Olivia Kelleher
A new study in the Lancet journal examining suicides during the early phase of the Covid-19 outbreak in multiple countries has found that numbers largely remained unchanged or declined in the pandemic’s early months.
The authors, including UCC Professor of Public Mental Health and Chief Scientist with the National Suicide Research Foundation, Ella Arensman, note that – while this study provides the best available evidence on the pandemic’s effects on suicide so far – it only provides a snapshot of the first few months of the pandemic and effects on suicide might not necessarily occur immediately.
Lead author, Professor Jane Pirkis, Director of the Centre for Mental Health at the University of Melbourne, Australia, says we need to continue to monitor the data and be alert to any increases in suicide, particularly as the pandemic’s full economic consequences emerge.
“Policymakers should recognise the importance of high-quality, timely data to support suicide prevention efforts, and should work to mitigate suicide risk factors associated with COVID-19, such as the heightened levels of stress and financial difficulties that some people may experience as a result of the pandemic. Increasing mental health services and suicide prevention programmes, and providing financial safety nets may help to prevent the possible longer-term detrimental effects of the pandemic on suicide.”
Remain vigilant
Prof Arensman said this study underlines the importance of prioritising access to real-time suicide mortality data at national level in Ireland.
She said whilst in most of the countries in this study there were no indications of an increase in suicide during COVID-19 wave 1, we have to remain vigilant.
Evidence from previous epidemics and pandemics has shown long-term negative impacts on mental health and suicidal behaviour,
“Evidence from previous epidemics and pandemics has shown long-term negative impacts on mental health and suicidal behaviour," she said.
Professor Arensman says it is likely that mental health effects of the pandemic will vary between and within countries, and over time, depending on factors such as the extent of the pandemic, the public health measures used to control it, the capacity of existing mental health services, and the strength of the economy to support those whose livelihoods are affected by the pandemic.
Few studies have examined the effects of any widespread infectious disease outbreaks on suicide.
30 countries
The new study included around 70 authors from 30 countries who are members of the International Covid-19 Suicide Prevention Research Collaboration (ICSPRC), which was created to share knowledge about the impact of the pandemic on suicide and suicidal behaviour, and advise on ways to mitigate any risks.
The study used real-time suicide data obtained from official government sources to determine whether trends in monthly suicide counts changed after the pandemic began.
They compared numbers of monthly suicides before Covid-19 (estimated using modelling of available data from at least January 1st 2019 to March 31st 2020, and in some cases ranging from January 1st 2016) with numbers observed in the early months of the pandemic (from April 1st 2020 to July 31st 2020) to determine how suicide trends changed during the pandemic.
The study included 21 countries and regions (16 high-income, and 5 upper-middle-income), including whole-country data in 10 countries and data for 25 specific areas in 11 countries.
Decrease
The authors found no evidence of an increase in suicide numbers in the early months of the pandemic in any of the countries included. In 12 areas there was evidence of a decrease in suicide, compared to the expected numbers.
The authors note that their findings could be explained by some of the steps that governments took in the various countries.
For example, in many countries mental health services were increased or adapted to mitigate the potential impact of lockdown measures on mental health and suicide.
Similarly, fiscal measures were put in place to buffer the financial hardship experienced by people who lost jobs or had to close their businesses as a result of stay at home orders.
They also note that the pandemic might have heightened some factors that are known to protect against suicide (such as community support of vulnerable individuals, new ways of connecting with others online, and strengthened relationships through households spending more time together), a beneficial collective feeling of ‘being in it together’, as well as a reduction in everyday stresses for some people.
Professor Pirkis says many countries in the study put in place additional mental health supports and financial safety nets, both of which might have buffered any early adverse effects of the pandemic. “There is a need to ensure that efforts that might have kept suicide rates down until now are continued, and to remain vigilant as the longer-term mental health and economic consequences of the pandemic unfold. The effect of the pandemic on suicide might vary over time and be different for different groups in the population.”
The authors note that their study did not include low or lower-middle-income countries, which account for 46% of the world’s suicides and might have been particularly hard hit by the pandemic.
Lower income countries
They say that there are some concerning signs that the pandemic might be adversely affecting suicide rates in these countries, but that it is difficult to verify as very few of these countries have good quality death registration systems and fewer collect real-time suicide data.
In addition, they note that data quality for all countries may have been less reliable if the pandemic disrupted data collection processes, but that sensitivity analyses to test for this in their study yielded similar results.
They also highlight that their data does not explore the association between the pandemic and suicide in different age groups, for males versus females, or for people of different ethnicities.
It also does not explore the effects of various public health measures to contain the pandemic or economic support packages on suicide patterns. The authors have plans to study this in future research.
If you have been affected by any of the issues raised in this article, you can freephone the Samaritans 24 hours a day for confidential support at 116 123 or email [email protected].
You can also freephone the national Bereavement Support Line run by the HSE and Irish Hospice Foundation at 1800 80 70 77 (Monday-Friday 10am-1pm), and the contact information for a range of mental health supports is available at https://www.mentalhealthireland.ie/get-support/.
In the case of an emergency, or if you or someone you know is at risk of suicide or self-harm, dial 999/112.
