Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries

Jane Pirkis*, Ann John, Sangsoo Shin, Marcos DelPozo-Banos, Vikas Arya, Pablo Analuisa-Aguilar, Louis Appleby, Ella Arensman, Jason Bantjes, Anna Baran, Jose M. Bertolote, Guilherme Borges, Petrana Brečić, Eric Caine, Giulio Castelpietra, Shu Sen Chang, David Colchester, David Crompton, Marko Curkovic, Eberhard A. DeisenhammerChengan Du, Jeremy Dwyer, Annette Erlangsen, Jeremy S. Faust, Sarah Fortune, Andrew Garrett, Devin George, Rebekka Gerstner, Renske Gilissen, Madelyn Gould, Keith Hawton, Joseph Kanter, Navneet Kapur, Murad Khan, Olivia J. Kirtley, Duleeka Knipe, Kairi Kolves, Stuart Leske, Kedar Marahatta, Ellenor Mittendorfer-Rutz, Nikolay Neznanov, Thomas Niederkrotenthaler, Emma Nielsen, Merete Nordentoft, Herwig Oberlerchner, Rory C. O'Connor, Melissa Pearson, Michael R. Phillips, Steve Platt, Paul L. Plener, Georg Psota, Ping Qin, Daniel Radeloff, Christa Rados, Andreas Reif, Christine Reif-Leonhard, Vsevolod Rozanov, Christiane Schlang, Barbara Schneider, Natalia Semenova, Mark Sinyor, Ellen Townsend, Michiko Ueda, Lakshmi Vijayakumar, Roger T. Webb, Manjula Weerasinghe, Gil Zalsman, David Gunnell, Matthew J. Spittal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)579-588
Number of pages10
JournalThe Lancet Psychiatry
Volume8
Issue number7
DOIs
StatePublished - Jul 2021
Externally publishedYes

Funding

FundersFunder number
Chukwudi Okolie and Dana Dekel
Coroners Court of Queensland
Greater Manchester Mental Health NHS Foundation Trust
ICSPRC
MQ Mental Health Research CharityMQBF/3 ADP
Mindstep Foundation
NHS Health Scotland/Public Health Scotland
Queensland Mental Health Commission
Scottish Association for Mental Health
American Foundation for Suicide PreventionIIG-0-002-17
Queensland Health
Wellcome Trust
International Association for Suicide Prevention
Health and Care Research Wales
Scottish Government
University Hospitals Bristol NHS Foundation Trust
Royal Perth Hospital Medical Research Foundation
Elizabeth Blackwell Institute for Health Research, University of Bristol
Medical Research CouncilMC_PC_17211
National Institute for Health and Care Research
University of Manchester
University of Bristol
Australian Research CouncilFT180100075
National Health and Medical Research CouncilGNT1173126, MQBF/3
Swansea University
Health Research BoardIRRL-2015-1586
National Natural Science Foundation of China81371502
Vienna Science and Technology FundCOV20-027
Fonds Wetenschappelijk OnderzoekFWO 1257821N
University of Toronto
Medizinische Universität Wien
Erasmus+2019-1-SE01-KA203-060571
NIHR Greater Manchester Patient Safety Translational Research Centre

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