Effects of the COVID-19 pandemic on suicide attempts in a rural region in Germany, a 5-year observational study

Abstract

Background: The COVID-19 pandemic and public life restrictions may have a negative impact on people's mental health. Therefore, we analyzed whether this condition affected the occurrence of suicide attempts (SA) over 20 months during the pandemic period.

Methods: We included patient records according to DSM-5 criteria for suicidal behavior disorders (n = 825) between Jan 1, 2017, and Dec 31, 2021. We applied interrupted time-series Poisson regression models to investigate the effect of the pandemic on SA occurrence, time trends, and seasonal patterns in the whole group of patients as well as stratified by age and gender.

Results: There was no significant effect of the pandemic on the occurrence of SA in the overall group. However, we observed a significant impact of the pandemic on the seasonal pattern of SA, also the variance differed significantly (pre-pandemic mean ± variance: 13.33 ± 15.75, pandemic: mean ± variance: 13.86 ± 7.26), indicating less periodic variation in SA during the pandemic. Male patients and young adults mainly contributed to this overall effect. Subgroup analysis revealed a significant difference in SA trends during the pandemic in older adults (>55 years) compared with younger adults (18-35 years); SA numbers increased in older adults and decreased in younger adults as the pandemic progressed.

Limitations: A few patients may have received initial care in an emergency department after SA without being referred to psychiatry.

Conclusions: In general, the COVID-19 pandemic and related measures did not significantly affect the occurrence of SA but did significantly affect the dynamics. In addition, the pandemic appeared to affect suicidal behavior differently across age groups as it progressed. Particularly for the older adult group, negative long-term effects of the pandemic on suicidal behavior can be derived from the present results, indicating the need to strengthen suicide prevention for the elderly.

Keywords: Covid-19 pandemic; Interrupted time-series analysis; Suicidal behavior; Suicidal ideations.

Fig. 1

In the Fig. 1A, the grey points indicate the number of suicide attempts per month before Covid-19 pandemic in the whole group of patients, and the red points show the number of suicide attempts during pandemic. In the Fig. 1B, the grey points indicate the number of suicide attempts per month before Covid-19 pandemic in male patients only, and the red points show the number of suicide attempts during pandemic. The solid grey line shows the Poisson trend line before and the solid red line after the first lockdown. The curvy grey solid line depicts the modeled seasonality pattern, and the curvy red solid line shows the seasonality pattern after the first lockdown. The dashed blue line shows the Poisson regression predicted based on data before COVID-19 lockdown. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

In the Fig. 2A, the grey points indicate the number of suicide attempts before Covid-19 pandemic in patients with age > 55 years, and the red points show the number of suicide attempts during pandemic. In the Fig. 2B, the grey points indicate the number of suicide attempts before Covid-19 pandemic in patients with age between 18 and 35 years, and the red points show the number of suicide attempts during pandemic. The solid grey line shows the Poisson trend line before the first lockdown, and the solid red line shows the Poisson trend line after the first lockdown. Comparing time trends, there was a significant interaction between both ages groups and the time trends during pandemic. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)