Dataset Information

Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries.

ABSTRACT:

Background

Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally.

Methods

We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation.

Findings

We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well.

Interpretation

Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue.

Funding

None.

SUBMITTER: Pirkis J

PROVIDER: S-EPMC9344880 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries.

Pirkis Jane J Gunnell David D Shin Sangsoo S Del Pozo-Banos Marcos M Arya Vikas V Aguilar Pablo Analuisa PA Appleby Louis L Arafat S M Yasir SMY Arensman Ella E Ayuso-Mateos Jose Luis JL Balhara Yatan Pal Singh YPS Bantjes Jason J Baran Anna A Behera Chittaranjan C Bertolote Jose J Borges Guilherme G Bray Michael M Brečić Petrana P Caine Eric E Calati Raffaella R Carli Vladimir V Castelpietra Giulio G Chan Lai Fong LF Chang Shu-Sen SS Colchester David D Coss-Guzmán Maria M Crompton David D Ćurković Marko M Dandona Rakhi R De Jaegere Eva E De Leo Diego D Deisenhammer Eberhard A EA Dwyer Jeremy J Erlangsen Annette A Faust Jeremy S JS Fornaro Michele M Fortune Sarah S Garrett Andrew A Gentile Guendalina G Gerstner Rebekka R Gilissen Renske R Gould Madelyn M Gupta Sudhir Kumar SK Hawton Keith K Holz Franziska F Kamenshchikov Iurii I Kapur Navneet N Kasal Alexandr A Khan Murad M Kirtley Olivia J OJ Knipe Duleeka D Kõlves Kairi K Kölzer Sarah C SC Krivda Hryhorii H Leske Stuart S Madeddu Fabio F Marshall Andrew A Memon Anjum A Mittendorfer-Rutz Ellenor E Nestadt Paul P Neznanov Nikolay N Niederkrotenthaler Thomas T Nielsen Emma E Nordentoft Merete M Oberlerchner Herwig H O'Connor Rory C RC Papsdorf Rainer R Partonen Timo T Phillips Michael R MR Platt Steve S Portzky Gwendolyn G Psota Georg G Qin Ping P Radeloff Daniel D Reif Andreas A Reif-Leonhard Christine C Rezaeian Mohsen M Román-Vázquez Nayda N Roskar Saska S Rozanov Vsevolod V Sara Grant G Scavacini Karen K Schneider Barbara B Semenova Natalia N Sinyor Mark M Tambuzzi Stefano S Townsend Ellen E Ueda Michiko M Wasserman Danuta D Webb Roger T RT Winkler Petr P Yip Paul S F PSF Zalsman Gil G Zoja Riccardo R John Ann A Spittal Matthew J MJ

EClinicalMedicine 20220802

<h4>Background</h4>Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally.<h4>Methods</h4>We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and ...[more]

PMID: 35935344

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Project description:BackgroundThe 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.MethodsWe 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).FindingsWe 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]).InterpretationThis 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.FundingNone.

Project description:Background From 2010 to 2019, suicide mortality fell steadily and substantially in Hungary: the declining trend remained stable, and the suicide rate decreased by more than one-third which was remarkable even from an international perspective. However, despite the declining trend, regional inequalities have always characterised the distribution of suicide mortality in Hungary. Following these favourable trends, COVID-19 appeared in Hungary on the 4th of March 2020 which might lead to an increase in suicides. We aimed to investigate this hypothesis in Hungary by gender, age, educational attainment, and region, as well. Methods To test whether the pandemic changed the declining trend of Hungarian suicide rates, the observed number of suicides during March–December 2020 (pre-vaccination period) was compared with the expected numbers (without the appearance of COVID-19). An interrupted time-series analysis was conducted by negative binomial regression using monthly data from January 2010 to February 2020 (pre-pandemic period). Results Suicide mortality increased significantly compared to the trend during the pre-pandemic period: overall (by 16.7%), among males (18.5%), in the age group 35–49 years (32.8%), and among vocational school graduates (26.1%). Additionally, significant growths in suicide rates were detected in the two regions (Central Hungary and Central Transdanubia) with the lowest COVID mortality rates (by 27.3% and 22.2%, respectively). Conclusions Our study revealed reversed trend in suicide mortality during the pre-vaccination period compared to the pre-pandemic period in Hungary. There were significant differences in the pattern of suicide rates by gender, age group, educational attainment, and region during the pre-vaccination period in Hungary, which might be attributed to the socio-economic effects of the COVID-19 pandemic. These findings could prove useful in preventive strategies as the identification of groups at higher risk may be important for suicide prevention; however, further investigations are needed to explore the reasons. Supplementary Information The online version contains supplementary material available at 10.1186/s12888-022-04322-2.

Project description:BackgroundPesticide bans and regulatory restrictions have been shown to be effective strategies for preventing suicide in several countries. Suicide and suicide by pesticides have decreased significantly in China over the past two decades. However, whether the reduction was associated with pesticide regulation is unknown.MethodsThe monthly data on suicide and suicide by pesticide from 2006 to 2018 were obtained from China's Disease Surveillance Point (DSP) system. Information on China's pesticide regulations since 1970 was obtained from Pesticide Action Network International (PAN International), Joint Meeting on Pesticide Management Highly Hazardous Pesticides (JMPM HHP) lists, the website of the Ministry of Agriculture of China, Pesticide Information Network of China, and the Wan Fang database. Change point detection and policy analysis were combined to identify the time of any trend change breakpoint of suicide and suicide by pesticide. Interrupted time series analysis was used to investigate the pre- and post-breakpoint trends of monthly standardized rates in suicide and suicide by pesticide.ResultsThe standardized pesticide suicide rate decreased by 60.5% from 6.50 in 2006 to 2.56 per 100,000 in 2018. Larger declines were evident among people in urban areas (67.3%), female individuals (63.5%), and people aged 15-44 years (68.1%). The effect of policies banning highly hazardous organophosphorus pesticides (HHOP) [rate ratio (RR) = 0.993, 95% CIs (0.991-0.994)] in December 2008 and stopping domestic sales and use of paraquat aqueous solution (RR = 0.992, 95% CIs: 0.990-0.994) in July 2016 were more pronounced than regulating the paraquat-related products (RR = 1.003, 95% CIs: 1.002-1.004) in April 2012.ConclusionDeclines in suicide by pesticide in China occurred contemporaneously with regulatory bans and restrictions implemented on several pesticides, particularly in urban areas, among female individuals, and the relatively low age profile. These findings indicate the potential influence of these bans on trends of suicide by pesticides.

Project description:ObjectivesTo complete a 30-year interrupted time-series analysis of the impact of austerity-related and prosperity-related events on the occurrence of suicide across Greece.SettingGreece from 1 January 1983 to 31 December 2012.ParticipantsA total of 11 505 suicides, 9079 by men and 2426 by women, occurring in Greece over the study period.Primary and secondary outcomesNational data from the Hellenic Statistical Authority assembled as 360 monthly counts of: all suicides, male suicides, female suicides and all suicides plus potentially misclassified suicides.ResultsIn 30 years, the highest months of suicide in Greece occurred in 2012. The passage of new austerity measures in June 2011 marked the beginning of significant, abrupt and sustained increases in total suicides (+35.7%, p<0.001) and male suicides (+18.5%, p<0.01). Sensitivity analyses that figured in undercounting of suicides also found a significant, abrupt and sustained increase in June 2011 (+20.5%, p<0.001). Suicides by men in Greece also underwent a significant, abrupt and sustained increase in October 2008 when the Greek recession began (+13.1%, p<0.01), and an abrupt but temporary increase in April 2012 following a public suicide committed in response to austerity conditions (+29.7%, p<0.05). Suicides by women in Greece also underwent an abrupt and sustained increase in May 2011 following austerity-related events (+35.8%, p<0.05). One prosperity-related event, the January 2002 launch of the Euro in Greece, marked an abrupt but temporary decrease in male suicides (-27.1%, p<0.05).ConclusionsThis is the first multidecade, national analysis of suicide in Greece using monthly data. Select austerity-related events in Greece corresponded to statistically significant increases for suicides overall, as well as for suicides among men and women. The consideration of future austerity measures should give greater weight to the unintended mental health consequences that may follow and the public messaging of these policies and related events.

Dataset Information

Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries.

Background

Methods

Findings

Interpretation

Funding

Publications

Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries.

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