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

Efstathiou, Vasiliki; Stefanou, Maria‐Ioanna; Siafakas, Nikolaos; Makris, Michaël; Tsivgoulis, Georgios; Zoumpourlis, Vassilios; Spandidos, Demetrios A.; Smyrnis, Nikolaos; Rizos, Emmanouil

doi:10.3892/etm.2021.11030

Cited by 37 publications

(43 citation statements)

References 86 publications

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“…Though mild symptoms predominated, moderate and severe depression were still more prevalent in infected patients than general society, in which the prevalence of moderate and severe depression is 5.1 percent and 1.5 percent, respectively. However, suicidality has not been shown to have necessarily increased during this pandemic, with a number of studies even finding instead an apparent decrease in the frequency of suicide attempts and self-harm [101].…”

Section: Depression Anxiety and Sleep Disordersmentioning

confidence: 99%

Neurological Sequelae of COVID-19

Ahmad¹,

Feigen²,

Vazquez³

et al. 2022

J. Integr. Neurosci.

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Background: Though primarily a pulmonary disease, Coronavirus disease 2019 caused by the SARS-CoV-2 virus can generate devastating disease states that affect multiple organ systems including the central nervous system (CNS). The various neurological disorders associated with COVID-19 range in severity from mild symptoms such as headache, or myalgias to more severe symptoms such as stroke, psychosis, and anosmia. While some of the COVID-19 associated neurological complications are mild and reversible, a significant number of patients suffer from stroke. Studies have shown that COVID-19 infection triggers a wave of inflammatory cytokines that induce endothelial cell dysfunction and generate coagulopathy that increases the risk of stroke or thromboses. Inflammation of the endothelium following infection may also destabilize atherosclerotic plaque and induce thrombotic stroke. Although uncommon, there have also been reports of hemorrhagic stroke associated with COVID-19. The proposed mechanisms include a blood pressure increase caused by infection leading to a reduction in angiotensin converting enzyme-2 (ACE-2) levels that results in an imbalance of the renin-angiotensin system ultimately manifesting inflammation and vasoconstriction. Coagulopathy, as demonstrated by elevated prothrombin time (PT), has also been posited as a factor contributing to hemorrhagics stroke in patients with COVID-19. Other neurological conditions associated with COVID-19 include encephalopathy, anosmia, encephalitis, psychosis, brain fog, headache, depression, and anxiety. Though there are several hypotheses reported in the literature, a unifying pathophysiological mechanism of many of these disorders remains unclear. Pulmonary dysfunction leading to poor oxygenation of the brain may explain encephalopathy and other disorders in COVID-19 patients. Alternatively, a direct invasion of the CNS by the virus or breach of the blood-brain barrier by the systemic cytokines released during infection may be responsible for these conditions. Notwithstanding, the relationship between the inflammatory cytokine levels and conditions such as depression and anxiety is contradictory and perhaps the social isolation during the pandemic may in part be a contributing factor to some of the reported CNS disorders. Objective: In this article, we review the current literature pertaining to some of the most significant and common neurological disorders such as ischemic and hemorrhagic stroke, encephalopathy, encephalitis, brain fog, Long COVID, headache, Guillain-Barre syndrome, depression, anxiety, and sleep disorders in the setting of COVID-19. We summarize some of the most relevant literature to provide a better understanding of the mechanistic details regarding these disorders in order to help physicians monitor and treat patients for significant COVID-19 associated neurologic impairments. Methods: A literature review was carried out by the authors using PubMed with the search terms "COVID-19" and "Neurology", "Neurological Manifestations", "Neuropsychiatric ...

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Section: Depression Anxiety and Sleep Disordersmentioning

confidence: 99%

Neurological Sequelae of COVID-19

Ahmad¹,

Feigen²,

Vazquez³

et al. 2022

J. Integr. Neurosci.

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“…As rates of depression have increased over the course of the pandemic (Ettman et al, 2022), one of the potential risks that might accompany that rise would be suicidal behaviour and ideation. At first glance, suicidality is a concept that is deceptively simple to conceptualize in the context of COVID-19, but is actually composed of multiple distinct facets including suicidal ideation (thoughts), suicide attempts, and completed suicides (Dubé et al, 2021;Efstathiou et al, 2022;Moutier, 2021). An international study conducted by Pirkis et al (2020) with over 20 countries examined suicide rates in the early months of the COVID-19 pandemic and found that there was no increase in suicide rates observed.…”

Section: Emerging Evidencementioning

confidence: 99%

Resilience and Wellbeing Strategies for Pandemic Fatigue in Times of Covid-19

Zarowsky

Rashid

2022

Int J Appl Posit Psychol

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The COVID-19 pandemic is truly one of the greatest collective health crises in history which have altered our life and living. For years, people have felt fatigued from following public health directives such as social distancing, wearing masks, washing hands frequently, and working or studying remotely without in-person interactions. In this paper, we explore strategies for resilience and wellbeing which can mitigate pandemic-caused stress and behavioural fatigue. We start with individual level strategies including reworking stress appraisals, the importance of psychological flexibility, reducing loneliness through adaptive online platform use, optimizing familial relationships when living in close quarters for a prolonged period, reducing symptoms of burnout and using adaptive distractions, using specific evidence-based resilience strategies. We discuss specific considerations which tap on our shared identities and shared responsibilities which can enhance a sense of community, especially for individuals from marginalized backgrounds and how suicide risks can be minimized.

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“…Known risk factors for suicide in older individuals include depression ( 4 ), social isolation ( 5 ), alcoholism ( 6 ), retirement ( 7 ), and medical illness/physical disability ( 8 ). These risk factors have become even more important during the COVID-19 pandemic, which has disproportionately affected the elderly ( 9 , 10 ). New approaches to suicide research are attempting to develop integrated models that incorporate the myriad of complex neurobiological, psychological, and social factors that may contribute to suicidal behavior in both younger and older populations ( 11 ).…”

Section: Descriptionmentioning

confidence: 99%

Completed Suicide by Firearm in an Individual With the Agrammatic Variant of Primary Progressive Aphasia: Case Report

Patel¹,

Andersen²,

Smith³

et al. 2022

Front. Neurol.

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The agrammatic or nonfluent variant of Primary Progressive Aphasia (nfvPPA) is a form of Frontotemporal Dementia (FTD) that is characterized by progressive language dysfunction, poor sentence construction, and low verbal fluency. Individuals with nfvPPA have intact insight into their decline, which may manifest as frustration and hopelessness, and show signs of impulsivity and disinhibition. Little is known about suicide risk in this patient population. Here we describe a case of an 84 year-old male with nfvPPA who, over the course of his care, experienced a decline in language and motoric functioning which coincided with increasing irritability and impulsivity. Despite this significant decline, he denied depressive symptoms or showed any suicidal tendencies, and he seemed to be looking forward to future events. His suicide, committed with a handgun during what appeared to be a rather innocuous trip to the garage, came as a significant shock to his spouse, family, and his clinical care team. To our knowledge, this is the first reported case of completed suicide in a patient with the nfvPPA subtype of FTD. Though this patient demonstrated demographic risk factors for suicide (advanced age, retired military veteran with easy access to firearms) there is a lack of data regarding how FTD may have contributed. Retained insight especially seems to be a risk factor for suicide across all forms of dementia. Impulsivity may be key when considering suicidality amongst FTD patients. Additionally, this case demonstrates the importance of addressing gun safety as there are few guidelines around gun ownership in this patient population.

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

Cited by 37 publications

References 86 publications

Neurological Sequelae of COVID-19

Neurological Sequelae of COVID-19

Resilience and Wellbeing Strategies for Pandemic Fatigue in Times of Covid-19

Completed Suicide by Firearm in an Individual With the Agrammatic Variant of Primary Progressive Aphasia: Case Report

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