Attempted suicide rates before and during the COVID-19 pandemic: interrupted time series analysis of a nationally representative sample

Abstract

Background To characterize the association between the protracted biopsychosocial coronavirus disease 2019 (COVID-19) pandemic exposures and incident suicide attempt rates. Methods Data were from a nationally representative cohort based on electronic health records from January 2013 to February 2021 (N = 852 233), with an interrupted time series study design. For the primary analysis, the effect of COVID-19 pandemic on incident suicide attempts warranting in-patient hospital treatment was quantified by fitting a Poisson regression and modeling the relative risk (RR) and the corresponding 95% confidence intervals (CIs). Scenarios were forecast to predict attempted suicide rates at 10 months after social mitigation strategies. Fourteen sensitivity analyses were performed to test the robustness of the results. Results Despite the increasing trend in the unexposed interval, the interval exposed to the COVID-19 pandemic was statistically significant (p < 0.001) associated with a reduced RR of incident attempted suicide (RR = 0.63, 95% CI 0.52–0.78). Consistent with the primary analysis, sensitivity analysis of sociodemographic groups and methodological factors were statistically significant (p < 0.05). No effect modification was identified for COVID-19 lockdown intervals or COVID-19 illness status. All three forecast scenarios at 10 months projected a suicide attempt rate increase from 12.49 (7.42–21.01) to 21.38 (12.71–35.99). Conclusions The interval exposed to the protracted mass social trauma of the COVID-19 pandemic was associated with a lower suicide attempt rate compared to the unexposed interval. However, this trend is likely to reverse 10 months after lifting social mitigation policies, underscoring the need for enhanced implementation of public health policy for suicide prevention.

Trends and prevalence of suicide 2017–2021 and its association with COVID-19: Interrupted time series analysis of a national sample of college students in the United States

“…Particularly, the prevalence of SI and SP statistically significantly dropped following the COVID-19 emergency declaration and associated mitigation policy. These findings align with previous studies suggesting decreases in suicide as a function of the pandemic ( Pirkis et al, 2021 ; Travis-Lumer et al, 2021 ). During the first year of this pandemic, governments and universities timely responded to the threat to collegiate wellness, implementing various measures, such as promoting mental health services, providing relief for federal student loans, and offering academic accommodations and online instruction.…”

“…During the first year of this pandemic, governments and universities timely responded to the threat to collegiate wellness, implementing various measures, such as promoting mental health services, providing relief for federal student loans, and offering academic accommodations and online instruction. Students might experience less everyday stress and gain more support from families and communities during stay-at-home periods ( Pirkis et al, 2021 ; Travis-Lumer et al, 2021 ). Such protective factors might prevent some students from suicide ( Pirkis et al, 2021 ; Travis-Lumer et al, 2021 ).…”

Increased incident rates of antidepressant use during the COVID-19 pandemic: interrupted time-series analysis of a nationally representative sample

“…Significant research efforts are underway worldwide to evaluate changes in the levels of psychological distress and psychiatric diagnoses associated with the COVID-19 pandemic amid ongoing fears that its adverse effect on mental health could persist long after the numbers of SARS-CoV-2 infections and COVID-19 disease subside (Horton, 2020 ; Travis-Lumer, Kodesh, Goldberg, Frangou, & Levine, 2021 ). Nationwide UK data demonstrate that since the beginning of the pandemic average ratings of overall mental well-being have declined and the proportion of individuals reporting depressive symptoms has nearly doubled compared to pre-pandemic levels, with social restrictions seemingly having a causal impact (Office of National Statistics, 2021a ).…”

Suizidales Erleben und Verhalten im Rahmen der COVID-19-Pandemie

“…In einer Auswertung israelischer Krankenkassendaten zeigte sich, dass es im Zeitraum von März 2020 bis Februar 2021 zu einem linearen Rückgang der stationär behandelten Suizidversuche gekommen ist, während die Zahl der behandlungsbedürftigen Suizidversuche im Vergleichszeitraum von Januar 2013 bis Februar 2020 stetig angestiegen war. Der Rückgang an Suizidversuchen hielt auch während dreier Lockdown-Zeiten in Israel an [ 39 ]. In vergleichbarer Weise zeigte sich in einer Studie aus Zürich, dass in den ersten 6 Monaten der Pandemie 32 % weniger Patienten nach einem Suizidversuch stationär aufgenommen wurden als im Vergleichszeitraum 2019; allerdings hatte sich der Anteil erstmaliger Suizidversuche nahezu verdreifacht: 10,8 % (2019) vs. 35,1 % (2020; [ 40 ].…”