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Suicide rates before, during and after the world wars

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Abstract

Suicide rates were found to decline during the major world wars of this century in both men and women and in both participating and non-participating nations. The increase in suicide rates after the conclusion of the wars, however, was not as pronounced.
... It is perhaps worth noting that experiences from the first and second world wars and natural disasters suggest a delayed increase in suicides after such crises (Baumert Lester, 1994). It is thus possible that suicidal attempts increase when the pandemic is over rather than at its onset (Reger et al., 2020). ...
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Hospital-treated intentional self-poisoning is common. The possibility of changed (increased) suicidal behaviors during the COVID-19 pandemic has been raised. To compare frequencies in self-poisoning events (SPEs) and the proportions with in-hospital mortality, in the year prior to and following the official onset of the COVID-19 pandemic, in a population of hospital-treated self-poisoning patients in Iran. All self-poisoned patients admitted to Loghman-Hakim Hospital, a clinical toxicology specialty hospital in Tehran, were included. The frequency of SPEs was compared between the one-year periods immediately before and after the onset of COVID-19 pandemic using Poisson regression. Differences in proportions of in-hospital mortality were also compared using logistic regression. A total of 14,478 patients with 15,391 SPEs (8,863 [61.2%] females) were evaluated in the study. There was no difference in the overall frequency of SPEs (relative risk [RR] of 0.99 [CI95% 0.96-1.03]), but a small increase in males (RR 1.07; 1.02-1.13) and a minor decrease in females (RR 0.95; 0.91-0.99). In total, 330 patients died (2.3% of all SPEs). There was no difference in overall in-hospital mortality odds ratio (OR: 0.98 [0.79-1.22]), in females (OR = 1.14 [0.80-1.60]) or males (OR = 0.92 [0.69-1.23]). There was no change in the frequency of SPEs and no difference in the in-hospital mortality proportions, suggesting that the COVID-19 pandemic had little or no effect on these aspects of suicidal behavior in Iran. Supplementary information: The online version contains supplementary material available at 10.1007/s12144-022-03248-y.
... Social cohesion or the degree of unity in the population is an example of a protective factor that has been observed in the The capital region 95% prediction interval COVID-19 pandemic [38]. Evidence from natural disasters [39], world wars [40], and modern time wars [41] show a similar pattern with increased social cohesion, reduced suicide rates, and protective effects on multiple detrimental mental health outcomes including suicidal ideation [42]. The trend toward fewer suicides observed among women and middle-aged adults in our study could perhaps be explained by increased social cohesion in these groups. ...
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Background There is a concern that the COVID-19 pandemic will lead to an increase in suicides. Several reports from the first months of the pandemic showed no increase in suicide rates while studies with longer observation times report contrasting results. In this study, we explore the suicide rates in Norway during the first year of the pandemic for the total population as well as for relevant subgroups such as sex, age, geographical areas, and pandemic phases. Methods This is a cohort study covering the entire Norwegian population between 2010 and 2020. The main outcome was age-standardized suicide rates (per 100,000 inhabitants) in 2020 according to the Norwegian Cause of Death Registry. This was compared with 95% prediction intervals (95% PI) based on the suicide rates between 2010 and 2019. Results In 2020, there were 639 suicides in Norway corresponding to a rate of 12.1 per 100,000 (95% PI 10.2–14.4). There were no significant deviations from the predicted values for suicides in 2020 when analyzing age, sex, pandemic phase, or geographical area separately. We observed a trend toward a lower than predicted suicide rate among females (6.5, 95% PI 6.0–9.2), and during the two COVID-19 outbreak phases in 2020 (2.8, 95% PI 2.3–4.3 and 2.8, 95% CI 2.3–4.3). Conclusion There is no indication that the COVID-19 pandemic led to an increase in suicide rates in Norway in 2020.
... Nevertheless, there is evidence to indicate that while suicide rates remain stable or decline during times of acute crises, delayed increases may appear in the period that follows. Indeed, a lag effect of exposure to distressing situations on suicide rates has been previously observed for major world events, such as World War I, World War II and other natural disasters; therefore, a timely implementation of effective prevention strategies is required (81)(82)(83). ...
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Since the outbreak of the coronavirus 2019 (COVID-19) pandemic, there has been widespread concern that social isolation, financial stress, depression, limited or variable access to health care services and other pandemic-related stressors may contribute to an increase in suicidal behaviors. In patients who have recovered from COVID-19, an increased risk of developing suicidal behaviors may be noted, while post-COVID syndrome comprises another potential risk factor contributing to increased suicidal behaviors. Despite the initial alarming predictions for an increase in suicide rates due to the COVID-19 pandemic, the majority of published studies to date suggest that experienced difficulties and distress do not inevitably translate into an increased number of suicide-related deaths, at least not in the short-term. Nevertheless, the long-term mental health effects of the COVID-19 pandemic have yet to be unfolded and are likely to remain for a long period of time. Suicide prevention and measures aiming at promoting well-being and mitigating the effects of COVID-19 on mental health, particularly among vulnerable groups, should thus be a priority for healthcare professionals and policymakers amidst the evolving COVID-19 pandemic.
... It remains unknown, however, whether data from these early months will reflect long-term trends in suicidality, particularly as emergency economic aid programs and a sense of social "togetherness" wanes [20,21]. There is reason to fear a lag effect in suicide rates, as a delayed uptick has been observed after wartime and other disasters [22]. ...
Article
Objective: This study aims to detail changes in presentations at a United States Emergency Department for suicidality before and after the outbreak of COVID-19. Methods: A retrospective chart review was conducted of all adult patients who presented to an ED with suicidality and underwent psychiatric consultation during the study period. The cohorts consisted of patients who presented between December 2018 - May 2019 and December 2019 - May 2020. Information was collected on demographics, characteristics of suicidality, reasons for suicidality and disposition. The first wave from March - May 2020 was examined, using a difference-in-differences design to control for factors other than COVID-19 that may have influenced the outcomes' trend. Results: Immediately following the pandemic outbreak there was a statistically significant increase in the proportion of undomiciled patients represented in visits for suicidality (40.7% vs. 57.4%; p-value <0.001). In addition, the proportion of patient visits attributed to social (18.0% vs. 29.2%; p-value 0.003) and structural (14.2% vs. 26.4%; p value <0.001) reasons for suicidality increased. Conversely, the proportion of visits due to psychiatric symptoms (70.5% vs 50.0%; p-value <0.001) decreased. Furthermore, patient visits were more likely to result in a medical admission (2.1% vs. 8.3%; p-value 0.002) and less likely to result in a psychiatric admission (68.4% vs 48.6%; p-value <0.001) during the initial phase of the pandemic. Conclusions: COVID-19 was associated with increased ED presentations for suicidality among undomiciled patients, as well as greater likelihood of social and structural reasons driving suicidality among all visits.
... Disasters and existential threats may result in higher rates of suicide and there was some evidence that suicide rates increased during the 2008 financial crisis in Europe (Parmar et al., 2016). However, this is not automatic and rates may even fall, perhaps due to increased social cohesion (Lester, 1994;Claassen et al., 2010), as postulated by Durkheim in the 19th century (Durkheim, 1897). There is a reason for concern about the impact of infectious outbreaks on the frequency of suicide and self-harm. ...
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Aims: Suicide accounts for 2.2% of all years of life lost worldwide. We aimed to establish whether infectious epidemics are associated with any changes in the incidence of suicide or the period prevalence of self-harm, or thoughts of suicide or self-harm, with a secondary objective of establishing the frequency of these outcomes. Methods: In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO and AMED were searched from inception to 9 September 2020. Studies of infectious epidemics reporting outcomes of (a) death by suicide, (b) self-harm or (c) thoughts of suicide or self-harm were identified. A random-effects model meta-analysis for the period prevalence of thoughts of suicide or self-harm was conducted. Results: In total, 1354 studies were screened with 57 meeting eligibility criteria, of which 7 described death by suicide, 9 by self-harm, and 45 thoughts of suicide or self-harm. The observation period ranged from 1910 to 2020 and included epidemics of Spanish Flu, severe acute respiratory syndrome, human monkeypox, Ebola virus disease and coronavirus disease 2019 (COVID-19). Regarding death by suicide, data with a clear longitudinal comparison group were available for only two epidemics: SARS in Hong Kong, finding an increase in suicides among the elderly, and COVID-19 in Japan, finding no change in suicides among children and adolescents. In terms of self-harm, five studies examined emergency department attendances in epidemic and non-epidemic periods, of which four found no difference and one showed a reduction during the epidemic. In studies of thoughts of suicide or self-harm, one large survey showed a substantial increase in period prevalence compared to non-epidemic periods, but smaller studies showed no difference. As a secondary objective, a meta-analysis of thoughts of suicide and self-harm found that the pooled prevalence was 8.0% overall (95% confidence interval (CI) 5.2-12.0%; 14 820 of 99 238 cases in 24 studies) over a time period of between seven days and six months. The quality assessment found 42 studies were of high quality, nine of moderate quality and six of high quality. Conclusions: There is little robust evidence on the association of infectious epidemics with suicide, self-harm and thoughts of suicide or self-harm. There was an increase in suicides among the elderly in Hong Kong during SARS and no change in suicides among young people in Japan during COVID-19, but it is unclear how far these findings may be generalised. The development of up-to-date self-harm and suicide statistics to monitor the effect of the current pandemic is an urgent priority.
... COVID-19 hit the world at a time when suicide rates were at their peak, as spring time typically has an increase in suicides (Postolache et al., 2010) in a seasonal variation we have known about since at least World War II (Lester, 1993). According to the World Health Organization (WHO), 800,000 deaths by suicide occur yearly, 79% of which happened in low-to middle-income countries, accounting for 1.4% of all deaths worldwide (WHO, 2016). ...
Article
COVID-19 hit the world amidst an unprecedented suicide epidemic in this century. As the world focuses on limiting the spread of the virus and prioritizing acutely medically ill patients, containment measures are not without mental health consequences. With rising anxiety and depression, risk of suicide-acutely and in the aftermath of the pandemic-also rises. This article aims to shed light on this major public health problem and better understand what factors may create or exacerbate psychiatric symptoms and suicide. We review suicide data predating the pandemic and examine impact of previous epidemics on suicide rates. We then focus on the current pandemic's impacts and the world's response to COVID-19. We examine how these may lead to increased suicide rates, focus-ing on the US population. Finally, we offer suggestions on mitigating interventions to curb the impending rise in suicide and the resultant increased burden on an already stretched health care system.
... The more stress, the higher the suicide rate for men and the lower the suicide rate for women. Lester (1994a) examined the evidence in as many nations as possible for the decline in the suicide rates during wartime. Not all nations had available data, and there may, of course, be systematic bias in the official suicide rates reported by nations. ...
Chapter
Research indicates that suicide rates decline during wartime. The most likely explanation for this decline is the greater social cohesion of societies during wartime, but changes in the economy during wartime, such as reduced rates of unemployment, may also play a role. The impact of civil wars on suicide rates is unclear since the data in the different reports are inconsistent. Prisoners of war who are treated harshly have higher suicide rates after release. The suicide rate of Jews was high during all phases of the Holocaust in the 1930s and 1940s. Whether suicide terrorists resemble typical suicides remains a subject for debate.
... However, given that it is likely to result in a confluence of risk factors for suicide and suicide attempt, it is highly possibly that the pandemic will lead to increases in rates of suicide and suicide attempt in the long run (Reger, Stanley, & Joiner, 2020). This lag effect of exposure to distressing situations on the rates of suicide and suicide attempt has been observed for World War 1 (1914-1918), World War 2 (1939-1945, and other natural disasters (Lester, 1994). However, predicting the impact of COVID-19 on decreasing then increasing rates of suicide and suicide attempt are but educated guesses, rather than hypotheses based on satisfactory evidence. ...
Article
The coronavirus (COVID-19) pandemic presents us with unusual challenges to the global health system and economics. The pandemic may not have an immediate impact on suicide rates, however, given that it is likely to result in a confluence of risk factors for suicide and economic crisis, it is highly possibly that it will lead to increases in suicide rates in the long-run. Elderly persons are more likely to live alone, be socially isolated during COVID-19 and have physical health problems, which are risk factors for suicide. Young children and health professionals may also be population at risk. Isolation, quarantine and the economic crisis that follows may impact mental health significantly. The International Academy of Suicide Research (IASR) is an organization dedicated to promote high standards of research and scholarship in the field of suicidal behaviour to support efforts to prevent suicide globally. This IASR’s board position paper gives recommendations for suicide research during the COVID-10 pandemic. Clinical research has to be modified due to COVID-19 shutdown.
... Specifically, he stated, "So there can only be one explanation for these facts, which is that great upheavals in society, like great popular wars, sharpen collective feelings, stimulate the party spirit and the national one and, by concentrating activities towards a single end, achieve, at least for a time, a greater integration of society" [1]. Many subsequent studies have also confirmed the decrease in suicide rates during wartime [2][3][4][5][6][7]. However, the theory needs a more detailed examination in terms of several conceptual and technical perspectives. ...
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After the seminal work of Durkheim (1897), many subsequent studies have revealed a decline in suicide rates during wartime. However, their main focus was inter-state wars and whether the same argument holds for civil conflicts within a country is an important unresolved issue in the modern world. Moreover, the findings of the previous studies are not conclusive due to unobserved confounding factors. This study investigated the relationship between civil war and suicide rate through a more rigorous statistical approach using the Sri Lankan civil war as a case study. For this purpose, we employed a linear regression model with district and year fixed effects to estimate a difference-in-difference in the suicide rate between the peacetime and wartime periods as well as the contested and non-contested districts. The results indicate that the suicide rate in the contested districts in the wartime was significantly lower than the baseline by 11.8–14.4 points (95% CI 6.46–17.22 and 7.21–21.54, respectively), which corresponds to a 43–52% decline. The robustness of the possible confounding factors was analyzed and not noted to have so much effect as to alter the interpretation of the results. This finding supports the Durkheimian theory, which places importance on social integration as a determinant of suicide, even for civil conflicts.
Article
The suicide rate generally appears to decline during the time of war. The traditional psychodynamic explanation that this decrease results from the legitimization of outward aggression is questioned. World War II evidence from both occupied and neutral countries, together with fluctuations of the suicide rates among the Scandinavian countries, are better understood as reflecting the social conditions of wartime, rather than the presence of actual fighting. These data, and others, point to the hypothesis that the decreased suicide rate during wartime is tied to the greater social integration–increased patriotism, ease of promotions, greater sense of purpose, and so forth–resulting from a state of war.
Mortality from suicide
  • Anon