Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries.
Journal: The lancet. Psychiatry
Volume: 8
Issue: 7
Year of Publication: 2021
Affiliated Institutions:
Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia. Electronic address: j.pirkis@unimelb.edu.au.
Swansea University Medical School, Swansea, UK.
Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia.
Ministry of Public Health, Department of Health Promotion, Quito, Ecuador.
National Confidential Inquiry into Suicide and Safety in Mental Health, University of Manchester, Manchester, UK.
School of Public Health, National Suicide Research Foundation, University College Cork, Cork, Ireland; Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia.
Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.
Working Group on Prevention of Suicide and Depression at Public Health Council, Warsaw, Poland; Department of Psychiatry, Blekinge Hospital, Karlshamn, Sweden.
Botucatu Medical School, Universidade Estadual Paulista, São Paulo, Brazil.
Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, Mexico.
Department for Medical Ethics, University Psychiatric Hospital Vrapče, School of Medicine, University of Zagreb, Zagreb, Croatia; Department for Psychiatry, University Psychiatric Hospital Vrapče, School of Medicine, University of Zagreb, Zagreb, Croatia.
University of Rochester Medical Center, Rochester, NY, USA.
Region Friuli Venezia Giulia, Central Health Directorate, Outpatient and Inpatient Care Service, Trieste, Italy; Department of Medicine, University of Udine, Trieste, Italy.
Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.
Thames Valley Local Criminal Justice Board, Bicester, UK.
Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia.
Department for Medical Ethics, University Psychiatric Hospital Vrapče, School of Medicine, University of Zagreb, Zagreb, Croatia.
Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria.
Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, USA.
Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Coroners Court of Victoria, Melbourne, VIC, Australia.
Danish Research Institute for Suicide Prevention, Copenhagen, Denmark; Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA; Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia.
Brigham and Women's Hospital Department of Emergency Medicine, Boston, MA, USA.
School of Population Health, University of Auckland, Auckland, New Zealand.
Magistrates Court of Tasmania (Coronial Division), Hobart, TAS, Australia.
Bureau of Vital Records and Statistics, Louisiana Office of Public Health, Baton Rouge, LA, USA.
Ministry of Public Health, Undersecretary of Health Services, Quito, Ecuador.
Research Department, Suicide Prevention, Amsterdam, Netherlands.
Departments of Psychiatry and Epidemiology, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, USA.
Centre for Suicide Research, University of Oxford, Oxford, UK.
Louisiana Department of Health, Baton Rouge, LA, USA.
Centre for Mental Health and Safety and National Institute for Health Research Patient Safety Translational Research Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
Department of Psychiatry, Aga Khan University, Karachi, Pakistan.
KU Leuven, Center for Contextual Psychiatry, Leuven, Belgium.
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
World Health Organization, Country Office for Nepal, Kathmandu, Nepal.
Karolinska Institutet, Stockholm, Sweden.
Bekhterev National Medical Research Center of Psychiatry and Neurology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia.
Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
School of Psychology, University of Nottingham, Nottingham, UK.
Mental Health Centre Copenhagen, Copenhagen, Denmark.
Department of Psychiatry and Psychotherapy, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria.
Suicidal Behaviour Research Lab, University of Glasgow, Glasgow, UK.
Preventing Deaths from Poisoning Research Group, University of Edinburgh, Edinburgh, UK.
Suicide Research and Prevention Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Departments of Psychiatry and Epidemiology, Columbia University, New York, NY, USA.
Usher Institute, University of Edinburgh, Edinburgh, UK.
Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany.
Psychosocial Services in Vienna, Vienna, Austria.
National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany.
Department of Psychiatry and Psychotherapeutic Medicine, Landeskrankenhaus Villach, Villach, Austria.
Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
Department of Borderline Disorders and Psychotherapy, Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg State University, Saint Petersburg, Russia.
Department of Psychiatry, Health Authority Frankfurt am Main, Frankfurt, Germany.
Department of Addictive Disorders, Psychiatry and Psychotherapy, LVR-Klinik Köln, Cologne, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Frankfurt am Main, Germany.
Organizational-Scientific Department, Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russia.
Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK.
Waseda University, Faculty of Political Science and Economics, Tokyo, Japan.
Sneha-Suicide Prevention Centre, Voluntary Health Services, Chennai, India.
Centre for Mental Health and Safety and National Institute for Health Research Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.
Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
Department of Psychiatry, Sackler School of Medicine, Tel Aviv University and Geha Mental Health Center, Tel Aviv, Israel; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, USA.
National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK.
Abstract summary
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.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).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]).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.None.
Authors & Co-authors:
Pirkis Jane J
John Ann A
Shin Sangsoo S
DelPozo-Banos Marcos M
Arya Vikas V
Analuisa-Aguilar Pablo P
Appleby Louis L
Arensman Ella E
Bantjes Jason J
Baran Anna A
Bertolote Jose M JM
Borges Guilherme G
Brečić Petrana P
Caine Eric E
Castelpietra Giulio G
Chang Shu-Sen SS
Colchester David D
Crompton David D
Curkovic Marko M
Deisenhammer Eberhard A EA
Du Chengan C
Dwyer Jeremy J
Erlangsen Annette A
Faust Jeremy S JS
Fortune Sarah S
Garrett Andrew A
George Devin D
Gerstner Rebekka R
Gilissen Renske R
Gould Madelyn M
Hawton Keith K
Kanter Joseph J
Kapur Navneet N
Khan Murad M
Kirtley Olivia J OJ
Knipe Duleeka D
Kolves Kairi K
Leske Stuart S
Marahatta Kedar K
Mittendorfer-Rutz Ellenor E
Neznanov Nikolay N
Niederkrotenthaler Thomas T
Nielsen Emma E
Nordentoft Merete M
Oberlerchner Herwig H
O'Connor Rory C RC
Pearson Melissa M
Phillips Michael R MR
Platt Steve S
Plener Paul L PL
Psota Georg G
Qin Ping P
Radeloff Daniel D
Rados Christa C
Reif Andreas A
Reif-Leonhard Christine C
Rozanov Vsevolod V
Schlang Christiane C
Schneider Barbara B
Semenova Natalia N
Sinyor Mark M
Townsend Ellen E
Ueda Michiko M
Vijayakumar Lakshmi L
Webb Roger T RT
Weerasinghe Manjula M
Zalsman Gil G
Gunnell David D
Spittal Matthew J MJ
Study Outcome
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