Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries.

Background: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally.
Methods: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation.
Findings: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well.
Interpretation: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue.
Funding: None.
Competing Interests: JP is funded by a National Health and Medical Research Council Investigator Grant (GNT1173126). DG receives funding support from the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust. He is an unpaid member of the UK Government's Department of Health and Social Care National Suicide Prevention Strategy Advisory Group, England and the COVID-19 response sub-group, an unpaid member of the Samaritan's Policy, Partnerships and Research Committee, and an unpaid member of the Movember Global Advisory Committee. LA has a research grant to Manchester University from Health Quality Improvement Partnership, on behalf of NHS England and devolved UK governments. He is also Chair, National Suicide Prevention Strategy Advisory Group, Department of Health and Social Care. SF was Special Advisor to a Coroner for a specific investigation and is Chairperson, New Zealand Mortality Review Committee. AB is supported by the EU Erasmus+ Strategic Partnership Programme (2019-1-SE01-KA203-060571). LFC is Primary Investigator for pesticide suicide research in Malaysia funded by the Centre of Pesticide Suicide Prevention Malaysia, University of Edinburgh (Oct 2020-31 March 2022). NK is Member, National Suicide Prevention Strategy Advisory Group (England) and Topic Advisor for NICE self-harm guidelines. NK also declares research grants paid to his institution by NIHR, HQIP and DHSC for work related to the treatment and prevention of suicidal behaviour (but not directly related to the current work). OJK is supported by a Senior Postdoctoral Fellowship from Research Foundation Flanders (FWO 1257821N); payment made to institution (KU Leuven). OJK reports grants from UCB Community Health Fund, outside the submitted work. The UCB Community Health funds in this case are managed and disbursed by the King Baudouin Foundation (Belgium). Selection is by an independent jury and UCB is not involved. Payment is to the institution (KU Leuven). OJK received a waived registration fee for the 2021 International Academy of Suicide Research (IASR) Summit in Barcelona (held online), as an invited speaker (unrelated to the current work). No payment was received directly. Fee was automatically waived at registration. OJK is a member of the Samaritans Research Ethics Board (SREB); this is an unpaid role. OJK is co-chair of the Early Career Group of the International Association for Suicide Prevention (IASP). This role is unpaid, but yearly IASP membership fee is covered in return for this service role. No funds are exchanged, but membership fee is covered directly by IASP. DK reports that the Wellcome Trust has supported the Elizabeth Blackwell Institute with a ISSF grant. DK also declares a grant from the Centre for Pesticide Suicide Prevention to conduct COVID-19 related work on self-harm in Sri Lanka, and panel fees from the Department of Health and Social Care for assessing grants. She also declares a leadership or fiduciary role with Migration Health and Development Research Initiative; no fees received. SL declares a $75,000 grant from Queensland Health; payment will be made to institution when payment occurs. SL also declares project funding from the Queensland Government for the Queensland Suicide Register; made to his institution. SL is also on the Technical Advisory Group (unfunded role), NSW Suicide Monitoring System. HO declares registration for the online congress DGPPN (2020 and 2021) and for the DGPPN congress (2019). He also declares registration for the congress OGPP (2019). SP declares a personal consultancy for support and advice to the National Office for Suicide Prevention (Health Service Executive, Dublin, Ireland) and a personal consultancy for support and advice to the National Suicide Prevention Leadership Group and the Scottish Government. SP also declares support from the World Health Organization for attending a workshop on National Suicide Prevention Implementation and Evaluation, Geneva, November 2019. SP also holds unpaid roles as adviser and committee chairmanships with the International Association for Suicide Prevention. GP is supported by the Flemish Government – Department of Health, Wellbeing and Family. AR and CR-L declare support by the Federal Health Ministry of Germany (BMG), grant number ZMVI1-2517FSB136. CR-L also declares payment or honoraria and participation on a Data Safety Monitoring Board or Advisory Board with Janssen and LivaNova. NR-V declares she is the designated representative of the Puerto Rico Department of Health in the Puerto Rico Administration of Mental Health and Anti-Addiction Services’ Mental Health and Addiction Council. It is not a paid position; she attends meetings as part of her responsibilities at the Puerto Rico Department of Health and is the Coordinator of the Public Policy Committee within this advisory council. The aforementioned council is a requisite with which the Puerto Rico Administration of Mental Health and Anti-Addiction Services must comply with because this Administration receives federal funding from the Substance Abuse and Mental Health Services Administration of the United States of America.
(© 2022 The Authors.)