The impact of the COVID-19 pandemic on suicide rates in Hungary: an interrupted time-series analysis

Abstract

Background: From 2010 to 2019, suicide mortality fell steadily and substantially in Hungary: the declining trend remained stable, and the suicide rate decreased by more than one-third which was remarkable even from an international perspective. However, despite the declining trend, regional inequalities have always characterised the distribution of suicide mortality in Hungary. Following these favourable trends, COVID-19 appeared in Hungary on the 4^th of March 2020 which might lead to an increase in suicides. We aimed to investigate this hypothesis in Hungary by gender, age, educational attainment, and region, as well.

Methods: To test whether the pandemic changed the declining trend of Hungarian suicide rates, the observed number of suicides during March-December 2020 (pre-vaccination period) was compared with the expected numbers (without the appearance of COVID-19). An interrupted time-series analysis was conducted by negative binomial regression using monthly data from January 2010 to February 2020 (pre-pandemic period).

Results: Suicide mortality increased significantly compared to the trend during the pre-pandemic period: overall (by 16.7%), among males (18.5%), in the age group 35-49 years (32.8%), and among vocational school graduates (26.1%). Additionally, significant growths in suicide rates were detected in the two regions (Central Hungary and Central Transdanubia) with the lowest COVID mortality rates (by 27.3% and 22.2%, respectively).

Conclusions: Our study revealed reversed trend in suicide mortality during the pre-vaccination period compared to the pre-pandemic period in Hungary. There were significant differences in the pattern of suicide rates by gender, age group, educational attainment, and region during the pre-vaccination period in Hungary, which might be attributed to the socio-economic effects of the COVID-19 pandemic. These findings could prove useful in preventive strategies as the identification of groups at higher risk may be important for suicide prevention; however, further investigations are needed to explore the reasons.

Keywords: Age group; COVID-19; Educational attainment; Gender; Hungary; Interrupted time-series; Region; Regression; Suicide; Trends.

Fig. 1

NUTS2 regions of Hungary. Regions were coloured by: A. Suicide mortality rates during 2010–2019 B. IRRs for suicide deaths during the pre-vaccination period C. COVID-19 death rates during the pre-vaccination period D. Divorce rates during 2012–2019. Incidence rate ratios (IRRs) were obtained from negative binomial (NB) regression and expressed as percentage increases with respect to the expected numbers that would have occurred without the appearance of COVID-19. COVID-19 death rates and divorce rates were expressed per 100,000 capita and per thousand capita, respectively. The maps depicted in the figure are the authors’ own work and were created by using packages rgdal (v1.5-32; https://cran.r-project.org/web/packages/rgdal/index.html) and cartography (v3.0.1; https://cran.r-project.org/web/packages/cartography/index.html) in R. Notes: NUTS2 Nomenclature of territorial units for statistics (from the French version Nomenclature des Unités territoriales statistiques), 2^nd level; Codes: HU10 Central Hungary, HU21 Central Transdanubia, HU22 Western Transdanubia, HU23 Southern Transdanubia, HU31 Northern Hungary, HU32 Northern Great Plain, HU33 Southern Great Plain. On January 1, 2018, Hungary split the region of Central Hungary into two new regions [Government Decision No. 2013/2015 (XII. 29.)]: the Budapest region (containing the capital of the same name; previously HU102) and the surrounding region of Pest (previously HU101). In favour of continuity, we examined the territorial units existing before January 1, 2018, and used their names.

Fig. 2

Trends of suicide rates during 2010–2020 for the whole population, males, 35–49-year-olds, and vocational school graduates. Monthly suicide rates per 100,000 persons over time: A. Whole population B. Males C. Age group 35–49 years. D. Vocational school graduates. Pre-intervention period: white background; post-intervention period: coloured background; observed rates: points; fitted rates/trends (annual trend and seasonal variation): continuous lines; counterfactual scenario (for annual trend): dashed line. Notes: Only those (sub)groups were displayed here for which the effect of the pandemic on suicide rates was significant both in the main and sensitivity analyses. Regions were displayed on the map (Fig. 1B)

Fig. 3

Incidence rate ratios (IRRs) for suicide deaths during March − December 2020 by various sociodemographic factors (compared to the same period of 2019). A. Whole population and by gender B. By age group C. By educational attainment (population aged 15 − 74 years). D. By region