Suicide attempt risks among hotline callers with and without the coronavirus disease 2019 related psychological distress: a case-control study

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic profoundly impacts on mental health, yet it is still unclear whether COVID-19 distress makes people more vulnerable to suicidal behavior. The present study aims to examine the association between COVID-19 related psychological distress and risk for suicide attempt, and moderators of this association, among hotline callers. Methods This case-control study was conducted at the largest psychological support hotline in China. Hotline callers who sought help for psychological distress and reported whether or not they attempted suicide in the last 2 weeks (recent suicide attempt) were analyzed. The primary predictor of recent suicide attempt was the presence or absence of COVID-19 related psychological distress. Demographic variables and common risk and protective factors for suicidal behavior were also studied. Callers with COVID-19 related distress (COVID-19 callers) and those without such distress (non-COVID-19 callers) were compared on these variables. Recent suicide attempt was regressed on COVID-19 related distress and the other variables, and significant interaction terms of aforementioned predictors by COVID-19 related distress, to identify variables that moderate the association of COVID-19 related distress and recent suicide attempt. Results Among 7337 included callers, there were 1252 COVID-19 callers (17.1%) and 6085 non-COVID-19 callers (82.9%). The COVID-19 callers were less likely to report recent suicide attempt (n = 73, 5.8%) than the non-COVID-19 callers (n = 498, 8.2%, P = 0.005). The COVID-19 callers were also less likely to have high scores on depressive symptoms (22.6% vs 26.3%, P < 0.001) and psychological distress (19.5% vs 27.3%, P < 0.001), and were more likely to have high hopefulness scores (46.5% vs 38.0%, P < 0.001). Tests of moderating effects showed that acute life events were associated with one-half lower risk (P = 0.021), and a trend that suicide attempt history was associated with two-thirds greater risk (P = 0.063) for recent suicide attempt, among COVID-19 callers than non-COVID-19 callers. Conclusions The COVID-19 calls are from individuals with lower suicide-related risk compared to more typical callers. Acute stressful life events provided a key context for suicide attempt in non-COVID-19 callers, i.e., more typical calls.

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

“…China (n = 6 studies) and Thailand (n = 1) were the only countries with eligible publications for the East Asia and Pacific region [16][17][18][19][20][21][22]; two studies from China [18,21] were rated as being of reasonable quality. There were no studies specifically from the Pacific region.…”

“…The remaining four studies from China investigated self-harm [16,[18][19][20], with one study explicitly reporting on non-suicidal self-injury (NSSI) [20]. This before and after study of 1241 Chinese primary school students reported a doubling in risk of self-harm (OR 2.20 95% CI PLOS GLOBAL PUBLIC HEALTH 1.56, 3.10) in the pandemic compared with a pre-pandemic period 6 months earlier [20].…”

“…One study reported on the volume of crisis hotline calls during the early months of the pandemic (Jan-Jul 2020), with callers asked whether they had self-harmed in the 2 weeks prior to the call [18]. The calls were then categorised into COVID-19 related calls versus non-COVID-19 calls.…”

Suicide Attempts Assisted By Firefighters According to Traumatic Brain Injury

“…In Japan, the percentage of emergency dispatches related to suicide attempts increased significantly in 2020 compared with the previous 2 years (Habu et al, 2021 ). In China, a study of the calls made to the largest suicide hotline suggests that COVID-19-related distress led to an increase in calls among individuals who are generally at lower risk of suicide attempt than those who normally call (Tong et al, 2021 ). A cross-sectional study of nearly 190 million emergency department visits carried out in the United States found that visit rates for suicide attempt were higher from mid-March through October 2020, during the COVID-19 pandemic, compared with the same period in 2019 (Holland et al, 2021 ).…”

Understanding cultural factors in mental health during the COVID-19 pandemic: when collectivism meets a tight culture

“…COVID-19 has led to the worsening of mental disorders, such as depression and anxiety, because of its unpredictable and rapidly increasing caseload (Nguyen et al, 2020;Xiong et al, 2020). Some researchers have indicated that mental health problems (e.g., depression) could lead to suicidal behaviours during the COVID-19 outbreak (Tong et al, 2021). Therefore, in addition to controlling the number of and rescuing patients with infection, people's mental health should also be considered.…”