Trends in suicide rates during the COVID-19
pandemic restrictions in a major German city
Daniel Radeloff1*, Rainer Papsdorf1, Kirsten Uhlig2, Andreas Vasilache3, Karen
Putnam4, Kai von Klitzing1
1 Department of Child and Adolescent Psychiatry, Psychotherapy and
Psychosomatics, University Hospital Leipzig, Leipzig, Germany
2 Leipzig Health Authority, Leipzig, Germany
3 Center for German and European Studies (CGES), Faculty of Sociology Bielefeld
University, Bielefeld, Germany
4 Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill,
*Corresponding author: Daniel Radeloff, Department of Child and Adolescent
Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig,
Liebigstrasse 20a, 04103 Leipzig, Germany e-mail: firstname.lastname@example.org-
leipzig.de, +49 - 34 - 97 2 40 11.
All authors declare no conflicts of interest. This study was conducted without external
wordcount manuscript: 2036, wordcount abstract: 249 / 250, references: 46, figures:
1, tables: 0
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.
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.
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
In 2020, suicide rates (SR, suicides per 100,000 LY) were lower in periods with
moderate (SR = 8.5, c2 = 4.374, p = 0.037) or severe COVID-19 restrictions (SR = 7.0,
c2 = 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.
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-
This study was conducted without external funding.
Suicide, COVID-19, pandemic, restrictions, quarantine, Germany
It remains unclear whether the COVID-19 pandemic is having an impact on suicide
rates. Some predict that suicide rates will rise, since actions to contain COVID-19, such
as social distancing, economic lockdown, or the temporary restructuring of the health
system, could cause risk factors for suicide to increase 1–5. Indeed, analyses of
previous economic crises have shown that an increase in unemployment was
associated with an increase in suicide rates 6–10; and according to leading theories of
suicide prevention, the loss of social inclusion is a major risk factor for suicide 11.
In Germany, a significant restriction of the free movement of persons was agreed upon
in March 2020, with the strongest restrictions coming into force in April and May.
German borders were virtually closed for travel from 16 March onwards 12–14. On 22
March 2020, the German Federal Government and the Länder agreed on a
comprehensive restriction of social contacts, which required people to reduce contacts
with others (except for members of one’s own household) to an absolute minimum 15.
In the Free State of Saxony, further restrictions on going out, and a ban on visiting care
homes, were adopted on 1 April 2020 16. While the restrictions on going out were eased
on 4 May, the restrictions on visiting care homes remained 17.
Following a meeting by the EU interior ministers on 15 June, extensive freedom of
movement within the EU’s Schengen Area was gradually restored, but differentiated
travel warnings and quarantine regulations following travel remained in place for parts
of it. The German Federal Foreign Office also maintained the existing travel warnings
for 160 countries until 31 August 2020 18.
Elderly people, particularly those with severe or multiple underlying health conditions,
are threatened by high fatality rates of COVID-19 19, and are therefore particularly
affected by the pandemic. Social distancing was practised more consistently by this
age group, and older people are more often dependent on help from third parties.
Thwarted belongingness and perceived burdensomeness are in turn central risk
factors for suicide, according to the interpersonal theory of suicide 11. In the case of
senior citizens, these risk factors affect an already vulnerable age group with the
highest age-related suicide rates 20.
This study investigated the influence of social distancing during the COVID-19
restrictions period on suicide rates (SR). We addressed the following hypotheses:
A. SR increased in the total population under conditions compared to periods without
restrictions. This applies to both the period of travel restrictions and that of restricting
B. Within the 70+ age group, the risk of suicide increased more strongly than in other
age groups during COVID-19 restrictions.
C. A comparison with previous years shows that differences in SR within 2020 are not
due to seasonal differences.
Sample and data acquisition
The data on suicides are based on the City of Leipzig’s cause of death statistics, and
were provided by the responsible health authority for the years 2010 to 2020. Data
were obtained for age ranges 0–4, 5–9, 10–14, …, 75-79, 80–84, 85+ and for both
sexes. Annual population statistics were provided for the corresponding age groups by
the residents’ registration office of Leipzig (https://statistik.leipzig.de/statcity/).
Data were analysed using the R software version 3.3.1 17, IBM SPSS 25.0 18, and
The analysis included suicides from the first six months of each of the years studied.
For the year 2020, months without restrictions on freedom of movement or social
contact were aggregated as period nR_2020 (January, February), those with moderate
restriction as period R1_2020 (travel restrictions; March to June), and those with
severe restrictions as period R2_2020 (restrictions on travel, going out and social
contact; April, May). To compare suicide mortality in 2020 before and during the
COVID-19 restrictions, suicide cases were assigned to group nR_2020, R1_2020 and
R2_2020. Corresponding life-years were calculated, according to the length of the
Life years (LY) and events were used to calculate the Risk Ratios (RR) with Incidence
Rate Ratios (IRR). Differences in suicide risk between nR_2020 and the risk groups
R1_2020 and R2_2020 were conducted using Chi-Square tests. In order to exclude
biases due to seasonal fluctuations in the suicide risk, Mantel-Haenszel statistics (MH,
Test for Heterogeneity) were performed to examine the risk of suicide within the 2020
restriction periods and with the paired periods for years 2010-2019. The Test for
Heterogeneity examines whether the IRR of n 2x2 tables differ. Post-hoc, Chi-Square
tests were used to examine differences for each pair (nR_2020 vs nR_2010/19;
R1_2020 vs R1_2010/19; R2_2020 vs R2_2010/19).
In order to examine age-related and gender-related differences within the 2020
restriction periods, suicide risk in nR_2020, R1_2020 and R2_2020 were compared
between senior age (70+) vs age group 0–69 and between genders using the MH.
The study was approved by the ethics committee of the medical faculty of the
University Hospital Leipzig, Germany (study ID: 272/20-ek) and conducted according
to the Declaration of Helsinki. This epidemiological cohort study is based on the death
statistics. For methodological reasons, no informed consent can be obtained.
A total of 2,791,131 LY were spent and 333 suicides were registered during the periods
studied. In 2020, 18 suicides (LY: 100,278) were attributed to nR_2020, 17 (LY:
200,556) to R1_2020, and 7 (LY: 100,278) to R2_2020. In the previous years 2010 to
2019, 90 suicides (LY: 930,377) were attributed to nR_2010/19, 208 (LY: 1,860,754)
to R1_2010/19, and 91 (LY: 930,377) to R2_2010/19. The suicide rates within the
individual periods were 18.0, 8.5, 7.0 in nR_2020, R1_2020, and R2_2020,
The suicide risk in 2020 was found to be different between nR_2020 and the periods
studied of R1_2020 c2 [1; N = 300,869] = 4.374, p = 0.037), and R2_2020 R2 (c2 [1; N
= 200,581] = 3.999, p = 0.046).
The difference for nR compared to R1 and R2 also remained in a comparison with the
previous years 2010 to 2019 (Test for Heterogeneity; periods nR vs R1: Q [df = 1] =
12.233, p < 0.001; periods nR vs R2: Q [df = 1] = 13.974, p < 0.001). The post hoc
analysis showed that the described difference was due to high suicide rates in
nR_2020 compared to nR_2010/19. The periods R1_2020 and R2_2020 were not
different compared to the previous years.
For details, see Figure 1.
< insert Figure 1 about here >
No gender- or age-related differences were demonstrated between R_2020, R1_2020,
Our hypotheses regarding suicide rates increasing during corona restrictions could not
be confirmed. On the contrary, we found lower suicide rates during the pandemic
restrictions in 2020 compared to previous months. However, a comparison with
preceding years showed that this difference in 2020 was mainly caused by high suicide
rates in the period without restrictions.
Results represent local suicide trends during the COVID-19 pandemic in a major city
in Saxony. In Saxony, as in most regions of Germany, the prevalence and mortality
rates of COVID-19 were comparatively low, with 135.8 and 251.0 cases per 100,000
inhabitants, respectively 24. The regional shut-down was much less restrictive than in
other European countries, i.e. United Kingdom, France, Spain or Italy. At an early stage
of the pandemic, the German government committed to support measures to prevent
insolvencies and unemployment. Accordingly, results should be evaluated under these
external conditions. Regional differences in the COVID-19 pandemic may produce
regional differences in the mental health situation, economic crises and suicide rates.
The findings of this study should not, therefore, be extrapolated uncritically to other
regions or countries. It should not be assumed either that the trend described will
remain stable. This study only provides a first regional snapshot.
The COVID-19 pandemic is a new phenomenon. Thus, it is not surprising, that little
scientific evidence of suicide trends during the COVID-19 pandemic exist. A number
of case reports describes a co-occurrence of suicidal behaviour and COVID-19, with
the underlying factors being fear of infection 25–27 or severe mental disorders such as
hallucinations or delusions 28–30. However, trends in suicide risks cannot be concluded
from case reports or case series.
Projections based on underlying risk factors for suicide, such as unemployment,
indicate rising suicide rates during the COVID-19 pandemic 1,2. This does not
contradict the reduced suicide risk found in our study, since unemployment has not yet
risen in the region investigated. It illustrates, however, that suicide rates will not
increase immediately, but possibly only with a time lag.
This is consistent with studies reporting no increase in suicidal behaviour, used as an
indirect measure for suicide risk, in the early stages of the COVID-19 pandemic 31–37.
For instance, online surveys showed a decrease in suicidal thoughts and intention
during the pandemic; presentation at emergency departments due to suicidal ideation
decreased 36, suicides in selective autopsy samples remained low 37, and search
engine users entered suicide-related terms less frequently 31–33,35. However, the overall
results are inhomogeneous, since other surveys indicate a high prevalence of suicidal
thoughts during the pandemic, in particular under quarantine conditions 3,38–41.
The findings have led us to change our initial hypothesis. We predict the pandemic will
see the following course of suicide rates; this will need to be verified in future studies:
In an initial phase, the pandemic was perceived as an incalculable new threat without
any social countermeasures being taken. In this phase of individual disorientation,
suicide rates were unusually high.
In a second phase, with the COVID-19 restrictions, a social response to the threat was
given. Rules were established to protect the most vulnerable individuals and to slow
down the spread of the virus. The omnipresent concern for the well-being of fellow
human beings led to an increased sense of social belonging despite physical distance.
According to Durkheim’s theory, a temporary increase of social integration and
cohesion results in a reduction in suicide rates 42. Some findings observed during the
Second World War and the 9/11 terror attacks support this hypothesis, but it remains
controversial 43–45 .
In a third phase, the pandemic could be perceived as more predictable and less
threatening. The feeling of belonging may once again be increasingly determined by
the quality and quantity of everyday contacts, which could continue to be reduced
depending on the regulations. A rise in loneliness, unemployment and mental disorders
may lead to a delayed increase in the suicide rates in the medium term. As other
authors have stressed, it is important to distinguish between physical distance and
social belonging 46. A major challenge for suicide prevention during the COVID-19
pandemic is to find an answer to the following question: How can we succeed in
maintaining a sense of social belonging in our society if physical distance persists in
the medium term?
In the population studied, suicide rates decreased during the COVID-19 restrictions,
but we expect suicide rates to increase with a time delay. Careful monitoring of suicide
rates in the further course of the COVID-19 crisis is therefore essential. Accordingly,
further investigations and meta-analytical approaches are urgently required to monitor
suicide rates. In this sense, the available results represent a first step in this direction.
Limitations and strengths
This study reports first data on suicide trends during the COVID-19 pandemic. The
investigated quarantine period covers only six months and the population studied is
relatively small with 0.5 M persons. These findings allow conclusions to be drawn for
the region and time period investigated. The results do not allow a supra-regional
evaluation or assessment of medium-term trends in suicide rates.
We would like to thank the Leipzig Health Authority for their support and fast provision
of relevant data sets. We would also like to thank Monica Buckland for her valuable
support in proofreading.
Figures and Tables
Figure 1: Suicide rates before and during COVID-19 restrictions.
This displays the suicide rates (SR, suicides per 100,000 life years) in 2020 (black columns) and the average SR
of the years 2010–2019 (white columns). nR = period in 2020 without COVID-19 restrictions (and corresponding
periods in previous years), R1 = period of moderate restrictions, R2 = period of severe restrictions. Asterisks indicate
significant differences (p < 0.05) in the underlying suicide numbers and population sizes based on Chi-Square
statistics. S = suicide numbers, Pop = population sizes (life years).
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