The holidays can be a particularly stressful time for many, and that's in "normal" years. This year, with the added strain from COVID-19 lockdowns and isolation, it's likely that more people than usual will be grappling with loneliness and hopelessness, and perhaps even experiencing more instances of depression and suicidal thoughts.
"It's my fall" by Moonasi
Suicide is already the 9th leading cause of death in Canada (10th in the USA). Earlier this month, the Mental Health Commission of Canada (MHCC) published a detailed report examining the potential association between COVID-19 and suicide in Canada.
I was pleased to see that the devastating problem of suicide is being given the attention it deserves during the pandemic, but I confess I was a bit surprised to see just how much time has passed from the beginning of the pandemic until publication of this policy brief. (WHO declared COVID-19 a global health crisis back on March 11, 2020, after all.) Given the seriousness of suicide as a mental health issue, I would have expected the MHCC to have published at least some preliminary findings several months ago.
Key points from the report
Physical distancing, while obviously required to curb the spread of COVID-19, has the potential for negative secondary outcomes, such as increased suicide risk.
Many believe that maintaining and enhancing the mental health of the public throughout a pandemic is just as important as reducing the spread of the virus.
Limited research exists on the impact of pandemics on suicide, but in one study exploring the impact of the 1918 flu, a significant positive association was found between that pandemic and suicide. Decreased social integration and fear of contracting the virus likely played the strongest roles.
Another study, which focused on the impact of the 2003 SARS outbreak in Hong Kong, found a significant increase in suicide among adults aged 65 and older. Many who died by suicide feared being infected, and experienced feelings of social disengagement, stress, anxiety, and being a burden (e.g., on the family or the health-care system). Concerns about the outbreak triggered or worsened some existing psychiatric conditions (such as anxiety, depression, or post-traumatic stress) and were associated with an increased risk of suicidal ideation and attempts.
Patients treated during the Ebola and Zika outbreaks suffered high levels of stress, anxiety, depression, trauma, panic, and suicidal ideation.
Early studies of health care workers treating patients with COVID-19 in China found that the workers suffered mental health effects including depression, anxiety, and insomnia.
During the early months of the COVID-19 pandemic, 6% of Canadians reported that they had experienced thoughts of suicide as a result of the pandemic. Certain subgroups were disproportionately impacted: people with pre-existing mental health problems, disabilities, low incomes and Indigenous people were two to four times as likely to have had suicidal thoughts since the outbreak of COVID-19.
People who identified as LGBTQ were three times as likely to have tried to harm themselves, and racialized groups, women, and parents with children under 18 were also more likely to report worse mental health.
Distress centres across the country are seeing surges in calls directly related to anxiety around COVID-19 and its related financial and social consequences.
We need to expand modes of mental health service delivery, addressing barriers to access for those without a phone, computer, and/or internet access.
Prolonged exposure to negative media coverage and irresponsible media reporting of suicide are associated with an increase in suicides. (Media reports should always include contact information for crisis services and hotlines for those seeking help.)
Artwork by Claralieu
Summary of the MHCC’s findings
The authors conclude that while history demonstrates the potential for COVID-19―and the resulting anticipated economic recession―to negatively impact suicide rates, an increase is not inevitable. With close attention to the risks, implementation of suicide prevention best practices, and strong social protection, people can get through the pandemic without additional loss of life to suicide.
Recognizing that the impacts of COVID-19 will be long term, complex, and may take time to fully emerge, it is important to advocate for expansion of universal mental health supports (such as online portals and distress lines), adequate funding to maintain and enhance mental health and substance use services, and improved monitoring and research to better understand the full impacts of the pandemic, now and in the future.
If you’re experiencing distress:
the Canada Suicide Prevention Service’s number is 1-833-456-4566;
and in the USA, the National Suicide Prevention Lifeline is 1-800-273-TALK.
(If you live elsewhere, please find your local emergency number and keep it handy.)
🔶 Is there anything else you would want to add to this reflection about COVID-19 and suicide?
Happy, peaceful, and safe holidays everyone!