Attempted suicide rates before and during the COVID-19 pandemic: interrupted time series analysis of a nationally representative sample.

Yael Travis-Lumer,Sophia Frangou,Arad Kodesh,Yair Goldberg,Stephen Z Levine

doi:10.1017/s0033291721004384

Abstract

To characterize the association between the protracted biopsychosocial coronavirus disease 2019 (COVID-19) pandemic exposures and incident suicide attempt rates. Data were from a nationally representative cohort based on electronic health records from January 2013 to February 2021 (N = 852 233), with an interrupted time series study design. For the primary analysis, the effect of COVID-19 pandemic on incident suicide attempts warranting in-patient hospital treatment was quantified by fitting a Poisson regression and modeling the relative risk (RR) and the corresponding 95% confidence intervals (CIs). Scenarios were forecast to predict attempted suicide rates at 10 months after social mitigation strategies. Fourteen sensitivity analyses were performed to test the robustness of the results. Despite the increasing trend in the unexposed interval, the interval exposed to the COVID-19 pandemic was statistically significant (p < 0.001) associated with a reduced RR of incident attempted suicide (RR = 0.63, 95% CI 0.52-0.78). Consistent with the primary analysis, sensitivity analysis of sociodemographic groups and methodological factors were statistically significant (p < 0.05). No effect modification was identified for COVID-19 lockdown intervals or COVID-19 illness status. All three forecast scenarios at 10 months projected a suicide attempt rate increase from 12.49 (7.42-21.01) to 21.38 (12.71-35.99). The interval exposed to the protracted mass social trauma of the COVID-19 pandemic was associated with a lower suicide attempt rate compared to the unexposed interval. However, this trend is likely to reverse 10 months after lifting social mitigation policies, underscoring the need for enhanced implementation of public health policy for suicide prevention.

Highlights

Suicide is preventable, yet annually, approximately 800 000 people die of suicide worldwide (World Health Organization, 2014)
We leveraged epidemiological data implemented a quasi-experimental design with national coverage spanning seven years before the COVID-19 pandemic, a year of the COVID-19 pandemic, information about the three lockdown intervals, and COVID-19 infection status to test for an effect on the rate of severe attempted suicide
Despite the increasing time trend during the unexposed period before the pandemic, we observed that the suicide incidence rate statistically significantly dropped during the COVID-19 pandemic

Summary

Introduction

Suicide is preventable, yet annually, approximately 800 000 people die of suicide worldwide (World Health Organization, 2014). Intuitive concerns have been expressed that the biopsychosocial adversities associated with the COVID-19 pandemic may increase the suicide attempt rate (Gunnell et al, 2020; Ongur, Perlis, & Goff, 2020; Reger, Stanley, & Joiner, 2020; Wasserman, Iosue, Wuestefeld, & Carli, 2020) These concerns stem from the potential increase in suicide risk factors due to COVID-19 attenuation strategies (e.g. social distancing; Reger et al, 2020) imposed on a national scale and the economic hardship introduced by the pandemic. It may be postulated that the COVID-19 attenuation strategies may act as a mechanism that reduces the means and opportunities for self-injurious behavior and neutralization of the impact of other risk factors (e.g. isolation) that are otherwise elevated, reducing the attempted suicide rate (Mann, Michel, & Auerbach, 2021) This trend is likely to reverse 10 months after lifting social mitigation policies, underscoring the need for enhanced implementation of public health policy for suicide prevention

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Conclusion