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Trends in suicide rates during the COVID-19 pandemic restrictions in a major German city

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Abstract

Background It remains unclear whether the COVID-19 pandemic is having an impact on suicide rates. Social distancing, economic insecurity and increasing prevalence rates of mental disorders may cause an increase in risk factors for suicide. Methods Data on suicide events in a major city in Germany, and the corresponding life years were provided by the local authorities. For the year 2020, periods without restrictions on freedom of movement and social contact were compared with periods of moderate and severe COVID-19 restrictions. To avoid distortions due to seasonal fluctuations in suicide risk, data from 2020 were compared to data from 2010 to 2019. Outcomes A total of 333 suicides were registered and 2,791,131 life years (LY) were spent between 2010 and 2020. Of these, 42 suicides and 300,834 LY accounted for the year 2020. In 2020, suicide rates (SR, suicides per 100,000 LY) were lower in periods with moderate (SR = 8.5, χ ² = 4.374, p = 0.037) or severe COVID-19 restrictions (SR = 7.0, χ ² = 3.999, p = 0.046) compared with periods without restrictions (SR = 18.0). A comparison with preceding years showed that differences cannot be attributed to seasonal variations. No age- or gender differences were found. Interpretation SR decreased during the COVID-19 restrictions; we expect SR to rise in the medium term. Careful monitoring of SR in the further course of the COVID-19 crisis is therefore urgently needed. The findings have regional reference and should not be over-generalized. Funding This study was conducted without external funding.
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Trends in suicide rates during the COVID-19
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pandemic restrictions in a major German city
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ORIGINAL ARTICLE
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Daniel Radeloff1*, Rainer Papsdorf1, Kirsten Uhlig2, Andreas Vasilache3, Karen
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Putnam4, Kai von Klitzing1
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1 Department of Child and Adolescent Psychiatry, Psychotherapy and
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Psychosomatics, University Hospital Leipzig, Leipzig, Germany
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2 Leipzig Health Authority, Leipzig, Germany
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3 Center for German and European Studies (CGES), Faculty of Sociology Bielefeld
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University, Bielefeld, Germany
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4 Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill,
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United States
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*Corresponding author: Daniel Radeloff, Department of Child and Adolescent
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Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig,
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Liebigstrasse 20a, 04103 Leipzig, Germany e-mail: daniel.radeloff@medizin.uni-
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leipzig.de, +49 - 34 - 97 2 40 11.
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All authors declare no conflicts of interest. This study was conducted without external
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funding.
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wordcount manuscript: 2036, wordcount abstract: 249 / 250, references: 46, figures:
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1, tables: 0
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Abstract
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Background
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It remains unclear whether the COVID-19 pandemic is having an impact on suicide
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rates. Social distancing, economic insecurity and increasing prevalence rates of mental
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disorders may cause an increase in risk factors for suicide.
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Methods
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Data on suicide events in a major city in Germany, and the corresponding life years
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were provided by the local authorities. For the year 2020, periods without restrictions
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on freedom of movement and social contact were compared with periods of moderate
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and severe COVID-19 restrictions. To avoid distortions due to seasonal fluctuations in
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suicide risk, data from 2020 were compared to data from 2010 to 2019.
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Outcomes
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A total of 333 suicides were registered and 2,791,131 life years (LY) were spent
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between 2010 and 2020. Of these, 42 suicides and 300,834 LY accounted for the year
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2020.
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In 2020, suicide rates (SR, suicides per 100,000 LY) were lower in periods with
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moderate (SR = 8.5, c2 = 4.374, p = 0.037) or severe COVID-19 restrictions (SR = 7.0,
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c2 = 3.999, p = 0.046) compared with periods without restrictions (SR = 18.0).
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A comparison with preceding years showed that differences cannot be attributed to
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seasonal variations. No age- or gender differences were found.
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Interpretation
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SR decreased during the COVID-19 restrictions; we expect SR to rise in the medium
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term. Careful monitoring of SR in the further course of the COVID-19 crisis is therefore
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urgently needed. The findings have regional reference and should not be over-
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generalized.
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Funding
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This study was conducted without external funding.
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Keywords
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Suicide, COVID-19, pandemic, restrictions, quarantine, Germany
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Introduction
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It remains unclear whether the COVID-19 pandemic is having an impact on suicide
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rates. Some predict that suicide rates will rise, since actions to contain COVID-19, such
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as social distancing, economic lockdown, or the temporary restructuring of the health
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system, could cause risk factors for suicide to increase 1–5. Indeed, analyses of
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previous economic crises have shown that an increase in unemployment was
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associated with an increase in suicide rates 6–10; and according to leading theories of
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suicide prevention, the loss of social inclusion is a major risk factor for suicide 11.
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In Germany, a significant restriction of the free movement of persons was agreed upon
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in March 2020, with the strongest restrictions coming into force in April and May.
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German borders were virtually closed for travel from 16 March onwards 1214. On 22
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March 2020, the German Federal Government and the Länder agreed on a
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comprehensive restriction of social contacts, which required people to reduce contacts
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with others (except for members of one’s own household) to an absolute minimum 15.
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In the Free State of Saxony, further restrictions on going out, and a ban on visiting care
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homes, were adopted on 1 April 2020 16. While the restrictions on going out were eased
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on 4 May, the restrictions on visiting care homes remained 17.
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Following a meeting by the EU interior ministers on 15 June, extensive freedom of
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movement within the EU’s Schengen Area was gradually restored, but differentiated
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travel warnings and quarantine regulations following travel remained in place for parts
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of it. The German Federal Foreign Office also maintained the existing travel warnings
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for 160 countries until 31 August 2020 18.
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Elderly people, particularly those with severe or multiple underlying health conditions,
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are threatened by high fatality rates of COVID-19 19, and are therefore particularly
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affected by the pandemic. Social distancing was practised more consistently by this
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age group, and older people are more often dependent on help from third parties.
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Thwarted belongingness and perceived burdensomeness are in turn central risk
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factors for suicide, according to the interpersonal theory of suicide 11. In the case of
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senior citizens, these risk factors affect an already vulnerable age group with the
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highest age-related suicide rates 20.
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This study investigated the influence of social distancing during the COVID-19
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restrictions period on suicide rates (SR). We addressed the following hypotheses:
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A. SR increased in the total population under conditions compared to periods without
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restrictions. This applies to both the period of travel restrictions and that of restricting
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social contact.
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B. Within the 70+ age group, the risk of suicide increased more strongly than in other
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age groups during COVID-19 restrictions.
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C. A comparison with previous years shows that differences in SR within 2020 are not
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due to seasonal differences.
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Methods
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Sample and data acquisition
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The data on suicides are based on the City of Leipzig’s cause of death statistics, and
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were provided by the responsible health authority for the years 2010 to 2020. Data
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were obtained for age ranges 0–4, 5–9, 10–14, …, 75-79, 8084, 85+ and for both
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sexes. Annual population statistics were provided for the corresponding age groups by
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the residents’ registration office of Leipzig (https://statistik.leipzig.de/statcity/).
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Analytical strategy
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Data were analysed using the R software version 3.3.1 17, IBM SPSS 25.0 18, and
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Microsoft Excel.
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The analysis included suicides from the first six months of each of the years studied.
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For the year 2020, months without restrictions on freedom of movement or social
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contact were aggregated as period nR_2020 (January, February), those with moderate
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restriction as period R1_2020 (travel restrictions; March to June), and those with
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severe restrictions as period R2_2020 (restrictions on travel, going out and social
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contact; April, May). To compare suicide mortality in 2020 before and during the
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COVID-19 restrictions, suicide cases were assigned to group nR_2020, R1_2020 and
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R2_2020. Corresponding life-years were calculated, according to the length of the
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periods examined.
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Life years (LY) and events were used to calculate the Risk Ratios (RR) with Incidence
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Rate Ratios (IRR). Differences in suicide risk between nR_2020 and the risk groups
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R1_2020 and R2_2020 were conducted using Chi-Square tests. In order to exclude
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biases due to seasonal fluctuations in the suicide risk, Mantel-Haenszel statistics (MH,
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Test for Heterogeneity) were performed to examine the risk of suicide within the 2020
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restriction periods and with the paired periods for years 2010-2019. The Test for
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Heterogeneity examines whether the IRR of n 2x2 tables differ. Post-hoc, Chi-Square
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tests were used to examine differences for each pair (nR_2020 vs nR_2010/19;
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R1_2020 vs R1_2010/19; R2_2020 vs R2_2010/19).
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In order to examine age-related and gender-related differences within the 2020
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restriction periods, suicide risk in nR_2020, R1_2020 and R2_2020 were compared
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between senior age (70+) vs age group 0–69 and between genders using the MH.
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Ethical considerations
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The study was approved by the ethics committee of the medical faculty of the
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University Hospital Leipzig, Germany (study ID: 272/20-ek) and conducted according
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to the Declaration of Helsinki. This epidemiological cohort study is based on the death
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statistics. For methodological reasons, no informed consent can be obtained.
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Results
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A total of 2,791,131 LY were spent and 333 suicides were registered during the periods
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studied. In 2020, 18 suicides (LY: 100,278) were attributed to nR_2020, 17 (LY:
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200,556) to R1_2020, and 7 (LY: 100,278) to R2_2020. In the previous years 2010 to
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2019, 90 suicides (LY: 930,377) were attributed to nR_2010/19, 208 (LY: 1,860,754)
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to R1_2010/19, and 91 (LY: 930,377) to R2_2010/19. The suicide rates within the
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individual periods were 18.0, 8.5, 7.0 in nR_2020, R1_2020, and R2_2020,
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respectively.
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The suicide risk in 2020 was found to be different between nR_2020 and the periods
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studied of R1_2020 c2 [1; N = 300,869] = 4.374, p = 0.037), and R2_2020 R2 (c2 [1; N
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= 200,581] = 3.999, p = 0.046).
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The difference for nR compared to R1 and R2 also remained in a comparison with the
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previous years 2010 to 2019 (Test for Heterogeneity; periods nR vs R1: Q [df = 1] =
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12.233, p < 0.001; periods nR vs R2: Q [df = 1] = 13.974, p < 0.001). The post hoc
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analysis showed that the described difference was due to high suicide rates in
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nR_2020 compared to nR_2010/19. The periods R1_2020 and R2_2020 were not
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different compared to the previous years.
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For details, see Figure 1.
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< insert Figure 1 about here >
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No gender- or age-related differences were demonstrated between R_2020, R1_2020,
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and R2_2020.
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Discussion
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Our hypotheses regarding suicide rates increasing during corona restrictions could not
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be confirmed. On the contrary, we found lower suicide rates during the pandemic
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restrictions in 2020 compared to previous months. However, a comparison with
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preceding years showed that this difference in 2020 was mainly caused by high suicide
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rates in the period without restrictions.
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Results represent local suicide trends during the COVID-19 pandemic in a major city
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in Saxony. In Saxony, as in most regions of Germany, the prevalence and mortality
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rates of COVID-19 were comparatively low, with 135.8 and 251.0 cases per 100,000
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inhabitants, respectively 24. The regional shut-down was much less restrictive than in
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other European countries, i.e. United Kingdom, France, Spain or Italy. At an early stage
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of the pandemic, the German government committed to support measures to prevent
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insolvencies and unemployment. Accordingly, results should be evaluated under these
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external conditions. Regional differences in the COVID-19 pandemic may produce
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regional differences in the mental health situation, economic crises and suicide rates.
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The findings of this study should not, therefore, be extrapolated uncritically to other
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regions or countries. It should not be assumed either that the trend described will
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remain stable. This study only provides a first regional snapshot.
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The COVID-19 pandemic is a new phenomenon. Thus, it is not surprising, that little
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scientific evidence of suicide trends during the COVID-19 pandemic exist. A number
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of case reports describes a co-occurrence of suicidal behaviour and COVID-19, with
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the underlying factors being fear of infection 2527 or severe mental disorders such as
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hallucinations or delusions 2830. However, trends in suicide risks cannot be concluded
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from case reports or case series.
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Projections based on underlying risk factors for suicide, such as unemployment,
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indicate rising suicide rates during the COVID-19 pandemic 1,2. This does not
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contradict the reduced suicide risk found in our study, since unemployment has not yet
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risen in the region investigated. It illustrates, however, that suicide rates will not
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increase immediately, but possibly only with a time lag.
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This is consistent with studies reporting no increase in suicidal behaviour, used as an
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indirect measure for suicide risk, in the early stages of the COVID-19 pandemic 3137.
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For instance, online surveys showed a decrease in suicidal thoughts and intention
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during the pandemic; presentation at emergency departments due to suicidal ideation
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decreased 36, suicides in selective autopsy samples remained low 37, and search
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engine users entered suicide-related terms less frequently 3133,35. However, the overall
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results are inhomogeneous, since other surveys indicate a high prevalence of suicidal
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thoughts during the pandemic, in particular under quarantine conditions 3,3841.
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The findings have led us to change our initial hypothesis. We predict the pandemic will
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see the following course of suicide rates; this will need to be verified in future studies:
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In an initial phase, the pandemic was perceived as an incalculable new threat without
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any social countermeasures being taken. In this phase of individual disorientation,
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suicide rates were unusually high.
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In a second phase, with the COVID-19 restrictions, a social response to the threat was
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given. Rules were established to protect the most vulnerable individuals and to slow
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down the spread of the virus. The omnipresent concern for the well-being of fellow
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human beings led to an increased sense of social belonging despite physical distance.
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According to Durkheim’s theory, a temporary increase of social integration and
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cohesion results in a reduction in suicide rates 42. Some findings observed during the
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Second World War and the 9/11 terror attacks support this hypothesis, but it remains
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controversial 4345 .
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In a third phase, the pandemic could be perceived as more predictable and less
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threatening. The feeling of belonging may once again be increasingly determined by
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the quality and quantity of everyday contacts, which could continue to be reduced
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depending on the regulations. A rise in loneliness, unemployment and mental disorders
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may lead to a delayed increase in the suicide rates in the medium term. As other
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authors have stressed, it is important to distinguish between physical distance and
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social belonging 46. A major challenge for suicide prevention during the COVID-19
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pandemic is to find an answer to the following question: How can we succeed in
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maintaining a sense of social belonging in our society if physical distance persists in
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the medium term?
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Conclusion
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In the population studied, suicide rates decreased during the COVID-19 restrictions,
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but we expect suicide rates to increase with a time delay. Careful monitoring of suicide
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rates in the further course of the COVID-19 crisis is therefore essential. Accordingly,
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further investigations and meta-analytical approaches are urgently required to monitor
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suicide rates. In this sense, the available results represent a first step in this direction.
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Limitations and strengths
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This study reports first data on suicide trends during the COVID-19 pandemic. The
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investigated quarantine period covers only six months and the population studied is
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relatively small with 0.5 M persons. These findings allow conclusions to be drawn for
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the region and time period investigated. The results do not allow a supra-regional
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evaluation or assessment of medium-term trends in suicide rates.
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Acknowledgements
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We would like to thank the Leipzig Health Authority for their support and fast provision
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of relevant data sets. We would also like to thank Monica Buckland for her valuable
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support in proofreading.
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Figures and Tables
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Figure 1: Suicide rates before and during COVID-19 restrictions.
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This displays the suicide rates (SR, suicides per 100,000 life years) in 2020 (black columns) and the average SR
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of the years 20102019 (white columns). nR = period in 2020 without COVID-19 restrictions (and corresponding
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periods in previous years), R1 = period of moderate restrictions, R2 = period of severe restrictions. Asterisks indicate
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significant differences (p < 0.05) in the underlying suicide numbers and population sizes based on Chi-Square
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statistics. S = suicide numbers, Pop = population sizes (life years).
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... These policies may not only reduce the burden of mental disorders during viral outbreaks but also promote health equity, the development of human capital, and sustained productivity of the workforce. Further research should examine the mental health consequences of COVID- 19 The United Nations International Labour Organization (ILO) finds that the economic effects of COVID-19 on the world appear worse than the 2008 recession. 9, 10 The ILO predicts that lockdown efforts will affect more than 2.7 billion workers-four out of every five individuals in the workforce. ...
... 17 However, overall suicide rates do not appear to rise in the United States and even show a decrease in other countries. [18][19][20] Mental health difficulties can, in turn, adversely impact economic growth. 21,22 Experts project the global economic costs of mental disorder to exceed US$16 trillion from 2010 to 2030. ...
... 52 Similarly, another study in China finds increased symptoms of depression and anxiety among early-career physicians during COVID-19. 50 A cohort study in China surveyed 385 young physicians surveyed two weeks before starting their residency, three months after starting (before COVID- 19), and six months after starting (during COVID-19). 50 Researchers found that daily mood scores decreased and symptoms of depression and anxiety increased. ...
... These policies may not only reduce the burden of mental disorders during viral outbreaks but also promote health equity, the development of human capital, and sustained productivity of the workforce. Further research should examine the mental health consequences of COVID- 19 The United Nations International Labour Organization (ILO) finds that the economic effects of COVID-19 on the world appear worse than the 2008 recession. 9, 10 The ILO predicts that lockdown efforts will affect more than 2.7 billion workers-four out of every five individuals in the workforce. ...
... 17 However, overall suicide rates do not appear to rise in the United States and even show a decrease in other countries. [18][19][20] Mental health difficulties can, in turn, adversely impact economic growth. 21,22 Experts project the global economic costs of mental disorder to exceed US$16 trillion from 2010 to 2030. ...
... 52 Similarly, another study in China finds increased symptoms of depression and anxiety among early-career physicians during COVID-19. 50 A cohort study in China surveyed 385 young physicians surveyed two weeks before starting their residency, three months after starting (before COVID- 19), and six months after starting (during COVID-19). 50 Researchers found that daily mood scores decreased and symptoms of depression and anxiety increased. ...
Article
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Viral outbreaks and economic contraction precede increased mental health symptoms in the population. This paper reviews existing literature, following the COVID-19 pandemic and the subsequent economic recession, on mental health among four vulnerable populations with the objective of making recommendations to mitigate the mental health consequences of the COVID-19 pandemic in the short, medium, and long term. The paper examined 20 studies concerning mental health and the COVID-19 pandemic among unemployed adults, youth, older-age populations, and healthcare workers that took place January–June 2020 and were published by September 2020. Mental health disorders and symptoms included depression, anxiety, post-traumatic stress, suicidal ideation, self-harm, and substance abuse measured across 13 countries and administrative regions. During the COVID-19 pandemic, vulnerable populations such as unemployed adults, youth, older -age populations, and frontline healthcare workers have an increased risk of mental health symptoms and disorders. Unemployment and economic instability increase symptoms of distress, depression, anxiety, suicidal ideation/self-harm, and substance abuse after COVID-19, with responses appearing especially strong among migrant workers. Among youth, those aged 18–24 years exhibit increased symptoms. In the older-age population, women experience greater depression and anxiety during the pandemic. Nurses and other intermediate-level healthcare workers have increased symptoms of distress. Using a global mental health perspective, we recommend several key policies. These policies may not only reduce the burden of mental disorders during viral outbreaks but also promote health equity, the development of human capital, and sustained productivity of the workforce. Further research should examine the mental health consequences of COVID-19 among other vulnerable groups, including those who have contracted the virus and those who have a preexisting mental disorder. Fully understanding the mental health consequences of COVID-19 can assist with development and country planning for the infrastructure required to handle future pandemics.
... However, existing studies use readily available and convenient data that could easily generate biased insights; many studies rely on some measures of suicidality rather than suicide mortality [19][20][21][22][23][24] and most of them compare suicidal behaviours using snapshot data during the pandemic without pre-pandemic baseline samples 19,20,22,23 . Even when studies use real suicide mortality, some rely on data that cover non-representative subsamples [25][26][27] , while others compare the whole suicide trend before and during the pandemic, which might capture common time trend, seasonality or temporal time shocks across individuals or locations [25][26][27][28][29][30][31] (we discuss why these time-series analyses and before-after comparisons can be problematic in the Methods). ...
... However, existing studies use readily available and convenient data that could easily generate biased insights; many studies rely on some measures of suicidality rather than suicide mortality [19][20][21][22][23][24] and most of them compare suicidal behaviours using snapshot data during the pandemic without pre-pandemic baseline samples 19,20,22,23 . Even when studies use real suicide mortality, some rely on data that cover non-representative subsamples [25][26][27] , while others compare the whole suicide trend before and during the pandemic, which might capture common time trend, seasonality or temporal time shocks across individuals or locations [25][26][27][28][29][30][31] (we discuss why these time-series analyses and before-after comparisons can be problematic in the Methods). ...
... Using high-frequency data covering entire Japanese population, we investigated whether suicide mortality changed during the pandemic. In Methods, we show how the use of time-series analysis [25][26][27][28][29][30][31] and simple before-after comparison [26][27][28][29][30] could generate biased estimates. Instead, we used a DID model with high-dimensional fixed effects that allows us to control for a number of potential confounders. ...
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There is increasing concern that the coronavirus disease 2019 (COVID-19) pandemic could harm psychological health and exacerbate suicide risk. Here, based on month-level records of suicides covering the entire Japanese population in 1,848 administrative units, we assessed whether suicide mortality changed during the pandemic. Using difference-in-difference estimation, we found that monthly suicide rates declined by 14% during the first 5 months of the pandemic (February to June 2020). This could be due to a number of complex reasons, including the government’s generous subsidies, reduced working hours and school closure. By contrast, monthly suicide rates increased by 16% during the second wave (July to October 2020), with a larger increase among females (37%) and children and adolescents (49%). Although adverse impacts of the COVID-19 pandemic may remain in the long term, its modifiers (such as government subsidies) may not be sustained. Thus, effective suicide prevention—particularly among vulnerable populations—should be an important public health consideration.
... Several large-scale epidemiological studies have compared completed suicide rates between the periods before and during the Covid-19 pandemic (John et al., 2020;Zortea et al., 2020). Most studies found that the completed suicide rate before and during the first Covid-19 pandemic wave was unchanged (Faust et al., 2021;Leske et al., 2021;Pirkis et al., 2021;Vandoros et al., 2020) or reduced (Calderon-Anyosa & Kaufman, 2021;Qin & Mehlum, 2021;Radeloff et al., 2020;Tanaka & Okamoto, 2021). However, the suicide completion rate increased in the second wave in Japan (Tanaka & Okamoto, 2021), while in Maryland, USA, it reduced progressively across three waves in white but increased in black people (Bray et al., 2021). ...
... The current study is the first to examine severe suicide attempts during the protracted Covid-19 pandemic intervals, including consideration of three lockdowns and Covid-19 infection status. The result of the primary analysis, reinforced by sensitivity analyses, generally aligns with published studies that focused on the early phases of the pandemic and showed reduced rates of completed suicide (Calderon-Anyosa & Kaufman, 2021;Qin & Mehlum, 2021;Radeloff et al., 2020;Tanaka & Okamoto, 2021) and self-harm (Carr et al., 2021;Jollant et al., 2020). Notably, in our study, the monthly suicide rate did not differ between Covid-19-positive cases and those not infected. ...
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Background To characterize the association between the protracted biopsychosocial coronavirus disease 2019 (COVID-19) pandemic exposures and incident suicide attempt rates. Methods Data were from a nationally representative cohort based on electronic health records from January 2013 to February 2021 ( N = 852 233), with an interrupted time series study design. For the primary analysis, the effect of COVID-19 pandemic on incident suicide attempts warranting in-patient hospital treatment was quantified by fitting a Poisson regression and modeling the relative risk (RR) and the corresponding 95% confidence intervals (CIs). Scenarios were forecast to predict attempted suicide rates at 10 months after social mitigation strategies. Fourteen sensitivity analyses were performed to test the robustness of the results. Results Despite the increasing trend in the unexposed interval, the interval exposed to the COVID-19 pandemic was statistically significant ( p < 0.001) associated with a reduced RR of incident attempted suicide (RR = 0.63, 95% CI 0.52–0.78). Consistent with the primary analysis, sensitivity analysis of sociodemographic groups and methodological factors were statistically significant ( p < 0.05). No effect modification was identified for COVID-19 lockdown intervals or COVID-19 illness status. All three forecast scenarios at 10 months projected a suicide attempt rate increase from 12.49 (7.42–21.01) to 21.38 (12.71–35.99). Conclusions The interval exposed to the protracted mass social trauma of the COVID-19 pandemic was associated with a lower suicide attempt rate compared to the unexposed interval. However, this trend is likely to reverse 10 months after lifting social mitigation policies, underscoring the need for enhanced implementation of public health policy for suicide prevention.
... Large, cross-sectional studies report an increase in depression, substance use, and suicidal ideation following the COVID-19 pandemic in the US (Czeisler et al., 2020;Ettman et al., 2020). However, overall suicide rates do not appear to rise in the US and even show a decrease in other countries (Czeisler et al., 2020;Differences, 2019;Radeloff et al., 2020;Tanaka & Okamoto, 2020). Concerns about the psychological fallout from the pandemic prompted urgent calls to examine the relation between mental health and substance use to better inform public policy, practice, and recommendations (Holmes et al., 2020). ...
... Literature on this topic forecasts that a 5.7% worldwide unemployment rate would precede a predicted increase in>9000 suicides, globally (Kawohl & Nordt, 2020). This forecast, however, should be reconciled with the somewhat counterintuitive results of fewer (or no change in) suicides than expected following the COVID-19 pandemic (Differences, 2019;Radeloff et al., 2020;Tanaka & Okamoto, 2020), as well as acute decreases in opioid-related ED visits following economic downturns (Trinh et al., 2021). Examination of potential psychiatric and substance use sequelae of the COVID-19 recession, as well as development of theory regarding collective responses to large societal shifts, need further investigation. ...
Article
Objective Previous literature finds an increase in depressive symptoms, substance use, and suicidal ideation following the COVID-19 pandemic in the US – suicides do not appear to increase. We examine whether 1) state lockdown policies in the US precede an increase in mental health symptoms; and 2) the extent to which using substances amplifies or attenuates the relation. Methods We specified, as our exposure variable, the timing of state-level lockdown orders. We used, as the outcome variable, the 4-item Patient Health Questionnaire (PHQ-4) that measures anxiety and depression symptoms. We utilized the Understanding America Study (UAS), a nationally representative sample of 7,597 adults across 50 states in the US, surveyed biweekly between March 10, 2020 and November 11, 2020. Linear fixed effect analyses controlled for time-invariant individual factors, as well as employment status, household income, and previous mental health diagnosis. Results Regression results indicate an increase in PHQ-4 scores of approximately 1.70 during lockdown, relative to no lockdown (p<0.05). Relative to no lockdown, an increase in alcohol use corresponds with a 0.08 unit decrease in PHQ-4 scores during lockdown (p<0.05). Conclusion State lockdown policies precede greater mental health symptoms. Increases in consuming alcohol attenuates the relation between state lockdown policies and mental health symptoms. Results may portend greater addiction following the pandemic warranting further investigation into utilization of substance use treatment.
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Background: The COVID-19 pandemic has caused considerable morbidity, mortality and disruption to people’s lives around the world. There are concerns that rates of suicide and suicidal behaviour may rise during and in its aftermath. Our living systematic review synthesises findings from emerging literature on incidence and prevalence of suicidal behaviour as well as suicide prevention efforts in relation to COVID-19, with this iteration synthesising relevant evidence up to 19 th October 2020. Method: Automated daily searches feed into a web-based database with screening and data extraction functionalities. Eligibility criteria include incidence/prevalence of suicidal behaviour, exposure-outcome relationships and effects of interventions in relation to the COVID-19 pandemic. Outcomes of interest are suicide, self-harm or attempted suicide and suicidal thoughts. No restrictions are placed on language or study type, except for single-person case reports. We exclude one-off cross-sectional studies without either pre-pandemic measures or comparisons of COVID-19 positive vs. unaffected individuals. Results: Searches identified 6,226 articles. Seventy-eight articles met our inclusion criteria. We identified a further 64 relevant cross-sectional studies that did not meet our revised inclusion criteria. Thirty-four articles were not peer-reviewed (e.g. research letters, pre-prints). All articles were based on observational studies. There was no consistent evidence of a rise in suicide but many studies noted adverse economic effects were evolving. There was evidence of a rise in community distress, fall in hospital presentation for suicidal behaviour and early evidence of an increased frequency of suicidal thoughts in those who had become infected with COVID-19. Conclusions: Research evidence of the impact of COVID-19 on suicidal behaviour is accumulating rapidly. This living review provides a regular synthesis of the most up-to-date research evidence to guide public health and clinical policy to mitigate the impact of COVID-19 on suicide risk as the longer term impacts of the pandemic on suicide risk are researched.
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A novel coronavirus (SARS-CoV-2), which causes the COVID-19 respiratory illness, emerged in December of 2019 and has since spread globally. The dramatic lifestyle changes and stressors associated with this pandemic pose a threat to mental health and have the potential to exacerbate risk factors for suicide. We used autoregressive integrated moving average (ARIMA) models to assess Google Trends data representing searches in the United States for 18 terms related to suicide and known suicide risk factors following the emergence of COVID-19. Although the relative proportion of Google searches for suicide-related queries was lower than predicted during the early pandemic period, searches for the following queries representative of financial difficulty were dramatically elevated: “I lost my job” (226%; 95%CI, 120%-333%), “laid off” (1164%; 95%CI, 395%-1932%), “unemployment” (1238%; 95%CI, 560%-1915%), and “furlough” (5717%; 95%CI, 2769%-8665%). Searches for the Disaster Distress Helpline, which was promoted as a source of help for those impacted by COVID-19, were also remarkably elevated (3021%; 95%CI, 873%-5169%). Google searches for other queries representative of help-seeking and general mental health concerns were moderately elevated. It appears that some indices of suicidality have fallen in the United States in this early stage of the pandemic, but that COVID-19 may have caused an increase in suicide risk factors that could yield long-term increases in suicidality and suicide rates.
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Introduction : The aim of the study was to investigate mental health in university students in Greece, during lockdown due to COVID-19. Material and Methods : The data were collected online and anonymously, during lockdown; they included 1104 females (aged 22.08±4,96) and 431 males (aged 22.35±3.11). The analysis included transformation of the data with post-stratification method, descriptive statistics, Chi-square tests, Factorial Analysis of Variance and Relative Risk ratios Results : The results suggest that during, lockdown major depression was present in 12.43% with 13.46% experiencing severe distress. Risk factors were female sex, history of self-injury, suicidal attempts and following theoretical studies (RR=2-5.71). Conspiracy theories were accepted by 20-68%, with students of theoretical studies manifesting higher rates. Discussion : The results of the current study confirmed that students are at high risk to develop depression and suicidality in relation to the COVID-19 outbreak. They also identified specific risk factors and pointed to the role of believing in conspiracy theories in copying with stress. They also identified populations with higher prevalence of these beliefs. Further targeted research is necessary as well as targeted intervention in vulnerable groups but concerning mental health as well as the reduction of believing in conspiracy theories.
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Objective The social and economic consequences of COVID‐19 and related public health interventions aimed at slowing the spread of the virus have been proposed to increase suicide risk. However, no research has examined these relations. This study examined the relations of two COVID‐19 consequences (i.e., stay‐at‐home orders and job loss) to suicide risk through thwarted belongingness, perceived burdensomeness, and loneliness. Method Online data from a nationwide community sample of 500 adults (mean age = 40) from 45 states were collected between March 27 and April 5, 2020. Participants completed measures assessing thwarted belongingness, perceived burdensomeness, loneliness, and suicide risk, as well as whether they (a) were currently under a stay‐at‐home order and (b) had experienced a recent job loss due to the pandemic. Results Results revealed a significant indirect relation of stay‐at‐home order status to suicide risk through thwarted belongingness. Further, whereas recent job loss was significantly correlated with suicide risk, neither the direct relation of job loss to suicide risk (when accounting for their shared relations to perceived burdensomeness) nor the indirect relation through perceived burdensomeness was significant. Conclusions Results highlight the potential benefits of interventions targeting thwarted belongingness and perceived burdensomeness to offset suicide risk during this pandemic.
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Coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of people’s lives all over the world. This Facebook survey study aimed to investigate the COVID-19-related factors that were associated with sleep disturbance and suicidal thoughts among members of the public during the COVID-19 pandemic in Taiwan. The online survey recruited 1970 participants through a Facebook advertisement. Their self-reported experience of sleep disturbance and suicidal thoughts in the previous week were collected along with a number of COVID-19-related factors, including level of worry, change in social interaction and daily lives, any academic/occupational interference, levels of social and specific support, and self-reported physical health. In total, 55.8% of the participants reported sleep disturbance, and 10.8% reported having suicidal thoughts in the previous week. Multiple COVID-19-related factors were associated with sleep disturbance and suicidal thoughts in the COVID-19 pandemic. Increased worry about COVID-19, more severe impact of COVID-19 on social interaction, lower perceived social support, more severe academic/occupational interference due to COVID-19, lower COVID-19-specified support, and poorer self-reported physical health were significantly associated with sleep disturbance. Less handwashing, lower perceived social support, lower COVID-19-specified support, poorer self-reported physical health, and younger age were significantly associated with suicidal thoughts. Further investigation is needed to understand the changes in mental health among the public since the mitigation of the COVID-19 pandemic.
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Background: The 2020 Coronavirus pandemic is a major international public health challenge. Governments have taken public health protection measures to reduce the spread of the virus through non-pharmalogical measures. The impact of the pandemic and the public health response on individual and population mental health is unknown. Methods: We used Google Trends data (1 Jan 2020 - 30 Mar 2020) to investigate the impact of the pandemic and government measures to curb it on people’s concerns, as indexed by changes in search frequency for topics indicating mental distress, social and economic stressors and mental health treatment-seeking. We explored the changes of key topics in Google trends in Italy, Spain, USA, UK, and Worldwide in relation to sentinel events during the pandemic. Results: Globally there appears to be significant concerns over the financial and work-related consequences of the pandemic, with some evidence that levels of fear are rising. Conversely relative searching for topics related to depression and suicide fell after the pandemic was announced, with some evidence that searches for the latter have risen recently. Concerns over education and access to medication appear to be particular social stressors. Whilst searches for face-to-face treatments have declined, those for self-care have risen. Conclusions: Monitoring Google trends shows promise as a means of tracking changing public concerns. In weeks to come it may enable policy makers to assess the impact of their interventions including those aiming to limit negative consequences, such as government funded financial safety nets.
Article
Quarantine plays a key role in controlling the pandemic of 2019 coronavirus disease (COVID-19). This study investigated (a) the associations between mandatory quarantine status and negative cognitions (perceived discrimination because of COVID-19 and perceived risk of COVID-19 infection)/mental health status (emotional distress because of COVID-19, probable depression, and self-harm/suicidal ideation), (b) the associations between the negative cognitions and mental health status, and (c) potential mediations between quarantined status and probable depression and self-harm/suicidal ideation via COVID-19-related negative cognitions/emotional distress. An online cross-sectional survey was conducted among 24,378 students of 26 universities in 16 Chinese cities (February 1-10, 2020). Correlation coefficients, odds ratios (OR), structural equation modeling, and other statistics were used for data analysis. Mandatory quarantined status was significantly and positively associated with perceived discrimination (Cohen's d = 0.62), perceived high/very high risk of infection (OR = 1.61), emotional distress (Cohen's d = 0.46), probable depression (OR = 2.54), and self-harm/suicidal ideation (OR = 4.98). Perceived discrimination was moderately and positively associated with emotional distress (Spearman correlation = 0.44). Associations between perceived risk of infection and mental health variables were significant but relatively weak. Cross-sectional mediation models showed good model fit, but the overall indirect paths via COVID-19-related negative cognitions/emotional distress only accounted for 12-15% of the total effects between quarantined status and probable depression and self-harm/suicidal ideation. In conclusion, quarantined participants were more likely than others to perceive discrimination and exhibit mental distress. It is important to integrate mental health care into the planning and implementation of quarantine measures. Future longitudinal studies to explore mechanisms underlying the mental health impact of quarantines are warranted. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Article
The COVID-19 pandemic has created psychological burden of the frontline healthcare professionals (HCPs) causing fear of infection, stress and depression while proving treatment and services. HCPs are not facilitated with appropriate and quality personal protective equipment and socioeconomic packages for ensuring their health and occupational safety resulting treatment related consequences and inattention. Negligence in the treatment created more physiological pressure to the patients lead to anxiety, depression, trauma, stress. This study discussed a case of suicide due to non-treatment in hospital by healthcare workers fearing COVID-19 infection to evaluate the causes and potential options to help allay the fears among HCPs.
Article
Objective To determine the effect of the COVID-19 pandemic on the mental health of older adults with pre-existing major depressive disorder (MDD). Participants Participants were 73 community-living older adults with pre-existing MDD (mean age 69 [SD 6]) in Los Angeles, New York, Pittsburgh, and St Louis. Design and Measurements During the first two months of the pandemic, we interviewed participants with a semi-structured qualitative interview evaluating access to care, mental health, quality of life, and coping. We also assessed depression, anxiety, and suicidality with validated scales and compared scores before and during the pandemic. Results Five themes from the interviews highlight the experience of older adults with MDD: (1) They are more concerned about the risk of contracting the virus than the risks of isolation. (2) They exhibit resilience to the stress and isolation of physical distancing. (3) Most are not isolated socially, with virtual contact with friends and family. (4) Their quality of life is lower, and they worry their mental health will suffer with continued physical distancing. (5) They are outraged by an inadequate governmental response to the pandemic. Depression, anxiety, and suicidal ideation symptom scores did not differ from scores before the pandemic. Conclusions Most older adults with pre-existing MDD show resilience in the first two months of the COVID-19 pandemic but have concerns about the future. Policies and interventions to provide access to medical services and opportunities for social interaction are needed to help to maintain mental health and quality of life as the pandemic continues.
Article
In order to reduce transmission of COVID-19, social distancing measures were proposed, including spatial distancing (2 m distance), or even generalized lockdown. Main concern was to prevent overwhelming of the healthcare systems, mainly of the intensive care units (ICUs) by decreasing the spreading of the disease. In Greece, the Government, after consulting with experts in the fields of infectious disease and epidemiology, implemented a rather aggressive stance with an early lockdown. Aim of our study, is to identify and compare the characteristics of cases referred for autopsy during the first month of the lockdown period for the COVID-19 outbreak, versus the cases referred during the same period in 2019. 231 autopsy cases were included in our study, 125 in 2019 and 106 in 2020. Regarding gender, age and nationality, no significant differences were detected between the two time periods. Age subgroup analysis demonstrated increased number of cases within the age group 70-79 years, in 2020. As to the place of death, the increase in the percentage of out-of-hospital deaths was not confirmed as statistically significant. Regarding type of death (violent, sudden/unexpected), the drop of violent deaths in the 2020 examined period, was not confirmed as statistically significant; however, further subgroup analysis showed a significant drop of fatal injuries resulting from road traffic accidents in the 2020 period. The slight increase of sudden/unexpected deaths, especially myocardial infarction cases, did not reach statistical significance. One month after lockdown, we cannot detect significant differences in the two time periods examined. Further study should be conducted soon when more data will become available. Frequency of fatal myocardial infarction seems to remain unaffected by the COVID-19 pandemic while deaths resulting from road traffic accidents exhibit a significant decrease. Homicides and suicides remain at low levels, in our jurisdiction area, seemingly unaffected by the COVID-19 outbreak and the subsequent lockdown. It appears that since sudden/unexpected deaths, statistically remain unaffected, the preventive measures taken by the Greek authorities prevented overwhelming of the healthcare system, which could function properly.