Suicide trends in the early months of the COVID-19 pandemic: interrupted time series analysis of preliminary data from 21 countries

Pirkis, J. et al. (2021) Suicide trends in the early months of the COVID-19 pandemic: interrupted time series analysis of preliminary data from 21 countries. Lancet Psychiatry, 8(7), pp. 579-588. (doi: 10.1016/S2215-0366(21)00091-2) (PMID:33862016)

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Background: The COVID-19 pandemic is having profound mental health consequences for many people. Concerns have been expressed that, at their most extreme, these consequences could manifest as increased suicide rates. We aimed to assess the early effect of the COVID-19 pandemic on suicide rates around the world. Methods: We sourced real-time suicide data from countries or areas within countries through a systematic internet search and recourse to our networks and the published literature. Between Sept 1 and Nov 1, 2020, we searched the official websites of these countries’ ministries of health, police agencies, and government-run statistics agencies or equivalents, using the translated search terms “suicide” and “cause of death”, before broadening the search in an attempt to identify data through other public sources. Data were included from a given country or area if they came from an official government source and were available at a monthly level from at least Jan 1, 2019, to July 31, 2020. Our internet searches were restricted to countries with more than 3 million residents for pragmatic reasons, but we relaxed this rule for countries identified through the literature and our networks. Areas within countries could also be included with populations of less than 3 million. We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from at least Jan 1, 2019, to March 31, 2020) in each country or area within a country, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). Findings: We sourced data from 21 countries (16 high-income and five upper-middle-income countries), including whole-country data in ten countries and data for various areas in 11 countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas: New South Wales, Australia (RR 0·81 [95% CI 0·72–0·91]); Alberta, Canada (0·80 [0·68–0·93]); British Columbia, Canada (0·76 [0·66–0·87]); Chile (0·85 [0·78–0·94]); Leipzig, Germany (0·49 [0·32–0·74]); Japan (0·94 [0·91–0·96]); New Zealand (0·79 [0·68–0·91]); South Korea (0·94 [0·92–0·97]); California, USA (0·90 [0·85–0·95]); Illinois (Cook County), USA (0·79 [0·67–0·93]); Texas (four counties), USA (0·82 [0·68–0·98]); and Ecuador (0·74 [0·67–0·82]). Interpretation: This is the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. In high-income and upper-middle-income countries, suicide numbers have remained largely unchanged or declined in the early months of the pandemic compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond if the situation changes as the longer-term mental health and economic effects of the pandemic unfold.

Item Type:Articles
Additional Information:The authors would like to acknowledge the help the International COVID-19 Suicide Prevention Research Collaboration (ICSPRC) has received from the International Association for Suicide Prevention (IASP) in establishing and supporting its activities. This study was supported by the Adolescent Mental Health Data Platform (ADP). The ADP is funded by MQ Mental Health Research Charity (Grant Reference MQBF/3 ADP). JP is funded by a National Health and Medical Research Council Investigator Grant (GNT1173126). AJ is funded by MQ (MQBF/3) and the Medical Research Council (MC_PC_17211). MDPB is funded by Health and Care Research Wales (CA04). VA is supported by Australian Government Research Training Program Scholarship. EA is supported by the Health Research Board Ireland (IRRL-2015-1586). AB is supported by the European Union’s Erasmus+ Strategic Partnership Programme (2019-1-SE01-KA203-060571). NK is supported by the University of Manchester, Greater Manchester Mental Health NHS Foundation Trust, and the NIHR Greater Manchester Patient Safety Translational Research Centre. OJK is supported by a Senior Postdoctoral Fellowship from Research Foundation Flanders (FWO 1257821N). DK is funded by the Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund. TN has been supported by the Vienna Science and Technology Fund (WWTF) through project COV20-027. RCO’C reports grants from Samaritans, Scottish Association for Mental Health, Mindstep Foundation, NIHR, Medical Research Foundation, Scottish Government, and NHS Health Scotland/Public Health Scotland. MRP is supported in part by a grant from the Global Alliance of Chronic Diseases and the Chinese National Natural Science Foundation of China (NSFC, No. 81371502). PLP is an employee of the Medical University of Vienna, Austria. AR, CR-L and CS are responsible for FraPPE, which is funded by the German Ministry (BMG). MS is supported by Academic Scholar Awards from the Departments of Psychiatry at Sunnybrook Health Sciences Centre and the University of Toronto. MW is funded by a Focus Grant from American Foundation for Suicide Prevention (IIG-0-002-17). DGu is supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. MJS is a recipient of an Australian Research Council Future Fellowship (FT180100075).
Glasgow Author(s) Enlighten ID:O'Connor, Professor Rory and Kirtley, Dr Olivia
Authors: Pirkis, J., John, A., Shin, S., DelPozo-Banos, M., Arya, V., Aguilar, P. A., Appleby, L., Arensman, E., Bantjes, J., Baran, A., Bertolote, J. M., Borges, G., Brečić, P., Caine, E., Castelpietra, G., Chang, S.-S., Colchester, D., Crompton, D., Curkovic, M., Deisenhammer, E. A., Du, C., Dwyer, J., Erlangsen, A., Faust, J. S., Fortune, S., Garrett, A., George, D., Gerstner, R., Gilissen, R., Gould, M., Hawton, K., Kanter, J., Kapur, N., Khan, M., Kirtley, O. J., Knipe, D., Kolves, K., Leske, S., Marahatta, K., Mittendorfer-Rutz, E., Neznanov, N., Niederkrotenthaler, T., Nielsen, E., Nordentoft, M., Oberlerchner, H., O'Connor, R. C., Pearson, M., Phillips, M. R., Platt, S., Plener, P. L., Psota, G., Qin, P., Radeloff, D., Rados, C., Reif, A., Reif-Leonhard, C., Rozanov, V., Schlang, C., Schneider, B., Semenova, N., Sinyor, M., Townsend, E., Ueda, M., Vijayakumar, L., Webb, R. T., Weerasinghe, M., Zalsman, G., Gunnell, D., and Spittal, M. J.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
Journal Name:Lancet Psychiatry
ISSN (Online):2215-0374
Published Online:13 April 2021

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