingies are among my favorite thingies.

0:00:29 Lindsey: Oh. Oh I see. Yeah. Yeah, me too.

0:00:39 Thomas: And uh, having you explain them to me, even better, uh, this is uh, this, this topic I imagine might be kind of tough so um, is related to COVID restrictions and the fact that there's an obvious uh backlash against them by, I don't know, right wingers, I guess. I don't, I don't really understand where it comes from exactly, but I guess how do you even describe that group of people, Trump supporters who want the bad things to not exist so they, so they don't want to do anything or something. What, what even is that group of people?

0:00:49 Lindsey: Mm-hmm. Yeah I

0:01:15 Thomas: I'm failing in the moment to come up with it, like uh, you know, the Big Lebowski quote, like uh, yeah, least that's a ethos or whatever. It's like I don't even know how to describe these people, um, but anyway, people who are against people who are essentially children, that whenever you tell them they need to maybe do a thing to prevent mass death, are like, "Oh, a thing, I hate things, I'm not doing anything." It's like that, those people yeah

0:01:15 Lindsey: Don't know. I don' know.

0:01:28 Lindsey: Yeah and they've been incredibly consistent throughout this this whole thing. So I think this is relevant. So my, my friend Stacey actually suggested that we cover this like months ago because she was concerned about, you know, folks making, making the kind of cure can't be worse than the disease kind of arguments against pandemic mitigation measures, you know, remote schooling and things like that, because they were citing supposed evidence that mental health issues were increasing because of these things. So we made plans to cover it, like, again, like months ago. And I started prepping it, and then it like became this huge prep, and we didn't do it. And by the time we got back to recording, I was I was like, well, this clearly isn't gonna be topical anymore. But it is.

0:01:45 Thomas: Yeah uh -huh right it's always topical

0:02:22 Lindsey: Because people are still making these, these claims but now it's not about remote schooling or whatever, it's about mask wearing or, you know, whatever kind of good thing people want people to do, so that COVID doesn't spread

0:02:22 Thomas: Yeah, yeah right oh first note thanks for, for everybody who messaged me about the KN95 kids masks. Appreciate it. Yeah. Yeah, and then secondly, yeah, absolutely. I also think I want to make very clear, I'm kind of coming into this as the, I don't know what this report says. I'm Lindsay to explain it to me, but going into it, I think that it's not unreasonable to suspect that there's a cost to pandemic -related measures, of course.

0:03:02 Thomas: Nothing's free. I don't think the left needs to be like, no, everything's totally cool with working from home and not going to school. That's a straw man position.

0:02:35 Lindsey: Oh yeah sure yeah yeah

0:03:12 Thomas: But I the open question is like, well, how bad is it? What are these effects? And it's hard for me to imagine what would possibly be worse than, as you say, the cure's worse than than the disease. Like, well, I don't even know what that would look like. Like we've lost a million people, you know? So like, what would it have to be to be worse than that? It's a tough question. And guess you know, it's denialism is what it is, that group of people. It's like the people who are around, obviously aren't ones who've died of COVID, although maybe, you, they probably know somebody who does, but by definition, they haven't died of COVID yet. So they're like, well, the bad thing that's happening hasn't happened to me, so I don't want to do anything to help or to prevent it because that might have a bad effect on my kids or whatever they think. So anyway, you're going to tell us maybe what the real numbers are.

0:03:30 Lindsey: Yeah well yeah, right, and in terms of trying to imagine, like, what cure would be worse than the disease, right? I mean, so content warning, warning for the entire content of this episode. The topic of this report is about suicidality and specifically suicidality in pretty young people, right? So adolescents, 12 to 17. So at least in...

0:04:25 Thomas: Well, I'm out. I don't want to hear about that. So I'll join you after the show like like the Muppets and Muppet Christmas Carol.

0:04:26 Lindsey: Yeah, it's dark Stuff, right. And so, I think that if claims were true, you be worth taking seriously if it really was true that these pandemic mitigation measures were resulting in high rates of suicidal behavior in young kids, right? Especially fatal suicidal behavior. Like, yeah, that's a real cost that we really need to weigh seriously here. And so, yeah. I think the question is where the evidence is on this stuff.

0:04:48 Thomas: Yeah. Yeah, all right, well, I'm sure we can talk more after you give us a science thingy, so let's get into it.

0:05:02 Lindsey: Yeah. Okay. Yeah, so just to talk about where this came from. So a couple of weeks ago, SIO listener Shane recommended that we covered this CDC report that we're talking about. And the gist is that the CDC report, which was published last year, so June 2021, appears to show that emergency department visits for suspected suicide attempts among teens, and especially teen girls, were and perhaps still are elevated as a result of something that's happening related to the pandemic. And so there's been a lot of reporting and online discussion about what could explain that increase and its public health implications. And I mean, most of the calls to action that I'm seeing are pretty benign. They're just suggesting that we essentially provide more mental health support to adolescents, which like, sure, yes, let's do that.

0:05:43 Thomas: Yeah. I mean Yeah, I was gonna say that I don't want to bog you down, but it be true, like, let's say just hypothetically going into this that that's true, that like, oh, suicide is up or suicide attempts are up in children, I think you could very reasonably say, oh, okay, well, let's take measures to help that that don't include, you know, reckless disregard of COVID protocols.

0:06:09 Lindsey: Yes. Yeah, exactly. Right. And so those calls to action are fine, right? Like, I mean regardless of whether there's a pandemic, I'm always supportive of that kind of call to action. But as we were just talking about, some folks are using data to make arguments against the even very modest mitigation measures that we are still fighting to maintain in schools, like masks.

0:06:16 Thomas: Yeah. Mm -hmm. Yeah.

0:06:30 Lindsey: Anyway, a priori, I really wasn't sure what to expect from this data because, you know, it's so obvious that it barely bears saying that mental health struggles have like undoubtedly increased for some people.

0:06:41 Thomas: Yeah, of course. Yeah?

0:06:44 Lindsey: Yeah. And probably many people Right. I

0:06:47 Thomas: Probably most of the hosts and people listening to this show.

0:06:50 Lindsey: Think so. Right. You know, there's... there's some evidence to support this. Right? So according to recent surveys, demands for mental health services have increased dramatically since March 2020. And that could be an indicator of elevated distress. Stress. In fairness, it could also be an indicator that people are seeking more help for mental health struggles than they were before.

0:07:07 Thomas: Yeah. True.

0:07:09 Lindsey: But yeah, intuitive isn't quite strong enough describe the intuition that the pandemic had some negative effects on mental health. Right. A lot of things about living through a pandemic that intuitively could elevate mental mental health issues, including suicidality at a population level. But from what I'm seeing thus far, and I think that this will surprise people, it surprised me to some degree, the picture that is emerging from the research on mental health during the pandemic is actually very, very complicated. First of all, just to give a little bit of a preview, there's not clear evidence that suicidology overall has increased since the beginning of the pandemic. And that's true if if you look at total rates, and it's still true if you break the rates into demographic categories along the lines of age and gender, right?

0:07:19 Thomas: When you say suicidality, does that just mean successful attempts or attempts?

0:08:01 Lindsey: Means suicidal behavior more broadly. So suicidal attempts and fatalities, There's not strong evidence that that has increased. This is going to surprise you more. Even the evidence about how the pandemic has impacted various other aspects of mental health more broadly among different groups does not point toward a singular, clear trend in one direction or the other. So, for instance, you know, I've read several meta-analyses suggesting that the pandemic and the pandemic response did not have uniform impacts on mental health. So certain studies pointed to struggles or increases in struggles, other studies suggested decreases among certain groups, and others suggested no change at

0:08:04 Thomas: Okay. Gotcha.

0:08:42 Thomas: Yeah.

0:08:42 Lindsey: All. And all of those studies could be right, meaning that there has not been one effect of the pandemic. People have been vastly differently affected by the events of the last two years. So I do find that kind of surprising, really, that like when you look at the meta -analyses, the effects at the level of the broader population seem to kind of cancel each other out in terms of like an overall trend. All that said, my take-homes from sifting through this stuff are not exactly reassuring. So the evidence is very thin that the COVID-19 pandemic has any population level impacts on suicidality, but there are some concerning trends in suicidal behavior that significantly predate the pandemic, and that's what we're going to end with, right? So that was a very long preamble to this report, but I think it's important to get the framing of this stuff right, because it's a really complicated issue and a charged one, but we

0:08:50 Thomas: Yeah, I was

0:09:40 Lindsey: Talk about the CDC report? Okay. So again, published in June 2021. And I want to start by directly quoting their first sentence. So they say, quote, beginning in March 2020, the COVID-19 pandemic and response, which included physical distancing and stay-at-home orders, disrupted daily life in the United States. Compared with the rate in 2019, a 31% increase in the proportion of mental health-related emergency department visits occurred among adolescents age 12 to 17 in 2020, right? So right off the bat, they're setting up two claims here.

So one is that some indicators suggest an increase in mental health issues in 2020, especially among young people. And two, that this increase may be related to the pandemic response, right, so they specifically cite stay-at-home orders and everything that came along with them, right. So I know that we're only two sentences into the report, and I'm not going to do this after every two sentences. But I already have to pick apart one of these claims.

So it's, and it's a point that's going to be relevant to evaluating the current data too. So I think this is worth spending a little time on. So they say in that second sentence that there was a 31% increase from 2019 to 2020 in the proportion of mental health related emergency department visits among adolescents. And that sounds bad, right? So I went back to the report that they're referencing. It's another report from the CDC. And this statistic is not what it appears to be.

This report actually shows is that the number of mental health-related emergency department visits were markedly lower in March and April of 2020 compared to that period in 2019. And then they slowly trended upward to roughly the same levels that they were in 2019 by late summer and early fall of 2020. Thing that was higher that they're referencing here was the proportion of all emergency department visitations that were were due to mental health-related concerns. The main wrinkle here is that overall, what happened to emergency department visits in 2020?

0:11:33 Thomas: All hospital visits in 2020 would be COVID.

0:11:37 Lindsey: But like, so early in the pandemic, so this is March 2020, right, and April 2020, we're not necessarily seeing like the level of surges.

0:11:39 Thomas: Yeah. Yeah, of course. Not then. Yeah right.

0:11:47 Lindsey: Yeah, right. You are going to have increases due to COVID, but overall, emergency department business dropped dramatically in 2020. So like in March 2020, they were down by like 42%. And they stayed somewhat suppressed throughout all of 2020. And at least through the first months of 2021, based on the reports that I've been able to find about this. Essentially, what this report that they're citing shows is, you you when you're talking about a rate, like the mental health visits, as a proportion of all emergency department visits, you're saying that that rate goes up. But the absolute number doesn't change, right? No, it doesn't, right? If the rate goes up, it means the numerator of this ratio, right, it's declining actually during the pandemic, but the denominator is declining even more. So total emergency department visits are declining even more than emergency department visits due to mental health concerns.

0:12:16 Thomas: Yeah that doesn't really tell you much does it?

0:12:41 Thomas: Mean I would have just assumed that the stat was just talking about number of visits. Like if I just read that, that's what I would assume.

0:12:48 Lindsey: Nope. Nope, nope.

0:12:50 Thomas: Well that seems misleading.

0:12:51 Lindsey: And yeah, Yeah, I think so, too. Right. And so, yeah, so the way that they're representing this finding, the thing, the point that they seem to be trying to make by referencing it is that there's an increase in mental health issues. Right. As as indicated by mental health related emergency department visits. And it's just not interpretable that way. Right? We're already off to a shaky start here.

0:13:02 Thomas: Mm -hmm. Yeah. So who's responsible for that bullshit statistic?

0:13:15 Lindsey: Another CDC report.

0:13:16 Thomas: Oh, CDC.

0:13:17 Lindsey: Yeah. And you know what? This is something where this is going to be a recurring theme. I'm really curious about who the intended audience is for these reports, because it really doesn't seem like these are for public consumption. Like, these are full of these sort of very declarative statements without a lot of interpretation, without a whole lot of context around them. Like they read very much like an internal document.

0:13:18 Thomas: Hmm.

0:13:40 Thomas: Why would the CDC put out that number? What use is that statistic to anybody?

0:13:45 Lindsey: I don't know. I would really, somebody that has sort of insider knowledge of this stuff, like works for the CDC or something, needs to tell us.

0:13:51 Thomas: Yeah, Mr. CDC. Mr.

0:13:54 Lindsey: Actually. I might be be making this up, but I feel like I might know someone with a relative who works for the CDC, maybe I'll try to get the the scoop here, um.

0:13:55 Thomas: Sent I you could tell if you were making that up. No, but for real, that makes no sense. There be, you that first report was issued, that's during Trump time. Could this be like right-wing activism kind of BS?

0:14:16 Lindsey: I'm not sure, I mean it doesn't, it didn't read that way necessarily. It's it's not like they were in that other report trying to draw policy implications and saying we should, we should curtail shutdowns or anything, um, I'm genuinely uncertain as to what the intended audience is for these for these documents, I, I don't know, but back to the report, after they, they open with this, they then point to some reports from early in the pandemic indicating that suicidal ideation might've been elevated in some age groups, but they say that the patterns in suicidal behavior were less clear. And so the goal of the current report is to examine the incidence of suspected suicide attempts between March 2020 through May of 2021. Right. Specifically they examine in emergency department visits among adolescents, so folks aged 12 to 17, and among young adults, folks aged 18 to 25, from January 2019, so the year leading up to the pandemic, through May of 2021. So they've got this comparison year before the pandemic and then roughly the first 15 months of the pandemic to compare.

0:14:19 Thomas: Hmm. Yeah.

0:15:19 Thomas: Know if this is going to be important, but when did Delta hit? Was that?

0:15:22 Lindsey: Was after this observation period.

0:15:23 Thomas: Okay. Gotcha.

0:15:24 Lindsey: Wasn't that like July, I think, that we saw the big spike?

0:15:26 Thomas: That's kind of what I was thinking. Yeah, Yeah.

0:15:28 Lindsey: Mm -hmm. Yeah. Got these years of data, and they're going to look to see if there are any discernible changes in the incidence of emergency department visits due to suspected suicide attempts. And if anybody's wondering how suspected suicide attacks were defined, they recorded these based on diagnostic codes from the reporting hospitals. So these data were collected as part of this ongoing program called the National Syndromic Surveillance Program, which collects data from participating hospitals across the country to collect and monitor health data. But one thing that I wanted to point out about their definition of suspected suicide attempts is that it includes visits for suicide attempts, but also includes, quote, some non-suicidal self-harm visits. Deficits. And in the scope of everything that we need to cover in this report, this is a smallish detail and I don't want to spend too much time on it, but non-suicidal self-harm is a very distinct behavior from a suicide attempt.

0:15:28 Thomas: Okay. Yeah.

0:16:22 Lindsey: And it bothers me a little bit that these are being lumped into the same category. So it's another sort of interpretational problem. It's typical when you see actual research by people in the area of suicide research. It is very typical to examine those behaviors separately because conceptually, Theoretically, they are so distinct, they're predicted by different things, and they serve different functions. So, so, continuing, they briefly describe how they examine their data. So they're plotting the weekly counts and rates. So we've got both counts and rates, we're going to come back to the rate thing, of emergency department visits due to suspected suicides from January 2019 through May of 2021. And they've got these plotted separately for adolescents and adults of each gender, right? So they've got like a time graph comparing these periods.

They're also comparing three separate four week periods in 2020 and 2021 to corresponding periods pre -pandemic in 2019, in order to see if certain representative points during the pandemic showed elevated suicide attempts. So they're going to do direct comparisons there. And so the three periods that they chose were during spring of 2020, so that's late March through late April in 2020. There's a four -week period in summer of 2020 that ranges from late July to late August.

And then the third period that they examine is spring of 2021, so that's late February through late March. And they don't give any additional reasoning for choosing these specific four -weak periods beyond simply saying that they were representative distinct periods of the pandemic. But the periods that they chose were, in fact, meaningfully different times. And I think this context is a little bit important.

So, you know, obviously, the spring 2020 period, March or late March through late April, that's right after this was declared as sort of a global emergency. It's also the period during which life was most restricted across the U.S.

0:16:38 Thomas: Yeah, yeah. Right.

0:18:17 Lindsey: Due to pandemic mitigation. Litigation. So California's, yeah,

0:18:20 Thomas: Not to mention it's novel, you know, like it could be harder to, there could be that period of like taking, having a hard time dealing with the fact of what's happening. And then like that adjustment period.

0:18:30 Lindsey: Yeah exactly right. So I think it was a good time to choose like I'm interested in what's happening during that particular period. Yeah, so, like, March 19th, which is 10 days before this four-week period starts, that was the day that California issued its statewide stay-at-home order. It was the first state to do so, and then the majority of states followed suit within a maximum of about three weeks, right. Then restrictions started to ease in many states by May, which is soon. So anyway, so during this first spring observation period, most states were under stay-at-home orders and schools were remote.

And so if we're looking at things like social isolation, disconnection from peers as potentially being relevant factors here, this is a period that's a pretty dark time for a lot of people, right? The second observation period that they had in summer 2020, so this is again late July to late August, represents the period following many states' decisions to postpone or reverse decisions to reopen economies.

So a lot of states were making plans to do this, and then we start getting indicators that things are going to get bad again, and they're reversing those decisions. Also during this period, we're getting announcements by many schools, including K-12, and also colleges and universities, that they're going to be opening remotely. So again, for a lot of people, this was probably a difficult time that they're selecting from again. I think it's hard, hard to remember these days at this point.

But I think that early in the summer, a lot of us were still walking around with the thought that, like, maybe things are going to get back to relative normalcy by the following fall. Naive we were.

0:18:37 Thomas: Mm -hmm.

0:20:01 Thomas: Yeah. Not me. I'm on the record as saying we were screwed forever.

0:20:05 Lindsey: Yep, you knew it. Right. Yeah, no, I mean, I think I remember thinking, well, maybe we won't start remotely.

0:20:11 Thomas: Oh people are optimists. You know?

0:20:13 Lindsey: Yep. That's what it is. Right? But yeah, by this second observation period that they have, like nobody, none of us thought that was happening at that point, right? We all knew what was coming. So that's a potentially depressing period for a of groups of people. Period that They selected for specific comparison was again, winter of 2021. So this is late February 2021 to March. And if you remember this, this actually was a period I think of relative optimism compared to what had happened previously. So we were fully past the biggest wave to date of cases. We saw that big spike in the winter that was over. New daily case counts by this date had plateaued at a relatively low rate. And we were months into the vaccine rollout. So by beginning of February 2021, the U.S. had administered 26.5 million doses of the vaccines, and we were boasting the fastest rate of vaccine administration of any country.

0:20:57 Thomas: Good times.

0:21:07 Lindsey: Boy, how things change.

0:21:09 Thomas: Yeah. Those were the days.

0:21:10 Lindsey: Yeah, right? So, I mean, this period of time I thought was interesting as another comparison period because things were starting to look up, at least in regards to pandemic news, Right. Okay, so my point in bringing in all this context is that if someone wants to make a case for, you know, ceasing pandemic mitigation measures based data like these in this report, like they're going to need need to pay pretty close attention with what you're seeing in terms of these mental health indicators in observation periods like this, right?

0:21:20 Thomas: Yeah, it seems like it's easy, ripe for cherry picking.

0:21:44 Lindsey: It does, right. Do plot the entire, like observation period. So like the full time graph is plotted from January 2019 through May of 2021. It's just that they're doing like actual statistical comparisons with these three observation periods. I thought that was worth saying, like they do plot all the data. But okay, so here's their summary of key findings for adolescents. So they say, quote, among adolescents aged 12 to 17 years, the number of weekly emergency department visits for suspected suicide attempts decreased, decreased during the spring 2020 period compared with that period in 2019. So again, this period coincides with the initiation of stay -at -home orders. You know, the pandemic is just sort of sinking in as a reality. I think that this is a relatively dark time for a lot of people, but suspected suicide attempts decreased during this period relative to 2019, right?

0:21:54 Thomas: Hmm. Okay. Yeah. I mean, there's so many possible explanations, right? Like people, maybe honestly, who knows, like, maybe you're going to tell us what the typical, you know, contributing factors to suicide might be, but I could imagine there could be a component of like, if, you these are going to be things that might cancel out. You know, on one hand, there may be one type of person who, if you're, maybe if youre alone in that time and everybody's holed up and you got no family or something, you know, maybe that's a time you're you might be more susceptible.

0:23:09 Thomas: But I don't know, maybe it could go the other way where it's like you hated your job and you hated going to your job. And then all of a sudden you're staying home. Like maybe you're like, oh, OK, you Know, just that maybe just having people around more could have. So, like, I do you think? Do you have any hypotheses, or is it, is there any speculation into why that would have happened? Mm-

0:22:40 Lindsey: Yes, Yes, absolutely. Mm -hmm. Yep. Mm -hm. Yeah.

0:23:28 Lindsey: I think that the kinds of examples that you're giving, I think that that illustrates exactly what I think is going on when we look at the broader data in terms of suicidality. There's some specific things I want to say about what they're showing in their report here.

0:23:36 Thomas: -hmm. Oh- Yeah, I'm sorry, were we talking about everybody or age 12 to 17? I missed, lost track of that.

0:23:46 Lindsey: Talking about 12 to 17. Yeah. But

0:23:47 Thomas: Okay. So- Yeah, okay, so then, restating- That, I mean- I- Could still see it being like some people love going to school, some people- Hate- Going to school, like, who knows if those things offset. Yeah.

0:23:52 Lindsey: Mm -hmm, mm -hm, mm. Nope. Again, yes, that is exactly what I think is happening, that accounts for sort of the washout that you see at a population level in these things. The effects of things like stay-at-home orders are totally heterogeneous. They're going to- hit some people really, really poorly. Some people, that actually, I think exactly what you're saying, that might have been a good thing. So I was actually talking to my developmentalist friend, Danielle, earlier today about this stuff. And, you know, the heterogeneity that seems to be in the literature around these things. And she's like, yeah, you Know, I saw some data presented from people that were collecting data on peer victimization when the pandemic hit.

0:24:37 Lindsey: So they had some longitudinal longitudinal stuff on this.

0:24:15 Thomas: Yeah. Oh- Yeah. Yeah. Yeah. I have to imagine that in this specific group, 12 to 17 years, this I would hope is not a very suicidal group just in general. I wrong? Do you have a higher risk for suicide then?

0:24:58 Lindsey: And And they might be higher than you would expect, but they're not like the highest over the lifespan.

0:25:03 Thomas: Okay. Right. I like comparatively but just in overall in number, I guess, I'm, I, all the statement I was making is like, it's not like 50 of these kids are killing themselves, it's like got to be a small number just in total, right, and point I want to make is like, of that small number, I could imagine that being bullied could be like a very large contributing factor, percentage wise, and that, that, that would maybe explain why there would be a decrease once you were not allowed to go to school. On one hand, maybe these parents who are against these things are thinking, yeah, my kid is depressed from staying at home all day, but you don't know if that kind of mental health, you would necessarily be as acute or be as something that would lead to suicide as much as like fierce bullying by your friends or something like that.

0:25:14 Lindsey: Right, right. Yeah, it is. Sure, sure. Yeah.

0:25:53 Lindsey: These are all like really, really good points. There's a lot to pick out of that. So that's along the lines of what I'm thinking too. So, okay. So one thing to reinforce is that, yeah. When people think about how intuitive it is that remote schooling, for instance, staying at home might lead to things like depression and suicidality, they're thinking about the relative isolation from peers. And isolation absolutely is a precursor to suicidology, social isolation. But when people are imagining that, they are imagining the people have these sort of like healthy, happy social environments.

0:26:00 Thomas: Hmm. Yeah.

0:26:27 Lindsey: And as you're saying, right, not everybody has that experience. If you remove that really negative experience, then, like, yeah, it could alleviate things, things that otherwise would contribute to suicidality.

0:26:37 Thomas: Hmm, and Not only that, is the isolation leading to suicidality typical in ages 12 to 17? Because I think of that as more like, I don't know, the typical like middle -aged dude that, like, is not married, doesn't really have anybody, and so, like, that's a whole different thing than if you're a kid and then you're, you stuck at home with your family. It's like, like you're not really isolated in quite the same way. Okay?

0:26:38 Lindsey: No.

0:27:00 Lindsey: But, like, peer contact is especially important during this developmental period, and so, yeah, the disconnection from peers, I think, has probably felt pretty acutely in this age range.

0:27:04 Thomas: Sure. Gotcha. Hmm. Okay.

0:27:10 Lindsey: Um, again, they're showing that you're actually getting decreases in suicide attempts during this period, which could seem counterintuitive. But I think that all these points are reasonable in trying to explain, like, why you might not see increases here, or why you might even expect to see a decrease, right? Then they say, quote, "However, by early May 2020, emergency department visits, visit counts for suspected suicide attempts began increasing among adolescents aged 12 to 17 years, especially among girls. During July 26 to August 22, 2020, the mean weekly number of emergency department visits for suspected suicide attempts among girls aged 12-17 years was 26% higher than during the same period a year earlier. During February 21st to March 20, 2021, mean weekly emergency department counts for suspected suicide attempts were 50.6% higher among girls" aged 12 to 17 years compared with the same period in 2019. that sounds really bad, right?

0:27:10 Thomas: Oh, Now, It does sound really bad. Did you tell us the gender breakdown of that, that decrease?

0:28:13 Lindsey: The gender breakdown, I did not. So I gave that to you combined, right.

0:28:15 Thomas: Right. So, Could it be that the decrease was also like disproportionately girls, and then when it came back up, then it looks like girls are disproportionately rising again? Okay.

0:28:18 Lindsey: Right?

0:28:28 Lindsey: I'm going to look at the graph right now to check, but my memory is that this was not a gender differentiated decrease. I don't think that this looks particularly different by gender.

0:28:39 Thomas: So that's good to know, though. So the decrease was all kids, basically, it decreased, and then when it started rising again, it's disproportionately girls.

0:28:49 Lindsey: That's right. Yeah. Sounds bad. And this is the finding that has really been highlighted in reporting. So I think that what What many people are taking away from this is that, you know, maybe the increase in suicidal behavior wasn't immediate, didn't happen as soon as, you know, the pandemic was declared and things shut down, but that it did start to happen as the pandemic wore on, and this was especially impacting adolescent girls. I think that's how people are interpreting this and talking about it. So there's a couple of things to point out here. First has to do with the noisiness of this data, or the random variability in these emergency department visits from week to week. And the the second has to do with these typical annual fluctuations that you see in suicidal behavior. Of these are, I think, very important context for trying to interpret these patterns that they're describing.

So first of all, suicides and suicide attempts, as you were talking about a minute ago, are relatively low occurrence behaviors. And I think that this is important to point out because that means that there's going to be a lot of fluctuation in the counts of these behaviors over time, especially if you're looking at the rates with the granularity of weekly counts,

0:28:50 Thomas: Okay. Right. Yeah.

0:29:59 Lindsey: Which is what they do in this report. So when you're looking at these graphs, these case counts week by week are like super, the trends that here are like, super jagged and noisy. So they fluctuate considerably. And so if you look at the graphs comparing these emergency department visits across these years, the differences that are being reported in the text of this report do not look as interpretable as as their summary implies.

So like, if you were to take any two years of data on suicide attempts, even comparable years, their weekly counts are going to differ from each other due to random fluctuations. So some weeks you're going to, you know, one year is going to be higher than the other and vice versa. When you compare 2019 and 2020, the differences look like random fluctuations to me. The rates are a little bit higher in 2019. Sometimes they're a little little bit higher in 2020, the lines cross, right? The only piece of this data that could potentially be a little bit different maybe is that first part of 2021, but we'll come back to that, right, but in terms of 2019 and 2020, there are not periods of time in which these visits look meaningfully different to me between these two years, right.

0:30:46 Thomas: Huh. Oh, okay.

0:31:05 Thomas: So more cherry picking then for reason.

0:31:08 Lindsey: Potentially, right or like not not considering that context, I guess. I mean, again, I don't know what the point of doing these comparisons were. I don'T know what THE point of this report is. But when I was looking at this, I'm like, man, it just it seems like they're making a lot out of fluctuations that really could just be noise. I donT know.

0:31:08 Thomas: Yeah, yeah, yeah.

0:31:29 Thomas: We look at the total by the year or what do we, resolve that?

0:31:33 Lindsey: I've got I've GOT some stuff that I pulled That I think will help us interpret this, right? Second point that I wanted to make about about this is in response to their claim that despite lower rates of suspected suicide attempts in March and April of 2020, that, again, quote, "by early May 2020, emergency department counts for suicide attempts began increasing among adolescents, especially among girls." So an important point of context for this trend is the fact that suicidal behavior fluctuates across the year in really predictable ways.

0:31:34 Thomas: Okay. Yeah.

0:32:01 Lindsey: This is a pattern that has been noted by scholars in this area going back a very long time, at least as early as Emile Durkheim's book, Suicide, which was published in 1897, right? So it's been documented that suicidal behavior increases from spring to late summer, and then decreases from fall to early winter. So it sort of follows this arcing pattern across the year. And then you see the lowest average rates in November and December.

0:32:11 Thomas: Wow. Oh, wow.

0:32:27 Lindsey: So isn't that a little bit surprising? Because you think those are dark months.

0:32:28 Thomas: It's almost the exact opposite of what I thought.

0:32:32 Lindsey: I know, right? Yeah, it's weird. Good. Yeah, these are pretty stable trends. If you graph years against each other, you can definitely see them following this pattern with some noise in there, of course, right? Those well -documented patterns show up in these 2019 and 2020 data. The trend upward that these researchers notice is one that appears annually, regardless of whether there's a pandemic happening or not. And So just to confirm that the past few years haven't looked substantially different for some reason in terms of this annual pattern. I pulled the monthly counts of deaths by suicide from January 2014 to July 2021. That was the last month for which they had data available. And I plotted the monthly rates separately for each year so that I could compare the trends across all of those years and get a sense of variability between them, right?

And obviously, deaths by suicide are a different category of outcome than non -fatal attempts, right, right? The demographic trends look very different for those two categories. But the rates of suicide attempts and death by suicide are highly correlated with each other at a population level. So in aggregate, non -fatal and fatal attempts rise and fall together. And so looking at these monthly counts, even of fatal suicides, could give you a sense of the monthly and seasonal variability in suicidal behavior.

I would have found non -fatal attempts by month if I could of, by the way. I just, I could not find that data broken out by month. So if folks look at this graph that I created, and I'll give you a link to a shareable version for that, what you'll notice is that, first of all, I'm not lying about the rates of suicide showing discernible patterns across the seasons, right?

So across these years, 2014 to 2021, you can see that there's an increase in deaths by suicide from spring to late summer, and then the rates drop from fall to winter. But the second thing that you'll notice is that the apparent differences between 2019 and 2020 data look a lot less meaningful when you plot the monthly averages and rates and compare them to a wider band of years. Years.

0:32:33 Thomas: Yeah. Yeah, yeah. Right. Yeah.

0:34:25 Lindsey: So when you've got like, you know, 2014 to 2021, and you're looking at the rates across these years, the numbers maybe surprisingly look profoundly average for 2020 and 21 compared to these other years and compared to the average for the pre-COVID years, for the six years prior to COVID that I pulled. So main point I want to drive home here is that trying to interpret fluctuations in these behaviors within a year is really tricky.

0:34:51 Lindsey: And I think it's very easy to over-interpret normal fluctuations. So, you know, maybe there's something that was going on in 2020 and these differences really are meaningful, but I think that a very reasonable interpretation of the differences in this report is that they're just typical fluctuations in noise. Everybody should look at the report that I'm talking about and look at these lines. You tell me if that looks like an actual meaningful difference when you see it across the years. I don't think it does. That one line is that's a little bit elevated, that's 2021, that's the piece that we're going to come back to. But like, yeah, those lines for 2019 and 2020, like, do those look meaningfully different to you? Yeah.

0:34:51 Thomas: I Those two years, no, it's like higher for a while and it's lower, you know, it's like kind of evens Out, it

0:35:37 Lindsey: Kind Of looks like, you know, any two years that you might compare, you wouldn't know that a pandemic was happening during one of them. So,

0:35:44 Thomas: Looks like you get the two, like, dips, like, it must, what is that, Thanksgiving, Christmas, or something like, you got these two very equal dips, it's interesting, interesting.

0:35:53 Lindsey: Oh, toward the end of the year? Yeah, it is around holidays. Yeah.

0:35:55 Thomas: Yeah, yeah. Which, you know, that's interesting because we're talking about kids, so that shows you that when kids are at home that it does decrease, right? Seems To

0:36:06 Lindsey: Potentially. Yeah. So, yeah. So, that dip that we talked about in that first observation period, I don't want to over -interpret it and say that's a meaningful drop, but it could be, you So, those were the primary results for adolescents. The results among 18 to 25 -year -olds looked somewhat different. So this age group showed about a 17% drop in emergency department visits for suspected suicide attempts in spring 2020 compared to 2019. So that's similar to what we saw with the adolescents. And then increased to be consistent with 2019 counts. So they say, quote, however, the emergency, however the emergency department visit rate for suspected suicide attempts among adults age 18 to 25 years was higher throughout the a pandemic Compared with that of 20 during 2019. uh Yeah, but like, as we talked about before, I Right, it kind of is, I don't see that as interpretable Data At all. I

0:36:17 Thomas: Yeah. Oh, Meaningless I Literally Can't Think of a use of that data, like, it's too, it's, it's, you know, what would that ever be? I don't understand.

0:37:11 Lindsey: Know, especially not when you have this, like, this obvious, very powerful influence that's driving down the denominator Of that ratio, it doesn't make any sense, right? If anything, if you, if you know, if you're going to do a rate of these things, do it as a function of population, that can matter.

0:37:17 Thomas: Yeah. Yeah. Oh, I meant to say that earlier. Like, yeah, that would be interesting.

0:37:25 Lindsey: Right. Mm-hmm. Yeah. But no, in terms of as a part to total emergency department visits, it doesn't make any sense. Right. So that's basically meaningless. Well, well done to them. How do the authors of this report interpret and discuss these findings? Right. And they really, again, they don't do a lot of interpretation here, but they start off this section by conceding that that indeed there were overall fewer emergency department visits for suspected suicide attempts directly following the declaration of COVID-19 as a national emergency.

And that this happened, they do note, in the context of a 42% decrease in total emergency department visits in the U.S. So I read this and I was like, oh, good for them. They're going to acknowledge that their rate there is totally meaningless, but then they don't elaborate on how that affects the interpretation of the rate data. But whatever. I don't know why they included it because they don't explain why that's important.

They say, quote, however, emergency department visits for suspected suicide attempts increased among adolescent girls aged 12 to 17 years during summer 2020 and remained elevated throughout the remaining study period, right? Again, I think this is an over-interpretation. Importantly, they note that this is, quote – and this is important – this is, consistent with research before the COVID-19 pandemic indicating that young females had both both higher and increasing rates of emergency department visits for suicide attempts compared with males, again, predating the COVID-19 pandemic.

So in other words, if there is an increasing trend here, it predates the pandemic. And that's important, and we're going to come back to that in just a minute. They continue, the findings from this study suggest more severe distress among young females than has been identified in previous reports during the pandemic, reinforcing the need for increased attention to and prevention for this population. And like, again, I don't have any problems with recommending that we attend to the mental health of adolescents. That's great. But they are over-interpreting the trends in their data. Is nothing here that says elevated distress to me.

0:39:25 Thomas: I think the way to fix this problem is to breathe into each other's mouths as much as we can. That's the only way that we're going to fix it. Let's fix this, Lindsey. A person on the street, go up to their face, go right in their face. And then just be like I'm trying to help end child suicide and they'll be like, thank you for your service

0:39:33 Lindsey: Yes. Mm-hmm. Right. Yeah. Just Mm hm. Yep. And then lick them. Exactly. Yep, that's a good plan. I'm on board with this. So then they provide several very important limitations and caveats about things like representativeness and data completeness and so on. But there's one in particular that I want to highlight. They say, quote, this analysis was not designed to determine whether a causal link existed between these trends and the COVID-19 pandemic. And that's a pretty critical Thing to keep in mind. But of course, when this stuff is reported, popular press articles don't highlight that statement. Instead, they highlight what the authors say directly next, which is they spend about a paragraph speculating about what factors from the pandemic response might have caused these trends, right?

And they talk about, you know, mitigation measures, reduced connectedness to peers and teachers, you know, a bunch of different things, but like, it feels like a very weird way to handle this point about the study not being designed to link the pandemic causally with suicide rates or suicide attempt rates. From my perspective, it's like they're admonishing against over interpretation, and then they just throw out all these potential causal mechanisms.

And so of course the reporting on this was going to be summarized as suicidal behaviors up among teen girls, and it's probably because of social isolation due to pandemic mitigation. Yeah, so where are we at in terms of being concerned about suicide attempts among 12 to 17 year old girls, because that's what people are concerned about from this report.

Overall, these data do not scream clear and convincing evidence that suicidality is elevated right now among any of these age groups, including 12 to 17-year-old girls. The only part of this data that reasonably could tentatively be considered a possible trend upward is that three-month period in early 2021. So roughly March through early May. And among 12 to 16-year-old girls, it does look like the rates could be trending upward during that period. And that, honestly, that still could be random variability. You get a lot of that from

0:40:12 Thomas: Sorry Yeah,

0:41:43 Lindsey: Year to year, but it is a larger departure from typical trends than the other sort of pieces of data that they're highlighting in this report.

0:41:50 Thomas: I got a question and I actually kind of mean this seriously. Does losing a loved one to COVID possibly increase suicide risk?

0:41:58 Lindsey: I I would not want to speculate about that, actually. I'd have to look into that.

0:42:00 Thomas: Yeah ,I don't know. Not. I can see it going either way. But so I this the latest data they've given us? We don't have anything more recent than May 2021. I guess the government can be a little slow sometimes, right? But, you

0:42:04 Lindsey: Yeah. Yeah. Not that I was able to find, I mean, even the separate stuff that I pulled, I think ended mid-year in 2021.

0:42:20 Thomas: Know, hmm.

0:42:20 Lindsey: Yeah, so yeah, I don't know. Be interested to see when more more stuff comes out because, yeah, I want to see what happens to that line across all of these age groups. Yeah, so this trend in early 2021, like it's possible that there's something here to be concerned about. And from what I found, I think it is potentially reasonable to interpret that increase in 2021 as possibly real.

I think that if it is, it's probably part of a trend that is much longer term than the pandemic. So I think it's possible that we might have seen essentially these same numbers even if COVID hadn't happened. So, I pulled CDC data on annual counts of emergency department visits due to non-fatal self-inflicted injuries from 20 or from 2001 to 2019. Category of visits, by the way, includes only self-inflicted injuries that with suicidal intent.

So it's a fairly comparable metric to what they have in this report, except that it doesn't include non-suicidal self-harm, right? I pulled this data from a service card called Whiskers, which is pretty cute. WhiskERS is a database providing estimates of, among other things, fatal and non-fatal injuries each year in the US. These estimates are based off of a probability sample of hospitals in the U.S. And probability sample is another word for random sample.

So these are population estimates of injuries based on a representative sample of the U.S. And with these data, what I wanted to look at was whether there were any patterns of change over the past couple of decades that can help us contextualize what was going on in these couple of recent years, and particularly the early months of 2021. So I pulled data on these emergency department visits, non-fatal self-inflicted injuries, I got counts separately by gender and by the age groups that they used in the CDC report, report. Got these estimates. The only drawback to what I did here is that I couldn't get numbers, that I only had numbers from 2001 to 2019. So 2020 and 2021 were not available in this database yet. Here's what I noticed that I think is relevant to interpreting the data in this report.

And unfortunately, the news is not great. So emergency department visits for non-fatal suicide attempts have remained roughly stable for adolescent boys and young men from 2001 to 2019, although it looks like there could be some slight elevation in recent years. Like the line's still pretty flat, so it's hard to tell if that's meaningful, but maybe it's turning upward. But there are far more striking increases in emergency department visits for non-fatal suicide attempts among adolescent girls and young women across this period.

0:44:48 Thomas: Huh.

0:44:48 Lindsey: And the increase becomes particularly striking starting around 2009, it's

0:44:53 Thomas: This clash with, I mean, didn't we cover some of this with the social media and the influence on mental health? I mean I thought that my takeaway from that was that there wasn't necessarily like a suicide epidemic from that.

0:45:01 Lindsey: No. It's so, from what we were looking at, it doesn't seem to be linked with social media usage, which is what some people are arguing right now, like Jonathan Haidt is pointing to this trend in the overall population levels and saying, like, that's because of social media and back to that stuff, right, and look at it with this question in mind. But yeah, my memory from looking at this stuff is that the evidence is not there, that it's driven by social media. But the population trend is there. I, just from looking at these rates going up in the US, you knows, it's impossible to tell what's driving that.

I think in that recording that you're talking about, we talked about the fact that, you now, there was a financial crisis that started Around that point. There's lots of things that are happening that maybe are are contributing to this. We don't know. But what is striking descriptively from looking at these data is that if the early 2021 increase in attempts on adolescent girls is meaningful, it likely does not have its causal origins in the pandemic, right? It's a continuation of a trend that is at least a decade old and maybe longer than that.

So after I looked at this stuff, then I pulled deaths by suicide going back to 1950. And among women and girls in most age groups, deaths by suicide spiked in 1970, then declined around 2000, and since then have been slowly but steadily trending upward, and that slope just got more steep in 2009. Boys and men in most age groups, deaths by suicides, again, also spiked around 1970. Then they plateaued at a pretty high level until the mid-90s, dipped down to a new plateau around 2000. And then also have been been showing slow but steady increases in recent years, so these trends don't look great, um.

0:45:26 Thomas: Yeah. Yeah.

0:46:47 Thomas: When you talk about successful suicides, quote unquote, I guess, I mean, I remember when you compare numbers like internationally, just gun prevalence in the United States has a huge effect, just a gun being around like A gun is a very surefire way to kill yourself most of the time. And I think that like one of the explanations for why the male, like I remember what it was, it was like the male suicide rate versus female is like the suicide attempts were actually pretty similar, it's just that more often men tended to use guns, so they were more like, oh.

0:46:51 Lindsey: Yeah. Yes. Yeah.

0:47:24 Lindsey: That's essentially right, actually, suicide attempts are much higher among uh and girls, yeah. Um.

0:47:29 Thomas: Right, okay, yeah. Sorry.

0:47:30 Lindsey: Higher uh yes, the fatality rate is much higher amongst men and boys, well, mostly men, actually, not so much among adolescent lesson boys, um, yeah, that's absolutely true. Yeah, point that you're making there that like maybe we can't learn a lot from looking at deaths by suicide, right?

0:47:44 Thomas: I guess the point I was making is that um, proliferation of guns in America is still, like, especially after uh DC v. Heller and all, like the right-wing court taking away every possible gun restriction ever, like it's, there's just more and more weapons around, I don't know. If that could tell some of the story of the increase in successful suicides, I don't, or

0:47:59 Lindsey: I Don't know, I'd be interested to sort of like go back and find some of the important dates for some of that stuff, or Maybe and see if

0:48:10 Thomas: Compare States Where there's yeah, like gun control Versus where it was rolled back, yeah.

0:48:11 Lindsey: Yeah. Mm. -hmm, yeah, actually there's some, I know about some of this work, maybe I should go back and look at it. It'd, it'd be an interesting follow-up to some of this stuff, I think. Yeah, it could contribute to part of what's going on here. I mean, it's definitely well established that the availability of lethal means is going to increase the of actual lethal suicides. So, so, where does all this leave us? I don't know, think that my conclusion from looking at all this stuff is that there are some concerning trends here. It's just, I don't think they have their origins, the pandemic, and comparing these two years that are compared in this report, it's like, can't really see from these data that this even was the year that the pandemic started. It doesn't look different at all.

0:48:57 Thomas: Well Not only that, I think we had kind of touched on this, but so I'm looking at the graph here, and and like there's that big uptick summer 2021, right? And then it kind of ends on a giant downswing. And again, these are small numbers, so it's who knows what that means. But what, the whole hypothesis from the right is that masking, school closures, whatever, affects this, I mean, by summer 2021, people were just like, all right, we're back to normal.

0:49:16 Lindsey: Exactly. Yeah.

0:49:30 Lindsey: I'm glad you said that, right? Because that was one of the reasons that I wanted to spend all that time talking about what was happening in these three observation periods, because you would predict essentially the reverse of what they actually showed in this report, right? Third period, that should have been a time where things were lower. And the other, the first two periods should have ben higher if these mitigation measures were really what's driving these changes in suicidal behavior. You see the exact opposite of that. So yeah, I'm totally with you on that.

0:49:42 Thomas: Yeah.

0:50:00 Thomas: Or If, I means, honestly, if our earlier thoughts about being at school increases suicide risk possibly, like opening schools back up could be, like that, I I Don't know, like I guess if that's summer, I don't know what week number on this chart, um, actually ends or whatever, but uh, doesn't I, it it does seem like nothing from this data and from the breakdown tells me that masking or online classes have anything to do with this, so

0:50:12 Lindsey: Yeah.

0:50:29 Lindsey: Nope. Are on the same page. You

0:50:31 Thomas: I wonder, um, longer term though, I I am curious about the effects of those things, not really masking, because I, masking is nothing, I don't really understand, that's one where I have a hard time even believing, what the, you understanding what the hypothesis is there.

0:50:47 Lindsey: So there's a few specific claims that I've heard being bandied about in like school board meetings and stuff. Read some claims specifically about mental health, like, you know, having some effect on anxiety and things like that. But I've also, this was recent and new to me, somebody was making the claim, one of the parents was making the claim that wearing masks was significantly impairing, like, socio -emotional development or something. Guessing that there's a seed of something in that that's based in a real study, but I'm guess the point of that is not what this person was saying it was.

0:51:17 Thomas: Yeah. Hmm. Well. In Terms of anxiety, the man, I love wearing a mask, I've It's The best, are you kidding, going out in public and just covering most of my face, I love it, I Want to cover my whole face, I I just want to wear a hood, mask. But, you know, I think people get the wrong idea.

0:51:27 Lindsey: Yeah, I know, right? Right? No, I had the same experience, actually. It was very freeing to, to, it, it very much could be.

0:51:41 Thomas: I love it. Is it because we're introverts? Is that what's going on here? Yeah.

0:51:47 Lindsey: Yeah. Um, it

0:51:48 Thomas: So it may have the opposite effect on people like, you know, my wife. But for me, I love the idea. I love I don't, I don't It's easier. It's more protection from society. Not even just COVID.

0:51:53 Lindsey: Could, yeah. And it was also, that's

0:51:59 Thomas: Just, just mental protection.

0:52:02 Lindsey: Right. Just having to interact with people. Yeah. No, but also there was like a degree of like self -consciousness that went down, right? Like if I had to go to the store and I was kind of in rough shape or whatever, it was like, like, ah, you know, got a mask.

0:52:03 Thomas: Yeah. Yeah. Yeah. Yeah. I want to see the graph that charts nose hair, because I think we'll see a significant increase in that, you know, staying at home all day wearing a mask.

0:52:21 Lindsey: Yeah, for sure. Mm-hmm. Really all the hairs, leg hairs.

0:52:26 Thomas: Yeah, yeah, true. All hair. Yeah, that's a good point. Yeah!

0:52:28 Lindsey: Yeah. They're all covered up.

0:52:30 Thomas: So, hair is up! Hair attempts and hair, yeah! That's all up! Um, anyway, yeah, not good to have school at home. I don't think anybody's saying it's like great, it really sucks, but I, I wonder what the effect will be and I, you know, if I had to guess, I imagine it's gonna be more about like much kids have actually learned, like they will have learned less and done, and that's bad, yeah, yeah

0:52:31 Lindsey: Mm-hmm.

0:52:42 Lindsey: No. Oh, for surer. I mean, this is still anecdotal evidence, but, you teaching sort of post-remote learning, and it's, yeah, I've got concerns, concerns about how behind folks are from this couple of years, um, those are, those are definitely real concerns, but in terms of these, these specific claims about mental health, like, again, it's heterogeneous, I don't know, and even actually even the learning stuff I think is heterogeneous. There were, um, really interesting shifts in looking at the performance of my students when we were, when we remote, like high performers kind of dropped off in some cases. And some folks that really struggled seemed to adapt to the online environment incredibly well and started performing really well. So I think, you know, even with the academics, the effects that it had on individuals really varied and actually went in opposite directions. And I think the same thing is true here with mental health and these social variables and things. I don't know.

0:53:08 Thomas: Well I kind of inconclusive. I don't know. I'm pretty definitive in that the right wing line about this causing a suicide epidemic in kids doesn't seem to be right. But in terms of what actually might be causing an increase, I suppose. I guess we don't know. Again, the increase is longer term. Yeah.

0:54:03 Lindsey: Yeah. Yeah, on the same page there. And actually, so obviously, yeah, we didn't have time to get into this, but it might be worth doing another episode on this other thing that I found that's connected to this. So I found a couple of sort of like meta-analyses slash systematic reviews that looked at suicide rates just during like pandemics and epidemics, like some, you know, COVID-19 was included, but they also included data from other epidemics and pandemics. And the The conclusions from those articles seem to suggest that like there might be some surprising things about how epidemics affect suicidality.

0:54:31 Thomas: Hmm. Hmm.

0:54:41 Lindsey: So I would actually be interested in like reading those deeply. And if they're interesting enough, maybe we do another one on that. Yeah, possible there's an evo perspective on that, I don't know.

0:54:47 Thomas: Yeah. All right. Right. The explanation, the breakdown, and we can keep an eye on new data, new reports to come out of the CDC. I don't know what's going on. This report is, by the way, proof that like the CDC doesn't make perfect choices. I don' t think we ever needed to believe that, you not in a conspiracy to ruin your life or anything, but yeah.

0:54:57 Lindsey: Yeah, yeah, no. Reports didn't feel ideological to me. They just felt kind of incomplete. Maybe, Weirdly decontextualized, I think, in a way that was easy to weaponize and misinterpret.

0:55:21 Thomas: Yeah. So. We'll keep an eye on it, uh, of follow-ups potentially, but thanks, Lindsey, for uh sciencing us this week. We uh, we love it so much.

0:55:28 Lindsey: Thank you.

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