Health

No Global Increase in Suicides During Early Months of COVID

Deaths from suicide either stayed the same or dropped in 21 high- and upper-middle-income countries, including a handful of American states, in the first few months of the COVID-19 pandemic compared with expected levels, according to an analysis of preliminary data.

In fact, in 12 countries or areas, there was statistical evidence of a decrease from what was expected based on pre-pandemic years, reported Jane Pirkis, PhD, director of the Centre for Mental Health at the University of Melbourne, and colleagues.

The 12 areas that saw a decrease in suicides were California, Illinois, and Texas in the U.S.; New South Wales, Australia; Alberta and British Columbia, Canada; Chile; Leipzig, Germany; Japan; New Zealand; South Korea; and Ecuador, they noted in Lancet Psychiatry.

As COVID-19 began to ravage the globe last year, clinicians and mental health experts worried that suicides would skyrocket as loved ones became ill or lost jobs and despair became widespread.

National efforts to support mental health interventions, fiscal programs that buffered loss of income, and other factors perhaps shielded some people from suicidal ideation, the authors noted.

“Communities might have actively tried to support at-risk individuals, people might have connected in new ways, and some relationships might have been strengthened by households spending more time with each other,” they wrote.

For the study, the researchers culled statistics from government sources and used an interrupted time-series analysis to model the trend in suicides each month before COVID-19 (Jan. 1, 2019 to March 31, 2020) in each area, comparing the expected number of suicides with the observed number of suicides in the early months of the pandemic (April 1 to July 31, 2020).

Countries or areas within countries were included if statistics on suicides were available by month and they had a population of at least 3 million residents.

In a sensitivity analysis, the authors inflated the numbers of suicides in each month of this period by 5%, to account for potentially delayed reporting, and found “little difference,” with only two areas — New Jersey and Puerto Rico — showing evidence of increased suicides not found in the primary analysis.

For the U.S., Pirkis and colleagues compared observed versus expected suicide occurrences in five states. In only one, New Jersey, did observed suicides noticeably outpace the number expected from past trends (389 vs 364).

This study is the first to look at suicide during the COVID-19 pandemic in multiple countries. For each of the countries included, the data were remarkably consistent.

However, Pirkis and team cautioned against complacency: We need to remain vigilant and be poised to respond if the situation changes as the longer-term mental health and economic effects of the pandemic unfold.”

In an accompanying comment, Stella Botchway, MPH, and Seena Fazel, BSc, MD, of the University of Oxford in England, suggested that the decline in suicides during these early months “is consistent with the observation that national crises can be associated with a protective effect against suicide, perhaps due to greater social cohesion.”

Nevertheless, they warned of a possible delayed impact. “Suicide can be a lagging indicator of psychosocial difficulties, influenced by medium-term and longer-term disruptions to civic life and the economy,” they wrote.

Other studies have shown an increase in suicides following an economic recession, and that increase can be sustained for several years, they added.

However, according to study co-author Mark Sinyor, MD, of the Hurvitz Brain Sciences Program at Sunnybrook Health Sciences Centre in Toronto, “this is not predestined.”

“If the right actions are taken, for example, governments provide or continue to provide financial safety nets, communities make efforts to promote social cohesion and togetherness once physical distancing is no longer required, and health systems offer timely access to high-quality mental healthcare, there is no reason why suicide rates have to increase and, in fact, it is possible that there could be ongoing reductions,” he told MedPage Today.

There were some limitations to the study. Suicide rates in low-income or lower-middle-income countries could not be captured, and these “account for 46% of the world’s suicides and might have been hit particularly hard by the pandemic.” Additionally, data collection in many countries may have been impeded by COVID-19 disruptions.

Disclosures

The study authors and editorialists reported no conflicts of interest.

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