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What’s behind Minnesota’s surprising ‘deaths of despair’ data from the pandemic year

Deaths from alcohol and drugs were up in 2020, continuing a long-term trend. But the number of suicides was down.

Suicides in 2020 were down compared to 2019, while drug and alcohol-attributed deaths were up.
Suicides in 2020 were down compared to 2019, while drug and alcohol-attributed deaths were up.
Photo by Erik Mclean on Unsplash

Every year, the Minnesota Department of Health reports the number of deaths due to suicide, alcohol and drug overdoses. Almost every year, the news is grim: the number of fatalities attributed to “deaths of despair” have risen steadily over the past 20 years.

In 2020, the news was mixed, which might surprise some who were expecting or even predicting rates of suicide, in particular, to rise given the stresses and tensions of the year: suicides were down compared to 2019, while drug and alcohol-attributed deaths were up.

The numbers aren’t a big surprise to experts, however, who say the factors influencing these types of deaths are various and complicated.

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The data

MDH produces one chart displaying deaths attributed to suicide, alcohol and drugs for a reason, said Colin Planalp, a senior research fellow at the University of Minnesota’s State Health Access Data Assistance Center (SHADAC)

Put together, these causes are often called deaths of despair, and Planalp said there’s a general belief among researchers that one of the factors driving them is that people, at increasing levels of despair, are dying by suicide, misusing drugs or drinking excessively, “and this is killing Americans at an increasing rates,” he said.

‘Deaths of despair’ by category
Note: 2020 data are preliminary and could change before they are finalized.
Source: Minnesota Department of Health

Data released last month show the number of deaths due to suicide dropping from 830 in 2019 to 723 in 2020. Meanwhile, the number of drug overdoses went from 792 to 1,008, and alcohol-attributed deaths rose from 821 to 992.

The data are preliminary, and do not yet include all Minnesotans whose died outside the state. They are also not mutually exclusive, meaning a death could appear in multiple categories.

Suicides down

Stefan Gingerich, a senior epidemiologist with MDH’s injury and violence prevention section, said it wasn’t a huge surprise to see the decrease in suicide numbers by the time the annual data came out because the department had seen it in the data coming in.

The trickier question is why the decrease happened. MDH doesn’t know why the suicide numbers are down this year, but the numbers mirror trends seen in some other states.

“It’s something there are probably going to be researchers looking into for years come, I would guess, just like everything else related to the pandemic,” Gingerich said.

The drop in suicides between 2019 and 2020 is currently the largest seen since 2000, but Gingerich said once data are finalized, he expects that decrease could be smaller.

When they have full data on demographic factors such as age distribution, race and ethnicity, epidemiologists will be digging into the data to try to find patterns.

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One that appears so far: the number of deaths due to suicide among Minnesotans under the age of 64. (For those 65 and older, suicides were up in 2020 compared to 2019.)

Preventable deaths by category
Source: Minnesota Department of Health

Gingerich said further analysis of these numbers could help inform future suicide prevention efforts.

Planalp said the decrease in suicide deaths wasn’t particularly surprising to him.

Suicide deaths are complicated, and the factors — both individual and bigger picture — that drive them aren’t fully understood. And research has been all over the map as to the effect of big, stressful events — natural disasters, economic declines — on suicides, finding increases, decreases and no change, Planalp said.

“It’s certainly good news that we saw a decline in 2020,” he said — but the long-term trajectory is still troubling.

“Even with that decline, Minnesota, and probably the U.S., when those data come out, are still at record levels for suicide deaths in terms of numbers and rates,” Planalp said, and 2020 is just one year of data — it’s very possible the numbers will continue to rise in the future following the previous trajectory.

Further, he said, the decrease in suicide numbers in 2020 should not be taken as a sign that the pandemic didn’t have negative effects on Minnesotans’ mental health.

SHADAC research on mental health conditions found that depression and anxiety symptoms were elevated in 2020. “Probably unsurprisingly, they increased significantly during the course of the year; throughout 2020,” Planalp said. “There appears to be a a mental health impact from the various events of 2020, but suicide is such a complex one … oftentimes, people who die of suicide did not necessarily have any diagnoses with mental health conditions. That’s kind of a misconception a lot of people have.”

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Drug and alcohol deaths up

If the news on suicide deaths in 2020 could be seen as relatively good compared to other years, the numbers on alcohol and drug-related deaths were not — but also not particularly surprising to those working in the field.

The number of drug overdose deaths has been rising for decades, in part, it’s thought, due to a rise despair, but also because of the types of drugs people are using: powerful synthetic opioids like fentanyl are often laced into other drugs in amounts unknown to the user, as are cocaine and psychostimulants like methamphetamines, causing a rise in overdoses.

“Almost everybody today who’s buying drugs on the street knows that they’re buying drugs with fentanyl in them, but they don’t know how much will be in there how potent it would be so it is really just kind of a gamble each and every time,” said Cecelia Jayme, the director of clinical services at the Hazelden Betty Ford Foundation.

But Jayme said she believes the precipitous rise in drug and alcohol-related deaths in 2020 may have been due, in part, to pandemic factors.

“Alcohol and other drugs are often used as coping mechanisms for significant stress, and the stress of the past year has been extreme,” Jayme said, bringing about job unpredictability isolation, and family at home, among other things.

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It’s not yet clear how many of the 2020 alcohol-attributable deaths were due to long-term conditions that may have started before the pandemic versus immediate causes — typically meaning alcohol poisoning, Planalp said. But the rise in alcohol sales and research on the way people are drinking during the pandemic is cause for concern when it comes to drinking behaviors now and likely into the future.

“We also see in survey data throughout 2020 from multiple surveys, people saying that they are engaging in more risky drinking patterns, so those can be heavy drinking, or people exceeding recommended alcohol consumption levels on a regular basis,” he said.

When it comes to alcohol, Jayme said she worries the pandemic has further normalized drinking in isolation, which could lead to a rise in alcohol-related deaths and health conditions into the future.

The bottom line, when it comes to deaths due to suicide, drugs and alcohol, is that they are preventable, Gingerich said.

The National Suicide Hotline can be reached at 800-273-8255. The Substance Abuse and Mental Health Services Administration’s mental health and addiction helpline can be reached at 1-800-662-HELP (4357).