Trends in death from suicide in Hawaii, 2010 through July
2020
Objective: Assess trends in deaths from suicide among residents in Hawaii,
given the interest in the pandemic's effect on general financial and
emotional well-being.
Data source and methods: Preliminary death certificate data through
September, 2020. The first Covid-19 case in Hawaii was reported on March
6, and the Governor's stay-at-home order took effect on March 25, so the 6month period of April through September serves as the pandemic period in
Hawaii. Two 5-year periods are used for comparison: suicides from 20102014, and from 2015-2019. Monthly or quarterly averages for these periods
were compared to 2020 counts.
Results: Statewide, there were fewer deaths from suicide during the
pandemic period in 2020 (76) than in comparable 6-month periods from
2010-2014 (94) or 2015-2019 (99) (figure). There was no consistent trend in
the 2020 deaths, with lowest totals in April, June and September. The 2020
victims were mostly comparable to victims in the earlier periods in
distribution of age, county of residence and mechanism. The proportion of
female victims was slightly higher in 2020 (28%), compared to the 20102019 period (21%).

25

Average monthly number of deaths by suicide among Hawaii
residents,
by month and time period, 2010 through 9/2020*
25

20

15

15
15
14 14
13

18
16
15

18
14
13

18 18
18
17
17
17

1515
14 14

10

10

19

19
17
16
15
15

16

14

9

7
5

0

1

2

3

2010-2014
4
5
6 2015-2019
7
8

*2020 counts based on preliminary death certificate data.

2020
9

10

11

12

 The statewide pattern was consistent across all counties, with 2020 counts
for the first Quarter (January-March) being higher in 2020 than baseline
averages (except Kauai), and counts for the second Quarter (AprilSeptember, i.e. pandemic period) being lower than baseline averages.
Discussion and conclusions:
In conclusion, the preliminary 2020 mortality data do not indicate an
increase in deaths by suicide in association with the pandemic. Fatalities
were generally comparable or lower during the April through September
pandemic period, compared to previous years, both statewide and within
counties. It is possible that economic suffering has been somewhat
mitigated by state and federal safety nets, although it is uncertain how long
that will continue. On the other hand, financial or employment issues are
relatively rarely documented as suicide "triggers" in autopsy investigative
reports; mental illness, often with no documented treatment, is far more
prevalent. While these findings are encouraging, they should be considered
preliminary. It is possible, for example, that deaths coded as suicides require
more time before finalization and may therefore be under-represented in
these 2020 data. It is important to also examine trends in nonfatal suicide
attempts and other possible indicators such as reported mental health crises
or utilization of psychiatric care.

 Trends in hospital presentations for self-inflicted injuries
(suicide attempts)
in Hawaii, 2016 through May 2020
Data source and methods: Laulima Data Alliance inpatient and outpatient
counts downloaded via the slice-and-dice tool, all diagnoses cube. Limited to
patients residing in Hawaii, including transfers and patients who died in
hospital. Includes only records with a 7th place value of “A” or blank (initial
encounters). Not limited to records with an injury-related principal diagnosis.
The monthly averages over the 4-year period of 2016 through 2019 were
compared to the 2020 counts.
Results: Counts for 2020 were lower for each month, compared to the 4year averages (figure). However, 2020 counts decreased 8.6% during the
pre-pandemic period (January through March), compared to 22.8% during the
post-pandemic period (April through May). The 2020 totals for April (106)
and May (121) were lower than any corresponding total during the 20162019 period (114 and 137, respectively).

Monthly number of suicidal patients treated at Hawaii hospitals, average
of 2016-2019 vs. 2020
150
125

135

148

146

160

150

149

143

152
121

142

2

106

1

50

155
142

142
123

75

137
131

100

25
0

3

4

5

6

2016-2019

7

8

2020

9

10

11

12