Background
The expected increases in suicide were generally not observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns may vary across demographic groups. Our goal was to provide a detailed and timely picture of the pandemic’s impact on suicides globally.
When the COVID-19 pandemic began, there was widespread concern that suicide rates could increase . The media published largely unfounded and inaccurate reports of suicide spikes. Suicide prevention researchers were more moderate, but noted that the pandemic is likely to exacerbate certain risk factors for suicide (e.g., isolation, stress, mental disorders such as depression and anxiety, substance use, suboptimal access to health care, economic hardship).However, they also emphasized that some protective factors (e.g., community togetherness, resilience) could increase.
We studied 21 high- and upper-middle-income countries (population ≈435 million) and found that total suicide frequencies remained virtually unchanged or decreased during the first four months of the pandemic. We were unable to examine whether the pandemic was differentially affecting certain demographic groups; total numbers may have masked increases for some groups (particularly if these were offset by decreases for others).
Single-country studies suggest this may be the case, although the evidence is mixed. For example, a Japanese study found evidence of increases in female suicides, while studies from China, India, and Sweden found no sex differences or greater reductions for women. Similarly, an English study found no increases in suicides among children/adolescents, while studies from Japan and China identified increases for young people.
The image may also be changing. In most high-income countries, the economic consequences of the pandemic were initially cushioned by financial support schemes, but these have been progressively withdrawn. There may also be long-term impacts of COVID-19 on people with pre-existing mental disorders. Studies of other pandemics/epidemics suggest that if increases in suicides occur, they may be delayed.
The goal of this study was to provide an updated, more granular picture of the impact of COVID-19 on suicides globally to inform pandemic-related suicide prevention activities. We used data from a larger number of countries than before, expanded our observation period to include the first 9 to 15 months of the pandemic, and examined patterns by sex, age, and sex by age.
Methods
We identified suicide data from official public sector sources for countries/areas within countries, searching websites and academic literature and contacting data custodians and authors as necessary. We submitted our first data request on June 22, 2021 and stopped collecting data on October 31, 2021.
We used interrupted time series (ITS) analysis to model the association between the onset of the pandemic and total suicides and suicides by sex, age, and sex by age in each country/area within the country.
We compared the observed and expected numbers of suicides in the first nine and first 10 to 15 months of the pandemic and used meta-regression to explore sources of variation.
Results
We obtained data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income, 25 with data for the entire country, 12 with data for areas within the country, four with both).
There was no evidence of a higher than expected number of suicides in most countries/areas within countries in any analysis; more commonly, there was evidence of lower than expected numbers. Certain sex, age and sex-by-age groups were highlighted as potentially concerning, but these were not consistent across countries/areas within countries.
In the meta-regression, the different patterns were not explained by the countries’ COVID-19 mortality rate, the rigor of the public health response, the level of economic support, or the presence of a national suicide prevention strategy. Nor were they explained by the income level of the countries.
Figure: Countries and areas within countries included in the analyzes
1. Countries with data available for the entire country are shaded in dark brown. The names of these countries are written in capital letters.
2. Countries with data available for one or more areas within the country are shaded in light brown.
3. Areas within countries with available data are indicated by dark brown dots. The names of these areas within countries are written in lower case.
4. Countries with no data available are shaded blue.
5. The boundaries and names shown and designations used on this map do not imply the approval of all authors.
Interpretation
Although there are some countries/areas within countries where overall suicide numbers and figures for certain sex and age groups are higher than expected, these countries/areas within countries are in the minority .
Any upward movement in the number of suicides in any place or group is worrying, and we must remain alert and respond to changes as the pandemic and its economic and mental health consequences continue.
Added value of this study
We synthesized sex- and age-specific suicide trend data from 33 countries during the first 9 to 15 months of the pandemic and used time series models to account for pre-pandemic suicide trends.
There was no evidence of a change in pre-pandemic suicide trends in most countries/areas within countries, and there was no consistent evidence that any age/sex group was differentially affected by the pandemic. pandemic.
There were suggestions that proportionally more countries/areas within countries had higher suicide numbers than expected in analyzes with longer follow-up periods, and that areas within lower-middle-income countries had worse outcomes than others. environments.
Implications of all available evidence
In most countries/areas within countries we studied, suicide frequencies were no higher than expected based on previous trends during the first 9 to 15 months of the pandemic.
We need to understand the underlying drivers of this stability, particularly in the context of increases in reported population mental distress in many settings, to inform future suicide prevention efforts more generally. We urgently need timely suicide surveillance data from low-income countries.
Discussion
Our results suggest that there has not been the sharp increase in suicides that some commentators predicted when the pandemic began.
This does not mean that suicides are no longer a cause for concern; Those that have occurred have had a major impact on families and communities, and the pandemic continues to cause unprecedented levels of stress for many. However, in most of the 25 countries and 34 areas within countries in our study there was no divergence from existing trends in overall suicide numbers and in some the numbers were lower than expected.
There were exceptions, with observed numbers of suicides higher than expected in certain countries/areas within countries. We noticed more of these exceptions at nine months than in our previous study at four months and there were suggestions that they might become more common at 10-15 months, although the countries/areas within countries where this occurred were still in the minority. . However, these findings may partly reflect greater statistical power provided by the longer time series.
Our finding that a higher-than-expected number of suicides was not the norm is somewhat at odds with documented pandemic-related increases in mental disorders. This may be because there is no simple relationship between mental disorders and suicide. . There may also be longer lag times for suicide-related outcomes than for mental health-related outcomes following public health emergencies and responses to increases in mental disorders (e.g., funding for strengthening crisis and mental health services) may have mitigated increases in suicide risk.
The fact that communities appear to have gained a greater collective understanding of distress and rallied around those who are struggling, including those with emerging mental disorders, may have been protective. Spending more time with families, working more flexibly and living a quieter life may also have had mental health benefits for some.
