The study published in The Lancet Psychiatry journal provides the best available evidence on the pandemic’s effects on suicide so far, however it only provides a snapshot of the first few months of the pandemic and effects on suicide might not necessarily occur immediately.
The study looked at numbers of suicides in 21 countries between 1 April and 31 July 2020 and compared these with trends in the previous one to four years.
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.'
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 suicide prevention programmes, and the strength of the economy and relief measures to support those whose livelihoods are affected by the pandemic.
Few studies have examined the effects of any widespread infectious disease outbreaks on suicide. The new study included around 70 authors from 30 countries who are members of the International COVID-19 Suicide Prevention Research Collaboration (ICSPRC), which came together to share knowledge about the impact of the pandemic on suicide and suicidal behaviour, and advise on ways to mitigate any risks.
Professor Keith Hawton, Director of the Centre for Suicide Research, University of Oxford, co-author and member of ICSPRC, said:
'It is reassuring that despite some dire early predictions about potential impact of the COVID-19 pandemic on suicides these turned out to be unduly pessimistic. But considerable efforts on the part of government and support agencies will be required to counter potential longer-term impacts which could influence suicide rates, especially those resulting from recession and mental health consequences of the pandemic.'
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.
Writing in a linked Comment, Dr Stella Botchway and Professor Seena Fazel, University of Oxford, UK, say:
'… despite this initial snapshot, governments and services need to remain vigilant for a possible delayed increase in suicides as a result of the pandemic. Suicide can be a lagging indicator of psychosocial difficulties, influenced by medium-term and longer-term disruptions to civic life and the economy. Other work has shown that suicides can increase following economic recession, and such increases can be sustained for several years. Without counter-measures, ongoing reductions in economic activity can translate into individual financial and personal problems, such as job losses, reduced social status, housing instability, and relationship breakdowns. Alongside social isolation and disruption of normal routines, these factors can, in turn, increase the incidence of suicide through rises in mental health conditions such as depression as well as drug and alcohol misuse. Similar mechanisms might be relevant during the COVID-19 pandemic and its aftershocks.'
'Reducing the global impact on mental health of the COVID-19 pandemic will involve continued monitoring alongside early intervention and investment into mental health services. Local, regional, and national strategies should not overlook at-risk groups, including those that might be hidden from view, such as people who are homeless, living in prison, or in abusive relationships. These strategies will be informed by consortia, such as the International COVID-19 Suicide Prevention Research Collaboration, allowing for ongoing surveillance, particularly of populations at higher risk. This collaboration can also lead to more consistent collection of high-quality suicide data across different countries. Pirkis and colleagues’ results are reassuring in that there has not been an initial clear increase in suicide deaths, but will need to be followed up across a wider set of countries over the next few years to investigate whether suicide will be one of the health-related aftershocks of the pandemic.'