Suicide and COVID-19 Pandemic

COVID-19 has swept the world in an unprecedented suicide epidemic in this century. As the world is concerned about limiting the spread of the virus and prioritizing patients with acute illnesses, containment measures are not without mental health consequences. As anxiety and depression intensify, the risk of suicide and pandemics also increases. This article aims to clarify this important public health issue and to better understand which factors can cause or exacerbate mental symptoms and suicide.

COVID-19 ASSOCIATED SUICIDE

Epidemics and pandemics have already occurred, and the death toll has exceeded the direct cause of death. Suicide deaths are a category of death that is easier to prevent. To a large extent, they remain silent and underreported and are sometimes mistaken for deaths caused by the outbreak itself or other causes. The COVID-19 pandemic is no different from the previous outbreaks of fear, stress, and disturbances in daily life that have been caused around the world.

Record of Suicides

Since the first day of the COVID-19 pandemic, people from different countries and backgrounds have attempted or completed suicide. 

A 50-year-old from India is the father of three children, his thoughts on being infected and spreading the virus to others panicking his family.

A 19-year-old British girl could not bear the idea of isolation and isolation.

This veteran American emergency doctor treats critically ill patients on the front line.

These are just a few examples of how some people end their lives to deal with the pressures of the new reality. During the pandemic, depression, anxiety, despair, helplessness, insomnia, and drug abuse, all risk factors for suicide, increase. This could be a perfect storm for the devastating effects of an established suicide epidemic.

FACTORS 

Therefore, it is important to clarify this important public health issue during and after the pandemic and to better understand which factors can cause or exacerbate psychiatric symptoms and suicide.

Overview of Suicide Pandemic

From Suicide Pre-pandemic COVID-19 hit the world when the suicide rate peaked, because there is usually a seasonally changing in the spring, and we have known this at least since the beginning of World War II. According to statistics from the World Health Organization (WHO), 800,000 people die every year by suicide, 79% of which occur in low- and middle-income countries, accounting for 1.4% of all deaths worldwide.

In the United States, the latest suicide rate in 2018 was 14 suicides per 100,000 people, and the increase in suicide rates for women was higher than that for men. Data from the same study shows that suicide is the second leading cause of death between the ages of 10 and 34, the fourth leading cause of death between the ages of 35 and 54, and the 10^th leading cause of death in all age groups. Substance use disorders, especially alcoholism and mood disorders are considered to be the main causes of suicide. Death caused by despair is defined as death caused by drugs, alcohol, and suicide, and is considered the result of a long-term social and economic recession.

Hunger Strikes

During the pandemic, it increased from a low of 3.6% in January 2020 to 14.7% at the peak of the crisis. Since then, interest rates have increased to 6.7% in December 2020. In a report released in late April 2020, the International Labor Organization (ILO) estimated that compared with the fourth quarter of 2019, working hours in the second quarter of 2020 will be reduced by 17.3%. 81% of the world’s workforce lives in countries that are forced or recommended to close their jobs. This leads to increased poverty, housing instability, and severe hunger.

The new standards of basic care

As medical resources are redistributed to treat COVID-19 patients, all "non-essential" medical appointments and procedures are canceled or started online as much as possible, leading to increased health anxiety, Increased pain, and delays in investigations and surgical procedures.

Physical fatigue and pain are also exacerbated by the increase in Internet use and are inversely proportional to physical activity, which for many people is limited during strict confinement. Despite the worsening pain and medical problems, patients also avoided the hospital for fear of contracting COVID-19 as they did during previous outbreaks.

Health and Mental Health

Access to mental health treatment is at least as negatively affected, and patients must meet online with their psychiatrist, therapist, and case manager. This new reality presents challenges to those who are uncomfortable and suspicious of sharing confidential information, such as being abused on the Internet, suicide, or re-addicting drugs or alcohol.

Patients who were unwelcome in the emergency room before the pandemic avoid emergency rooms and hospitals during the pandemic, not only for fear of contracting the virus but to avoid feeling a way that they think staff will disappoint them.

Firearms availability

In the United States, guns are the most common method of suicide: In 2009, 51.8% of suicides in the United States were related to guns, and this number has remained relatively stable (50%, 5%) until 2018.

Gun suicide is especially common in rural communities where guns are flooded, and each family owns more than one gun. People with easy access to guns are more likely to die by suicide than those with restricted access to guns.

Suicide in Covid-19

COVID-19 and suicide researchers at the University of Zurich Mental Hospital calculated that the number of suicides worldwide has increased by 10,000. The Robert Graham Center in the United States and the Well-being trust model predict that the number of “deaths due to despair” will increase from 27,644 to 154,037, depending on the speed of economic recovery.

These figures include deaths caused by suicide, alcohol, or drug overdose. In Texas, the Meadows Institute of Mental Health Policy reports that for every 5 percent increase in the unemployment rate each year, 725 Texans will die from 300 suicides and 425 from a drug overdose.

Initial Record

It has been observed worldwide that infection is one of the main causes of suicide. In the United States, we read about police attempted suicide and couples whose autopsy results were negative. In India, people are afraid of spreading the infection, and if they are infected, they do not have the resources to treat symptoms, or they cannot tolerate isolation even if they have no symptoms or evidence of infection. The report included suicide by hanging himself, cutting himself and committing suicide by jumping off the seventh floor of the hospital. Other international cases include a German finance minister unable to withstand citizens’ expectations of financial aid, and a Chinese student living in Saudi Arabia who jumped from the third floor of a hospital and was quarantined, suspected of being positive for COVID-19.

The medical staff has also become victims of suicide due to COVID-19. The pandemic has not spared the emergency medical technicians who used his father’s registered weapons to commit suicide during the initial COVID-19 surge in New York City or the emergency medical director who died of self-harm. In the UK, just like in Italy, nurses committed suicide due to overdose or drowning themselves. According to reports, all people had no mental illness before, but were overwhelmed by the pandemic pain, helplessness in the face of patient deaths and lack of resources for help, and fear of infection and spread of the virus.

WAY OUT/ RECOMMENDATIONS

Significant symptoms of COVID-19 have been or will appear, but its impact on mental health cannot say to be the same. Although the pandemic that began more than a year ago is alarming, it has changed the parameters of our daily lives and highlighted the vulnerability of us, our society, and our government. The adjustments are huge, and those who cannot bear the effects of this global health crisis can find comfort at the end of their lives. However, suicide can be prevented, and everyone is responsible for controlling the suicide pandemic. Although the following recommendations present their own challenges and may not be applied globally or even in the United States, these recommendations are our starting recommendations as we continue to improve our prevention and mitigation strategies.

Education

Prevention is education. The public should be educated to raise awareness of the potential mental health consequences of this epidemic, eliminate the stigma of the occurrence or recurrence of mental illness and drug abuse, and provide people with practical tools to identify those at risk around them personally. As everyone’s attention turns to social media and the Internet, the way to promote and raise mental health awareness should not be stingy with any news media.

The government should also consider adding a mental health consultant to its pandemic task force and staff, because the efforts made by organizations and institutions at the national level may be different from those made by local governments or citizens.

Screening

Caregivers in all areas should consider mental health as a vital sign and look for signs of depression, anxiety, substance abuse, and suicidal thoughts in every encounter. Ask about family life, including activities, screening times, financial difficulties, marital discord, gender-based violence, and child abuse in the family. We must also pay special attention to patients who are exposed to guns and directly ask questions about ownership, storage, and usage ideas or plans.

With the increase in purchases observed in the United States in 2020, the increase in time at home, and the overall decline in mental health, the temptations are greater and the barriers are weaker.

Surveillance

Although the time limit for appointments may be a limiting factor, providers should have time to discuss vaccination and help patients who need to register for vaccination.

Vaccination can not only reduce the risk of serious infection and death, but the large-scale incident that will occur next year can also bring people a sense of unity and hope. As the government currently provides free vaccines and some insurance companies cover COVID-19 testing and treatment to varying degrees, not only should we continue to work in this direction, but we should also expand mental health coverage and suicide prevention programs.

Strategies

Reducing the risk of suicide is related to the safe storage of guns. Consideration should be given to removing guns from children and mentally ill persons or people whose mental health has deteriorated. Otherwise, store weapons in a closed, safe, preferably dismantled and unloaded cabinet.

Separate storage of ammunition has been shown to reduce the risk of suicide by 55-73%. Discuss similar considerations with patients and their family members during the consultation to understand the use of other harmful tools and their safe disposal and storage, such as safes for medicines, lockers with detergents, etc.