Abstract
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.
Funding
None.
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.
Funding
None.
| Original language | English |
|---|---|
| Pages (from-to) | 579-588 |
| Number of pages | 10 |
| Journal | Lancet Psychiatry |
| Volume | 8 |
| Issue number | 7 |
| Early online date | 13 Apr 2021 |
| DOIs | |
| Publication status | Published - Jul 2021 |
Bibliographical note
Funding Information:We acknowledge the help that the ICSPRC has received from 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 acknowledge the Queensland Mental Health Commission for funding the Queensland Suicide Register from 2013 to the present day and Queensland Health for funding the register from 1990?2013. The authors acknowledge the Coroners Court of Queensland and the Victorian Department of Justice and Community Safety as the source organisations of data, and the National Coronial Information System as the database source of data. The authors also acknowledge Queensland Police Service staff for sending police reports of suspected suicides. 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), and Chukwudi Okolie and Dana Dekel (University of Swansea). 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). MDP-B 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 EU 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 National Institute for Health Research (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 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 (81371502). PLP is an employee of the Medical University of Vienna, Austria. AR, CR-L, and CS are responsible for Frankfurter Projekt zur Pr?vention von Suiziden mittels Evidenz-basierten Ma?nahem (FraPPE; Frankfurt Project to prevent suicides using evidence-based measures), which is funded by the German Ministry. 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). Editorial note, The Lancet Group takes a neutral position with respect to territorial claims in published tables, figures, and institutional affiliations.
Funding Information:
We acknowledge the help that the ICSPRC has received from 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 acknowledge the Queensland Mental Health Commission for funding the Queensland Suicide Register from 2013 to the present day and Queensland Health for funding the register from 1990–2013. The authors acknowledge the Coroners Court of Queensland and the Victorian Department of Justice and Community Safety as the source organisations of data, and the National Coronial Information System as the database source of data. The authors also acknowledge Queensland Police Service staff for sending police reports of suspected suicides. 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), and Chukwudi Okolie and Dana Dekel (University of Swansea). 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). MDP-B 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 EU 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 National Institute for Health Research (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 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 (81371502). PLP is an employee of the Medical University of Vienna, Austria. AR, CR-L, and CS are responsible for Frankfurter Projekt zur Prävention von Suiziden mittels Evidenz-basierten Maßnahem (FraPPE; Frankfurt Project to prevent suicides using evidence-based measures), which is funded by the German Ministry. 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).
Publisher Copyright:
© 2021 Elsevier Ltd
Research Groups and Themes
- Covid19
- SASH
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