Suicide and self-harm in low- and middle- income countries during the COVID-19 pandemic: A systematic review

Abstract

There is widespread concern over the potential impact of the COVID-19 pandemic on suicide and self-harm globally, particularly in low- and middle-income countries (LMIC) where the burden of these behaviours is greatest. We synthesised the evidence from the published literature on the impact of the pandemic on suicide and self-harm in LMIC. This review is nested within a living systematic review (PROSPERO ID CRD42020183326) that continuously identifies published evidence (all languages) through a comprehensive automated search of multiple databases (PubMed; Scopus; medRxiv, PsyArXiv; SocArXiv; bioRxiv; the WHO COVID-19 database; and the COVID-19 Open Research Dataset by Semantic Scholar (up to 11/2020), including data from Microsoft Academic, Elsevier, arXiv and PubMed Central.) All articles identified by the 4th August 2021 were screened. Papers reporting on data from a LMIC and presenting evidence on the impact of the pandemic on suicide or self-harm were included. Methodological quality was assessed using an appropriate tool, and a narrative synthesis presented. A total of 22 studies from LMIC were identified representing data from 12 countries. There was an absence of data from Africa, the Pacific, and the Caribbean. The reviewed studies mostly report on the early months of COVID-19 and were generally methodologically poor. Few studies directly assessed the impact of the pandemic. The most robust evidence, from time-series studies, indicate either a reduction or no change in suicide and self-harm behaviour. As LMIC continue to experience repeated waves of the virus and increased associated mortality, against a backdrop of vaccine inaccessibility and limited welfare support, continued efforts are needed to track the indirect impact of the pandemic on suicide and self-harm in these countries.

The Impact of the COVID-19 Pandemic and Lockdowns on Self-Poisoning and Suicide in Sri Lanka: An Interrupted Time Series Analysis

“…Despite concerns, available data internationally suggest that there has been no increase in the rates of suicide during the pandemic, and our findings from Sri Lanka are in keeping with this [3,6]. During the pandemic period of 2019-2021, admissions for self-poisoning showed an overall decreasing pattern, with temporary step reductions during the periods of lockdown.…”

“…This is one of the very few studies investigating the impact of the pandemic on suicide and self-harm in populations living in LMICs [6] and presented data on both self-harm and suicide. It includes data from several years and is able, therefore, to model underlying trends.…”

“…Social isolation, financial strain, fears of contracting COVID-19, and the illness itself have all been linked to increased symptoms of anxiety, depression, and suicidal ideation in the community [1,2]. Yet the available evidence indicates that suicide rates did not increase during the early part of the pandemic [2][3][4][5][6] in most high-income countries. Initial evidence from Sri Lanka found that the number of people presenting to hospital due to self-harm by self-poisoning in the first five months of the pandemic was lower when compared to expected trends [7].…”

Suicide before and during the COVID-19 Pandemic: A Systematic Review with Meta-Analysis

“…A few primary studies found an overall increase in the prevalence of suicidal ideation and attempts, and in the rate of death by suicide during the pandemic period compared with the pre-pandemic period [ 8 , 9 , 10 ], while other studies found a decreased trend [ 11 , 12 , 13 ], and some reported an overall stable trend [ 14 , 15 , 16 ]. Suicide studies during the pandemic tend to be methodologically poor [ 17 ], and high-quality evidence from an interrupted time-series study covering 33 countries showed no significant increases in suicide death in most countries/regions [ 18 ]. After synthesizing three studies, Prati et al [ 19 ] found that the effect of the COVID-19 lockdown on suicide risk among the general population was not significant.…”

Digital Mental Health Service Engagement Changes during Covid-19 in Children and Young People across the UK: Presenting Concerns, Service Activity, and Access by Gender, Ethnicity, and Deprivation

“…There was evidence of trend line differences between the two periods when the increase in contact rate was compared. Other mental health services in the UK showed a reduction of service utilization during the pandemic too, along with a stable number of admissions before and during Covid-19 35,36 . One possible explanation for the change in user behaviour in digital service is that the need for support from young people peaks at the start of the pandemic.…”