Suicide Mortality and Coronavirus Disease 2019-A Perfect Storm?
TL;DR: Action could be taken to mitigate potential unintended consequences on suicide prevention efforts, which also represent a national public health priority, and to reduce the rate of new infections.
Abstract: Suicide rates have been rising in the US over the last 2 decades. The latest data available (2018) show the highest age-adjusted suicide rate in the US since 1941.1 It is within this context that coronavirus disease 2019 (COVID-19) struck the US. Concerning disease models have led to historic and unprecedented public health actions to curb the spread of the virus. Remarkable social distancing interventions have been implemented to fundamentally reduce human contact. While these steps are expected to reduce the rate of new infections, the potential for adverse outcomes on suicide risk is high. Actions could be taken to mitigate potential unintended consequences on suicide prevention efforts, which also represent a national public health priority.
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TL;DR: In this article, the authors examined relations of both stay-at-home orders and the perceived impact of COVID-19 on daily life to psychological outcomes (depression, health anxiety, financial worry, social support, and loneliness) in a nationwide U.S. community adult sample.
Abstract: The COVID-19 pandemic has resulted in the widespread implementation of extraordinary physical distancing interventions (e.g., stay-at-home orders) to slow the spread of the virus. Although vital, these interventions may be socially and economically disruptive, contributing to adverse psychological outcomes. This study examined relations of both stay-at-home orders and the perceived impact of COVID-19 on daily life to psychological outcomes (depression, health anxiety, financial worry, social support, and loneliness) in a nationwide U.S. community adult sample (N = 500; 47% women, mean age = 40). Participants completed questionnaires assessing psychological outcomes, stay-at-home order status, and COVID-19's impact on their daily life. Being under a stay-at-home order was associated with greater health anxiety, financial worry, and loneliness. Moreover, the perceived impact of COVID-19 on daily life was positively associated with health anxiety, financial worry, and social support, but negatively associated with loneliness. Findings highlight the importance of social connection to mitigate negative psychological consequences of the COVID-19 pandemic.
626 citations
TL;DR: The psychological impact of COVID-19 lockdowns is small in magnitude and highly heterogeneous, suggesting that lockdowns do not have uniformly detrimental effects on mental health and that most people are psychologically resilient to their effects.
Abstract: Lockdowns to control the spread of the coronavirus disease 2019 (COVID-19) have had profound effects on everyday life worldwide, but their effect on mental health remains unclear because available meta-analyses and reviews rely mostly on cross-sectional studies. We conducted a rapid review and meta-analysis of longitudinal studies and natural experiments investigating the relationship between COVID-19 lockdowns and mental health. A total of 25 studies involving 72 004 participants and 58 effect sizes were analyzed. Using a random effects model, we found that lockdowns had small effects on mental health symptoms, g = 0.17, s.e. = 0.05, 95% CI (0.06-0.24), p = 0.001, but the effects on positive psychological functioning, g = -0.12, s.e. = 0.11, 95% CI (-0.33 to 0.09), p = 0.27, were not significant. Multivariate analysis of effect sizes revealed significant and relatively small effect sizes for anxiety and depression, while those for social support, loneliness, general distress, negative affect, and suicide risk were not significant. The results indicated substantial heterogeneity among studies, but meta-regression analyses found no significant moderation effects for mean age, gender, continent, COVID-19 death rate, days of lockdown, publication status or study design. The psychological impact of COVID-19 lockdowns is small in magnitude and highly heterogeneous, suggesting that lockdowns do not have uniformly detrimental effects on mental health and that most people are psychologically resilient to their effects.
424 citations
TL;DR: Pre-COVID-19 emotional distress was the strongest predictor of during-pandemic emotional distress, followed by during-Pandemic economic and psychosocial stressors, and pre- pandemic social stressors (e.g. bullying victimization and stressful life events).
Abstract: Background The coronavirus disease 2019 (COVID-19) pandemic and associated lockdown could be considered a 'perfect storm' for increases in emotional distress Such increases can only be identified by studies that use data collected before and during the pandemic Longitudinal data are also needed to examine (1) the roles of previous distress and stressors in emotional distress during the pandemic and (2) how COVID-19-related stressors and coping strategies are associated with emotional distress when pre-pandemic distress is accounted for Methods Data came from a cohort study (N = 768) Emotional distress (perceived stress, internalizing symptoms, and anger), COVID-19-related stressors, and coping strategies were measured during the pandemic/lockdown when participants were aged 22 Previous distress and stressors were measured before COVID-19 (at age 20) Results On average, participants showed increased levels of perceived stress and anger (but not internalizing symptoms) during the pandemic compared to before Pre-COVID-19 emotional distress was the strongest predictor of during-pandemic emotional distress, followed by during-pandemic economic and psychosocial stressors (eg lifestyle and economic disruptions) and hopelessness, and pre-pandemic social stressors (eg bullying victimization and stressful life events) Most health risks to self or loved ones due to COVID-19 were not uniquely associated with emotional distress in final models Coping strategies associated with reduced distress included keeping a daily routine, physical activity, and positive reappraisal/reframing Conclusions In our community sample, pre-pandemic distress, secondary consequences of the pandemic (eg lifestyle and economic disruptions), and pre-pandemic social stressors were more consistently associated with young adults' emotional distress than COVID-19-related health risk exposures
394 citations
TL;DR: The COVID-19 pandemic and the lockdown has taken the world by storm and this study examines its impact on the anxiety level of university students in Malaysia during the peak of the crisis and the pertinent characteristics affecting their anxiety.
Abstract: The COVID-19 pandemic and the lockdown has taken the world by storm. This study examines its impact on the anxiety level of university students in Malaysia during the peak of the crisis and the pertinent characteristics affecting their anxiety. A cross-sectional online survey, using Zung’s self-rating anxiety questionnaire was conducted during the COVID-19 pandemic and lockdown. Out of the 983 respondents, 20.4%, 6.6%, and 2.8% experienced minimal to moderate, marked to severe, and most extreme levels of anxiety. Female gender (OR = 21.456, 95% CI = 1.061, 1.998, p = 0.020), age below 18 years (OR = 4.147, 95% CI = 1.331, 12.918, p = 0.014), age 19 to 25 (OR = 3.398, 95% CI = 1.431, 8.066, p = 0.006), pre-university level of education (OR = 2.882, 95% CI = 1.212, 6.854, p = 0.017), management studies (OR = 2.278, 95% CI = 1.526, 3.399, p < 0.001), and staying alone (OR = 2.208, 95% CI = 1.127, 4.325, p = 0.021) were significantly associated with higher levels of anxiety. The main stressors include financial constraints, remote online teaching and uncertainty about the future with regard to academics and career. Stressors are predominantly financial constraints, remote online learning, and uncertainty related to their academic performance, and future career prospects.
369 citations
Cites background from "Suicide Mortality and Coronavirus D..."
...It is a hostile experience that can cause severe financial stress [40,41] due to loss of employment; social disorders such as social withdrawal, cyberbullying, alcohol misuse, and addiction; and mental health issues such as suicide attempts and depression [42,43]....
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Lola Kola1, Lola Kola2, Brandon A. Kohrt3, Charlotte Hanlon4, Charlotte Hanlon5, John A. Naslund6, Siham Sikander7, Siham Sikander8, Madhumitha Balaji, Corina Benjet, Eliza Yee Lai Cheung, Julian Eaton, Pattie Pramila Gonsalves9, Maji Hailemariam10, Nagendra P. Luitel11, Daiane Borges Machado6, Daiane Borges Machado12, Eleni Misganaw, Olayinka Omigbodun2, Tessa Roberts5, Tatiana Taylor Salisbury5, Rahul Shidhaye13, Charlene Sunkel, Victor Ugo, André Janse van Rensburg14, André Janse van Rensburg15, Oye Gureje2, Soumitra Pathare16, Shekhar Saxena6, Graham Thornicroft5, Vikram Patel6 •
University of Washington1, University of Ibadan2, George Washington University3, College of Health Sciences, Bahrain4, King's College London5, Harvard University6, Health Services Academy7, University of Liverpool8, University of Sussex9, Michigan State University10, Kathmandu11, Oswaldo Cruz Foundation12, Pravara Institute of Medical Sciences13, University of the Free State14, University of KwaZulu-Natal15, Centre for Mental Health16
TL;DR: In this article, the authors examined the mental health implications of the COVID-19 pandemic in low-income and middle-income countries (LMICs) in four parts: the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders.
359 citations
References
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TL;DR: The theory is proposed that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs-thwarted belongingness and perceived burdensomeness (and hopelessness about these states)-and further that the capability to engage in suicidal behavior is separate from the desire to engageIn suicidal behavior.
Abstract: Suicidal behavior is a major problem worldwide and, at the same time, has received relatively little empirical attention. This relative lack of empirical attention may be due in part to a relative absence of theory development regarding suicidal behavior. The current article presents the interpersonal theory of suicidal behavior. We propose that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs—thwarted belongingness and perceived burdensomeness (and hopelessness about these states)—and further that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior. According to the theory, the capability for suicidal behavior emerges, via habituation and opponent processes, in response to repeated exposure to physically painful and/or fear-inducing experiences. In the current article, the theory’s hypotheses are more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theory’s hypotheses.
3,428 citations
TL;DR: A systematic program of contact with persons who are at risk of suicide and who refuse to remain in the health care system appears to exert a significant preventive influence for at least two years, andDiminution of the frequency of contact and discontinuation of contact appear to reduce and eventually eliminate this preventive influence.
Abstract: OBJECTIVE: This study tested the hypothesis that professionals' maintenance of long-term contact with persons who are at risk of suicide can exert a suicide-prevention influence. This influence was hypothesized to result from the development of a feeling of connectedness and to be most pertinent to high-risk individuals who refuse to remain in the health care system. METHODS: A total of 3,005 persons hospitalized because of a depressive or suicidal state, populations known to be at risk of subsequent suicide, were contacted 30 days after discharge about follow-up treatment. A total of 843 patients who had refused ongoing care were randomly divided into two groups; persons in one group were contacted by letter at least four times a year for five years. The other group—the control group—received no further contact. A follow-up procedure identified patients who died during the five-year contact period and during the subsequent ten years. Suicide rates in the contact and no-contact groups were compared. RESUL...
443 citations
TL;DR: This low-cost brief intervention may be an important part of suicide prevention programmes for underresourced low- and middle-income countries.
Abstract: Resumen Eficacia de una intervencion de informacion y contactos en los casos de intento de suicidio: ensayo controlado aleatorizado en cinco paises Objetivo Determinar si una intervencion de informacion breve y contactos es una medida eficaz para reducir la mortalidad posterior por suicidio entre quienes han intentado suicidarse en los paises de ingresos bajos y medios.Metodos Un total de 1867 personas que habian intentado suicidarse seleccionadas por personal medico en los servicios de urgencia de ocho hospitales colaboradores en cinco lugares con distinto contexto cultural (Campinas, Brasil; Chennai, India; Colombo, Sri Lanka; Karaj, Republica Islamica del Iran; y Yuncheng, China) participaron entre enero de 2002 y octubre de 2005 en un ensayo controlado aleatorizado para someterse bien al tratamiento habitual, o bien al tratamiento habitual mas una intervencion consistente en una sesion breve de informacion y educacion del paciente y una serie de contactos de seguimiento (I+C). Globalmente, finalizaron el estudio el 91% de los pacientes. La variable principal de medicion del resultado del estudio fue la muerte por suicidio en los 18 meses de seguimiento.Resultados En el grupo sometido a I+C se observo una tasa de defunciones por suicidio significativamente menor que en el grupo tratado de la forma habitual (0,2% frente al 2,2%, respectivamente; c² = 13,83,
367 citations
Journal Article•
TL;DR: In this article, the authors investigated the effect of maintaining long-term contact with high suicide-risk psychiatric patients refusing further treatment, which was associated with a significant reduction in suicide rates for at least 2 years after discharge from the in-patient setting.
Abstract: Introduction Suicide is a preventable cause of death. After about two centuries of research in suicide prevention, the effectiveness of a number of interventions has been demonstrated and various risk factors have been placed in perspective. Thus, "it is no longer acceptable to state blandly that there is no convincing evidence for the effectiveness of suicide prevention measures ..." and, even more importantly, "... the unacceptable rate of suicide worldwide can be reduced." WHO estimated that 877 000 deaths were due to suicide in the year 2002, (2) the majority of which (85%) occurred in low- and middle-income countries. (3) Attempted suicide can be up to 40 times more frequent than completed suicide. (4,5) Many of those who attempt suicide require medical attention and they are at high risk for completed suicide. (6-8) Self-inflicted injuries represented 1.4% of the global burden of disease in 20022 and are expected to increase to 2.4% by 2020. As suicide is among the top three causes of death in the population aged 15-34 years, (9) there is a massive loss to societies of young people in their productive years of life. Suicide mortality statistics are available at: http://www.who.int/mental_health! prevention/suicide/country_reports/en/ index.html. There have been several recent reviews of interventions that may be considered effective in reducing suicides. (1,10-12) Under the framework of universal, selective, and indicated interventions, (13) the general population is targeted by universal interventions (e.g. restricting access to means of suicide) and selective interventions focus on high-risk subgroups (e.g. people with mental disorders), whereas those who have attempted suicide are considered high-risk individuals and are therefore addressed with indicated interventions, which include a range of behavioural therapies and approaches such as cognitive therapy. (14) Among indicated interventions, various approaches have been tested to prevent subsequent suicidal behaviour by suicide attempters; extensive review articles are available. (15,16) Usually, the primary outcome measure used for these interventions was repeated suicide attempts. It is suggested that extrapolation from attempted to completed suicide is valid. (17) As completed suicide is a rare outcome in statistical terms, large numbers of suicide attempters would be needed to demonstram the effectiveness of an intervention in terms of a reduction of completed suicides. The multisite study presented here tried to tackle this challenge by combining data from different sites that had applied the same research protocol. Previously, completed suicides were used as an outcome measure in a study that investigated the maintenance of long-term contact (i.e. a total of 5 years and 24 contacts) with high suicide-risk psychiatric patients refusing further treatment. (18-20) The contact comprised regular short letters expressing concern for the person's well-being and inviting them to respond. This was associated with a significant reduction in suicide rates for at least 2 years after discharge from the in-patient setting. In addition, a "tele-help/tele-check" service (i.e. an alarm system that can be activated to call for help and a service that contacts a person twice a week for assessment of their needs and to provide emotional support) could significantly reduce the number of suicide deaths in the elderly, who typically have an elevated risk of suicide compared with an age-adjusted number for the general population. (21,22) These two examples demonstrate that it is possible to reduce the suicide rate in populations at risk by keeping in regular contact with patients. Brief interventions for alcohol problems are another promising type of intervention that have not been previously applied to suicidal behaviours. (23-25) These are designed to address the specific behaviour of drinking with information, feedback, health education and practical advice and focus in order to raise awareness of the problem and advise change. …
323 citations
TL;DR: Physicians are an at-risk profession of suicide, with women particularly at risk, and the rate of suicide in physicians decreased over time, especially in Europe.
Abstract: Background :
Medical-related professions are at high suicide risk. However, data are contradictory and
comparisons were not made between gender, occupation and specialties, epochs of times.
Thus, we conducted a systematic review and meta-analysis on suicide risk among healthcare workers.
Method :
The PubMed, Cochrane Library, Science Direct and Embase databases were searched
without language restriction on April 2019, with the following keywords: suicide* AND
(« health care worker* » OR physician* OR nurse*). When possible, we stratified results by
gender, countries, time, and specialties. Estimates were pooled using random-effect metaanalysis. Differences by study-level characteristics were estimated using stratified metaanalysis and meta-regression. Suicides, suicidal attempts, and suicidal ideation were
retrieved from national or local specific registers or case records. In addition, suicide
attempts and suicidal ideation were also retrieved from questionnaires (paper or internet).
Results :
The overall SMR for suicide in physicians was 1.44 (95CI 1.16, 1.72) with an important heterogeneity (I2 = 93.9%, p<0.001). Female were at higher risk (SMR = 1.9; 95CI 1.49, 2.58;
and ES = 0.67; 95CI 0.19, 1.14; p<0.001 compared to male). US physicians were at higher
risk (ES = 1.34; 95CI 1.28, 1.55; p <0.001 vs Rest of the world). Suicide decreased over
time, especially in Europe (ES = -0.18; 95CI -0.37, -0.01; p = 0.044). Some specialties might
be at higher risk such as anesthesiologists, psychiatrists, general practitioners and general
surgeons. There were 1.0% (95CI 1.0, 2.0; p<0.001) of suicide attempts and 17% (95CI 12,
21; p<0.001) of suicidal ideation in physicians. Insufficient data precluded meta-analysis on
other health-care workers.
Conclusion :
Physicians are an at-risk profession of suicide, with women particularly at risk. The rate of
suicide in physicians decreased over time, especially in Europe. The high prevalence of physicians who committed suicide attempt as well as those with suicidal ideation should benefits
for preventive strategies at the workplace. Finally, the lack of data on other health-care
workers suggest to implement studies investigating those occupations.
249 citations
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