Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries

Jane Pirkis¹, David Gunnell², Sangsoo Shin¹, Marcos Del Pozo-Banos³, Vikas Arya¹, Pablo Analuisa Aguilar⁴, Louis Appleby⁵, S M Yasir Arafat⁶, Ella Arensman^{7

8}, Jose Luis Ayuso-Mateos⁹, Yatan Pal Singh Balhara¹⁰, Jason Bantjes^{11

12}, Anna Baran^{13

14

15}, Chittaranjan Behera¹⁶, Jose Bertolote¹⁷, Guilherme Borges¹⁸, Michael Bray¹⁹, Petrana Brečić²⁰, Eric Caine²¹, Raffaella Calati^{22

23}, Vladimir Carli²⁴, Giulio Castelpietra²⁵, Lai Fong Chan²⁶, Shu-Sen Chang²⁷, David Colchester²⁸, Maria Coss-Guzmán²⁹, David Crompton³⁰, Marko Ćurković³¹, Rakhi Dandona^{32

33}, Eva De Jaegere³⁴, Diego De Leo³⁵, Eberhard A Deisenhammer³⁶, Jeremy Dwyer³⁷, Annette Erlangsen^{38

39

40

41}, Jeremy S Faust⁴², Michele Fornaro⁴³, Sarah Fortune⁴⁴, Andrew Garrett⁴⁵, Guendalina Gentile⁴⁶, Rebekka Gerstner^{47

48}, Renske Gilissen⁴⁹, Madelyn Gould⁵⁰, Sudhir Kumar Gupta¹⁶, Keith Hawton⁵¹, Franziska Holz⁵², Iurii Kamenshchikov⁵³, Navneet Kapur^{54

55}, Alexandr Kasal^{56

57}, Murad Khan⁵⁸, Olivia J Kirtley⁵⁹, Duleeka Knipe⁶⁰, Kairi Kõlves⁸, Sarah C Kölzer⁵², Hryhorii Krivda⁶¹, Stuart Leske⁸, Fabio Madeddu²², Andrew Marshall⁶², Anjum Memon⁶³, Ellenor Mittendorfer-Rutz⁶⁴, Paul Nestadt¹⁹, Nikolay Neznanov^{65

66}, Thomas Niederkrotenthaler⁶⁷, Emma Nielsen⁶⁸, Merete Nordentoft³⁸, Herwig Oberlerchner⁶⁹, Rory C O'Connor⁷⁰, Rainer Papsdorf⁷¹, Timo Partonen⁷², Michael R Phillips^{73

74}, Steve Platt⁷⁵, Gwendolyn Portzky³⁴, Georg Psota⁷⁶, Ping Qin⁷⁷, Daniel Radeloff⁷¹, Andreas Reif⁷⁸, Christine Reif-Leonhard⁷⁸, Mohsen Rezaeian⁷⁹, Nayda Román-Vázquez²⁹, Saska Roskar⁸⁰, Vsevolod Rozanov^{81

65}, Grant Sara⁸², Karen Scavacini⁸³, Barbara Schneider^{78

84}, Natalia Semenova⁸⁵, Mark Sinyor^{86

87}, Stefano Tambuzzi⁴⁶, Ellen Townsend⁶⁸, Michiko Ueda⁸⁸, Danuta Wasserman²⁴, Roger T Webb⁵⁴, Petr Winkler⁵⁶, Paul S F Yip⁸⁹, Gil Zalsman⁹⁰, Riccardo Zoja⁴⁶, Ann John³, Matthew J Spittal¹

Affiliations

¹ Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
² National Institute of Health and care Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, United Kingdom.
³ Swansea University Medical School, Swansea, United Kingdom.
⁴ Ministry of Public Health, Department of Health Promotion, Quito, Ecuador.
⁵ National Confidential Inquiry into Suicide and Safety in Mental Health, University of Manchester, Manchester, United Kingdom.
⁶ Department of Psychiatry, Enam Medical College and Hospital, Dhaka, Bangladesh.
⁷ School of Public Health, National Suicide Research Foundation, University College Cork, Cork, Ireland.
⁸ Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia.
⁹ Department of Psychiatry, Universidad Autonoma de Madrid, Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.
¹⁰ National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
¹¹ Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.
¹² Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.
¹³ Working Group on Prevention of Suicide and Depression at Public Health Council, Ministry of Health, Warsaw, Poland.
¹⁴ Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.
¹⁵ Department of Psychiatry, Blekinge Hospital, Karlshamn, Sweden.
¹⁶ Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India.
¹⁷ Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, Brazil.
¹⁸ Department of Global Mental Health, Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, Mexico.
¹⁹ Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
²⁰ Department for Psychiatry, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia.
²¹ University of Rochester Medical Center, Rochester, NY, United States.
²² Department of Psychology, University of Milan-Bicocca, Milan, Italy.
²³ Department of Psychiatry, Nimes University Hospital, Nimes, France.
²⁴ National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden.
²⁵ Region Friuli Venezia Giulia, Central Health Directorate, Outpatient and Inpatient Care Service, Trieste, Italy.
²⁶ Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.
²⁷ Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.
²⁸ Thames Valley Police, Bicester, United Kingdom.
²⁹ Puerto Rico Department of Health's Commission on Suicide Prevention, San Juan, Puerto Rico.
³⁰ School of Applied Psychology, Griffith University, Brisbane, Australia.
³¹ Department for Medical Ethics, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia.
³² Public Health Foundation of India, Gurugram, India.
³³ Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States.
³⁴ Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium.
³⁵ Griffith University, Brisbane, Australia.
³⁶ Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology; University Hospital for Psychiatry 2, Medical University of Innsbruck, Innsbruck, Austria.
³⁷ Coroners Court of Victoria, Melbourne, Australia.
³⁸ Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.
³⁹ Copenhagen Research Centre for Mental Health, Copenhagen, Denmark.
⁴⁰ Centre for Mental Health Research, Australian National University, Canberra, Australia.
⁴¹ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
⁴² Brigham and Women's Hospital Department of Emergency Medicine, Harvard Medical School, Boston, United States.
⁴³ Department of Psychiatry, Neuroscience Institute, Federico II University of Naples, Naples, Italy.
⁴⁴ School of Population Health, The University of Auckland, Auckland, New Zealand.
⁴⁵ Coronial Division, Tasmanian Magistrates Court, Hobart, Australia.
⁴⁶ Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
⁴⁷ Undersecretary of Health Services, Ministry of Public Health, Quito, Ecuador.
⁴⁸ Monitoring and Evaluation, German Institute for Medical Mission, Tübingen, Germany.
⁴⁹ 113 Suicide Prevention, Research Department, Amsterdam, the Netherlands.
⁵⁰ Departments of Psychiatry and Epidemiology, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, United States.
⁵¹ Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
⁵² Institute of Legal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.
⁵³ Udmurtia Republican Clinical Psychiatric Hospital, Izhevsk, Russian Federation.
⁵⁴ Centre for Mental Health and Safety and National Institute for Health Research (NIHR) Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom.
⁵⁵ Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.
⁵⁶ National Institute of Mental Health, Klecany, Czechia.
⁵⁷ Faculty of Social Sciences, Charles University, Prague, Czechia.
⁵⁸ Department of Psychiatry, Aga Khan University, Karachi, Pakistan.
⁵⁹ KU Leuven, Center for Contextual Psychiatry, Leuven, Belgium.
⁶⁰ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
⁶¹ Department of Forensic Medicine, Odessa National Medical University, Odessa, Ukraine.
⁶² Brigham and Women's Hospital, Harvard Medical School, MA, United States.
⁶³ Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom.
⁶⁴ Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
⁶⁵ Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation.
⁶⁶ Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation.
⁶⁷ Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
⁶⁸ School of Psychology, University of Nottingham, Nottingham, United Kingdom.
⁶⁹ Department of Psychiatry and Psychotherapy; Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria.
⁷⁰ Suicidal Behaviour Research Lab, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland.
⁷¹ Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany.
⁷² Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
⁷³ Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁷⁴ Departments of Psychiatry and Epidemiology, Columbia University, New York, United States.
⁷⁵ Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
⁷⁶ Psychosocial Services in Vienna, Vienna, Austria.
⁷⁷ National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁷⁸ Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany.
⁷⁹ Department of Epidemiology and Biostatistics, Occupational Environment Research Center, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
⁸⁰ National Institute of Public Health, Ljubljana, Slovenia.
⁸¹ Saint Petersburg State University, Saint Petersburg, Russian Federation.
⁸² System Information and Analytics Branch, NSW Ministry of Health, Sydney, Australia.
⁸³ Instituto Vita Alere, São Paulo, Brazil.
⁸⁴ LVR Klinik Köln, Department of Addictive Disorders, Psychiatry and Psychotherapy, Cologne, Germany.
⁸⁵ Organizational-Scientific Department, Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation.
⁸⁶ Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.
⁸⁷ Department of Psychiatry, University of Toronto, Toronto, Canada.
⁸⁸ Waseda University, Faculty of Political Science and Economics, Tokyo, Japan.
⁸⁹ 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.
⁹⁰ Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

PMID: 35935344
PMCID: PMC9344880
DOI: 10.1016/j.eclinm.2022.101573

Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries

Jane Pirkis et al. EClinicalMedicine. 2022.

. 2022 Aug 2:51:101573.

doi: 10.1016/j.eclinm.2022.101573. eCollection 2022 Sep.

Authors

Affiliations

¹ Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
² National Institute of Health and care Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, United Kingdom.
³ Swansea University Medical School, Swansea, United Kingdom.
⁴ Ministry of Public Health, Department of Health Promotion, Quito, Ecuador.
⁵ National Confidential Inquiry into Suicide and Safety in Mental Health, University of Manchester, Manchester, United Kingdom.
⁶ Department of Psychiatry, Enam Medical College and Hospital, Dhaka, Bangladesh.
⁷ School of Public Health, National Suicide Research Foundation, University College Cork, Cork, Ireland.
⁸ Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia.
⁹ Department of Psychiatry, Universidad Autonoma de Madrid, Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.
¹⁰ National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
¹¹ Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.
¹² Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.
¹³ Working Group on Prevention of Suicide and Depression at Public Health Council, Ministry of Health, Warsaw, Poland.
¹⁴ Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.
¹⁵ Department of Psychiatry, Blekinge Hospital, Karlshamn, Sweden.
¹⁶ Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India.
¹⁷ Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, Brazil.
¹⁸ Department of Global Mental Health, Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, Mexico.
¹⁹ Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
²⁰ Department for Psychiatry, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia.
²¹ University of Rochester Medical Center, Rochester, NY, United States.
²² Department of Psychology, University of Milan-Bicocca, Milan, Italy.
²³ Department of Psychiatry, Nimes University Hospital, Nimes, France.
²⁴ National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden.
²⁵ Region Friuli Venezia Giulia, Central Health Directorate, Outpatient and Inpatient Care Service, Trieste, Italy.
²⁶ Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.
²⁷ Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.
²⁸ Thames Valley Police, Bicester, United Kingdom.
²⁹ Puerto Rico Department of Health's Commission on Suicide Prevention, San Juan, Puerto Rico.
³⁰ School of Applied Psychology, Griffith University, Brisbane, Australia.
³¹ Department for Medical Ethics, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia.
³² Public Health Foundation of India, Gurugram, India.
³³ Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States.
³⁴ Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium.
³⁵ Griffith University, Brisbane, Australia.
³⁶ Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology; University Hospital for Psychiatry 2, Medical University of Innsbruck, Innsbruck, Austria.
³⁷ Coroners Court of Victoria, Melbourne, Australia.
³⁸ Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.
³⁹ Copenhagen Research Centre for Mental Health, Copenhagen, Denmark.
⁴⁰ Centre for Mental Health Research, Australian National University, Canberra, Australia.
⁴¹ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
⁴² Brigham and Women's Hospital Department of Emergency Medicine, Harvard Medical School, Boston, United States.
⁴³ Department of Psychiatry, Neuroscience Institute, Federico II University of Naples, Naples, Italy.
⁴⁴ School of Population Health, The University of Auckland, Auckland, New Zealand.
⁴⁵ Coronial Division, Tasmanian Magistrates Court, Hobart, Australia.
⁴⁶ Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
⁴⁷ Undersecretary of Health Services, Ministry of Public Health, Quito, Ecuador.
⁴⁸ Monitoring and Evaluation, German Institute for Medical Mission, Tübingen, Germany.
⁴⁹ 113 Suicide Prevention, Research Department, Amsterdam, the Netherlands.
⁵⁰ Departments of Psychiatry and Epidemiology, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, United States.
⁵¹ Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
⁵² Institute of Legal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.
⁵³ Udmurtia Republican Clinical Psychiatric Hospital, Izhevsk, Russian Federation.
⁵⁴ Centre for Mental Health and Safety and National Institute for Health Research (NIHR) Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom.
⁵⁵ Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.
⁵⁶ National Institute of Mental Health, Klecany, Czechia.
⁵⁷ Faculty of Social Sciences, Charles University, Prague, Czechia.
⁵⁸ Department of Psychiatry, Aga Khan University, Karachi, Pakistan.
⁵⁹ KU Leuven, Center for Contextual Psychiatry, Leuven, Belgium.
⁶⁰ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
⁶¹ Department of Forensic Medicine, Odessa National Medical University, Odessa, Ukraine.
⁶² Brigham and Women's Hospital, Harvard Medical School, MA, United States.
⁶³ Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom.
⁶⁴ Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
⁶⁵ Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation.
⁶⁶ Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation.
⁶⁷ Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
⁶⁸ School of Psychology, University of Nottingham, Nottingham, United Kingdom.
⁶⁹ Department of Psychiatry and Psychotherapy; Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria.
⁷⁰ Suicidal Behaviour Research Lab, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland.
⁷¹ Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany.
⁷² Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
⁷³ Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁷⁴ Departments of Psychiatry and Epidemiology, Columbia University, New York, United States.
⁷⁵ Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
⁷⁶ Psychosocial Services in Vienna, Vienna, Austria.
⁷⁷ National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁷⁸ Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany.
⁷⁹ Department of Epidemiology and Biostatistics, Occupational Environment Research Center, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
⁸⁰ National Institute of Public Health, Ljubljana, Slovenia.
⁸¹ Saint Petersburg State University, Saint Petersburg, Russian Federation.
⁸² System Information and Analytics Branch, NSW Ministry of Health, Sydney, Australia.
⁸³ Instituto Vita Alere, São Paulo, Brazil.
⁸⁴ LVR Klinik Köln, Department of Addictive Disorders, Psychiatry and Psychotherapy, Cologne, Germany.
⁸⁵ Organizational-Scientific Department, Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation.
⁸⁶ Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.
⁸⁷ Department of Psychiatry, University of Toronto, Toronto, Canada.
⁸⁸ Waseda University, Faculty of Political Science and Economics, Tokyo, Japan.
⁸⁹ 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.
⁹⁰ Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

PMID: 35935344
PMCID: PMC9344880
DOI: 10.1016/j.eclinm.2022.101573

Abstract

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.

Keywords: COVID-19; Monitoring; Pandemic; Suicide.

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Conflict of interest statement

JP is funded by a National Health and Medical Research Council Investigator Grant (GNT1173126). DG receives funding support from the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust. He is an unpaid member of the UK Government's Department of Health and Social Care National Suicide Prevention Strategy Advisory Group, England and the COVID-19 response sub-group, an unpaid member of the Samaritan's Policy, Partnerships and Research Committee, and an unpaid member of the Movember Global Advisory Committee. LA has a research grant to Manchester University from Health Quality Improvement Partnership, on behalf of NHS England and devolved UK governments. He is also Chair, National Suicide Prevention Strategy Advisory Group, Department of Health and Social Care. SF was Special Advisor to a Coroner for a specific investigation and is Chairperson, New Zealand Mortality Review Committee. AB is supported by the EU Erasmus+ Strategic Partnership Programme (2019-1-SE01-KA203-060571). LFC is Primary Investigator for pesticide suicide research in Malaysia funded by the Centre of Pesticide Suicide Prevention Malaysia, University of Edinburgh (Oct 2020-31 March 2022). NK is Member, National Suicide Prevention Strategy Advisory Group (England) and Topic Advisor for NICE self-harm guidelines. NK also declares research grants paid to his institution by NIHR, HQIP and DHSC for work related to the treatment and prevention of suicidal behaviour (but not directly related to the current work). OJK is supported by a Senior Postdoctoral Fellowship from Research Foundation Flanders (FWO 1257821N); payment made to institution (KU Leuven). OJK reports grants from UCB Community Health Fund, outside the submitted work. The UCB Community Health funds in this case are managed and disbursed by the King Baudouin Foundation (Belgium). Selection is by an independent jury and UCB is not involved. Payment is to the institution (KU Leuven). OJK received a waived registration fee for the 2021 International Academy of Suicide Research (IASR) Summit in Barcelona (held online), as an invited speaker (unrelated to the current work). No payment was received directly. Fee was automatically waived at registration. OJK is a member of the Samaritans Research Ethics Board (SREB); this is an unpaid role. OJK is co-chair of the Early Career Group of the International Association for Suicide Prevention (IASP). This role is unpaid, but yearly IASP membership fee is covered in return for this service role. No funds are exchanged, but membership fee is covered directly by IASP. DK reports that the Wellcome Trust has supported the Elizabeth Blackwell Institute with a ISSF grant. DK also declares a grant from the Centre for Pesticide Suicide Prevention to conduct COVID-19 related work on self-harm in Sri Lanka, and panel fees from the Department of Health and Social Care for assessing grants. She also declares a leadership or fiduciary role with Migration Health and Development Research Initiative; no fees received. SL declares a $75,000 grant from Queensland Health; payment will be made to institution when payment occurs. SL also declares project funding from the Queensland Government for the Queensland Suicide Register; made to his institution. SL is also on the Technical Advisory Group (unfunded role), NSW Suicide Monitoring System. HO declares registration for the online congress DGPPN (2020 and 2021) and for the DGPPN congress (2019). He also declares registration for the congress OGPP (2019). SP declares a personal consultancy for support and advice to the National Office for Suicide Prevention (Health Service Executive, Dublin, Ireland) and a personal consultancy for support and advice to the National Suicide Prevention Leadership Group and the Scottish Government. SP also declares support from the World Health Organization for attending a workshop on National Suicide Prevention Implementation and Evaluation, Geneva, November 2019. SP also holds unpaid roles as adviser and committee chairmanships with the International Association for Suicide Prevention. GP is supported by the Flemish Government – Department of Health, Wellbeing and Family. AR and CR-L declare support by the Federal Health Ministry of Germany (BMG), grant number ZMVI1-2517FSB136. CR-L also declares payment or honoraria and participation on a Data Safety Monitoring Board or Advisory Board with Janssen and LivaNova. NR-V declares she is the designated representative of the Puerto Rico Department of Health in the Puerto Rico Administration of Mental Health and Anti-Addiction Services’ Mental Health and Addiction Council. It is not a paid position; she attends meetings as part of her responsibilities at the Puerto Rico Department of Health and is the Coordinator of the Public Policy Committee within this advisory council. The aforementioned council is a requisite with which the Puerto Rico Administration of Mental Health and Anti-Addiction Services must comply with because this Administration receives federal funding from the Substance Abuse and Mental Health Services Administration of the United States of America.

Figures

**Figure 1**
**Time series in primary and secondary analyses**.

**Figure 2**
**Countries and areas-within-countries included in the analyses**. 1. Countries with data available for the whole country are shaded in dark brown. The names of these countries are written in upper case. 2. Countries with data available for one or more areas within the country are shaded in light brown. 3. Areas-within-countries with available data are indicated by dark brown dots. The names of these areas-within-countries are written in lower case. 4. Countries with no data available are shaded in blue. 5. The boundaries and names shown and the designations used on this map do not imply endorsement by all authors.

See this image and copyright information in PMC

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Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries

Affiliations

Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

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