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.

Alcohol Tobacco and Other Drug Research Unit South African Medical Research Council Cape Town South Africa

Australian Institute for Suicide Research and Prevention School of Applied Psychology Griffith University Brisbane Australia

Bekhterev National Medical Research Center of Psychiatry and Neurology Saint Petersburg Russian Federation

Brigham and Women's Hospital Department of Emergency Medicine Harvard Medical School Boston United States

Brigham and Women's Hospital Harvard Medical School MA United States

Centre for Mental Health and Safety and National Institute for Health Research Patient Safety Translational Research Centre University of Manchester Manchester United Kingdom

Centre for Mental Health Melbourne School of Population and Global Health University of Melbourne Melbourne Australia

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; School of Medicine University of Zagreb Zagreb Croatia

Department for Psychiatry University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb Zagreb Croatia

Department of Child and Adolescent Psychiatry Psychotherapy and Psychosomatics University Hospital Leipzig Leipzig Germany

Department of Epidemiology and Biostatistics Occupational Environment Research Center Medical School Rafsanjan University of Medical Sciences Rafsanjan Iran

Department of Forensic Medicine and Toxicology All India Institute of Medical Sciences New Delhi India

Department of Forensic Medicine Odessa National Medical University Odessa Ukraine

Department of Global Mental Health Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz Mexico City Mexico

Department of Medicine and Optometry Linnaeus University Kalmar Sweden

Department of Mental Health Johns Hopkins Bloomberg School of Public Health Baltimore MD United States

Department of Neurology Psychology and Psychiatry Botucatu Medical School Universidade Estadual Paulista Botucatu Brazil

Department of Primary Care and Public Health Brighton and Sussex Medical School Brighton United Kingdom

Department of Psychiatry Aga Khan University Karachi Pakistan

Department of Psychiatry and Behavioural Sciences Johns Hopkins University School of Medicine Baltimore MD United States

Department of Psychiatry and Psychotherapy; Klinikum Klagenfurt am Wörthersee Klagenfurt Austria

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 Psychosomatic Medicine and Psychotherapy University Hospital Frankfurt Goethe University Frankfurt am Main Germany

Department of Psychiatry Psychotherapy Psychosomatics and Medical Psychology; University Hospital for Psychiatry 2 Medical University of Innsbruck Innsbruck Austria

Department of Psychiatry Sunnybrook Health Sciences Centre Toronto Canada

Department of Psychiatry Universidad Autonoma de Madrid Centre for Biomedical Research in Mental Health Madrid Spain

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 Medical Center New York State Psychiatric Institute New York NY United States

Departments of Psychiatry and Epidemiology Columbia University New York United States

Division of Insurance Medicine Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden

Faculty of Social Sciences Charles University Prague Czechia

Flemish Centre of Expertise in Suicide Prevention Department of Head and Skin Ghent University Ghent Belgium

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

Hong Kong Jockey Club Centre for Suicide Research and Prevention Department of Social Work and Social Administration The University of Hong Kong Hong Kong SAR China

Institute for Health Metrics and Evaluation University of Washington Seattle United States

Institute for Life Course Health Research Department of Global Health Stellenbosch University Stellenbosch South Africa

Institute of Forensic Medicine Department of Biomedical Sciences for Health University of Milan Milan Italy

Institute of Health Behaviors and Community Sciences College of Public Health National Taiwan University Taipei Taiwan

Institute of Legal Medicine University Hospital Frankfurt Goethe University Frankfurt Frankfurt Germany

Instituto Vita Alere São Paulo Brazil

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 Centre for Suicide Research and Prevention Institute of Clinical Medicine University of Oslo Oslo Norway

National Centre for Suicide Research and Prevention of Mental Ill Health Karolinska Institutet Stockholm Sweden

National Confidential Inquiry into Suicide and Safety in Mental Health University of Manchester Manchester United Kingdom

National Drug Dependence Treatment Center and Department of Psychiatry All India Institute of Medical Sciences New Delhi India

National Institute of Health and care Research Biomedical Research Centre University Hospitals Bristol and Weston NHS Foundation Trust University of Bristol Bristol United Kingdom

National Institute of Mental Health Klecany Czechia

National Institute of Public Health Ljubljana Slovenia

Organizational Scientific Department Bekhterev National Medical Research Center of Psychiatry and Neurology Saint Petersburg Russian Federation

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

Region Friuli Venezia Giulia Central Health Directorate Outpatient and Inpatient Care Service Trieste Italy

Saint Petersburg State University Saint Petersburg Russian Federation

School of Applied Psychology Griffith University Brisbane Australia

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

Suicidal Behaviour Research Lab Institute of Health and Wellbeing University of Glasgow Glasgow Scotland

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

Unit Suicide Research and Mental Health Promotion Department of Social and Preventive Medicine Center for Public Health Medical University of Vienna Vienna 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

Working Group on Prevention of Suicide and Depression at Public Health Council Ministry of Health Warsaw Poland

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