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Abstract
Objective
The COVID-19 pandemic has had a complex impact on risks of suicide and non-fatal self-harm worldwide with some evidence of increased risk in specific populations including women, young people, and people from ethnic minority backgrounds. This review aims to systematically address whether SARS-CoV-2 infection and/or COVID-19 disease confer elevated risk directly.
Method
As part of a larger Living Systematic Review examining self-harm and suicide during the pandemic, automated daily searches using a broad list of keywords were performed on a comprehensive set of databases with data from relevant articles published between January 1, 2020 and July 18, 2021. Eligibility criteria for our present review included studies investigating suicide and/or self-harm in people infected with SARS-CoV-2 with or without manifestations of COVID-19 disease with a comparator group who did not have infection or disease. Suicidal and self-harm thoughts and behaviour (STBs) were outcomes of interest. Studies were excluded if they reported data for people who only had potential infection/disease without a confirmed exposure, clinical/molecular diagnosis or self-report of a positive SARS-CoV-2 test result. Studies of news reports, treatment studies, and ecological studies examining rates of both SARS-CoV-2 infections and suicide/self-harm rates across a region were also excluded.
Results
We identified 12 studies examining STBs in nine distinct samples of people with SARS-CoV-2. These studies, which investigated STBs in the general population and in subpopulations, including healthcare workers, generally found positive associations between SARS-CoV-2 infection and/or COVID-19 disease and subsequent suicidal/self-harm thoughts and suicidal/self-harm behaviour.
Conclusions
This review identified some evidence that infection with SARS-CoV-2 and/or COVID-19 disease may be associated with increased risks for suicidal and self-harm thoughts and behaviours but a causal link cannot be inferred. Further research with longer follow-up periods is required to confirm these findings and to establish whether these associations are causal.
The COVID-19 pandemic has had a complex impact on risks of suicide and non-fatal self-harm worldwide with some evidence of increased risk in specific populations including women, young people, and people from ethnic minority backgrounds. This review aims to systematically address whether SARS-CoV-2 infection and/or COVID-19 disease confer elevated risk directly.
Method
As part of a larger Living Systematic Review examining self-harm and suicide during the pandemic, automated daily searches using a broad list of keywords were performed on a comprehensive set of databases with data from relevant articles published between January 1, 2020 and July 18, 2021. Eligibility criteria for our present review included studies investigating suicide and/or self-harm in people infected with SARS-CoV-2 with or without manifestations of COVID-19 disease with a comparator group who did not have infection or disease. Suicidal and self-harm thoughts and behaviour (STBs) were outcomes of interest. Studies were excluded if they reported data for people who only had potential infection/disease without a confirmed exposure, clinical/molecular diagnosis or self-report of a positive SARS-CoV-2 test result. Studies of news reports, treatment studies, and ecological studies examining rates of both SARS-CoV-2 infections and suicide/self-harm rates across a region were also excluded.
Results
We identified 12 studies examining STBs in nine distinct samples of people with SARS-CoV-2. These studies, which investigated STBs in the general population and in subpopulations, including healthcare workers, generally found positive associations between SARS-CoV-2 infection and/or COVID-19 disease and subsequent suicidal/self-harm thoughts and suicidal/self-harm behaviour.
Conclusions
This review identified some evidence that infection with SARS-CoV-2 and/or COVID-19 disease may be associated with increased risks for suicidal and self-harm thoughts and behaviours but a causal link cannot be inferred. Further research with longer follow-up periods is required to confirm these findings and to establish whether these associations are causal.
| Original language | English |
|---|---|
| Pages (from-to) | 812-827 |
| Number of pages | 16 |
| Journal | Canadian Journal of Psychiatry |
| Volume | 67 |
| Issue number | 11 |
| DOIs | |
| Publication status | Published - 9 May 2022 |
Bibliographical note
Funding Information:We thank Profs Ella Arensman, Keith Hawton, Rory O’Connor, Nav Kapur, Paul Moran, Siobhan O’Neill for their assistance and guidance in the context of the larger systematic review from which this study derives. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funders had no influence on the conduct or interpretation of this review. MS was supported by Academic Scholars Awards (MS) from the Departments of Psychiatry at the University of Toronto and Sunnybrook Health Sciences Centre. DK was supported by the Wellcome Trust through an Institutional Strategic Support Fund Award to the University of Bristol [204813] and the Elizabeth Blackwell Institute for Health Research, University of Bristol. DG and JPTH are supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. JPTH is supported by NIHR Applied Research Collaboration West at University Hospitals Bristol and Weston NHS Foundation Trust. JPTH is a National Institute for Health and Care Research (NIHR) Senior Investigator (NF-SI-0617-10145). LAM and LM are supported by NIHR Doctoral Research Fellowships (DRF-2018–11-ST2-048). RTW is supported by the NIHR Greater Manchester Patient Safety Translational Research Centre at The University of Manchester. LW is supported by Sciome.
Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funders had no influence on the conduct or interpretation of this review. MS was supported by Academic Scholars Awards (MS) from the Departments of Psychiatry at the University of Toronto and Sunnybrook Health Sciences Centre. DK was supported by the Wellcome Trust through an Institutional Strategic Support Fund Award to the University of Bristol [204813] and the Elizabeth Blackwell Institute for Health Research, University of Bristol. DG and JPTH are supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. JPTH is supported by NIHR Applied Research Collaboration West at University Hospitals Bristol and Weston NHS Foundation Trust. JPTH is a National Institute for Health and Care Research (NIHR) Senior Investigator (NF-SI-0617-10145). LAM and LM are supported by NIHR Doctoral Research Fellowships (DRF-2018–11-ST2-048). RTW is supported by the NIHR Greater Manchester Patient Safety Translational Research Centre at The University of Manchester. LW is supported by Sciome.
Publisher Copyright:
© The Author(s) 2022.
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The impact of COVID-19 on self-harm and suicidal behaviour: a living systematic review
Gunnell, D. J., Higgins, J. P. T., John, A., Knipe, D., Webb, R., Moran, P. A., Schmidt, L., Eyles, E. C. & McGuinness, L.
1/05/20 → 1/12/22
Project: Research