Cawthorn misrepresents data on youth suicides

EDITOR’S NOTE: If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.

U.S. Rep. Madison Cawthorn recently trekked hundreds of miles outside his mountainous western North Carolina congressional district to speak to a school board in Johnston County, a bedroom community southeast of Raleigh.

The board was considering whether to require students to wear masks in school. And Cawthorn argued that masks would further traumatize children who were already suffering from the effects of the pandemic. 

To support his argument, the Republican pointed to suicide data in the U.S.

Speaking to reporters outside before the board’s Sept. 14 meeting, Cawthorn said:

"You can see what the World Health Organization was saying, you know, putting masks on children does have some mental problem — it increases depression. You know, we saw death and suicide rates are up 255% in one study that a hospital did in America because they’re starting to see that people are really feeling disconnected from that social interaction."

Inside the meeting, Cawthorn offered a similar claim. But this time his focus was on suicide attempts, not deaths.

"Suicide attempts from children and teens stunted in their social interactions skyrocketed 250% in 2020 in one study a hospital did in the United States," he told the school board.

First things first: the World Health Organization told PolitiFact NC that it has "not published anything there (on its website) about a connection between children wearing masks and depression, to date."

Now, what about that stat Cawthorn referenced? Cawthorn’s vague comments could give the impression that suicides or attempts have increased more than 250% across America. But that’s not true.

While some findings suggest concerning numbers of suicide attempts by young people, the increases are nowhere near as high as the congressman's statements suggest.

Cawthorn spokesman Luke Ball told PolitiFact NC that the congressman was referring to numbers included in an NPR story from February, titled: "Child psychiatrists warn that the pandemic may be driving up kids' suicide risk."

Ball noted this paragraph from an NPR’s story:

"At Riley Hospital for Children in Indianapolis, the number of children and teens hospitalized after suicide attempts went up from 67 in 2019 to 108 in 2020. And October 2020 saw a 250% increase in these numbers over the previous October, says Hillary Blake, a pediatric psychologist at the hospital."

A few things stand out here.

First, in both quotes about suicide, Cawthorn referenced a "study." However, the hospital in NPR’s story didn’t conduct a study across the U.S. or even across its own state. The hospital merely reported its own data.

Second, the hospital reported suicide attempts — not suicide rates, as Cawthorn suggested when speaking to reporters.

Cawthorn also cherry-picked an alarming number comparing two months and ignored the other year-to-year numbers in the story that showed a smaller increase in suicide attempts.

PolitiFact NC reached out to Riley Hospital about its suicide attempt data for young people.

Courtney Taylor, a spokeswoman for the hospital, told PolitiFact NC that they saw "a 51% increase in admissions for suicide attempts in the 12 months prior to March 2020 (90 admissions) as compared to March 2020 through March 2021 (136 admissions)."

Taylor said the hospital limits what information it shares with the public, due to privacy concerns. She concluded her email with this statement: "Wearing a face mask does not increase suicidal ideation. Masks are effective in reducing the spread of COVID-19."

Experts told PolitiFact that the pandemic has definitely taken a toll on the mental health of adults and school-aged children. However, they said it’s wrong for Cawthorn to suggest that suicides or suicide attempts nationally rose as much as 250%.

The overall number of youth suicide attempts in the U.S. did rise in 2020 — though not as much as Cawthorn suggested.

Among minors aged 12 to 17, the CDC in June announced a 22% increase in suspected suicide attempts from the summer of 2019 to the summer of 2020. The CDC examined data from the National Syndromic Surveillance Program, which monitors 71% of emergency departments in 49 states. 

Attempts by young people have risen in North Carolina as well.

The health department tracks emergency department visits for self-inflicted injuries. A recent report shows that kids in the 10-to-18 age group accounted for roughly 30% of self-inflicted injury emergency department visits between May 2020 and April 2021, despite making up only 13% of the population.

While self-inflicted injury ER visits have stabilized for every other age group, rates for young people in April 2021 were 61% higher than they were in May 2020.

Preliminary data show that the number of young North Carolinians who died by suicide rose from 54 in 2019 to 66 in 2020, the health department says.

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What about overall numbers? 

The CDC says the total number of deaths by suicide for all ages actually decreased 5% between 2019 and 2020, from 47,511 to 44,834. In North Carolina, the health department says the overall number of deaths by suicide increased from 1,368 in 2019 to 1,385 in 2020.

Now, back to Cawthorn’s claim. Experts say it’s fair for anyone to point out that the pandemic has affected children’s mental health. However, they discourage people from jumping to conclusions about the data.

Hospital reports alone can’t capture the full extent of mental health crises among children, said Jeffrey Swanson, a professor in psychiatry and behavioral sciences at Duke University’s School of Medicine.

"If you think of all the kids who have been exposed to all kinds of stress and disruption, a very tiny proportion actually show up in emergency departments with mental health complaints," he said.

On the other hand, the increase in hospitalizations among young people may be because they were stuck at home with their parents more. "By spending more time at home together with young persons, adults might have become more aware of suicidal thoughts and behaviors, and thus been more likely to take their children to the (emergency department)," CDC researchers theorized in their report.

"It’s really the first time in the United States and in much of the world where there’s been an immediate focus on taking care of your mental health," said Jill Harkavy-Friedman, vice president for research at the American Foundation for Suicide Prevention.

Experts took issue with Cawthorn’s suggestion that there’s a link between school mask requirements and student suicide attempts. 

As PolitiFact previously reported, researchers wrote in a September 2020 paper for the International Journal of Environmental Research and Public Health that there are "minimal physiological impacts on wearing a mask." Overall, though, experts told PolitiFact NC they’re not aware of any research suggesting mask policies have anything to do with whether a child attempts suicide.

Depression is such a complicated condition that it’s often tough to identify a single reason or motivation for why someone might try to harm themselves. That’s why Cawthorn’s comments are misleading and "irresponsible," Swanson said. 

Dr. Marvin Swartz, Swanson’s colleague at Duke’s School of Medicine, said the pandemic has placed many different strains on children and their families. 

"It is clear that rates of distress and suicidal ideation are increasing for children. It is impossible to attribute this to masking," Swartz said. Harkavy-Friedman agreed, saying it will be difficult for any researcher to isolate peoples’ motivations "because COVID is so ubiquitous."

"What I want to say about the number (Cawthorn quoted) is, like everything else, we just don’t know right now," she said. "Let’s not worry as much about the number as the people."

Cawthorn said "death and suicide rates are up 255% in one study that a hospital did in America because they’re starting to see that people are really feeling disconnected from that social interaction."

Cawthorn’s office says he meant to refer to one Indiana hospital’s report showing that teens were hospitalized for suicide attempts 250% in October 2020 than in the previous October.

While data collected by that hospital, North Carolina’s health department and the CDC do signal a rise in hospitalizations among young people, there is no indication that suicide attempts or deaths have increased at the rate Cawthorn suggested.

The statement contains an element of truth but ignores critical facts that would give a different impression. We rate it Mostly False.