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In March, President Donald Trump predicted “suicide by the thousands” if the country didn’t as the COVID-19 pandemic tightened its grip on the United States.

Although experts as hyperbolic, a few widely publicized soon materialized.

Then came an alarming federal survey in late June that found 40% of American adults had struggled with mental health or drug use in the previous 30 days, with one in four people between the ages of 18 and 24 reporting they had

But preliminary data from state health regulators shows that suicide deaths in Hawaii have actually decreased slightly during the coronavirus pandemic, bucking the expectations of many.

The finding is in some ways counterintuitive. Hawaii mental health professionals have been bracing for a surge in psychiatric symptoms in people both with and without a history of mental illness as the pandemic continues to chip away at residents’ financial and emotional wellbeing.

Although suicide is often considered a mental health problem, a growing body of research links financial struggles — including debt, job loss and home foreclosure — to an increased suicide rate.

But it’s possible, according to the Hawaii health department report, that economic suffering has been somewhat mitigated by government safety nets, although it is uncertain how long that will continue. 

Jill Harkavy-Friedman, vice president of research at the , said Hawaii’s apparent drop in suicide deaths during the pandemic is a hopeful indication that increased mental health awareness and easier access to psychiatric treatment through telehealth could be paying off.

“It’s not a foregone conclusion that the suicide rates are going to go up,” Harkavy-Friedman said. “More people are in distress, but that doesn’t mean that that translates into suicidal behavior. People are talking more about their mental health and they’re seeking help.”

But she cautioned that the data is likely incomplete.

Real-time data on suicide is difficult to ascertain in part because it can take several months to determine a cause of death when a toxicology report is required.

It’s also not always clear when a death is a suicide.

For every nine suicides in Hawaii, there is approximately one death that’s ruled to be of “undetermined intent.”

Early Findings

The Hawaii report is based on preliminary mortality data during the first six months of the pandemic. It tracks suicide deaths on a monthly basis starting in April, when there were seven suicide deaths. That compares to an average of 13 deaths during the same month for the five-year period from 2015 to 2019 and an average of 14 deaths during the same month for the five-year-period from 2010 to 2014.

The report tracks suicide deaths through September, when there were nine deaths compared to an average of 19 deaths during the same month in the five-year period from 2015 to 2019 and an average of 16 deaths during the same month in the five-year-period from 2010 to 2014.

All told, 76 Hawaii residents died by suicide from April to September, according to the report.

That compares to an average of 99 suicide deaths in the same six-month period from 2015 to 2019 and an average of 94 suicide deaths in the comparable period from 2010 to 2014.

Daniel Galanis, an epidemiologist at the Hawaii Department of Health who authored the report, said the initial data is encouraging. But he acknowledged that more time is needed to reveal the accuracy of the data.

He also noted that deaths are only one measure of suicidal behavior or struggles with mental health.

The report does not take into account attempted suicides. For every suicide in Hawaii there is an average of four or five non-fatal attempts, according to data from the Hawaii Department of Health.

In Hawaii, one person dies by suicide every two days.

In May, an unusual cluster of four suicides in seven days on Kauai raised concerns that the coronavirus pandemic and the collapse of the economy may be having devastating mental health consequences.

The four deaths were all young men in their 20s or 30s and took place between May 2 and May 8. There is no known connection between them.

The spate of deaths cannot necessarily be attributed to coronavirus-related despair. Kauai Police Chief Todd Raybuck said in May that some of the suicides had other precipitating factors, such as drug use, addiction, depression, relationship conflicts or financial failures.

Suicide data from other states is trickling in. But whether these findings are representative of a larger trend is still up for debate.

A study in Massachusetts found that the suicide rate during the state’s lockdown . But police in Wichita, Kansas, say the state’s largest city has seen this year — and they’re pinning this startling statistic at least in part on pandemic-related stress.

“Suicide is complicated,” Harkavy-Friedman said. “It’s something that has multiple causes. There’s never one cause.”

In Hawaii, one person dies by suicide every two days. That translates to an average of 190 suicides among Hawaii residents each year. Another nine non-residents die from suicide in the islands annually.

The statewide suicide rate was highest in 2020 during the months preceding the pandemic. The worst month was February, in which there were 25 suicide deaths in the state, according to the data. That compares to an average of 13 suicide deaths in 2015 to 2019 and an average of 14 suicide deaths in 2000 to 2014.

Over the past decade the number of suicides in the state has increased, following a national trend. In 2018, the country had the highest age-adjusted suicide rates since 1941.

The Link Between Suicide And Financial Strife

Mounting scientific research suggests that suicide is not solely a medical problem associated with mental illnesses like anxiety or depression — it’s also .

The results of a study published in September in the American Journal of Epidemiology show that unemployment, a history of homelessness, debt and low income lead to an increase in suicide attempts and suicidal ideation.

The study, which is based on two waves of national data from the early and mid-2000s, was conducted by Duke University researchers before the pandemic. But it’s nearly impossible to read the findings without thinking about how it’s relevant today. 

“Given that millions of people are experiencing economic hardship resulting from the pandemic, it suggests that we could see an increase in the suicide rate,” said Eric Elbogen, a Duke professor of psychiatry and behavioral sciences and lead author of the study.

A 2014 study published in the American Journal of Public Health argues that — a hallmark of the 2008 economic downturn — may have contributed to a spike in suicides that lead suicide deaths to surpass motor vehicle deaths in the United States for the first time in 2009.

“I think it’s pretty well known that mental health issues and substance abuse and depression are very significant risk factors for suicide,” Elbogen said. “Financial problems are sometimes seen as not necessarily the driving force, but there’s a growing body of research that suggests that they can be.”

Virus Disrupts Suicide Prevention Program

Although the pandemic has in some ways improved public awareness of psychiatric wellness and expanded access to mental health care in Hawaii, it has also interrupted important suicide prevention programming.

In March, the pandemic forced Mental Health America of Hawaii, an advocacy and education organization, to temporarily halt its youth suicide prevention training for middle school and high school students.

After a seven-month hiatus, the nonprofit launched a new virtual version of its largest program in mid-October.

There were many challenges in adapting such a sensitive curriculum to the internet, a process that took nearly four months, according to Bryan Talisayan, the nonprofit’s executive director.

From behind a computer screen it’s harder for program facilitators to detect subtle cues from participants’ body language that might offer insight into how well they’re absorbing such difficult subject matter. Program leaders encourage students to keep their video cameras on during the training so they can see if anyone becomes noticeably upset or uncomfortable.

There’s also an option to relocate any participant who’s feeling triggered into a private virtual chat room where the student can talk to a trained program leader about how they’re feeling.

One benefit of the virtual format is that some people are more comfortable opening up about their feelings from behind a computer screen.

The program typically reaches 5,000 students annually. But this year’s participation will undoubtedly be lower.

“We’re looking to get back into the schools with this curriculum virtually, at least for now, and then we’re hoping to be able to get back into classrooms physically at some point,” Talysian said. “But I suspect that won’t be for another year or so.”