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Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries
J. Pirkis, D. Gunnell, S. Shin, M. Del Pozo-Banos, V. Arya, PA. Aguilar, L. Appleby, SMY. Arafat, E. Arensman, JL. Ayuso-Mateos, YPS. Balhara, J. Bantjes, A. Baran, C. Behera, J. Bertolote, G. Borges, M. Bray, P. Brečić, E. Caine, R. Calati, V....
Language English Country Great Britain
Document type Journal Article
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PubMed Central
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- Publication type
- Journal Article MeSH
Background: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. Funding: None.
Brigham and Women's Hospital Harvard Medical School MA United States
Centre for Mental Health Research Australian National University Canberra Australia
Centre for Suicide Research Department of Psychiatry University of Oxford Oxford United Kingdom
Copenhagen Research Centre for Mental Health Copenhagen Denmark
Coroners Court of Victoria Melbourne Australia
Coronial Division Tasmanian Magistrates Court Hobart Australia
Danish Research Institute for Suicide Prevention Mental Health Centre Copenhagen Copenhagen Denmark
Department for Medical Ethics University Psychiatric Hospital Vrapče
Department for Psychiatry University Psychiatric Hospital Vrapče
Department of Forensic Medicine Odessa National Medical University Odessa Ukraine
Department of Medicine and Optometry Linnaeus University Kalmar Sweden
Department of Psychiatry Aga Khan University Karachi Pakistan
Department of Psychiatry and Psychotherapy
Department of Psychiatry Blekinge Hospital Karlshamn Sweden
Department of Psychiatry Enam Medical College and Hospital Dhaka Bangladesh
Department of Psychiatry Faculty of Medicine National University of Malaysia Kuala Lumpur Malaysia
Department of Psychiatry Neuroscience Institute Federico 2 University of Naples Naples Italy
Department of Psychiatry Nimes University Hospital Nimes France
Department of Psychiatry Psychotherapy Psychosomatics and Medical Psychology
Department of Psychiatry Sunnybrook Health Sciences Centre Toronto Canada
Department of Psychiatry University of Toronto Toronto Canada
Department of Psychology University of Milan Bicocca Milan Italy
Department of Public Health and Welfare Finnish Institute for Health and Welfare Helsinki Finland
Departments of Psychiatry and Epidemiology Columbia University New York United States
Faculty of Social Sciences Charles University Prague Czechia
Geha Mental Health Center Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
Greater Manchester Mental Health NHS Foundation Trust Manchester United Kingdom
Griffith University Brisbane Australia
Institute for Health Metrics and Evaluation University of Washington Seattle United States
Instituto Vita Alere São Paulo Brazil
Klinikum Klagenfurt am Wörthersee Klagenfurt Austria
KU Leuven Center for Contextual Psychiatry Leuven Belgium
LVR Klinik Köln Department of Addictive Disorders Psychiatry and Psychotherapy Cologne Germany
Ministry of Public Health Department of Health Promotion Quito Ecuador
Monitoring and Evaluation German Institute for Medical Mission Tübingen Germany
National Institute of Mental Health Klecany Czechia
National Institute of Public Health Ljubljana Slovenia
Pavlov 1st Saint Petersburg State Medical University Saint Petersburg Russian Federation
Population Health Sciences Bristol Medical School University of Bristol Bristol United Kingdom
Psychosocial Services in Vienna Vienna Austria
Public Health Foundation of India Gurugram India
Puerto Rico Department of Health's Commission on Suicide Prevention San Juan Puerto Rico
Saint Petersburg State University Saint Petersburg Russian Federation
School of Applied Psychology Griffith University Brisbane Australia
School of Medicine University of Zagreb Zagreb Croatia
School of Population Health The University of Auckland Auckland New Zealand
School of Psychology University of Nottingham Nottingham United Kingdom
School of Public Health National Suicide Research Foundation University College Cork Cork Ireland
Shanghai Mental Health Center Shanghai Jiao Tong University School of Medicine Shanghai China
Suicide Prevention Research Department Amsterdam the Netherlands
Swansea University Medical School Swansea United Kingdom
System Information and Analytics Branch NSW Ministry of Health Sydney Australia
Thames Valley Police Bicester United Kingdom
Udmurtia Republican Clinical Psychiatric Hospital Izhevsk Russian Federation
Undersecretary of Health Services Ministry of Public Health Quito Ecuador
University Hospital for Psychiatry 2 Medical University of Innsbruck Innsbruck Austria
University of Rochester Medical Center Rochester NY United States
Usher Institute University of Edinburgh Edinburgh United Kingdom
Waseda University Faculty of Political Science and Economics Tokyo Japan
References provided by Crossref.org
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- $a Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries / $c J. Pirkis, D. Gunnell, S. Shin, M. Del Pozo-Banos, V. Arya, PA. Aguilar, L. Appleby, SMY. Arafat, E. Arensman, JL. Ayuso-Mateos, YPS. Balhara, J. Bantjes, A. Baran, C. Behera, J. Bertolote, G. Borges, M. Bray, P. Brečić, E. Caine, R. Calati, V. Carli, G. Castelpietra, LF. Chan, SS. Chang, D. Colchester, M. Coss-Guzmán, D. Crompton, M. Ćurković, R. Dandona, E. De Jaegere, D. De Leo, EA. Deisenhammer, J. Dwyer, A. Erlangsen, JS. Faust, M. Fornaro, S. Fortune, A. Garrett, G. Gentile, R. Gerstner, R. Gilissen, M. Gould, SK. Gupta, K. Hawton, F. Holz, I. Kamenshchikov, N. Kapur, A. Kasal, M. Khan, OJ. Kirtley, D. Knipe, K. Kõlves, SC. Kölzer, H. Krivda, S. Leske, F. Madeddu, A. Marshall, A. Memon, E. Mittendorfer-Rutz, P. Nestadt, N. Neznanov, T. Niederkrotenthaler, E. Nielsen, M. Nordentoft, H. Oberlerchner, RC. O'Connor, R. Papsdorf, T. Partonen, MR. Phillips, S. Platt, G. Portzky, G. Psota, P. Qin, D. Radeloff, A. Reif, C. Reif-Leonhard, M. Rezaeian, N. Román-Vázquez, S. Roskar, V. Rozanov, G. Sara, K. Scavacini, B. Schneider, N. Semenova, M. Sinyor, S. Tambuzzi, E. Townsend, M. Ueda, D. Wasserman, RT. Webb, P. Winkler, PSF. Yip, G. Zalsman, R. Zoja, A. John, MJ. Spittal
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- $a Background: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. Funding: None.
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