Trends in suicide rates during the COVID-19 pandemic restrictions in a major German city.

Daniel Radeloff,Andreas Vasilache,Kai Von Klitzing,Rainer Papsdorf,Kirsten Uhlig,Karen Putnam

doi:10.1017/s2045796021000019

Abstract

It remains unclear whether the coronavirus disease 2019 (COVID-19) pandemic is having an impact on suicide rates (SR). Economic insecurity and mental disorders are risk factors for suicide, which may increase during the pandemic. Data on suicide events in a major city in Germany, and the corresponding life years (LY) were provided by the local authorities. For the year 2020, periods without restrictions on freedom of movement and social contact were compared with periods of moderate and severe COVID-19 restrictions. To avoid distortions due to seasonal fluctuations and linear time trends, suicide risk during the COVID-19 pandemic was compared with data from 2010 to 2019 using an interrupted time series analysis. A total of 643 suicides were registered and 6 032 690 LY were spent between 2010 and 2020. Of these, 53 suicides and 450 429 LY accounted for the year 2020.In 2020, SR (suicides per 100 000 LY) were lower in periods with severe COVID-19 restrictions (SR = 7.2, χ2 = 4.033, p = 0.045) compared with periods without restrictions (SR = 16.8). A comparison with previous years showed that this difference was caused by unusually high SR before the imposition of restrictions, while SR during the pandemic were within the trend corridor of previous years (expected suicides = 32.3, observed suicides = 35; IRR = 1.084, p = 0.682). SR during COVID-19 pandemic are in line with the trend in previous years. Careful monitoring of SR in the further course of the COVID-19 crisis is urgently needed. The findings have regional reference and should not be over-generalised.

Highlights

It remains unclear whether the coronavirus disease 2019 (COVID-19) pandemic is having an impact on suicide rates (SR)
We addressed the following hypotheses: SR increased in the total population under severe COVID-19 restrictions of social contact compared to periods without or with moderate restrictions
The time series analysis showed that monthly suicide numbers in the pre-COVID-19 period decreased by 0.3% per month (IRR = 0.997, p = 0.028) and the calendar months modulated this linear time trend with an IRR between 0.922 and 1.275

Summary

Introduction

It remains unclear whether the coronavirus disease 2019 (COVID-19) pandemic is having an impact on suicide rates (SR). According to leading theories of suicide prevention, the loss of social inclusion is a major risk factor for suicide (van Orden et al, 2010). It has not yet been clarified whether social cohesion decreased during the pandemic as a result of physical distance or increased, as has been observed during other existential threat scenarios (Durkheim, 1867/1951; Wasserman, 1992; Wasserman et al, 2020). On 22 March 2020, the German Federal Government and the Länder agreed on a comprehensive restriction of social contacts, which required people. We addressed the following hypotheses: SR increased in the total population under severe COVID-19 restrictions of social contact compared to periods without or with moderate restrictions. An interrupted time series analysis shows an increase of suicide risk during the COVID-19 pandemic compared with the time period before onset of the pandemic

Methods

Results

Discussion

Conclusion

Limitations and strengths