Social and Biological Parameters Involved in Suicide Ideation During the COVID-19 Pandemic: A Narrative Review

Abstract

Fear is an indispensable characteristic of any infectious disease, and the alarm will be further amplified when the infection spreads uncontrollable, unpredictable, and global. The novel corona virus (SARS CoV-2) lead Covid-19, has been declared as a global emergency by WHO as it has affected millions of people with a high mortality rate. The non-availability of medicine for Covid-19 and the various control measures such as social distancing, self-isolation, house quarantine, and the new normal implementation by different nations across the world to control the spread of Covid-19 made people vulnerable to fear and anxiety. As a result, considerable number of Covid-19-related suicidal deaths has been reported across the world during this pandemic. There have been several studies which describe the psychosocial aspects of suicidal ideation. However, the research on the biological aspects of suicidal ideation/suicidal risk factors that are related to pandemic are unreported. Hence this review article is intended to provide a comprehensive analysis of suicidal deaths during Covid-19 and also aimed to addresses the possible link between suicidal ideation and different factors, including psycho-social, behavioral, neurobiological factors (proximal, distal, and inflammatory) and immunity. The alterations in glutamatergic and GABAergic neurotransmitters had upregulated the GABARB3, GABARA4, GABARA3, GABARR1, GABARG2, and GAD2 gene expressions in suicidal victims. The changes in the Kynurenine (KYN) pathway, Hypothalamus-Pituitary-Adrenal axis (HPA axis) hyperactivation, and dysregulation of serotonin biosynthesis would significantly alter the brain chemistry in people with suicide ideation.

Suicidality and COVID‑19: Suicidal ideation, suicidal behaviors and completed suicides amidst the COVID‑19 pandemic (Review)

“…Accordingly, several mechanisms may be implicated in infection-associated brain damage as follows: The direct neurotropic effects of SARS-CoV-2 mediated by the retrograde axonal transport of the virus from the respiratory mucosa, hypoxic brain injury, peripheral inflammation and monocyte-macrophage system activation that precipitate neuronal dysfunction, and the disruption of the blood-brain barrier that induces a prolonged state of neuroinflammation and possibly neurodegeneration (60)(61)(62)(63)(64). The SARS-CoV-2-induced cytokine 'storm' has been shown to play a major role in the propagation of neuropsychiatric symptoms associated with COVID-19, while aberrations in inflammatory cytokines have been proposed as pathophysiological correlates of suicidality (22,63,65,66). In addition, neurotransmitter imbalances, including GABAergic, glutamatergic and serotoninergic pathways, as well as widespread neuronal network dysfunction, have been suggested to provide neurobiological links to COVID-19 suicidality.…”

“…Moreover, COVID-19 related sleep disturbances, neuroendocrine changes, including cortisol hypersecretion and the dysregulation of the hypothalamus-pituitary-adrenal axis, as well as the dysregulation of the gut microbiota and the brain-gut axis may all contribute to the emergence or exacerbation of suicidal behaviors in patients with COVID-19 ( Fig. 2 ) ( 22 , 67-69 ). Nevertheless, SARS-CoV-2-induced neurobiological changes that precipitate suicidality are possibly intertwined with superimposed psychological stressors associated with COVID-19.…”

“…Multiple public health interventions have also been implemented worldwide to decrease the transmission of SARS-CoV-2 (21). Nevertheless, measures aiming to attenuate the viral spread, such as self-isolation, quarantine, lockdown and movement restrictions, have led to significant restrictions in daily activities and routines, and along with the threat posed by the pandemic, these measures have propagated feelings of fear, uncertainty, stigmatization, social isolation and loneliness (22)(23)(24). Furthermore, there have been reports of a significant increase in alcohol consumption and a significant exacerbation of domestic violence during the implementation of the aforementioned restriction measures (25,26).…”

The potential impact of Covid-19 on CNS and psychiatric sequels

“…As a result, it promotes hyper-activation of the HPA axis, resulting in raised levels of cortisol and corticotropin-releasing hormone, both of which have been proven to rise in depression patients in studies. According to reports, patients treated with interferon- show evidence of depression due to HPA axis activation ( Adu et al, 2021 , Dhrisya et al, 2020 ). As a consequence, COVID-19 infection causes hyperinflation, which inhibits serotonin biosynthesis and causes hyperactivation of the HPA axis, resulting in MDD.…”

“…The most important psychosocial factors that influence the suicide rate when a virus pandemic strikes are emotional factors such as fear of being infected or long-term social isolation. The second culprit is the immune system's response, which leads to hyperinflammation ( Dhrisya et al, 2020 , Leaune et al, 2020 ). According to previous studies, emerging pandemics accelerate the number of suicides.…”