By Chris Adams

COVID-19 could be a “perfect storm” for suicide – triggered by social isolation combined with economic distress and health stress.

But it doesn’t have to be. In a session with the National Press Foundation, three leading experts on suicide and mental health discussed the conditions that could lead to more suicides, offered recommendations for prevention and answered questions from  reporters on how to cover the topic responsibly.

“We are living in extraordinary times,” said David Gunnell, at epidemiologist at the University of Bristol in the United Kingdom and one of the world’s leading suicidologists. “It’s difficult to predict what will happen. … But it’s really important for us to be prepared.”

Gunnell (bio) was joined by Holly Wilcox (bio) of the Johns Hopkins Bloomberg School of Public Health in Baltimore and Alfiee Breland-Noble (bio, Twitter) of the AAKOMA Project, a nonprofit research and outreach organization based in Northern Virginia.

In recent weeks, experts and reporters exploring the ramifications of COVID-19 have turned to mental health. As researchers in JAMA Psychiatry asked: “Suicide Mortality and Coronavirus Disease 2019 – A Perfect Storm?

The NPF briefing for journalists from around the world came on the day news emerged that a top emergency room doctor at a New York City hospital had died by suicide. The news underscored one of the central dilemmas in coverage of the issue: While it’s important to prepare and explain what is happening because of COVID-19, it’s also possible that too much or graphic coverage can itself become a triggering event.

In a recent article for The Lancet Psychiatry, Gunnell wrote that “irresponsible media reporting of suicide can lead to spikes in suicide.” His recommendations: Do not report on the method of death. Be wary of reporting the contents of a suicide note – they may not be accurate. And avoid graphic headlines.

Wilcox, who specializes in population-based research on suicidal behaviors, shared 10 tips for reporting on suicide; the tips come from the American Foundation for Suicide Prevention. Among them: avoid reporting that a suicide death was “caused” by a single event, since research shows no one takes his or her life for one single reason but rather a combination of them.

Wilcox also shared the long-term trends in suicide in the U.S. Suicide has been on a steady increase for the past two decades. The rate for men is almost four times the rate for women, and the increase among male suicides has accelerated faster than it has for women. Overall, the rates are at levels not seen since the tail end of the Great Depression. (For a comprehensive overview of suicide statistics, see the Centers for Disease Control and Prevention data and resources.)

Gunnell said the there is some evidence of a slight rise in suicides during previous pandemics: influenza in 1918 and among older people in Hong Kong during the 2003 SARS outbreak. But the evidence is not strong, and he noted that the numbers of suicides were vastly outweighed by other deaths.

But, as Breland-Noble noted, “Every suicide death is a tragedy.”

Loss of employment and financial stressors are well-recognized risk factors for suicide, and the U.S. has rapidly lost more than 20 million jobs. Beyond that, men are less likely than women to seek mental health care, and they are known to experience shame over financial difficulties. “So making sure during tough financial times that there is less stigma associated with seeking financial help should be seen” as a suicide prevention measure, Gunnell said.

Breland-Noble also said reporters should be aware of the disparities in health care that existed before COVID-19 and how they are being aggravated. Lower-wage workers in service and other industries are more likely to be African American or Latino and they’re more like to be affected by COVID-19. (See JAMA: “COVID-19 and African Americans.”)

“What the COVID crisis does is exacerbate the problem,” she said.

She said it’s especially important to reach underserved communities during the crisis, since they are most likely dealing with urgent issues of economic survival.