Psychological distress among individuals with a suicide attempt or suicidal ideation and suicide attempts patterns: first two years of the pandemic

Abstract

Background: The COVID-19 pandemic and related restrictions may have led to increased stress, particularly in people with mental health problems. Since stress factors play important role in the emergence of suicide attempts (SA) and suicidal ideation (SI), they may have been exacerbated by the pandemic, which could have led to an increased number of suicide attempts. Thus, we first investigated whether the pandemic affected personal stress experiences and appraisal of coping potential in individuals with and without SA and SI. In a second step, we analyzed the frequency and dynamics of SAs by patients admitted to a psychiatric university clinic over a period of four years.

Methods: We examined stress experiences and appraisal of coping resources of inpatients recruited between March 2021 and February 2022 with SA (n=38), SI (n=27), and with mood disorder without SA or SI (n=45). In the second study, we investigated the time course of prospectively recorded patients with a suicide attempt (n=399) between January 1^st 2018 and December 31^st 2021 using interrupted time-series Poisson regression models.

Results: There was a significant main effect of group (F[2,107]=6.58, p=0.002) regarding psychological stress levels, which was significantly higher in the SA and SI groups than in the psychiatric control group. No significant differences were found in the appraisal of coping resources or in the frequency of SAs before and during pandemic. However, the pandemic had a significant impact on the seasonal pattern of SAs.

Conclusions: The pandemic increased psychological stress levels in individuals with SA and SI, which may be related to SI and do not necessarily result in SA. The pandemic did not affect the overall frequency of SA between March 2020 and December 2021, but interfered with the seasonal pattern of SA occurrence. Effective intervention strategies during a pandemic should include programs to strengthen the psychological resilience of people who are susceptible to mental health problems.

Keywords: COVID-19; coping resources; interrupted time series analysis; mental health; psychological stress; suicidal ideation; suicide; suicide attempts.

Figure 1

Psychological and physical stress symptoms experienced due to the COVID-19 pandemic, assessed with Subclinical Stress Symptom Questionnaire (SSQ-25). Error bars correspond to the first standard deviation. Patients with SA and SI reported significantly higher levels of psychological stress symptoms compared to the control patients. (*, p<0.05; **, p<0.01).

Figure 2

Frequencies of subjects reporting stress due to the COVID-19 pandemic in the domains of “family/partnership” and “life perspectives” (*, p<0.05; **, p<0.01).

Figure 3

(A) Observed, fitted and predicted (during pandemic) values by applying simple seasonal model regarding the frequency of suicide attempts from 01 Jan 2018, until 31 Dec 2021. (B) Scatter plot and R-squared with observed data, fitted (R²=0.48) and predicted data (R²=0.03) for pre-pandemic (red dots) and pandemic (blue dots).