Social distancing and influenza mortality in 1918 did not increase suicide rates in the United States

Abstract

Recent research has suggested that the social distancing mandates introduced in the United States during the main waves of the 1918–20 influenza pandemic caused an increase in suicide rates. However, that finding relies on poor-quality, temporally mismatched data and has signs of omitted variable bias. Similarly, a long-standing finding that American suicide rates in 1918–20 were also boosted by the influenza mortality of the time has gone unquestioned in the literature, despite the original research admitting its risk of ecological fallacy. Using higher-powered mortality data, I cast doubt on both findings by analyzing the experiences of the pandemic in 43 of the largest American cities of the time. In line with some populations’ experiences of COVID-19, I report tentative evidence that social distancing mandates during the 1918–20 pandemic may have been associated with decreased suicide rates. Larger, cross-national investigations of the effects of historical pandemics and social distancing mandates on mental health and suicide are needed.

The impact of the COVID-19 pandemic on suicide mortality in Spain: Differences by sex and age

“…Interpreting these temporary decreases in suicide mortality is challenging, as suicide decreases were not expected ( Reger et al, 2020 ; Sher, 2020 ) based on the socioeconomic stressors brought about by the pandemic and on increases in population-level prevalence of mental health symptoms ( Prati and Mancini, 2021 ; Robinson et al, 2022 ) and suicidal thoughts ( Czeisler, 2020 ). On the one hand, suicide mortality can decrease in the early aftermath of certain major adverse societal events – including some natural disasters ( Matsubayashi et al, 2013 ), wars ( Thomas and Gunnell, 2010 ), genocides ( Lester, n.d. ), terrorist attacks ( Claassen et al, 2010 ), or pandemics ( Bastiampillai et al, 2021 ; Gaddy, 2021 ). Emile Durkheim's foundational work on suicide highlighted how wars and other major societal disruptors can result in temporary increases in social cohesion, sometimes referred to as “pulling together” effect ( Bastiampillai et al, 2021 ) that can lead to decreases in suicides ( Durkheim et al, 1966 ).…”

Protocol for a systematic review to understand the long-term mental-health effects of influenza pandemics in the pre-COVID-19 era

“…Further, Wasserman [7] concluded that the 1918 pandemic -and not other potential factors such as World War I or Prohibition -increased suicide rates, possibly due to reduction in social integration and fear of the epidemic. More recently, Stack and Rockett [8] came to similar conclusions, although both studies have been disputed by Gaddy [9]. Other studies have investigated potential connections between in utero exposure to the 1918 pandemic and health, socio-economic and other outcomes later in life (e.g.…”

Suicidal Behavior During COVID-19 Pandemic

“…Данные по тем же 43 городам США были проанализированы повторно, из этого анализа следует, что требования социального дистанцирования во время пандемии 1918-1920 гг. могли быть связаны со снижением, а не с повышением уровня самоубийств, более того, ни в одном из этих городов более высокая смертность от гриппа не сопровождалась повышением уровня суицидов [58]. Это указывает также на важность стандартизации приемов анализа, что является сложной задачей, поскольку «золотого стандарта» в суицидологии по этому вопросу не существует.…”