The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: update of living systematic review

Abstract

Background: The COVID-19 pandemic has caused considerable morbidity, mortality and disruption to people’s lives around the world. There are concerns that rates of suicide and suicidal behaviour may rise during and in its aftermath. Our living systematic review synthesises findings from emerging literature on incidence and prevalence of suicidal behaviour as well as suicide prevention efforts in relation to COVID-19, with this iteration synthesising relevant evidence up to 19th October 2020. Method: Automated daily searches feed into a web-based database with screening and data extraction functionalities. Eligibility criteria include incidence/prevalence of suicidal behaviour, exposure-outcome relationships and effects of interventions in relation to the COVID-19 pandemic. Outcomes of interest are suicide, self-harm or attempted suicide and suicidal thoughts. No restrictions are placed on language or study type, except for single-person case reports. We exclude one-off cross-sectional studies without either pre-pandemic measures or comparisons of COVID-19 positive vs. unaffected individuals. Results: Searches identified 6,226 articles. Seventy-eight articles met our inclusion criteria. We identified a further 64 relevant cross-sectional studies that did not meet our revised inclusion criteria. Thirty-four articles were not peer-reviewed (e.g. research letters, pre-prints). All articles were based on observational studies. There was no consistent evidence of a rise in suicide but many studies noted adverse economic effects were evolving. There was evidence of a rise in community distress, fall in hospital presentation for suicidal behaviour and early evidence of an increased frequency of suicidal thoughts in those who had become infected with COVID-19. Conclusions: Research evidence of the impact of COVID-19 on suicidal behaviour is accumulating rapidly. This living review provides a regular synthesis of the most up-to-date research evidence to guide public health and clinical policy to mitigate the impact of COVID-19 on suicide risk as the longer term impacts of the pandemic on suicide risk are researched.

Temporal trends in primary care-recorded self-harm during and beyond the first year of the COVID-19 pandemic: Time series analysis of electronic healthcare records for 2.8 million patients in the Greater Manchester Care Record

“…There is also a possibility that some patients who would have presented to their GP with self-harm presented to hospital instead. However, the magnitude of the reductions that we observed in April 2020 is in line with those observed internationally [32] . Furthermore, evidence from UK hospitals has shown that there were reductions in self-harm presentations of a similar degree to those that we observed [33] .…”

The impact of COVID-19 and control measures on public health in Thailand, 2020

“…Various factors associated with mental health included misinformation, lack of knowledge, socioeconomic problems, social media use, and isolation/quarantine issues. The systematic review showed significantly increased depression, fear, anxiety, stress, suicidal behavior, job loss, financial crisis, nutrition disorders and increase work load in medical personnel ( BC et al., 2021 ; Gao et al, 2020 ; Goodwin et al, 2020 ; John et al., 2020 ; Salari et al, 2020 ). These factors could lead to self-harm or suicidal behavior.…”

Examining the association between the COVID-19 pandemic and self-harm death counts in four Canadian provinces

“… Andriessen, 2006 , John et al, 2020 , Ståhl and MacEachen, 2021 , Statistics Canada 2021e , Calderon-Anyosa and Kaufman, 2021 …”