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. 2021 Nov;42(6):474-487.
doi: 10.1027/0227-5910/a000753. Epub 2020 Oct 16.

The Impact of Infectious Disease-Related Public Health Emergencies on Suicide, Suicidal Behavior, and Suicidal Thoughts

Tiago C Zortea  1 , Connor T A Brenna  2 , Mary Joyce  3 , Heather McClelland  1 , Marisa Tippett  4 , Maxwell M Tran  2 , Ella Arensman  3   5 , Paul Corcoran  3   5 , Simon Hatcher  6 , Marnin J Heise  7   8 , Paul Links  9 , Rory C O'Connor  1 , Nicole E Edgar  6 , Yevin Cha  7 , Giuseppe Guaiana  7 , Eileen Williamson  3 , Mark Sinyor  10 , Stephen Platt  11
Affiliations

The Impact of Infectious Disease-Related Public Health Emergencies on Suicide, Suicidal Behavior, and Suicidal Thoughts

Tiago C Zortea et al. Crisis. 2021 Nov.

Abstract

Background: Infectious disease-related public health emergencies (epidemics) may increase suicide risk, and high-quality evidence is needed to guide an international response. Aims: We investigated the potential impacts of epidemics on suicide-related outcomes. Method: We searched MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus, Web of Science, PsyArXiv, medRxiv, and bioRxiv from inception to May 13-16, 2020. Inclusion criteria: primary studies, reviews, and meta-analyses; reporting the impact of epidemics; with a primary outcome of suicide, suicidal behavior, suicidal ideation, and/or self-harm. Exclusion criteria: not concerned with suicide-related outcomes; not suitable for data extraction. PROSPERO registration: #CRD42020187013. Results: Eight primary papers were included, examining the effects of five epidemics on suicide-related outcomes. There was evidence of increased suicide rates among older adults during SARS and in the year following the epidemic (possibly motivated by social disconnectedness, fears of virus infection, and concern about burdening others) and associations between SARS/Ebola exposure and increased suicide attempts. A preprint study reported associations between COVID-19 distress and past-month suicidal ideation. Limitations: Few studies have investigated the topic; these are of relatively low methodological quality. Conclusion: Findings support an association between previous epidemics and increased risk of suicide-related outcomes. Research is needed to investigate the impact of COVID-19 on suicide outcomes.

Keywords: COVID-19; epidemics; pandemics; self-harm; suicide.

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Figures

Figure 1
Figure 1. PRISMA diagram for main search (S3).Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram. Reasons for exclusion: (i) the publication did not focus on suicidal behavior, suicidal ideation, and/or self-harm; (ii) the publication did not focus on any infectious disease-related public health emergency; (iii) the publication was excluded due to its publication type (not a primary study, systematic review, or meta-analysis); (iv) the publication did not contain empirical data eligible for data extraction and quality assessment; and (v) the publication was a duplicate of another in the study pool, missed in the initial duplicate removal.
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