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

Background: 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 (SH) and suicide are its extreme effects. The aim of this study was to provide an overview of the impact of the COVID-19 pandemic on the occurrence and clinical profile of suicide and SH in our ED. Methods: This is a cross-sectional observational study conducted in the ED of a tertiary care center. Records of all fatal and nonfatal SH patients presenting to the ED 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) was included by searching the electronic medical record (EMR) system. The prevalence and the clinical profile of the patients were compared between these three periods. Results: A total of 125 (periods 1=55, 2=38, and 3=32) suicide and SH cases were analyzed. The cases of suicide/SH had increased by 44% and 71.9% during the lockdown period in comparison to the period 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-value=0.045) with increased hospital admission (p-value =0.009) and in-hospital mortality (18.2% vs 2.6 % and 3.1%) (p-value=.001). Conclusion: We found an increase in patients presenting with suicide and SH in our ED during the pandemic which is likely to reflect an increased prevalence of mental illness in the community. We hope that the result will prime all mental health care stakeholders to initiate mental health screening and intervention for the vulnerable population during this period of crisis.

Hospital presentations for self-poisoning during COVID-19 in Sri Lanka: an interrupted time-series analysis

“…The findings of this study differ from similar previous investigations in neighbouring countries (India and Nepal), where there are reports of an increase in hospital presentations for self-harm 7 and suicide. 6 However, these previous investigations did not take into account prepandemic trends.…”

“…6 However, these previous investigations did not take into account prepandemic trends. 6,7 Given that pre-pandemic reports have indicated that the number of people presenting to hospital with self-harm and suicide in India and Nepal have increased over time, [17][18][19] the reported increases during the pandemic might reflect increases due to other underlying factors, as opposed to an increase related to the pandemic. A previous investigation in another middle-income country (Peru) modelled underlying trends of suicide and indicated a step reduction in suicide during the first few months of the pandemic.…”

“…Studies from India and Nepal have suggested an increase in deaths by suicide and in the number of individuals presenting to hospitals with self-harm in the pandemic period. 6,7 However, these studies compare a period before the pandemic to a period during the pandemic and do not account for any underlying trends. Evidence from Peru, Serbia, and Turkey suggests a decline in the number of individuals presenting with self-harm to hospitals and suicide deaths.…”

Reasons for Extraction of Permanent Teeth in Tertiary Care Hospital of Nepal

“…The study also found a significant number of increase cases of suicide during the Covid-19 pandemic while the number of women is predominantly high, and concluded that patients were late to have the lifesaving treatment because of this pandemic. 33 Yet, data about suicide and self-harm from the Government of Nepal is to be published for public. A systematic review by Xiong and collegues 34 presented the evidence of high level of poor mental health among general population during this pandemic and suggested mental health should be the global priority.…”

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

“…India (n=5), Sri Lanka (n=1) and Nepal (n=2) represented the South Asian region with 8 studies (12,(31)(32)(33)(34)(35)(36)(37), with only one (from Sri Lanka) rated as being of reasonable quality.…”