What 2020 looked like at Crisis Text Line
Depression and suicide plunged, and anxiety surged in text messages to Crisis Text Line in 2020, new analysis of 1.4 million conversations found.
Content Warning // This post may contain upsetting or triggering content about mental health issues including suicide, depression, anxiety, and eating disorders.
At a glance:
- Crisis Text Line conversation volume and volunteer applications spiked in March, 2020. The spike coincided with the first Monday after the State of Emergency announcement on March 13, and lasted for several days.
- Crisis Text Line texters were less likely to contact the service about thoughts of suicide, depression, or bullying in 2020 than in 2019.
- Texters were more likely to talk about anxiety and body image issues in 2020 than in 2019.
- The drop in suicidal ideation in Crisis Text Line conversations echoes national and international trends of plunging suicide rates in 2020.
- Crisis Text Line researchers will continue to explore messages to the service to learn about the unfolding mental health crisis in the United States.
- The next part in this series will explore how Crisis Text Line conversations about anxiety tracked COVID-19 infection rates and political events in 2020.
‘How did COVID-19 show up in messages to Crisis Text Line?’
As the COVID-19 crisis swept through the United States, we received this question over and over again — from journalists, researchers, and policymakers who were hoping to grasp the impact of the pandemic on mental health service needs in the country.
As data scientists at a text-message-only hotline, we see the world through the eyes — and texts — of people in crisis. It’s a dark universe, but it can provide unique insights into what exactly weighs down on the minds of people in pain. And because this is a text-only service, we have a (*scrubbed and anonymized*) dataset of nearly 200 million messages that helps us better understand how people talk about specific mental health pressures in their lives.
We had 1.4 million conversations with people in crisis last year, more than in any year previously. Each of our conversations was tagged by a volunteer Crisis Counselor, who also assessed the level of the texter’s suicidal risk. We have metadata on timestamps and area codes, which helps us estimate geographic location.
Our job is to explore these conversations for insights that we can use to improve the lives of people in crisis through mental health policy, research, and journalism. So, this is the first post in a series where we summarize 2020 trends in Crisis Text Line conversations. We hope that we can provide insights for those of you who are trying to understand how the COVID-19 crisis impacted mental health trends in the United States.
Here is a summary what we learned about a disastrous year from 1.4 million conversations with people in crisis. The next post in the series will be dedicated to the topic of anxiety in Crisis Text Line conversations.
Crisis Text Line conversations and volunteer applications spiked at the onset of the COVID-19 pandemic.
On March 16, over 3,000 Crisis Text Line volunteers received a text message to take a shift if they could. There were twice as many texters waiting in line as the previous week’s average, and there weren’t enough counselors to talk to them. Demand held unusually high for several days, and finally started to wane on Wednesday, March 18. This is what we call an epic volume spike.
Soon, we saw an unprecedented wave of people apply to volunteer with Crisis Text Line. In a typical month in early 2020, between 2,000 and 3,000 people created an account to become a volunteer at Crisis Text Line. In the month between March 16 and April 16, over 15,000 people did. Soon, the volunteer supply outpaced texter demand.
There are a few potential reasons for the spike. There is the obvious: as the lockdown became a reality, many Americans were feeling extremely anxious. The Kaiser Family Foundation reports that the pandemic caused a sharp increase in anxiety levels in the United States. (They found that the share of adults who suffered from anxiety went from 1 in 10 to 1 in 4.)
It is also possible that Crisis Text Line served as a substitute for therapeutic services and school counselors (nearly half of our texters were under 18 in 2020 based on our voluntary post-conversation survey). Remember that in the first few weeks of the pandemic, therapeutic offices shut down as they were considered non-essential in most parts of the country.
Some of the increase may also be the result of a preemptive media campaign as journalists shared Crisis Text Line’s number in anticipation of a nationwide mental health crisis, amping up Crisis Text Line’s volume. (The Crisis Text Line marketing team was also working hard to get out the word that help was available for those who felt intense emotional pain.)
People in crisis started more conversations with Crisis Text Line in 2020. But what did they want to talk about?
As the pandemic dragged on, we continued to see higher-than-average volume, and occasional sharp increases in the number of texters who wanted to talk. Overall, 25% more people contacted Crisis Text Line last year than the year before, and they had 19% more conversations with us.
Naturally, we expected 2020 conversations to be different, but we didn’t know what to expect in terms of the issues that people brought to us. Would talk of depression and suicide increase in a year of intense social isolation, school closures, and spotty mental health service delivery? Or would it ease in a year where everyone was experiencing the same crisis, together?
Three lessons emerged.
1. Texters were less likely to contact Crisis Text Line about depression or suicide in 2020.
To our surprise, our texters were 20% less likely to talk to us about suicide, and 10% less likely to discuss depression in 2020. (See full table below.) We can’t say for certain what caused the drop in depression and suicide-related conversations at Crisis Text Line, but we have a few ideas. It is possible that Crisis Text Line conversations signal a real drop in suicidality in the U.S.
The drop in conversations about suicide echoes a nationwide trend. Death by suicide in the United States fell by 5.6% in 2020. The Economist recently also reported a downward trend in suicidality in many other countries around the world. (This phenomena aligns with academic research on the mental health effects of natural disasters. There is often a drop in suicidal behaviors in the initial post-disaster period, followed by a delayed increase in suicide attempts once the disaster passes.)
It is also possible that the increase in our conversation volume came from people who were somehow fundamentally less depressed than those who came before them. It’s possible that these new texters were more likely to talk about anxiety and stress than depression and sadness. We’ll be exploring this question in the coming months.
What issues did Crisis Text Line texters talk about in 2019 and 2020?
2. Texters were more likely to discuss anxiety or stress in 2020.
As we expected, Crisis Text Line texters were more likely to talk to us about anxiety and stress in 2020 than 2019.
Surprisingly, most of the increase in anxiety-related discussions occurred in the early phase of the pandemic. Meanwhile, COVID-19 infections continued to reach new highs, presidential elections were held, and states began to reopen much later during the year. But after June, the percentage of Crisis Text Line conversations about anxiety returned to 2019 levels, and stayed there for the rest of the year.
When did mentions of anxiety and stress increase in Crisis Text Line conversations in the United States?
Again, we may have tapped into a nationwide anxiety trend. When Johns Hopkins epidemiologist John W Ayers and others used Google Trends to monitor the daily fraction of all internet searches that included the terms anxiety or panic, they found the same trend — an acute spike in anxiety early during the pandemic, followed by a return to typical trends. In the discussion, the researchers argued that Americans may have become more resilient to isolation and the loss of social interactions.
Why? The lockdown came suddenly to many, and the shutdowns and intense stay-at-home orders may have caused a sudden onset of anxiety. But once people settled into new routines, the added anxiety of staying at home may have waned; it was also no longer unknown. If families were experiencing financial pressure or job loss, their financial anxiety may have eased once they received stimulus checks. It is also possible that Americans in general were no less anxious, but they had wider options for counseling and therapeutic treatment once more service providers settled into tele-health in the later stages of the pandemic. (We are dedicating the next part of this series to a deep dive on anxiety.)
3. More texters discussed eating disorders and body image issues with Crisis Text Line volunteers in 2020.
We didn’t know what to expect around eating disorders and body image issues in 2020. Nearly half (49%) of our texters were 17 or younger based on our voluntary post-conversation survey. School and family routines were disrupted, and counseling services were temporarily unavailable to many in the first months of the lockdown. At the same time, school was out — which could have brought a relief from stressors related to school and peers.
In the end, we found that our texters were more likely to bring up eating disorders and body image issues in 2020. Again, this increase aligns with findings from the National Eating Disorder Association, whose helpline experienced a 70% increase in call volume; similarly, a survey of 1,000 people with anorexia found that over 60% of respondents experienced worsening symptoms. In our case, one reason for this may be that Crisis Text Line texters are overwhelmingly young. Not only were their school routines disrupted, they were locked in with their family without a sense of control or privacy. Both of these losses can cause eating disorders to surge among teens.
We will keep exploring Crisis Text Line conversations to help inform policy and journalism around the impact of the COVID-19 crisis.
While researchers are divided on what makes an event a disaster, the COVID-19 pandemic qualifies by most measures. It was an event that threatened death or harm to many people. The pandemic and the lockdown also disrupted social networks and infrastructure — like a natural disaster or a war.
A Columbia University literature review presents a long list of negative mental health outcomes that may follow a disaster. Beyond the better known symptoms such as PTSD and depression, researchers have found higher risk of generalized anxiety disorder, as well as death anxiety, panic disorder, phobias, prolonged grief disorder and a whole host of other issues.
Some of the mental health consequences of the past year may take years to manifest. We will continue to explore how the unfolding mental health crisis is reflected in Crisis Text Line data — what weighs on people in crisis after a truly difficult year, what language they use to share painful moments, and what techniques help them most to return to a place of cool calm. We will share our findings in the coming weeks and months on this blog.
Are you a journalist or a policy expert? Crisis Text Line seeks to support journalists, school administrators, states, and anyone seeking to understand the crises in their community. With press requests, please contact Julia Pacetti or Cordelia Sklansky of Verdant Communications. With inquiries about policy partnerships, please contact Jana French at Crisis Text Line and learn more about how we work with government partners here.
Methodology note. Data is never perfect; it provides a story based on an incomplete set of information. Crisis Text Line’s data is no different. We think Crisis Text Line has an important perspective to add to the national conversation, but it’s important to note that our data is not representative of all people in the U.S., nor is it representative of what all people in crisis are experiencing. Issue data is reported by volunteer Crisis Counselors for approximately 95% of conversations. Demographic data is self-reported by texters after a conversation, in a mobile-web survey. Surveys are completed by texters for approximately 21% of conversations. We have always used data to help us improve our service to texters in crisis, and regularly have third parties advise and verify that our processes are informed by best practices. We are engaging additional third parties to further review our data practices to ensure that they are proper, private, secure and as rigorous as possible.
This is how we calculated the percentage of conversations by issue: people in crisis initiated over 1.44 million conversations with Crisis Text Line in the United States in 2020. For this analysis, we kept conversations that were not pranks, tests of our service, or other non-crisis-related outliers, and only kept conversations where a volunteer counselor logged at least one conversation topic in a post-conversation counselor survey. Then, we eliminated conversations where a texter didn’t engage following their initial contact with us, which left us with 931,385 conversations in 2020, which we compared to 719,627 conversations in 2019.
