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Suicide rates before, during and after the world wars
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.
... There may be a lagged effect on suicide rates as was the case in previous disasters and wars (Lester, 1994;Zalsman et al., 2020). Or even a positive effect from the shared experiences that may create social cohesion and add value to life and health in general (Reger et al., 2020). ...
The COVID-19 pandemic, along with oppressive government interventions, placed a heavy burden on mental health. Suicide mortality is an outcome that may have been affected by the stringency of these lockdown measures. The aim of this study is to examine the association between lockdown intensity, measured by the Stringency Index, and suicide mortality rates in US states from March 2020 to December 2021. To this end, Bayesian methods were used for the estimation of the association for the total population, as well as by gender, and by race. Results show a small negative association between lockdown intensity and suicide mortality rates which applies to most of the examined populations. Future research will determine if this relationship remains the same after the pandemic.
... Indeed, although evidence is limited, data suggest, for example, that suicide generally declines during periods of societal conflict. [42][43][44][45][46] War and pandemics have different characteristics, but in both there is a shared threat and common focus on collective action to tackle that threat. ...
Objective:
To synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic.
Design:
Systematic review.
Data sources:
Medline, PsycINFO, CINAHL, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework Preprints.
Eligibility criteria for selecting studies:
Studies comparing general mental health, anxiety symptoms, or depression symptoms assessed from 1 January 2020 or later with outcomes collected from 1 January 2018 to 31 December 2019 in any population, and comprising ≥90% of the same participants before and during the covid-19 pandemic or using statistical methods to account for missing data. Restricted maximum likelihood random effects meta-analyses (worse covid-19 outcomes representing positive change) were performed. Risk of bias was assessed using an adapted Joanna Briggs Institute Checklist for Prevalence Studies.
Results:
As of 11 April 2022, 94 411 unique titles and abstracts including 137 unique studies from 134 cohorts were reviewed. Most of the studies were from high income (n=105, 77%) or upper middle income (n=28, 20%) countries. Among general population studies, no changes were found for general mental health (standardised mean difference (SMD)change 0.11, 95% confidence interval -0.00 to 0.22) or anxiety symptoms (0.05, -0.04 to 0.13), but depression symptoms worsened minimally (0.12, 0.01 to 0.24). Among women or female participants, general mental health (0.22, 0.08 to 0.35), anxiety symptoms (0.20, 0.12 to 0.29), and depression symptoms (0.22, 0.05 to 0.40) worsened by minimal to small amounts. In 27 other analyses across outcome domains among subgroups other than women or female participants, five analyses suggested that symptoms worsened by minimal or small amounts, and two suggested minimal or small improvements. No other subgroup experienced changes across all outcome domains. In three studies with data from March to April 2020 and late 2020, symptoms were unchanged from pre-covid-19 levels at both assessments or increased initially then returned to pre-covid-19 levels. Substantial heterogeneity and risk of bias were present across analyses.
Conclusions:
High risk of bias in many studies and substantial heterogeneity suggest caution in interpreting results. Nonetheless, most symptom change estimates for general mental health, anxiety symptoms, and depression symptoms were close to zero and not statistically significant, and significant changes were of minimal to small magnitudes. Small negative changes occurred for women or female participants in all domains. The authors will update the results of this systematic review as more evidence accrues, with study results posted online (https://www.depressd.ca/covid-19-mental-health).
Review registration:
PROSPERO CRD42020179703.
... The overall suicide rate in the Netherlands during the Second World War remained about the same as before the war (Lester, 1994); however, the rate for men declined while that for women increased (Kruijt, 1960). The overall rate conceals an increase in suicides within some sociodemographic groups such as the Jewish population. ...
OBJECTIVE Jewish suicides increased heavily under Nazi-rule. This research investigated risk factors for dying from suicide according to sociodemographic characteristics, local context, and time periods.
METHODS Nazi-registration of Amsterdam residents of Jewish origin in 1941 linked to death and suicide lists. The added suicides after the Nazi-invasion (1940, n = 115) and the suicides when deportation trains ran (1942/1943, n = 182) were each matched to 25 controls using sex and age. Suicide was compared across migrant, occupational, marital, and religious status and neighborhood religiosity. Conditional logistic regression was applied, stratified by time period.
RESULTS In 1940, immigrant (cf. native born, odds ratio (OR) 1.89, 95%CI 1.21–2.96, p = .005) and married Jews (cf. previously married) showed higher suicide risk; members of Israelite Congregations (cf. nonmembers, OR 0.35, 95%CI 0.22–0.56, p < .001) showed reduced risk. Jews living in low synagogue rate neighborhoods showed higher risk compared to those living in neighborhoods without any synagogues (OR 2.48, 95%CI 1.65–3.72, p < .001) while those living in high synagogue rate neighborhoods showed no increased risk (OR 0.58, 95%CI 0.30–1.11, p = .10). In 1942/1943, the association between religious status (OR 1.07, 95%CI 0.67, 1.72, p = .77), synagogue rate (OR 1.27, 95%CI 0.91–1.77, p = .16), immigrant status (OR 1.30, 95%CI 0.92–1.84, p = .14) and suicide attenuated; Jews in managerial/professional occupations (cf. workers) or unmarried (cf. married) showed higher risk.
CONCLUSIONS In 1940, immigrants’ higher suicide risk likely indicates greater fear of Nazis while religious affiliation’s lower risk might indicate a protective effect of religious belief. In 1942/1943, risk differences markedly attenuated likely indicating increased fear of Nazis among all Jews.
... 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). ...
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. ...
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). ...
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.
Over recent decades, the relative wellbeing of younger birth cohorts declined in many western countries, indicating growing generational inequality. Building on Durkheimian theory, this paper examines explanations for these changes, hypothesizing that differences in cohort wellbeing are related to variations in social integration associated with birth cohorts and national socio-political contexts. Age–period-specific suicide rates of men and women from 1950 to 2020 in 19 highly developed western nations, including 26 birth cohorts, born from 1875 to 2004, are examined using estimable function analysis and age–period–cohort characteristic (APCC) models. Cohort variations in wellbeing are significantly greater in English-speaking nations, which have traditionally provided less institutionalized support and social integration than continental European nations. Age-specific suicide rates are larger for cohorts with childhood demographic characteristics associated with less social integration (relative cohort size and family structure). Major historical events associated with social integration in formative years of late adolescence and young adulthood also influence cohort wellbeing, with higher age-specific rates for cohorts experiencing the Great Depression of the 1930s and health pandemics of the early 20th and 21st centuries and lower rates for those experiencing periods of war and national conflict. However, the magnitude of these associations is strongly influenced by socio-political context. Negative effects of cohort characteristics are muted and positive effects are enhanced in the continental nations. In addition, patterns of associations vary by age and gender. Results remain with strong controls for the pace of change, additional measures of national context, and sensitivity analyses.
Introduction. Russia's aggression, which began in 2014 with the occupation of Crimea and parts of Donetsk and Luhansk regions, is considered a powerful long-term socially stressful factor. The suicide rate, as an indicator of troubles in society and its health as a whole, helps to identify a vulnerable contingent of the population and evaluate the effectiveness of state preventive measures implemented in socially stressful conditions. The aim: to investigate the dynamics of suicide mortality in Ukraine for the period 2005-2021. and the impact on this indicator of a socially stressful factor – Russian aggression in order to determine the stability of Ukrainian society in the conditions of war, identify the most vulnerable contingent of the population and evaluate the state's multi-selective approach aimed at preventing suicide. Materials and methods. The research materials were official statistical data from the "Population of Ukraine" reports of the State Statistics Service of Ukraine for 2005-2021. Cases of suicide of men and women in the period 2005-2013 served as a comparison group. The analysis provided for the clarification of annual rates and dynamics of suicide mortality and its gender characteristics during the period of the social stress factor in 2014-2021, in comparison with the control period and world indicators (WHO). Bibliographic, epidemiological, analytical, statistical methods were used in the research. Results. In Ukraine, as well as in the world, in the period 2005-2021, a decrease in the death rate due to suicides is noted, however, the Ukrainian rates significantly exceed the world rates. In a relatively prosperous period, the mortality rate due to suicide was 20.8±0.3, and it decreased statistically significantly (p<0.001) to 16.1±0.36 in the socially stressful period of 2014-2021. The number of suicides among the male population significantly exceeds its number among the female population and is significantly higher than the world indicators, in contrast to the female population, where the indicators are even lower. During the socially stressful period, the number of suicides among men remains reduced to 28.76±0.92 (р<0.001) and among women to 5.64±0.3 (р<0.05), with more stable rates of decline among women. Conclusions. In Ukraine, there is a dynamic decrease in the number of deaths due to suicides, which correlates with global indicators. However, our country, despite the faster rate of decline of this indicator, still belongs to the countries with a high rate of suicide mortality. During the military events of 2014-2021, the death rate from suicides decreased significantly, compared to the previous relatively prosperous period of 2005-2013 (p<0.001), which indicates the stability of Ukrainian society in war conditions. Mortality due to suicides in Ukraine significantly prevails among men (p<0.001) and significantly exceeds global indicators, which makes them a vulnerable contingent of the population that needs socially oriented support. The positive dynamics of the decrease in the number of suicides among men (p<0.001) and women (p<0.05) in the conditions of war testifies to the effectiveness of the state's multi-selective approach aimed at preventing suicide.
During the COVID-19 pandemic, researchers have questioned how the devastation of the pandemic might impact suicide rates. While initial evidence on suicide rates during the early stages of the pandemic is mixed, there are signs we should still remain vigilant. One way of conceptualizing the long-term effects of the pandemic is as a source of multiple traumatic events: the collective trauma of widespread illness and death and social upheaval, individual traumas from the virus itself (e.g., serious illness and disability, traumatic grief, vicarious trauma), traumas from the social and economic consequences (e.g., domestic violence, unemployment), and its intersections with pre-pandemic traumas and oppression. Given trauma is a well-established risk factor for suicide, this carries significant implications for suicide prevention in the wake of the pandemic. Yet access to trauma-informed care, education, and research remains limited. The pandemic presents a unique opportunity to address these gaps and implement a trauma-informed approach to suicide prevention. Building on existing frameworks, we describe how effective suicide prevention for the pandemic must incorporate trauma-informed and trauma-specific services, strategies, and policies; capacity building; collaborative research; and knowledge exchange. Attending to the traumatic effects of the pandemic may reduce the long-term impact on suicide rates.
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