Hindcasts and forecasts of suicide mortality in US: A modeling study.

Deaths by suicide, as well as suicidal ideations, plans and attempts, have been increasing in the US for the past two decades. Deployment of effective interventions would require timely, geographically well-resolved estimates of suicide activity. In this study, we evaluated the feasibility of a two-step process for predicting suicide mortality: a) generation of hindcasts, mortality estimates for past months for which observational data would not have been available if forecasts were generated in real-time; and b) generation of forecasts with observational data augmented with hindcasts. Calls to crisis hotline services and online queries to the Google search engine for suicide-related terms were used as proxy data sources to generate hindcasts. The primary hindcast model (auto) is an Autoregressive Integrated Moving average model (ARIMA), trained on suicide mortality rates alone. Three regression models augment hindcast estimates from auto with call rates (calls), GHT search rates (ght) and both datasets together (calls_ght). The 4 forecast models used are ARIMA models trained with corresponding hindcast estimates. All models were evaluated against a baseline random walk with drift model. Rolling monthly 6-month ahead forecasts for all 50 states between 2012 and 2020 were generated. Quantile score (QS) was used to assess the quality of the forecast distributions. Median QS for auto was better than baseline (0.114 vs. 0.21. Median QS of augmented models were lower than auto, but not significantly different from each other (Wilcoxon signed-rank test, p > .05). Forecasts from augmented models were also better calibrated. Together, these results provide evidence that proxy data can address delays in release of suicide mortality data and improve forecast quality. An operational forecast system of state-level suicide risk may be feasible with sustained engagement between modelers and public health departments to appraise data sources and methods as well as to continuously evaluate forecast accuracy.

Evaluating the Experience of Teen-to-Teen Crisis Line Volunteers: A Pilot Study.

Teen-to-teen (t2t) crisis lines are a special type of crisis service where youth volunteers help their peers. Although prior research has examined the experience of adult crisis line responders, no research has examined the experience of adolescents who do this work. In collaboration with two of the largest t2t lines in the U.S., this pilot study is the first examination of t2t crisis line work. Volunteers (ages 14-20) reported: their primary motivation for joining the crisis lines was to help others and give back to the community; responding to a range of peers' problems on the t2t crisis line, including high-risk suicide contacts; and a range of ways the crisis line work impacted their lives. Findings provide preliminary information about the experience of adolescents engaging in t2t crisis line work. Additional research is needed in larger and more diverse samples to understand the impact of crisis line work for youth.

Age, period, and cohort effects on suicide death in the United States from 1999 to 2018: moderation by sex, race, and firearm involvement.

The role of sex, race, and suicide method on recent increases in suicide mortality in the United States remains unclear. Estimating the age, period, and cohort effects underlying suicide mortality trends can provide important insights for the causal hypothesis generating process. We generated updated age-period-cohort effect estimates of recent suicide mortality rates in the US, examining the putative roles of sex, race, and method for suicide, using data from all death certificates in the US between 1999 and 2018. After designating deaths as attributable to suicide according to ICD-10 underlying cause of death codes X60-X84, Y87.0, and U03, we (i) used hexagonal grids to describe rates of suicide by age, period, and cohort visually and (ii) modeled sex-, race-, and suicide method-specific age, period, and cohort effects. We found that, while suicide mortality increased in the US between 1999 and 2018 across age, sex, race, and suicide method, there was substantial heterogeneity in age and cohort effects by method, sex, and race, with a first peak of suicide risk in youth, a second peak in older ages-specific to male firearm suicide, and increased rates among younger cohorts of non-White individuals. Our findings should prompt discussion regarding age-specific clinical firearm safety interventions, drivers of minoritized populations' adverse early-life experiences, and racial differences in access to and quality of mental healthcare.

Suicide and the agent-host-environment triad: leveraging surveillance sources to inform prevention.

Suicide in the US has increased in the last decade, across virtually every age and demographic group. Parallel increases have occurred in non-fatal self-harm as well. Research on suicide across the world has consistently demonstrated that suicide shares many properties with a communicable disease, including person-to-person transmission and point-source outbreaks. This essay illustrates the communicable nature of suicide through analogy to basic infectious disease principles, including evidence for transmission and vulnerability through the agent-host-environment triad. We describe how mathematical modeling, a suite of epidemiological methods, which the COVID-19 pandemic has brought into renewed focus, can and should be applied to suicide in order to understand the dynamics of transmission and to forecast emerging risk areas. We describe how new and innovative sources of data, including social media and search engine data, can be used to augment traditional suicide surveillance, as well as the opportunities and challenges for modeling suicide as a communicable disease process in an effort to guide clinical and public health suicide prevention efforts.

"Breaking the silence" suicide Prevention media campaign in Oregon: Evaluation of impact on help-seeking and suicide mortality.

INTRODUCTION: Research has established that suicide-related media can impact suicide rates both positively and negatively, supporting efforts to engage the media in the service of suicide prevention. The goal of the current study is to evaluate the impact of a suicide prevention media campaign implemented April 7-14, 2019 in Oregon. METHODS: Several indices of help-seeking behavior and suicide risk were employed: suicide-related Google Health API searches, National Suicide Prevention Lifeline (Lifeline) (currently known as the 988 Suicide and Crisis Lifeline) call volume, and state suicide mortality data from April 7, 2016-May 6, 2019. Eight states with similar 2016-2018 average suicide rates were compared with Oregon. Bayesian structural time-series modeling in R was used to test intervention effects. RESULTS: During the 30 days following the start of the campaign, there was a significant increase in Lifeline calls from Oregon area codes (2488 observed vs. 2283 expected calls, p = 0.03). There were no significant changes in suicide mortality or suicide-related Google searches in Oregon. CONCLUSIONS: The campaign appeared to increase help-seeking behavior in the form of Lifeline calls, without any indication of an iatrogenic suicide contagion effect. However, the campaign's potential to reduce suicide mortality was unmet.

Emotion regulation difficulties, youth-adult relationships, and suicide attempts among high school students in underserved communities.

To develop and refine interventions to prevent youth suicide, knowledge is needed about specific processes that reduce risk at a population level. Using a cross-sectional design, the present study tested hypotheses regarding associations between self-reported suicide attempts, emotion regulation difficulties, and positive youth-adult relationships among 7,978 high-school students (48.6% male, 49.9% female) in 30 high schools from predominantly rural, low-income communities. 683 students (8.6%) reported a past-year suicide attempt. Emotion regulation difficulties and a lack of trusted adults at home and school were associated with increased risk for making a past-year suicide attempt, above and beyond the effects of depressive symptoms and demographic factors. The association between emotion regulation difficulties and suicide attempts was modestly lower among students who perceived themselves as having higher levels of trusted adults in the family, consistent with a protective effect. Having a trusted adult in the community (outside of school and family) was associated with fewer suicide attempts in models that controlled only for demographic covariates, but not when taking symptoms of depression into account. These findings point to adolescent emotion regulation and relationships with trusted adults as complementary targets for suicide prevention that merit further intervention studies. Reaching these targets in a broad population of adolescents will require new delivery systems and "option rich" (OR) intervention designs.

Trends in Crisis Hotline Call Rates and Suicide Mortality in the United States.

OBJECTIVE: Utilization of the 988 Suicide and Crisis Lifeline (Lifeline; formerly called the National Suicide Prevention Lifeline) was analyzed in relation to suicide deaths in U.S. states between 2007 and 2020 to identify states with potential unmet need for mental health crisis hotline services. METHODS: Annual state call rates were calculated from calls routed to the Lifeline during the 2007-2020 period (N=13.6 million). Annual state suicide mortality rates (standardized) were calculated from suicide deaths reported to the National Vital Statistics System (2007-2020 cumulative deaths=588,122). Call rate ratio (CRR) and mortality rate ratio (MRR) were estimated by state and year. RESULTS: Sixteen U.S. states demonstrated a consistently high MRR and a low CRR, suggesting high suicide burden and relatively low Lifeline use. Heterogeneity in state CRRs decreased over time. CONCLUSIONS: Prioritizing states with a high MRR and a low CRR for messaging and outreach regarding the availability of the Lifeline can ensure more equitable, need-based access to this critical resource.

County-level estimates of suicide mortality in the USA: a modelling study.

BACKGROUND: Suicide is one of the leading causes of death in the USA and population risk prediction models can inform decisions on the type, location, and timing of public health interventions. We aimed to develop a prediction model to estimate county-level suicide risk in the USA using population characteristics. METHODS: We obtained data on all deaths by suicide reported to the National Vital Statistics System between Jan 1, 2005, and Dec 31, 2019, and age, sex, race, and county of residence of the decedents were extracted to calculate baseline risk. We also obtained county-level annual measures of socioeconomic predictors of suicide risk (unemployment, weekly wage, poverty prevalence, median household income, and population density) and state-level prevalence of major depressive disorder and firearm ownership from US public sources. We applied conditional autoregressive models, which account for spatiotemporal autocorrelation in response and predictors, to estimate county-level suicide risk. FINDINGS: Estimates derived from conditional autoregressive models were more accurate than from models not adjusted for spatiotemporal autocorrelation. Inclusion of suicide risk and protective covariates further reduced errors. Suicide risk was estimated to increase with each SD increase in firearm ownership (2·8% [95% credible interval (CrI) 1·8 to 3·9]), prevalence of major depressive episode (1·0% [0·4 to 1·5]), and unemployment rate (2·8% [1·9 to 3·8]). Conversely, risk was estimated to decrease by 4·3% (-5·1 to -3·2) for each SD increase in median household income and by 4·3% (-5·8 to -2·5) for each SD increase in population density. An increase in the heterogeneity in county-specific suicide risk was also observed during the study period. INTERPRETATION: Area-level characteristics and the conditional autoregressive models can estimate population-level suicide risk. Availability of near real-time situational data are necessary for the translation of these models into a surveillance setting. Monitoring changes in population-level risk of suicide could help public health agencies select and deploy targeted interventions quickly. FUNDING: US National Institute of Mental Health.

Perceived Impact of COVID-19 Among Callers to the National Suicide Prevention Lifeline.

Background: Research indicates that the COVID-19 pandemic caused increases in psychological distress and suicidal ideation. Aims: To describe the ways suicidal callers to the National Suicide Prevention Lifeline (Lifeline) perceived COVID-19 to have impacted them and assess whether these callers perceived COVID-19-related stress as contributing to their suicidal thoughts. Method: Telephone interviews were conducted with 412 suicidal callers to 12 Lifeline centers. Logistic regression analyses were used to examine the associations between demographic factors and individual COVID-19 stressors and to determine whether callers who endorsed COVID-19-related stress as contributing to their suicidal thoughts differed from those who did not regarding demographics, current suicide risk, history of suicidality, Lifeline use, or individual COVID-19 stressors. Results: Over half of callers reported that COVID-19-related stress contributed to their suicidal ideation (CRSSI). Callers who endorsed CRSSI had higher odds than those who did not of mentioning financial difficulties when asked how COVID-19 impacted them. The two groups of callers did not differ on the other factors examined. Limitations: Interviewed callers may not be representative of all Lifeline callers. Conclusion: Despite the subjective burden of COVID-19-related stress on suicidal Lifeline callers, this was not associated with new suicidality or heightened suicide risk.

Ethnoracial Disparities in Rates of Non-Natural Causes of Death After the 2020 COVID-19 Outbreak in New York State.

Introduction: COVID-19 was associated with increases in non-natural cause mortality in the U.S., including deaths due to drug overdose, homicide, and motor vehicle crashes. Initial reports indicated higher rates of non-natural mortality among ethnoracial minority groups. This report aims to clarify these disparities by documenting trends in non-natural mortality across ethnoracial groups during the 2020 COVID-19 surge in New York State. Methods: We report monthly trends in non-natural cause mortality (overall and stratified by ethnoracial status) in New York State from January 2019 through December 2020, which included the COVID-19 onset in March 2020. Results: Total mean monthly unintentional overdose rates per 100,000 increased from 17.45 (before surge: January 2019-February 2020) to 23.19 (after surge: March 2020-December 2020) (mean difference=5.73, 95% CI=3.82, 7.65; p<0.001). Mean monthly homicide death rates increased from 2.34 before surge to 3.55 after surge (mean difference=1.20, 95% CI=0.60, 1.81; p<0.001), with the increase seen primarily in the non-Latinx Black population. Although increasing unintentional overdose death rates before surge equally affected non-Latinx White, Latinx, and non-Latinx Black persons, they remained high for non-Latinx Black persons but dropped for the other 2 groups after the pandemic onset. None of the ethnoracial subgroups showed significant increases in suicide or motor vehicle crash death rates. Conclusions: Non-Latinx Black persons showed disproportionately high and sustained increased rates of unintentional overdose and homicide death rates after the 2020 COVID-19 surge in New York State. Fatality review and death scene investigation research is needed to better understand these disparities.

Crisis text-line interventions: Evaluation of texters' perceptions of effectiveness.

OBJECTIVE: Crisis Text Line (CTL), the largest provider of text-based crisis intervention services in the U.S., has answered nearly 7 million conversations since its inception in 2013. The study's objective was to assess texter's perceptions of the effectiveness of CTL crisis interventions. METHOD: Survey data completed by 85,877 texters linked to volunteer crisis counselor (CC) reports from October 12, 2017, to October 11, 2018 were analyzed. The relationship of several effectiveness measures with texters' demographic and psychosocial characteristics, frequency of CTL usage, and texters' perceptions of engagement with their CCs was examined using a series of logistic regression analyses. RESULTS: By the end of the text-based conversation, nearly 90% of suicidal texters reported that the conversation was helpful, and nearly half reported being less suicidal. CONCLUSIONS: Our study offers evidence for CTL's perceived effectiveness. These findings are of critical importance in light of the launch of a nationwide three-digit number (988) for suicide prevention and mental health crisis supports in the U.S., which will include texting.

Treatment of Patients Presenting With Suicidal Behavior in North American Pediatric Emergency Departments.

OBJECTIVE: This study sought to identify current practices for the treatment of patients presenting with suicidal ideation or a recent suicide attempt in pediatric emergency departments (EDs) in North America. METHODS: From October 10, 2018, to January 19, 2020, the authors conducted a cross-sectional online survey on current practices of pediatric emergency medicine chiefs practicing in the United States and Canada. RESULTS: Forty-six (34%) of 136 chiefs of pediatric emergency medicine responded to the survey. The three most frequent improvements chiefs reported they would like to see in the care of young patients with suicidal ideation or suicide attempt were easier access to mental health personnel for evaluations, having mental health personnel take primary responsibility for patient evaluation and treatment, and better access to mental health personnel for dispositional planning. CONCLUSIONS: The findings highlight the need for better mental health care in pediatric EDs to serve patients at increased risk for suicide.

Third-party callers to the national suicide prevention lifeline: Seeking assistance on behalf of people at imminent risk of suicide.

OBJECTIVE: To assist suicidal individuals, people in their social network are often directed to the National Suicide Prevention Lifeline (Lifeline). The study's objective was to provide information on third-party calls made out of concern for another person. METHOD: Reports on 172 third-party calls concerning individuals deemed to be at imminent suicide risk were completed by 30 crisis counselors at six Lifeline crisis centers. RESULTS: Third-party callers were most likely to be calling about a family member or friend and were significantly more likely than persons at risk to be female and middle-aged or older. Counselors were able to collect information about suicide risk, and counselors and third-parties were nearly always able to identify at least one intervention to aid the person at risk. Emergency services were contacted on 58.1 percent of the calls, which represents a somewhat higher rate of emergency services involvement than previously reported on imminent risk calls placed by the person at risk. Characteristics of third-parties and persons-at-risk each predicted emergency service involvement, but counselor characteristics did not. Non-emergency interventions were implemented on 68.6 percent of calls. CONCLUSIONS: Individuals calling the Lifeline when they are worried about someone are provided a range of interventions which can supplement, and at times replace, calling 911.

Individuals who text crisis text line: Key characteristics and opportunities for suicide prevention.

OBJECTIVE: Text-based crisis services are increasingly prominent, with inclusion in the national 988 crisis number launching in 2022. Yet little is known about who uses them. This study seeks to understand the population served by Crisis Text Line (CTL), the largest crisis text service in the United States. METHODS: Secondary data analysis was conducted on de-identified Crisis Counselor reports, texter post-conversation survey responses, and anonymized text conversation data from 85,877 texters who contacted CTL during a 12-month period. We examined Crisis Counselor's ratings of suicide ideation severity, texters' reports of race, gender, sexual orientation, recent mental health symptoms, and additional sources of help, and logs of frequency of contact. RESULTS: 76% of texters were under 25. 79% were female. 48% identified as other than heterosexual/straight. 64% had only one conversation. 79% were above the clinical cutoff for depression and 80% for anxiety, while 23% had thoughts of suicide. 23% received help from a doctor or therapist, and 28% received help only from CTL. CONCLUSIONS: CTL reaches a highly distressed, young, mostly female population, including typically underserved minorities and a substantial percentage of individuals who do not receive help elsewhere. These findings support the decision to include texting in the forthcoming national 988 implementation.

Lifeline Crisis Chat: Coding form development and findings on chatters' risk status and counselor behaviors.

OBJECTIVE: This study aimed to develop a reliable tool for the abstraction of data from crisis chat transcripts; to describe chatters' suicide risk status and selected counselor behaviors; and to examine the relationship of chatters' self-reported pre-chat suicidal thoughts to counselor behaviors and to chatters' disclosures of suicide risk during the chat conversation. METHODS: Coders used an instrument developed for this study to abstract data from 1034 crisis chats handled by the National Suicide Prevention Lifeline Crisis Chat network in 2015. The relationship of transcript coding data to data from an automated pre-chat survey (PCS) was examined. RESULTS: Lifeline Crisis Chat serves a young (median age = 21), high-risk population: 84.0% of chats (869/1034) came from chatters endorsing current or recent suicidal thoughts on the PCS. Counselors engaged in rapport-building on 93.3%, problem-solving on 70.1%, and suicide risk assessment on 67.7% of these 869 chats. Counselor risk assessment behavior, and the availability of information on suicide risk in the chat transcript, varied significantly by the chatter's PCS response. CONCLUSION: Crisis counselors are able to implement keystones of Lifeline's crisis intervention model over the medium of online chat. Additional efforts are needed to ensure that suicide risk is assessed on every chat.

Racial Disparities in Spatial and Temporal Youth Suicide Clusters.

OBJECTIVE: Deaths by suicide correlate both spatially and temporally, leading to suicide clusters. This study aimed to estimate racial patterns in suicide clusters since 2000. METHOD: Data from the US National Vital Statistics System included all International Classification of Diseases, Tenth Revision (ICD-10)-coded suicide cases from 2000-2019 among American Indian/Alaska Native (AI/AN), Asian/Pacific Islander (A/PI), Black, or White youth and young adults, aged 5-34 years. We estimated age, period, and cohort (APC) trends and identified spatiotemporal clusters using the SaTScan space-time statistic, which identified lower- and higher-than-expected suicide rates (cold and hot clusters) in a prespecified area (150 km) and time interval (15 months). We also calculated the average proportion of deaths by suicide contained in clusters, to quantify the relative importance of spatiotemporal patterning as a driver of overall suicide rates. RESULTS: From 2010-2019, suicide rates increased from between 37% among AI/AN (95% CI = 1.22, 1.55) to 81% among A/PI (95% CI = 1.65, 2.01) groups. Suicide clusters accounted for 0.8%-10.3% of all suicide deaths, across racial groups. Since 2000, the likelihood of detecting cluster increased over time, with considerable differences in the number of clusters in each racial group (4 among AI/AN to 72 among White youth). Among Black youth and young adults, 27 total clusters were identified. Hot clusters were concentrated in southeastern and mid-Atlantic counties. CONCLUSION: Suicide rates and clusters in youth and young adults have increased in the past 2 decades, requiring attention from policy makers, clinicians, and caretakers. Racially distinct patterns highlight opportunities to tailor individual- and population-level prevention efforts to prevent suicide deaths in emerging high-risk groups.

Restrictive emotionality, depressive symptoms, and suicidal thoughts and behaviors among high school students.

Depression and suicidal thoughts and behaviors are prevalent among youth today. The current study sought to further our understanding of the correlates of depression and suicidality by assessing the relationship between restrictive emotionality (difficulty understanding and expressing emotions) and depressive symptoms and suicidal ideation and attempts among adolescents. A large group of high school students (n = 2189, 58.3% male; 13-18 years of age) completed a self-report survey as part of a 2-stage suicide screening project. Logistic regression analyses were used to assess the association between restrictive emotionality and depressive symptoms, suicidal ideation, and suicide attempts. Those reporting high restrictive emotionality were 11 times more likely to have elevated depressive symptom scores, 3 times more likely to report serious suicidal ideation (after controlling for depressive symptoms), and more than twice as likely to report a suicide attempt (after controlling for depressive symptoms) than those reporting low restrictive emotionality. Restrictive emotionality partially mediated the relationship between depressive symptoms and suicidal ideation and behavior. The pattern of association between restrictive emotionality and the outcome variables was similar for boys and girls. Restrictive emotionality is highly associated with elevated depressive symptoms and suicidal thoughts and behaviors among high school students, and may be a useful specific target in prevention and treatment efforts.

Role of Firearm Ownership on 2001-2016 Trends in U.S. Firearm Suicide Rates.

INTRODUCTION: In the U.S., state-level household firearm ownership is strongly associated with firearm suicide mortality rates. Whether the recent increases in firearm suicide are explained by state-level household firearm ownership rates and trends remains unknown. METHODS: Mortality data from the U.S. National Vital Statistics System and an estimate of state-level household firearm ownership rate were used to conduct hierarchical age-period-cohort (random-effects) modeling of firearm suicide mortality between 2001 and 2016. Models were adjusted for individual-level race and sex and for state-level poverty rate, unemployment rate, median household income in U.S. dollars, population density, and elevation. RESULTS: Between 2001 and 2016, the crude national firearm suicide mortality rate increased from 6.8 to 8.0 per 100,000, and household firearm ownership rate remained relatively stable, at around 40%. Both variables were markedly heterogeneous and correlated at the state level. Age-period-cohort models revealed period effects (affecting people across ages) and cohort effects (affecting specific birth cohorts) underlying the recent increases in firearm suicide. Individuals born after 2000 had higher firearm suicide rates than most cohorts born before. A 2001-2006 decreasing period effect was followed, after 2009, by an increasing period effect that peaked in 2015. State-level household firearm ownership rates and trends did not explain cohort effects and only minimally explained period effects. CONCLUSIONS: State-level firearm ownership rates largely explain the state-level differences in firearm suicide but only marginally explain recent increases in firearm suicide. Although firearms in the home increase firearm suicide risk, the recent national rise in firearm suicide might be the result of broader, more distal causes of suicide risk.

National Suicide Prevention Lifeline crisis chat interventions: Evaluation of chatters' perceptions of effectiveness.

OBJECTIVE: As part of the National Suicide Prevention Lifeline's crisis response system, the Lifeline Crisis Chat Network (LCC) answers chats from hundreds of thousands of at-risk individuals yearly. The study's objective was to assess the effectiveness of these online crisis interventions. METHOD: Data from 39,911 pre-chat surveys and 13,130 linked pre- and post-chat surveys completed by LCC chatters from October 2017-June 2018 were analyzed. The relationship of several effectiveness measures with chatter demographics, pre-chat distress, suicidal ideation, and chatters' perceptions of engagement with their counselors was examined using a series of logistic regression analyses. RESULTS: Chatters were significantly and substantially less distressed at the end of the chat intervention than at the beginning. By the end of the chat, two-thirds of suicidal chatters reported that the chat had been helpful, while just under half reported being less suicidal. CONCLUSIONS: Our study offers empirical evidence for the Lifeline's online crisis chat services' effectiveness, but also highlights areas for improvement. This is of critical import in light of the recent designation of 988 as the nationwide number for the Lifeline beginning in 2022, which will increase the Lifeline's prominence in providing suicide prevention and mental health crisis interventions in the United States.

Associations between COVID-19 mobility restrictions and economic, mental health, and suicide-related concerns in the US using cellular phone GPS and Google search volume data.

During the COVID-19 pandemic, US populations have experienced elevated rates of financial and psychological distress that could lead to increases in suicide rates. Rapid ongoing mental health monitoring is critical for early intervention, especially in regions most affected by the pandemic, yet traditional surveillance data are available only after long lags. Novel information on real-time population isolation and concerns stemming from the pandemic's social and economic impacts, via cellular mobility tracking and online search data, are potentially important interim surveillance resources. Using these measures, we employed transfer function model time-series analyses to estimate associations between daily mobility indicators (proportion of cellular devices completely at home and time spent at home) and Google Health Trends search volumes for terms pertaining to economic stress, mental health, and suicide during 2020 and 2021 both nationally and in New York City. During the first pandemic wave in early-spring 2020, over 50% of devices remained completely at home and searches for economic stressors exceeded 60,000 per 10 million. We found large concurrent associations across analyses between declining mobility and increasing searches for economic stressor terms (national proportion of devices at home: cross-correlation coefficient (CC) = 0.6 (p-value <0.001)). Nationally, we also found strong associations between declining mobility and increasing mental health and suicide-related searches (time at home: mood/anxiety CC = 0.53 (<0.001), social stressor CC = 0.51 (<0.001), suicide seeking CC = 0.37 (0.006)). Our findings suggest that pandemic-related isolation coincided with acute economic distress and may be a risk factor for poor mental health and suicidal behavior. These emergent relationships warrant ongoing attention and causal assessment given the potential for long-term psychological impact and suicide death. As US populations continue to face stress, Google search data can be used to identify possible warning signs from real-time changes in distributions of population thought patterns.