Suicide, self-harm and thoughts of suicide or self-harm in infectious disease epidemics: a systematic review and meta-analysis

Abstract

Aims Suicide accounts for 2.2% of all years of life lost worldwide. We aimed to establish whether infectious epidemics are associated with any changes in the incidence of suicide or the period prevalence of self-harm, or thoughts of suicide or self-harm, with a secondary objective of establishing the frequency of these outcomes. Methods In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO and AMED were searched from inception to 9 September 2020. Studies of infectious epidemics reporting outcomes of (a) death by suicide, (b) self-harm or (c) thoughts of suicide or self-harm were identified. A random-effects model meta-analysis for the period prevalence of thoughts of suicide or self-harm was conducted. Results In total, 1354 studies were screened with 57 meeting eligibility criteria, of which 7 described death by suicide, 9 by self-harm, and 45 thoughts of suicide or self-harm. The observation period ranged from 1910 to 2020 and included epidemics of Spanish Flu, severe acute respiratory syndrome, human monkeypox, Ebola virus disease and coronavirus disease 2019 (COVID-19). Regarding death by suicide, data with a clear longitudinal comparison group were available for only two epidemics: SARS in Hong Kong, finding an increase in suicides among the elderly, and COVID-19 in Japan, finding no change in suicides among children and adolescents. In terms of self-harm, five studies examined emergency department attendances in epidemic and non-epidemic periods, of which four found no difference and one showed a reduction during the epidemic. In studies of thoughts of suicide or self-harm, one large survey showed a substantial increase in period prevalence compared to non-epidemic periods, but smaller studies showed no difference. As a secondary objective, a meta-analysis of thoughts of suicide and self-harm found that the pooled prevalence was 8.0% overall (95% confidence interval (CI) 5.2–12.0%; 14 820 of 99 238 cases in 24 studies) over a time period of between seven days and six months. The quality assessment found 42 studies were of low quality, nine of moderate quality and six of high quality. Conclusions There is little robust evidence on the association of infectious epidemics with suicide, self-harm and thoughts of suicide or self-harm. There was an increase in suicides among the elderly in Hong Kong during SARS and no change in suicides among young people in Japan during COVID-19, but it is unclear how far these findings may be generalised. The development of up-to-date self-harm and suicide statistics to monitor the effect of the current pandemic is an urgent priority.

Determining What Changed Japanese Suicide Mortality in 2020 Using Governmental Database

“…Several analytical studies that have utilised governmental suicide databases covering the entire population reported that the impact of the COVID-19 pandemic on suicide mortality in Japan may change over time and could have various different targets [ 11 , 12 ]. In Japan, suicide mortality was steadily decreasing between 2009 and 2019, but increasing in 2020: from 20,169 (males: 14,078, females: 6091) to 20,919 (males: 13,943, females: 6976) ( Figure 1 ) [ 13 ].…”

Reasons for Suicide During the COVID-19 Pandemic in Japan

“…Furthermore, although several studies have highlighted that the COVID-19 pandemic has heightened the risk of poor mental health, few have used national-level data to examine suicide in this period. A systematic review has warned about the low quality of the design and sampling of extant studies, 38 and studies that used nationallevel data to examine mental health burden owing to the COVID-19 pandemic [39][40][41][42] have not directly explored the reasons for suicide. This study aimed to assess which reasons for suicide had higher monthly numbers during the COVID-19 pandemic than the estimated number of suicide deaths for that month.…”

Social distancing and influenza mortality in 1918 did not increase suicide rates in the United States

“…Otherwise, one limited study reported no effect of the pandemic on acute compulsory psychiatric admissions in Amsterdam ( van der Heide & Coutinho, 2006 ). Two recent systematic reviews on the experience of mental health during epidemics found no other literature relating to the 1918–20 influenza pandemic ( Neelam et al, 2021 ; Rogers et al, 2021 )—although the search strategies of the reviews may have been too narrow. Additionally, I am aware that two research teams have reported no connection between the pandemic and psychiatric admissions in Croatia ( Milovan Delić and Plavšić, 2020 ; Vukojević et al, 2021 ) and that Dimka and Mamelund (2020) report on the high case-fatality of medically institutionalized individuals, including psychiatric patients, in Norway.…”