TY - JOUR

T1 - Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries

AU - Pirkis, Jane

AU - John, Ann

AU - Shin, Sangsoo

AU - DelPozo-Banos, Marcos

AU - Arya, Vikas

AU - Analuisa-Aguilar, Pablo

AU - Appleby, Louis

AU - Arensman, Ella

AU - Bantjes, Jason

AU - Baran, Anna

AU - M Bertolote, Jose

AU - Borges, Guilherme

AU - Brečić, Petrana

AU - Caine, Eric

AU - Castelpietra, Giulio

AU - Chang, Shu-Sen

AU - Colchester, David

AU - Crompton, David

AU - Curkovic, Marko

AU - Deisenhammer, Eberhard A Deisenhammer

AU - Du, Chengan

AU - Dwyer, Jeremy

AU - Erlangsen, Annette

AU - Faust, Jeremy

AU - Fortune, Sarah

AU - Garrett, Andrew

AU - George, Devin

AU - Gerstner, Rebekka

AU - Gilissen, Renske

AU - Gould, Madelyn

AU - Hawton, Keith

AU - Kanter, Joseph

AU - Kapur, Navneet

AU - Khan, Murad

AU - Kirtley, Olivia

AU - Knipe, Duleeka

AU - Kolves, Kairi

AU - Leske, Stuart

AU - Marahatta, Kedar

AU - Mittendorfer-Rutz, Ellenor

AU - Незнанов, Николай Григорьевич

AU - Niederkrotenthaler, Thomas

AU - Nielsen, Emma

AU - Nordentoft, Merete

AU - Oberlerchner, Herwig

AU - O'Connor, Rory

AU - Pearson, Melissa

AU - Phillips, Michael

AU - Platt, Steve

AU - Plener, Paul

AU - Psota, Georg

AU - Qin, Ping

AU - Radeloff, Daniel

AU - Rados, Christa

AU - Reif, Andreas

AU - Розанов, Всеволод

AU - Schlang, Christiane

AU - Schneider, Barbara

AU - Семенова, Наталия Владимировна

AU - Sinyor, Mark

AU - Townsend, Ellen

AU - Ueda, Michiko

AU - Vijayakumar, Lakshmi

AU - Webb, Roger

AU - Weerasinghe, Manjula

AU - Zalsman, Gil

AU - Gunnell, David

AU - Spittal, Matthew

N1 - Publisher Copyright: © 2021 Elsevier Ltd

PY - 2021/7

Y1 - 2021/7

N2 - 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. Weaimed 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 theofficial 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 anattempt 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 beincluded 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 acountry, 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 basedon 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.

AB - 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. Weaimed 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 theofficial 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 anattempt 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 beincluded 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 acountry, 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 basedon 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.

UR - http://www.scopus.com/inward/record.url?scp=85104991133&partnerID=8YFLogxK

U2 - https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00091-2/fulltext

DO - https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00091-2/fulltext

M3 - Article

VL - 8

SP - 579

EP - 588

JO - The Lancet Psychiatry

JF - The Lancet Psychiatry

SN - 2215-0366

IS - 7

ER -