There seems to be no getting away from the coronavirus disease 2019 (COVID-19) pandemic. Not only is social distancing and health restrictions the new norm in most parts of the world, but we are besieged by news stories about the loss of life, the dangers faced by the most vulnerable, health care professionals, and other essential personnel, and the natural exhaustion we all feel while wondering when it will end.
But what about the long-term consequences to our mental health? Will life go on as before when the pandemic finally passes or are we looking at permanent changes to how we live? Unfortunately, the damage may be more far-reaching than anyone realizes, especially in terms of suicide risk.
While pandemic-related suicides have already been reported in many of the hardest-hit countries, these deaths have been largely overshadowed by the high rate of fatalities linked to COVID-19. In Italy, for example, the first known pandemic-related suicide occurred in March when a patient suffering from bronchopneumonia jumped out of the hospital window where he was awaiting test results to see if he was infected. Since then, numerous other suicides have been reported, primarily among front-line health workers, people awaiting test results, and those affected by coronavirus-related bankruptcy.
While similar cases are also being reported internationally, the risk of a pandemic-related risk in suicides remains a particular concern for the United States, since it has the largest number of COVID-19 deaths in the world. According to Centers for Disease Control and Prevention statistics, suicide is already the 10th-leading cause of death in the U.S., with a 35 percent rise in the suicide rate from 1999 to 2018. But a new article recently published in the Journal of the American Medical Association suggests that we may be at the beginning of something far worse.
Titled "Suicide Mortality and Coronavirus Disease 2019: A Perfect Storm?" the article suggests that the unprecedented public health actions needed to contain the new pandemic, along with social distancing requirements, stay-at-home orders, and stress due to job loss, may well result in far more suicides in the years to come. Written by a team of mental health professionals led by Mark Regger of the University of Washington, the article outlines many of the economic, psychosocial, and health-associated risk factors that can be expected to increase suicide risk.
Economic Stress: Considering all the recent business closures, lost jobs, as well as a shutdown in most public events, the fear of a new economic recession, or even a depression matching that of the 1930s, seems all too real. Research studies have long demonstrated that economic downturns are often followed by increased suicides, but the uncertainty surrounding the current downturn, including the sharp drop in stock markets (and a resulting loss in retirement funds, housing foreclosures, and the question of when, or if, people can return to work), will certainly trigger more deaths in the future.
Social Isolation: Research has also shown the importance of social connections in helping people overcome depression and suicidal thoughts. While social distancing remains an important tool in containing the coronavirus threat, the resulting loss of contact with friends and family will certainly add to the emotional burden we are all experiencing. This is especially hard on retirement home residents and hospital patients who, because of health precautions, have been denied regular contact with loved ones except through phone or Skype links. Though social media has become increasingly important in helping to maintain personal contacts, the uncertainty over when distancing rules might be eased can only add to the emotional stress we are all feeling.
Loss of Community and Religious Contact: For Americans who are part of a religious, ethnic, or social community, being able to attend regular events, including religious services, can be essential in feeling connected with others. While some religious congregations have opposed social distancing rules, the closing of most religious and community centres has increased social isolation for many Americans. Given that weekly attendance at religious services has long been shown to reduce suicide risk compared to non-attenders, losing this support may make social isolation harder to bear.
Barriers to Mental Health Treatment: While hospitals and other primary care facilities continue to see clients, mental health services have not been given the same priority. As a result, people dealing with mental health crises have little choice but to wait in overcrowded hospital emergency departments to get the help they need, something that might discourage many of them from even making the effort. Though suicide hotlines and telehealth services are still available, the wait time is much longer than usual due to increased demand. This means that people contemplating suicide often have nowhere to turn. And this includes front-line health care workers who are at the forefront of dealing with the pandemic.
Other Medical Problems: Along with these other issues, people with existing medical problems are also finding their access to health services being restricted given the surge in coronavirus cases. This means the cancellation of elective surgeries, a much longer wait in hospital emergency departments and urgent care clinics, and having to deal with symptoms such as chronic pain without significant relief. Since many people with chronic medical problems are already vulnerable to suicidal thinking, losing access to medical services can reduce their ability to cope with their issues.
Social and Medial Influences: Since the pandemic began, we have been regularly besieged with round-the-clock news coverage describing the impact of COVID-19, both nationally and internationally. Given the pessimism being conveyed by these news stories, it's hardly surprising that many people are becoming increasingly depressed and angry at the prospect of the pandemic dragging on for months. At the same time, gun sales are also surging in many parts of the country. With access to firearms being a major risk factor in suicides, the number of firearm-related suicides are expected to rise as well.
What About the Future?
Research studies looking at the effects of trauma in previous disasters, including the 2003 severe acute respiratory syndrome (SARS) epidemic in Hong Kong and the 2011 earthquake and nuclear disaster in Fukushima, Japan, has shown a significant rise in suicides both during the emergency itself and in the months that followed. With the SARS epidemic in particular, most suicides involved elderly or chronically ill people who were afraid of becoming burdens to their families due to becoming infected, a concern that is already common among many COVID-19 patients.
Finding real solutions won't be easy, especially as the coronavirus pandemic drags on. Even with video conferencing and social media to help people avoid feeling isolated, enhanced suicide prevention services will still be needed along with public education to ensure that people in crisis are aware of what resources are available to them.
But research looking at past crises can also offer some hope as well. Suicide rates actually decreased following national crises such as 9/11 due to the shared support such crises often bring. Despite the pessimism seen in recent weeks due to pandemic worries and racial protests, we can still work together to prevent unnecessary deaths and plan for a better future.
Mark A. Reger, PhD1,2; Ian H. Stanley, MS1,3; Thomas E. Joiner, PhD. (2020). Suicide Mortality and Coronavirus Disease 2019—A Perfect Storm? JAMA Psychiatry. Published online April 10, 2020. doi:10.1001/jamapsychiatry.2020.1060
Lennon, J. C. (2020). What lies ahead: Elevated concerns for the ongoing suicide pandemic. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication.