COVID-19 Suicide Survivors—A Hidden Grieving Population

Abstract

Present time has been dominated by the COVID-19 pandemic. People are grieving several non-death related situations: the loss of a job, of a status, of a role, of their life. Restrictive measures and uncertainty about the future makes individuals vulnerable to feelings of hopelessness and helplessness. Mental health support has been hindered and teams are reinventing themselves to reach people in need. Nevertheless, decompensation of previous psychiatric disorders, increasing levels of depression and anxiety, economical handicaps and fear of the infection, are prompting several cases of COVID-19 related suicides worldwide. Every suicide affects between 5 and 80 individuals, which are known as suicide survivors. Suicide grief is particularly challenging, with rates of complicated grief as high as 40%. Suicide survivors are at increased risk of developing depression, anxiety disorders and of suicidal behaviors. Moreover, feelings of guilt and shame, as well as social stigma, are major obstacles for them to reach form help. This article aims to review the existing literature on COVID-19 related suicides, complicated grief in suicide survivors and highlight modifiable risk factors for both conditions, as well as propose some public health measures to reduce the impact of the pandemic context on self-inflicted harm and its consequences on families, friends and the community. Obstacles to access to mental health support need to be overcome through the use of technology. Technicians should actively approach populations more vulnerable to develop suicidal ideation. Social media have the obligation to provide accurate an non-sensationalistic information. Families and friends should maintain social proximity, despite the need for physical distancing. When a suicide death occurs, police forces and health staff should be prepared to share the news with the family using an empathic and humane approach and providing psychological support. Funerals, memorials and other services should be held as much as possible. Closer contacts should be signalized and closely followed in order to detect the need for specific interventions. Help seeking behaviors should be promoted. Additionally, people should be educated on suicide and its impacts, in order to reduce stigma.

Gender Differences in Anxiety Among COVID-19 Inpatients Under Isolation: A Questionnaire Survey During the First and Second Waves of the COVID-19 Pandemic in Japan

“…One possible interpretation for the absence of significant improvement of the GHQ-28 and STAI scores in male subjects might be due to the lack of communication in male patients, which could have contributed to greater anxiety. Although the quantity of information on the virus and disease increased at T2, it has been suggested that COVID-19-related mental health problems such as suicides ( 22 ) and the complex grief of bereaved families may increase ( 23 ). The course of the pandemic is still unpredictable.…”

Suicidality and COVID‑19: Suicidal ideation, suicidal behaviors and completed suicides amidst the COVID‑19 pandemic (Review)

“…Worldwide, cases of individuals who died through suicide have been reported, mainly in the media, linking their deaths to the fear of COVID-19 infection, fear of transmitting SARS-CoV-2 to others, anxiety over COVID-19, fear of isolation due to imposed country pandemic-related lockdown and a lack of knowledge. Further triggers that have been identified for suicides related to the COVID-19 pandemic are xenophobia, COVID-19-related stigma and social boycott, financial insecurities and uncertainty concerning the future ( 73 , 74 ). In previous a review article on suicide reports, possible factors and predictors of COVID-19-related suicide were categorized according to ‘social isolation and distancing’, ‘worldwide lockdown creating economic recession’, ‘stress, anxiety and pressure in medical healthcare professionals’ and ‘social boycott and discrimination’ ( 73 ).…”

“…Moreover, it is worth noting, that each suicide may affect 5-80 individuals, including nuclear family members, relatives, friends and acquaintances, which are known as ‘suicide survivors’. Suicide survivors face an increased risk of prolonged or persistent complex bereavement (with rates reaching up to 40%), depression, anxiety and substance-abuse disorders, as well as suicidal behaviors, while social stigma and feelings of shame may discourage them from seeking mental health-related assistance ( 74 , 86 ). The suicide of a ‘significant other’ amidst the COVID-19 pandemic is even more challenging for suicide survivors, who are already struggling to adjust to new conditions and are likely experiencing psychological difficulties.…”

“…The suicide of a ‘significant other’ amidst the COVID-19 pandemic is even more challenging for suicide survivors, who are already struggling to adjust to new conditions and are likely experiencing psychological difficulties. Feelings of confusion, doubt, non-acceptance, hopelessness, helplessness and stigmatization may emerge, while the fact that death and grief rituals, that would facilitate adjustment to bereavement and a healthy adaptation to the loss, have either been suspended or modified due to pandemic-related regulations, rendering it even harder for suicide survivors to mourn their loved ones and ‘say their goodbyes’ ( 74 , 87 ).…”

COVID-19 Fear, Resilience, Social Support, Anxiety, and Suicide among College Students in Spain

“…The high degree of exposure to the disease COVID-19 and the social and economic effects associated with the pandemic may result in some experiencing a worsening of these psychiatric characteristics (particularly anxiety, depression, and stress), with possible adverse effects on suicidal behaviors [16,17]. The death of close family members and friends, the stigma towards infected people and their families, isolation, physical distancing, changes caused by the digitalization of educational and work activities, unemployment and economic insecurity, information overload, or fear about the lack of social health resources are all critical risk factors that have contributed to the increase in ideation and suicide during the pandemic [18].…”