Impact of the COVID-19 pandemic on suicide and self-harm among patients presenting to the emergency department of a teaching hospital in Nepal

Abstract

The COVID-19 pandemic is a global challenge that is not just limited to the physical consequences but also a significant degree of a mental health crisis. Self-harm and suicide are its extreme effects. We aim to explore the impact of this pandemic on suicide and self-harm in our Emergency Department. A cross-sectional study was conducted including all fatal and nonfatal self-harm patients presenting to the emergency department during the lockdown period (March 24-June 23, 2020; Period1), matching periods in the previous year (March 24-June 23,2019; Period 2) and 3 months period prior (December 24 2019-March 23, 2020; Period 3) were included through the electronic medical record system. The prevalence and the clinical profile were compared between these three periods. A total of 125 (periods 1 = 55, 2 = 38, and 3 = 32) suicide and self-harm cases were analyzed. Suicide and self-harm had increased by 44% and 71.9% during the lockdown in comparison to periods 2 and 3. Organophosphate poisoning was the most common mode. Females were predominant in all three periods with a mean age of 32 (95%CI: 29.3–34.7). There was a significant delay in arrival of the patients in period 1 (p = 0.045) with increased hospital admission (p = 0.003) and in-hospital mortality (18.2% vs 2.6% and 3.1%) (p<0.001). Our study showed an increase in suicide and self-harm cases in the emergency department during the initial phase of the COVID-19 pandemic which may reflect the increased mental health crisis in the community in low resource settings like Nepal. This study highlights the importance of priming all mental health care stakeholders to initiate mental health screening and intervention for the vulnerable population during this period of crisis.

Association between COVID-19 pandemic and the suicide rates in Nepal

“…Other studies have also reported a COVID-19 pandemic-related increase in suicide in some parts of South Asia [ 31 , 32 ]. Our results are also consistent with the report of increased suicide and self-harm cases during the COVID-19 pandemic in one of the biggest teaching hospitals in Nepal [ 33 ]. Our results are different from a study that suggests the suicide rates have not increased during the COVID-19 pandemic in some high-income countries [ 10 ].…”

Impact of COVID-19 lockdown on self-harm and violence among patients presenting to the emergency department

“…These findings are consistent with the study carried out in the neighbouring country of Nepal in early 2020 by Shrestha et al, 2021 which demonstrated a 44% increase in self harm attempts along with increased admissions and increase in in-hospital mortality [ 20 ].…”

COVID-19 pandemic and suicides in Nepal: Way forward for prevention

“…The multifactorial manner in which COVID-19 engulfs our lives via massive the lockdowns and the fear of death induces such a damaging cycle to the mental health of all. One such nation who seems to be particular hard hit by both COVID-19 and the mental health implications thereof is the mountainous country of Nepal [8]. Every year, around 700,000 people die by suicide globally.…”

“…The importance of this study is multifaceted as it both shows the negative effect of COVID-19 on mental and simultaneously exposes the hidden dimension of looming poor mental health circulating within the country. This subsurface level of poor mental health has been exposed through the precipitating factor of COVID-19 [8]. Further research into the suicidality and current impact of COVID-19 on the mental health of those in Nepal conducted by Acharya SR, et al has highlighted the significant and dire situation that Nepal is facing as an average of 18 suicides a day occurred throughout the lockdown period.…”

“…The importance of this study is multifaceted as it both shows the negative effect of COVID-19 on mental and simultaneously exposes the hidden dimension of looming poor mental health circulating within the country. This subsurface level of poor mental health has been exposed through the precipitating factor of COVID-19 [ 8 ].…”