Suicide prevention and COVID-19: the role of primary care during the pandemic and beyond

TLDR: In this paper, the authors outline the current evidence for impact of the COVID-19 pandemic on self-harm and suicide rates, and consider how primary care can contribute to suicide prevention during the crisis.

Abstract: The COVID-19 pandemic has brought with it multiple threats to mental wellbeing — the possibility or reality of serious physical illness; complex COVID-related bereavement; lockdowns that cause isolation and inhibit social contact, or that can increase exposure to abuse in the family; caring for children unable to go to school; and precarious employment and redundancy, failing businesses, and financial insecurity. The pandemic has exacerbated the longstanding pressure on resources and underinvestment in both statutory mental health and wider community services. Against this background we outline the current evidence for impact of COVID-19 on self-harm and suicide rates, and we consider how primary care can contribute to suicide prevention during COVID-19 and after the acute crisis has passed. There is international evidence of raised prevalence of anxiety disorder, post-traumatic stress disorder, and depression symptoms, especially during lockdowns implemented to contain COVID-19, and particularly in young people and those living with children.1,2 Those with pre-existing mental and chronic illness may be at higher risk.3 These increases in prevalence of symptoms of mental illness are important in their own right, and may also increase suicide risk. Self-harm is the strongest risk factor for suicide. Although thoughts of self-harm and suicide are common accompaniments of adversity and poor mental health, evidence to date has not indicated increased rates of self-harm during the UK’s COVID-19 epoch.4 Data from electronic health records in UK general practice identified substantial reductions in recorded incident diagnoses of anxiety disorders, depression, and self-harm episodes during April 2020 compared to previous years.5 Although these rates had returned to expected levels in England by mid-September 2020, we do not yet know the impact of the subsequent stringent regional restrictions and two successive …