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The Coronavirus: Risk for increased Suicide and Self-Harm in the Society after the Pandemic

The National Centre for Suicide Research and Prevention (NASP) wants to raise awareness about the potential increase in suicide and self-harm behavior as a result of the societal impact of the corona pandemic (COVID-19). Risks are linked but not limited to the social, economic and health-related consequences of the pandemic which will continue in the future.

Every year around 1 500 individuals commit suicide in Sweden, which corresponds to 18 suicides per 100 000 inhabitants aged 15 and over [1]. Research on suicide during war or natural disasters points to a temporary decline in suicide rates during times of societal crises [2, 3]. However, these temporary reductions tend to be compensated – even overcompensated – with an increase in suicide rates after the immediate crisis has passed. Sweden is currently facing the same type of risk with regards to the corona pandemic and its aftermath.

The coronavirus (COVID-19) was declared a pandemic in March 2020. Currently, the number of infected individuals, as well as the mortality rate associated with the infection, are continuing to rise in Sweden and worldwide. Swedish authorities have taken some preventive measures to reduce the infection rate and health impact of the spread of the virus. Some of these measures, which have been implemented or will need to be implemented, can be expected to have a significant impact on other sectors of society, such as the labor market and the economy [4-6]. Reports of termination of employment, bankrupt companies, and stock market fluctuations have already been recorded. The number of such reports is likely to increase since the International Monetary Fund (IMF) predicts an economic crisis, which will, at the least, be as extensive as the crisis of 2008 [7].

The loss of close relatives is an important risk factor for the suicides of survivors of crises, particularly to vulnerable individuals [8]. Additionally, the involuntary social isolation imposed to reduce the spread of the infection entails both suffering and is a risk factor by itself [9, 10]; these measures reduce the chances of closely connected persons to recognize and stop a potential ongoing suicide attempt. Furthermore, there is a large body of scientific literature showing that several factors related to a potential recession increase the risk of suicide. Such factors include unemployment, increased social inequality, economic loss, or loss of property [11, 12]. In Sweden, poisoning with drugs and narcotic substances is a common practice in suicide cases, which account for about one third of all completed suicides [1, 13]. With regards to risk factors for suicide, access to lethal means is one of the most important factors [14]. Thus, suicide risk is particularly high for those who have accumulated toxic medication (e.g., Paracetamol) for preventive purposes and who fear the onset of prolonged social isolation. Presumably several people also gather medication which are not intended for the treatment of influenza symptoms, but for several other conditions which are feared to be disregarded by an overburdened healthcare system. Moreover, if there is an actual constraint in the healthcare (or other resources such as the 1177 Health Care Guide) to caring for suicidal persons, this would increase the risk even more [14]. 

The Swedish Public Health Agency has a responsibility to protect the health of the population and is doing its utmost to reduce the rapid spreading of COVID-19 by recommending the most balanced possible measures. Regardless of how balanced these measures may be, they have major implications for society as a whole as well as for every single individual. Some of the consequences present the very tangible risk that the incidence of suicide and suicide attempts will increase with the pandemic. This risk is likely to increase towards the end, and especially in the aftermath of the Corona epidemic in Sweden. With this text, NASP calls for population-oriented suicide prevention measures, which are already underway in large parts of society, to be extended and strengthened in order to prevent the potential increase of suicides. There are a number of evidence-based strategies to prevent suicides at the population level, according to a recent survey carried out by NASP on behalf of Region Stockholm [15]. In order to successfully combat the outlined problem of increasing suicide rates, these strategies must be politically anchored within the regions and local authorities, as well as then prioritized, organized, and implemented by the relevant stakeholders.

Considerations for the public

The social life of many people is restricted by the fact that more people work from home, travel less and do not have the same opportunities to visit their older close ones. The situation is ever-changing and new recommendations or restrictions may change life even more. It is, and always has been, fundamental to good health to try to counter feelings of loneliness. However, special efforts are now needed, particularly to reduce the loneliness of older people whose social lives are further impacted. To quote the Director-General of the World Health Organization (WHO), Dr. Tedros Adhanom Ghebreyesus:

“Physical distance doesn’t mean social distance. We all need to check in regularly on older parents, neighbors, friends or relatives who live alone or in care homes in whatever way is possible, so they know how much they are loved and valued.”

When one does not meet someone in person and as regularly as one is used to, changes in another person’s mood or behavior may be difficult to detect. It may, therefore, be more difficult to notice whether someone is not feeling well or is feeling alone. If you suspect that another person is having difficulties right now, search for contact, for example by phone, text or social media. Check in regularly to ask how the person feels and how their day has been to show your support. Do not be afraid to ask whether the person has thought about suicide. It is a myth that this could be dangerous. People with suicidal thoughts usually feel relieved from talking about these feelings to someone who shows that they are willing to listen and talk about the subject. Do not take it for granted that the person would address the issue themselves or that the person’s situation or feelings will pass. The most important thing is to show that you are listening and are open to what the persons want to talk about and how they feel. Having the opportunity to talk to someone who offers to listen without prejudice can give hope for the future and increase the chances that the person will look for help again.

Protect each other and try as much as you can to maintain connectedness and solidarity despite the physical distance.

National centre for suicide research and prevention of mental ill-health (NASP)
Centre for health economics, informatics and health care research (CHIS)
, Stockholm County Council
Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet

Stockholm, 2020-03-26

References

1. National centre for suicide research and prevention. Självmord i Sverige [Suicide in Sweden]. Updated: 10-11_2019. [accessed 23-03-2020 from: https://ki.se/nasp/sjalvmord-i-sverige].

2. Kõlves K, Kõlves KE, De Leo D. Journal of Affective Disorders. Natural disasters and suicidal behaviours: a systematic literature review. 2013 Mar 20;146(1):1-14. doi: 10.1016/j.jad.2012.07.037. Epub 2012 Aug 20.

3. Lester D. Suicide during war and genocide. In: Oxford Textbook of Suicidology and Suicide Prevention: A Global Perspective (Editor: D Wasserman, C Wasserman). Oxford University Press; Oxford, 2009. DOI:10.1093/med/9780198570059.003.0031

4. Folkhälsomyndigheten. Antal fall av covid-19: Fall av covid-19 i Sverige 23 Mars 2020 (kl. 14.00) [Number of covid-19 cases in Sweden 23rd of March 2020 (3 pm). Updated: 03-23-2020. [Accessed 2020-03-23 from: https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuel…].

5. Regeringskansliet. Regeringens beslut och initiativ med anledning av nya coronaviruset [The government’s decision and initiatives responding to the new coronavirus]. Updated: 03-20-2020. [Accessed 03-23-2020 from: https://www.regeringen.se/regeringens-politik/regeringens-arbete-med-an…].

6. Regeringskansliet. Ekonomiska åtgärder med anledning av covid-19 [Financial measures in response to covid-19] . Updated: 03-20-2020. [Accessed 03-16 -2020from: https://www.regeringen.se/sveriges-regering/finansdepartementet/statens…].

7. International Monetary Fund. IMF’s Georgieva: COVID-19 Economic Outlook Negative, But Rebound in 2021. Updated: 03-23-2020. [Accessed 03-24-2020from: https://www.imf.org/external/mmedia/view.aspx?vid=6144138845001]

8. Mogensen H, Möller J, Hultin H, Mittendorfer-Rutz E. Death of a Close Relative and the Risk of Suicide in Sweden—A Large Scale Register-Based Case-Crossover Study. PLoS One. 2016; 11(10): e0164274. Published online 2016 Oct 11. doi: 10.1371/journal.pone.0164274

9. Calati R, Ferrari C, Brittner M, Oasi O, Olié E, Carvalho AF, Courtet P. Suicidal thoughts and behaviors and social isolation: A narrative review of the literature. Journal of Affective Disorders. 2019 Feb 15; 245:653-667. doi: 10.1016/j.jad.2018.11.022.

10. Thelander K. Ensamhet dödar – ofrivillig ensamhet i Sverige [Loneliness kills – involuntary loneliness in Sweden]. Kerstin Thelander och Arena Idé, Stockholm, 2020. [Accessed from: https://arenaide.se/wp-content/uploads/sites/2/2020/03/ofrivillig-ensam…]

11. Chang SS, Stuckler D, Yip P, Gunnell D. Impact of 2008 global economic crisis on suicide: time trend study in 54 countries. BMJ. 2013 Sep 17;347:f5239. doi: 10.1136/bmj.f5239.

12. Oyesanya M, Javier Lopez-Morinigo J, Dutta R. Systematic review of suicide in economic recession. World J Psychiatry. 2015 Jun 22; 5(2): 243–254. Published online 2015 Jun 22. doi: 10.5498/wjp.v5.i2.243

13. Socialstyrelsen. Statistikdatabas för dödsorsaker [Statisticsdatabase for cause of death]. Updated: 02-20-2020. [Accessed 03-23-2020from: https://sdb.socialstyrelsen.se/if_dor/val.aspx].

14. World Health Organization. Preventing suicide: A global imperative. World Health Organization; Geneva, 2014. ISBN 978 92 4 156477 9.

15. National centre for suicide research and prevention. Rekommendationer för suicidpreventiva insatser på befolkningsnivå [Recommendations for population-based suicide prevention measures]. Centrum för hälsoekonomi, informatik och sjukvårdsforskning; Stockholm, 2019. Updated: 13-2-2020 [Accessed from: https://ki.se/nasp/rekommendationer-for-suicidpreventiva-insatser-pa-be…]