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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
eClinicalMedicine, Volume: 51, Start page: 101573
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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 global...
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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.
Suicide; COVID-19; Pandemic; Monitoring
Faculty of Medicine, Health and Life Sciences
We acknowledge the help that 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 ADP, which is funded by MQ Mental Health Research Charity (grant reference MQBF/3 ADP). ADP and the authors acknowledge the data providers who supplied the datasets enabling this study. The views expressed are entirely those of the authors and should not be assumed to be the same as those of ADP or MQ Mental Health Research Charity. The authors would also like to thank the team working on the living systematic review of COVID-19 and suicidal behaviour: Emily Eyles, Luke McGuinness, Babatunde K Olorisade, Lena Schmidt, Catherine MacLeod Hall, and Julian Higgins (University of Bristol); Chukwudi Okolie, Dana Dekel, and Amanda Marchant (University of Swansea); Faraz Mughal (University of Keele); Lana Bojanic (University of Manchester). 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. AB is supported by the European Union's Erasmus+ Strategic Partnership Programme (2019-1-SE01-KA203-060571). OJK is supported by a Senior Postdoctoral Fellowship from Research Foundation Flanders (FWO 1257821N). MRP funded in part by a Global Alliance for Chronic Diseases – National Natural Science Foundation of China grant (NSFC. No. 81761128031). AK is supported by the project “Sustainability for the National Institute of Mental Health”, LO1611, Ministry of Education, Youth and Sports of the Czech Republic under the NPU I programme and by the Charles University, Prague (SVV 260 596 and GA UK 552119). MS is supported by Academic Scholar Awards from the Departments of Psychiatry at Sunnybrook Health Sciences Centre and the University of Toronto. RTW is supported by the NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK. 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).