Tyler Black, MD
@tylerblack32
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Suicidologist, emergency psychiatrist and pharmacologist. Data geek, ok, lots of other geek. Views expressed are my own and not my employers'. he/him/his
Vancouver, BC, Canada
Joined July 2010
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Last Seen Profiles
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PARENTS and all who care about kids!!
A team of hardworking people, especially AMAZING youth with lived experience, helped make these videos for non-suicidal self injury (NSSI) & suicidality (SI).
I am so proud to be a part of it.
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Child psychiatrist here. It is a very bad idea to search your teens room, and a very good idea to respect their privacy and develop them into humans who trust their parents instead of reasonably distrust them.
Do not take advice from this account. The proper # of searches is 0.
Do you know how to properly search your child's room? 🤔👀📦 If not, stick around for our first episode of
#ParentAware
with Sgt. Gunsolley. Remember:
🌱To support and guide pre-teens and teenagers, you need to monitor what’s happening in their lives.
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Suicidology update: School closures & Child suicide
These economists *really* analyse the data in technical ways to demonstrate the key point i made way back:
Child suicide dropped tremendously when "school shutdowns highest," & increased when schools opened
/1
This looks like another important paper on schooling during the pandemic. The authors find that in-person schooling was associated with MORE teen suicides. I have something to read on my flight now.
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A reminder to everyone claiming that masks might have some form of impact emotional/educational development children.
1.1 million kids have lost a primary caregiver due to COVID. We are 100% positive that losing a primary caregiver has major emotional/educational impact on kids.
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I'm sure all the "Sweden did fine" folks are going to absolutely reevaluate their position now that Sweden is absolutely not "doing fine", right?
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Jordan Peterson: I would rather DIE than delete that tweet.
Jordan Peterson: I deleted the tweet.
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Covid created over 7.5 million orphans (loss of a parent), and over 10.5 million kids lost a primary or secondary caregiver.
But sure, "child experts," tell me how vaccinations or masking or a month or two without school is awful for kids and "impairs their development."
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🚨POST-COVID & Kids🚨
New
@CDCgov
report showing quite clearly that children are at significantly more risk for life-threatening diagnoses after COVID infection. Very convincing evidence that prevention of COVID-19 in children is very important to reduce childhood mortality.
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To the world:
On behalf Canada, I am very sorry for Jordan Peterson. On behalf of academia, I am very sorry for Jordan Peterson. On behalf of people with the title of "Dr," I am very sorry for Jordan Peterson. On behalf of white men, I am very sorry for Jordan Peterson.
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/1 Hi Lucy and your colleagues.
Your advocacy toolkit contains poorly sourced, contexted, and biased information on mental health during the pandemic/schooling.
And I have receipts too!
(thread)
#urgencyofnormal
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/1 THREAD: I knew this day would come.
While pediatric societies & "hospital organizations" did "science by press release," breathlessly discussing a correlation on a parent survey or releasing a statement about 1 month of admissions in May 2021, I knew we would get REAL DATA.
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This incredible study looked at emergency department visits in children for suicidality (attempts & ideation) before & during the pandemic and found, unsurprisingly:
a) kids more likely suicidal during school months
b) school closures associated with DECREASED ER visits
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THREAD: School closure and kids
I am an expert in child & adolescent EMERGENCY psychiatry. This is my expert opinion: It's complex, and it is not easy to answer
COVID = BAD
Education = GOOD
In person schooling in a deadly pandemic
= GOOD + BAD
(context link)
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@ashleypmiller
Well both, sorta. I mean definitely the second. They very selectively and inappropriately cited those studies. A review of evidence that concludes that school decisions should be made cautiously and using best available evidence shouldn't be summarized as a stat about PTSD.
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People really believe that being rich = being a genius.
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I'm staying for now (barely! thanks to the support given to
@PeterHotez
by so many of my friends, & the cool support by
@GeorgeTakei
,
@MarkHamill
, and
@mcuban
), but it's clear that Musk has taken Twitter into a far worse position for scientists.
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Hey anti-vaxxers:
Seatbelts prevent auto deaths.
Helmets prevent head injuries.
Parachutes prevent fall injuries.
Antibiotics prevent sepsis.
Exercise prevents CV disease.
Drinking water prevents kidney stones.
Prevent has NEVER meant "100% stop" in medical language.
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Children need privacy. They will have private thoughts, they will have things happen that they don't want you to know. Always want to be the parent that the child knows they can go to for help even if they have disappointed you. Work really really hard to be that parent.
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Anyone parent citing how "happy kids are" taking off masks as evidence that masks are harmful should consider how happy they are when mommy gets McDonald's + ice cream cake, or when mom+dad leave for the weekend giving them the house to themselves, or when school is out.
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Did my very best in travel to prevent c19. Open spaces, masking (n95), traveling by car, minding ventilation. Unfortunately I couldnt do better than one way masking because no policy put masks on others. Now c19 positive. I don't think travel is safe if you want to avoid covid.
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One of the weirdest antivax/covid denialist claims is that COVID is somehow "just a flu" or that its no deadlier than a flu. This is so ridiculously and easily disprovable that it should only be met with a single response: "nah"
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There's a very sad story being circulated written by the New York Times about the death of a Dr.
It violates almost all suicide reporting guidelines.
I know this is tricky and I know this is painful but it is not helpful to share this story.
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Hey, "science debaters," Vaccines cause less myocarditis than COVID does.
This meta-analysis shows clearly that COVID Vaccines's risk of myocarditis is far less than COVID's risk of myocarditis in 12 to 17 year olds by an order of magnitude.
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I have already received a few nasty DMs and let me save you the time.
It is not bullying to criticize a physician publicly when they are publicly making mistakes on a national stage.
It is not unprofessional to correct misinformation.
I don't care what you think about my tone.
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4) if you ever use the phrase "but underprivileged kids receive [food, support, etc] at school!!" I want you to take a long hard look at yourself and consider whether or not this might be an opportunity for you to MATERIALLY SUPPORT UNDERPRIVILEGED PEOPLE.
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The medical field did not miss this. It was well reported and early.
Medical administrators, health care officials, and political organizations dodged this most of the pandemic to avoid paying the $ necessary to clean indoor air.
When COVID-19 surfaced in 2020, the medical field missed something, and it cost lives.
Airborne viruses can travel much further than originally thought. To curb infection, we should have focused on indoor air systems.
@DrLaPook
reports, Sunday.
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@joerogan
Hi Joe, have you given any consideration to how you are so easily mislead? The tweet was longer than 240 characters and the date at the bottom was wrongly formatted. Basic due diligence and fact checking would have prevented this.
You could hire fact checkers.
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@MarkMilliganDPT
Yet, a donut has 450 calories and a bottle of Coke has 210. So this chart would be a lot less interesting.
Or we could compare fats and there would be infinity cokes per donut.
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US hits an awful milestone: 300 deaths per 100,000 due to COVID, meaning that 0.3% of the US population has died of COVID.
One in 331 Americans have died due to COVID.
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So, maybe take a page out of the Dr. Black playbook:
"School doesn't matter right now, we need to focus on safety, security, and the things that will make you healthy"
/fin
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hey
@davidaxelrod
heard you on
@PodSaveAmerica
today - you mentioned suicides had increased, and i'm a suicidologist. Suicides did not increase in the US (down 3% for 2020 and for the 5 months we have reliable data for in 2021 still lower than 2019).
No change in kids.
per CDC
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New policy: calling masking "child abuse" = block. please self declare. please take a look in the mirror and think about how much you are devaluing victims of abuse by equating 3mm of cloth on a face with what kids of abuse go through.
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Simple graphs to counter COVID denialism & revisionism
1) American Deaths '99-'23 (raw)
Sometimes simple graphs tell a powerful story. When we talk about the United States having > 1 million excess deaths due to the pandemic, this is the visualization of what that looks like.
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In conclusion, if you are media or a politician, please:
1) don't cite science as supporting "schools reopening is best for kids"
2) recognize that saving lives is likely the most trauma-supported thing we can do for kids
3) be creative in supporting learning
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Now, worried parent, which situation would you like to be in? Do you really believe that you can search better than your teen child can hide? Do you really believe that your parental supervision is more clever than your child's intelligence?
No?
Then don't search.
Talk.
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Scenario 2: I am in trouble because I'm using drugs and something bad is about to happen. But I don't talk to my parents because they invade my privacy disrespect me and I know that talking to them will result in punishment. So, no, I will not call my parents.
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Are you not convinced, worried parent? Consider two scenarios:
Scenario 1: I am in trouble because I am using drugs and something unsafe is about to happen. Even though I'm worried about their reaction, I can trust my parents so maybe I should call them.
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"Natural infection immunity is better than vaccinated immunity" is an anti-vax trope that has existed for *literally* hundreds of years, and has no basis in reality.
In fact, Vaccinated immunity is far superior, more reliable, and less dangerous than Infection-based immunity.
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I did the math that
@DLeonhardt
and the
@nytimes
couldn't do, because, unlike him, I know how to use mortality statistics.
Age standardization matters.
Graph: On all three years of the pandemic, non-white/Asian Americans had a higher odds ratio of
#COVID
death at every age.
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@MarkMilliganDPT
And even the math doesn't check out. A donut as pictured (vanilla with sprinkles) has 15g of sugar, so it would be 4 donuts for a coke and so on.
#ididthemath
#honesthealthcommunication
#micronutritonwoo
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People need to understand that science isn't a religion, or a faith, or a belief. It's way to discover truth by systematically testing and challenging hypotheses. It's very nature is debate, and disproof.
That we have vaccines at all is a testament to how science DEBATES
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I'm honestly surprised it took this long. As her career continues to flourish at the expense of public health and those that need most protection, the rest of us in medicine will just sit back and shake our heads at how easy it is to ascend with the worst principles.
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/2 I'm skipping the first line (for now), but the second part, about "deaths from child suicide vastly outnumbering deaths from COVID and are increasing" is about as awful as it gets. I consider it ghoulish to wield child suicide statistics inaccurately to make advocacy points.
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Suicidology Update
=-=-=-=-=-=-=-=-=
The CDC has released their preliminary data. Contrary to the moral panic, there was NO "wave" or "spike" of childhood suicides in the 2nd year of the pandemic.
Youth suicide rates simply continued their trends.
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Large population cohort in Denmark **during lockdown** periods finds "no support" for the notion of increased self injury, suicidality, and eating disorder symptoms in young people.
Data that needs amplification as it speaks against the moral panic.
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"Learning loss" & school closures:
A district-level analysis
A mini-twitter paper
What if I told you that the LARGEST LEARNING GAINS were seen in the school district that was CLOSED LONGEST for the pandemic?
It's true!
Let's a take a deep look at "learning loss"
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The idea that kids, perpetrators of indiscriminate & rampant coughing, yelling, spit-talking, licking things, & wiping their noses on everything couldnt spread a respiratory virus as easily was ridiculous on face value.
Embarrassing how many eggheads & doofuses bought it.
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Dr. Drew carefully crafted every word here, specifically to dogwhistle to antivaxxers to 'make the connection'. When physicians do this (despite being trained about arrhythmias/chest trauma), they open the door to so much misinformation.
Dr. Drew is (unsurprisingly) awful.
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/2 This day has arrived. We have the incredible article by Ray et al, showing that during the first 15 months of the pandemic, youth ER presentations of self harm, overdose, and hospital admissions of both decreased by ~18% in Ontario.
1.6 MILLION YOUTH
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Right in my back yard (where I'm from). Reprehensible and boorish behaviour.
This is the net result of all this Desantis-y, Peterson-y, Shapiro-y, Musk-y bullcrap.
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Jordan Peterson is not being "silenced."
He will have a huge platform & can say what ever he wants as long as there is right wing grift.
He is a licensed professional being held standard.
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/13 Oh, and happy birthday to me :) On this day in the *cough* late seventies, at this exact time, I was brought, breech & premie, into this world, of course beating my amazing but never-winning-when-I'm-involved twin brother by 300 whole seconds.
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Not to directly contradict a major society in Canada, but BC has not been experiencing a spike in suicidality, emergency mental health presentations, or severe MH admission rates during periods of school closure.
In Feb to May 2021, with schools fully open here, yes, yes we did.
The
@CanPaedSociety
,
@PedsOntario
, and the Pediatric Section of
@OntariosDoctors
urge Ontario to open schools no later than Jan 17.
"The deteriorating health and well-being of children & youth is also a public health emergency."
Full letter here:
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FREQUENTLY, as an expert in emergency child and adolescent psychiatry, I have to use the phrase "School doesn't matter right now (short term), we need to focus on safety, security, and the things that will make you healthy"
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/11 And as I've demonstrated before, when ALL KIDS EXPERIENCED SCHOOL CLOSURES in the US, there was, for the first time in history, a flattening of suicide risk during school months.
/7 The first school year of the pandemic (with full lockdowns) also represents the FIRST TIME IN 21 YEARS that March-June (school months) had the same low suicide rate as July (non school month). Typically, school months associated with 36-55% increase in HS kids.
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/7 But this is academic misconduct. You have mis-cited the CDC report. I don't care if its an oversight, it's unacceptable.
Not only were children NOT the only age to show increase (25-34 did as well in males), NO CHILD GROUP SHOWED A SIGNIFICANT INCREASE. The citation says so.
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Your daily reminder that the prevention of the transmission the virus that has killed millions of people on this planet is the best possible way to protect our kids' mental health.
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If I hear one more person talk about "absolute risk" in kids for a preventable illness, I'm gonna freaking lose my mind.
Suicide occurs rarely in kids (4.5 per 100k/yr). If I could do **anything** to bring that down to 3.5 via public policy I would be advocating for it forever.
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Any pediatric emergency department member or child psychiatrist who has worked for at least 12 months consecutively will tell you, flat out, that school days cause more distress than non-school days.
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And from the science end, there is NO convincing evidence that:
* creative non-school based education
* technical skills learning
* home education
* distance education
* hiking-based education
is INFERIOR to school.
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5) pandemics/disasters ALWAYS disproportionately affect marginalized people. To get VERY political: white rich abled kids from loving homes will be FAR more "protected" going to school than kids of color, kids with disability, and kids with neglectful parents.
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That never means I think school is bad or they should never go, and I certainly think that education, social experiences, and adult-guided childhood development are very important.
But it DOES MEAN when safety is on the line, school is less important
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/4 We have data out of Paris showing pediatric suicide attempt presentations did not increase further during periods of school closure, rather decreased/same, but they increased significantly at times when lockdowns were lifted and pandemic was spreading.
1/ THREAD: Actual data (not claims):
Presentations of pediatric suicide attempts during the pandemic
A study out of Paris looking at suicide attempts in kids <16y, presenting to the Robert Debré. It has unsurprising (to me) results, but demonstrates some interesting things.
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/12 So now that I've debunked your claim about suicides increasing, shown that you improperly cited your narrative-selected citation, and demonstrated that school closures were associated with less risk, you'll update your advocacy, right?
Because this is about evidence, right?
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/12 But there is one promise to you: I am going to be reporting on ALL of it. Every single major study that comes out regarding mental health, our kids, and the pandemic, I'm going work hard to REPORT ON IT and tell you what it means and what it doesn't.
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The number of people who didn't (and don't) understand the basic physics of masks working to prevent viral infections is and was always too damned high.
Mask denialism is like flat eartherism at this point: it's just denying the way the universe works.
Does wearing a face mask help to prevent Covid? Linsey Marr, a Virginia Tech University professor specializing in aerosol science, explains what scientists have learned since the pandemic began.
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The net effect until the last possible month we can measure (May 2022)?
Child suicides:
* have not increased since the pandemic
* decreased sharply during the period of strongest school closures
* are strongly associated with school attendance
Suicidology update: 2022 pediatric suicide rates
=-=-=-=-=
We now have 5 months of data for 2022, which allows me to calculate the "january-may" suicide rate for the past 23 years in the US.
In the start of the 3rd year of the pandemic, a significant decrease is seen.
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Now is a world moment to both PROTECT our kids and NOURISH their well-being. there is NO reason to REQUIRE IN SCHOOL EDUCATION to accomplish those things, there are many ways to do it.
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Myth spread by antivaxxers:
Vaccination does not prevent transmission
Reality:
You are 3x less likely to get covid if you have a vaccine, and you clear the virus faster, reducing your likelihood transmission significantly if you are vaccinated.
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Finally, the "peaks" in cardiac deaths correspond with waves of covid that killed people in that age bracket. The simplest explanation is likely the best explanation. COVID-19 has increased cardiac deaths and NOT the vaccine.
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@ProfEmilyOster
@TheAtlantic
Emily, in your piece about amnesty you still spread misinformation, and you continue on the same tack you have taken the entire time. Is not the purpose of amnesty to acknowledge settled issues and changed behaviour? Demonstrate that first.
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/10 And yet, the narrative by LARGE public organizations has coopted mental health concerns for their political/moral panic messaging.
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/6 You & your colleagues missed something very important in your inaccurate and sensationalistic reporting.
Both 2019 & 2020 are SIGNIFICANTLY lower than 2018.
Sometimes though, we cite things and the citation source made a mistake.
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Kids, School, and Suicide
=-=-=-=-=-=-=-=-
People are asking about the stats I presented about school days being associated with child suicide. There are many ways to look at it.
Simply, using July as a reference month, you can easily see "school peaks."
It's very striking.
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/3 There is OTHER data out of Ontario showing that acute mental health ER and admission levels DID NOT INCREASE during the first 12 months of the pandemic. (broken down by age group)
THEY DECREASED.
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Myths about suicide:
* Highest in winter months - no, December is usually a record low each year
* Must be mentally ill to die of suicide - no, mental illness adds to risk but 30 to 50% of people who die (depending on age) have no major mental illness prior to their death
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This is absolutely an
#urgencyofequity
situation. We need to ensure that we reduce the spread of COVID-19 by:
a) using masks
b) staying home when sick
c) ensuring schools have good ventilation
d) remote/home learning during outbreaks
e) vaccinating our kids
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See, school is both a pathway to personal and social success, and **one of the major causes of stress**. It's the kids "full time job." We put SO much pressure on kids:
* attendance
* marks + competition
* social expectations
* extracurricular activities
etc.
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Unsurprisingly, the current hero of the Ottawa Trucker story is a young person, who did what entire police forces and governments could not do.
I promise you friends, the generation replacing us is SO MUCH better than us.
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/29 This is the new me - less snark, more pointed, data driven. I hope threads like this go as viral as my snarky one, because I want to be less snarky.
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The
@CDC
's new guidance is like "people are going to smoke anyway, so we don't recommend that they don't smoke."
If the politics push against evidenced public health, the public health position should push against the politics! Not "oh the politics are bad here go ahead."
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Bizarre new trend: painting fears about the virus (thousands of deaths daily, approaching 1M us deaths, no current end in sight, vaccine effectiveness but waning over time) as "unreasonable" and "unsustainable."
What a weird form of gaslighting.
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Hey remember all of the posturing and data free statements from major Ontario hospitals?
This is why I wanted data.
The pandemic associated with a SIGNIFICANT DECREASE in self harm and overdose for kids and young adults.
Thank you, authors!
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/3 In order, I'm going to go through your awful slide on mental health as you selectively cited "scary findings." Of course, as the suicidologist, I'm going to start with your clearly expert-free statement on child suicides in the US, as this is my expertise.
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This guy seems stable, balanced, and totally like who you should listen to for psychological or medical advice.
F**k you
Seriously
Never never again
You bloody pathetic fear-mongering
Pharma-fascist shills
The faster you disappear
@CNN
the better
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"... It’s not vaccines instead of masks, it’s not vaccines instead of distancing, it’s not vaccines instead of ventilation or hand hygiene. Do it all. Do it consistently. Do it well."
- Tedros Adhanom Ghebreyesus, director,
@WHO
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Really stunning data, putting to rest the notion that COVID doesn't affect the young.
In 2021, COVID became the 4th leading cause of death for people 25-34. 45-54, it was NUMBER ONE.
(Age 35-44, it was 5th)
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If I read one more "peer reviewed article" talking about pediatric mental health during the pandemic that mentions "lockdown measures" as a factor but doesn't mention "millions of new orphans" and "most kids rank fear that someone they love could get sick or die near the top" ...
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Mythbusting about COVID:
"Vaccines didn't benefit kids"
FACT: At every age, children benefit greatly from vaccination.
Infants <6mo (via maternal vaccination)
* 52% less likely to be hospitalized (80% during Delta, 38% during Omicron)
* 70% less likely to be in the ICU
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/9 But I hope for the sake of the kids you all see as pediatricians (and one child psychiatrist who either did not know how to interpret the evidence or wasn't listened to) you don't do this "fewer kids died of X vs Y so X isn't really a concern" thing. That's pretty ghoulish.
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Aside from the obvious fact that there is a worldwide pandemic which affects our vascular system, it should be noted that the COVID-19 vaccines have amazing safety profiles, & belief that more people are "dying suddenly" is purely due to a bias: Baader-Meinhof Phenomenon.
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Pediatric Suicidology
Suicides during the pandemic
=-=-=-=-=-=-=-=-=-=-=-=-=
We now have 31 months of US pandemic data on suicides for kids <18. There has been no increase in suicides to September 2022. No tsunami. No delayed effect. Suicides have not increased for children.
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People who follow me are used to this data, of course, but they ran it statistically to correspond at the county level to foot traffic, school foot traffic, seasonality, and in a number of covariates like race and method.
they posit a bullying/school stress hypothesis
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