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Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries

Pirkis J 1 , Gunnell D 2 , Shin S 1 , Del Pozo-Banos M 3 , Arya V 1 , Aguilar PA 4 Show all authors , Appleby L 5 , Arafat SMY 6 , Arensman E 7 , Ayuso-Mateos JL 8 , Balhara YPS 9 , Bantjes J 10 , Baran A 11 , Behera C 12 , Bertolote J 13 , Borges G 14 , Bray M 15 , Brečić P 16 , Caine E 17 , Calati R 18 , Carli V 19 , Castelpietra G 20 , Chan LF 21 , Chang SS 22 , Colchester D 23 , Coss-Guzmán M 24 , Crompton D 25 , Ćurković M 26 , Dandona R 27 , De Jaegere E 28 , De Leo D 29 , Deisenhammer EA 30 , Dwyer J 31 , Erlangsen A 32 , Faust JS 33 , Fornaro M 34 , Fortune S 35 , Garrett A 36 , Gentile G 37 , Gerstner R 38 , Gilissen R 39 , Gould M 40 , Gupta SK 12 , Hawton K 41 , Holz F 42 , Kamenshchikov I 43 , Kapur N 44 , Kasal A 45 , Khan M 46 , Kirtley OJ 47 , Knipe D 48 , Kõlves K 49 , Kölzer SC 42 , Krivda H 50 , Leske S 49 , Madeddu F 18 , Marshall A 51 , Memon A 52 , Mittendorfer-Rutz E 53 , Nestadt P 15 , Neznanov N 54 , Niederkrotenthaler T 55 , Nielsen E 56 , Nordentoft M 32 , Oberlerchner H 57 , O'Connor RC 58 , Papsdorf R 59 , Partonen T 60 , Phillips MR 61 , Platt S 62 , Portzky G 28 , Psota G 63 , Qin P 64 , Radeloff D 59 , Reif A 65 , Reif-Leonhard C 65 , Rezaeian M 66 , Román-Vázquez N 24 , Roskar S 67 , Rozanov V 68 , Sara G 69 , Scavacini K 70 , Schneider B 65 , Semenova N 71 , Sinyor M 72 , Tambuzzi S 37 , Townsend E 56 , Ueda M 73 , Wasserman D 19 , Webb RT 44 , Winkler P 45 , Yip PSF 74 , Zalsman G 75 , Zoja R 37 , John A 3 , Spittal MJ 1

Affiliations 

  • 1 Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
  • 2 National Institute of Health and care Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, United Kingdom
  • 3 Swansea University Medical School, Swansea, United Kingdom
  • 4 Ministry of Public Health, Department of Health Promotion, Quito, Ecuador
  • 5 National Confidential Inquiry into Suicide and Safety in Mental Health, University of Manchester, Manchester, United Kingdom
  • 6 Department of Psychiatry, Enam Medical College and Hospital, Dhaka, Bangladesh
  • 7 School of Public Health, National Suicide Research Foundation, University College Cork, Cork, Ireland
  • 8 Department of Psychiatry, Universidad Autonoma de Madrid, Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
  • 9 National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
  • 10 Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
  • 11 Working Group on Prevention of Suicide and Depression at Public Health Council, Ministry of Health, Warsaw, Poland
  • 12 Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
  • 13 Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
  • 14 Department of Global Mental Health, Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, Mexico
  • 15 Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
  • 16 Department for Psychiatry, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia
  • 17 University of Rochester Medical Center, Rochester, NY, United States
  • 18 Department of Psychology, University of Milan-Bicocca, Milan, Italy
  • 19 National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
  • 20 Region Friuli Venezia Giulia, Central Health Directorate, Outpatient and Inpatient Care Service, Trieste, Italy
  • 21 Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
  • 22 Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
  • 23 Thames Valley Police, Bicester, United Kingdom
  • 24 Puerto Rico Department of Health's Commission on Suicide Prevention, San Juan, Puerto Rico
  • 25 School of Applied Psychology, Griffith University, Brisbane, Australia
  • 26 Department for Medical Ethics, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia
  • 27 Public Health Foundation of India, Gurugram, India
  • 28 Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
  • 29 Griffith University, Brisbane, Australia
  • 30 Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology; University Hospital for Psychiatry 2, Medical University of Innsbruck, Innsbruck, Austria
  • 31 Coroners Court of Victoria, Melbourne, Australia
  • 32 Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
  • 33 Brigham and Women's Hospital Department of Emergency Medicine, Harvard Medical School, Boston, United States
  • 34 Department of Psychiatry, Neuroscience Institute, Federico II University of Naples, Naples, Italy
  • 35 School of Population Health, The University of Auckland, Auckland, New Zealand
  • 36 Coronial Division, Tasmanian Magistrates Court, Hobart, Australia
  • 37 Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
  • 38 Undersecretary of Health Services, Ministry of Public Health, Quito, Ecuador
  • 39 113 Suicide Prevention, Research Department, Amsterdam, the Netherlands
  • 40 Departments of Psychiatry and Epidemiology, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, United States
  • 41 Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
  • 42 Institute of Legal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
  • 43 Udmurtia Republican Clinical Psychiatric Hospital, Izhevsk, Russian Federation
  • 44 Centre for Mental Health and Safety and National Institute for Health Research (NIHR) Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
  • 45 National Institute of Mental Health, Klecany, Czechia
  • 46 Department of Psychiatry, Aga Khan University, Karachi, Pakistan
  • 47 KU Leuven, Center for Contextual Psychiatry, Leuven, Belgium
  • 48 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
  • 49 Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
  • 50 Department of Forensic Medicine, Odessa National Medical University, Odessa, Ukraine
  • 51 Brigham and Women's Hospital, Harvard Medical School, MA, United States
  • 52 Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
  • 53 Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  • 54 Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
  • 55 Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
  • 56 School of Psychology, University of Nottingham, Nottingham, United Kingdom
  • 57 Department of Psychiatry and Psychotherapy; Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
  • 58 Suicidal Behaviour Research Lab, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
  • 59 Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
  • 60 Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
  • 61 Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • 62 Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
  • 63 Psychosocial Services in Vienna, Vienna, Austria
  • 64 National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  • 65 Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
  • 66 Department of Epidemiology and Biostatistics, Occupational Environment Research Center, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
  • 67 National Institute of Public Health, Ljubljana, Slovenia
  • 68 Saint Petersburg State University, Saint Petersburg, Russian Federation
  • 69 System Information and Analytics Branch, NSW Ministry of Health, Sydney, Australia
  • 70 Instituto Vita Alere, São Paulo, Brazil
  • 71 Organizational-Scientific Department, Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
  • 72 Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
  • 73 Waseda University, Faculty of Political Science and Economics, Tokyo, Japan
  • 74 Hong Kong Jockey Club Centre for Suicide Research and Prevention, Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
  • 75 Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
EClinicalMedicine, 2022 Sep;51:101573.
PMID: 35935344 DOI: 10.1016/j.eclinm.2022.101573

Abstract

BACKGROUND: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally.

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 sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation.

FINDINGS: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of 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 stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well.

INTERPRETATION: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue.

FUNDING: None.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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