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.