The psychological and social effects of the COVID-19 pandemic will persist for years after the pandemic itself has subsided. Recent studies have shown that the pandemic is associated with distress, fear of contagion, anxiety, depression, and insomnia amongst the general population and health care professionals. This may lead to the exacerbation of stress related substance abuse and mood disorders. Both are associated with suicidal behavior. An increase in suicides is a likely consequence of the pandemic both during and after. It is vital that programs are set in place to reduce stress, anxiety, and loneliness during the pandemic to hopefully decrease the suicides. Further research is needed on this subject, but active outreach is needed to curb the rising suicide rate.
To observe how the pandemic has affected suicide and if it can be helped with active outreach.
Coronavirus disease pandemic
Millions around the world are infected and the symptoms vary wildly from asymptomatic to severe cases. There is a plethora of research going into how to take care of the sick, but a small amount on how to treat the psychological impacts of the COVID-19 pandemic. Recent research indicates that the general population is unsure about the future, and a sentiment for economic and political upheaval.
Previous epidemics and suicide
The Spanish Flu caused by the H1N1 virus from birds infected nearly one third the world's population and killed at least 50 million. The epidemic caused a lack of social cohesion and integration which is believed to have resulted in the increase in suicide during that period.
During the 2003 SARS outbreak in Hong Kong, there was an increase in suicides for those 65 years and older. It is believed that it was done out of fears of contraction, burden to family, general anxiety, social isolation, and psychological distress.
The psychological impact of COVID-19
In the beginning of the outbreak, some studies in China show that 53.8% of respondents rated the psychological impact of the outbreak as moderate to severe. Similarly, a study by the Kaiser Family Foundation indicates that 45% of adults in the US report negative impacts from the pandemic.
Analysis of Chinese social media posts display a decrease in life satisfaction and happiness and an increase in anxiety, depression, and anger after the pandemic started. These psychological stressors cause decreased sleep quality and worked to further increase anxiety.
Another Chinese study shows that young people aged 21-40 had the highest rates of anxiety and depression than other age groups. Another study from China indicates that healthcare professionals are likely to have the highest rates of a negative psychological impact. The study shows that 50.4% reported depression, 44.6% anxiety, 34.0% insomnia, and 71.5% distress.
Another study indicates higher issues about physical health, anger, impulsivity, and suicidal ideation. According to market research alcohol consumption jumped 55% at the end of March and online alcohol consumption jumped 243%.
There are already a plethora of examples of suicide as a result of COVID-19 fears and anxieties.
Suicidal behavior in the COVID-19 era
Social isolation likely plays an enormous part in the increase in suicidal ideation. Studies show that social isolation and a perception of being alone are associated with greater suicidal ideation. This observation is consistent amongst cultures. This is a troubling discovery when the best method against COVID-19 is social distancing. Depression and anxiety can cause sleep disturbances which can in turn cause more depression and anxiety. This is worrisome as sleep disturbances are a stand alone risk factor for suicide.
The economic uncertainly is also associated with stress-related disorders and suicide. The economic downturn that will result from COVID-19 will likely have detrimental effects on the mental health of Americans. COVID-19 survivors also have neurological involvement in roughly 25% of patients. A Chinese study indicates that 96.2% of recovered individuals have post traumatic stress symptoms. These symptoms are also associated with an increase in suicidal ideation. This is worrisome as U.S suicide rates have already been steadily growing over the last two decades.
Suicide prevention in the COVID-19 era
The National Academy of Medicine Committee on Prevention of Mental Disorders suggests that prevention of psychiatric conditions should be divided into three categories: Universal, selective, and indicated preventive interventions.
A universal approach does not take into account individual suicide risk and is applied to all of the general population. The population should be encouraged to maintain connectedness online and to get enough sleep, eat healthy food, exercise, and encourage family checkups. Primary care should be integrated with basic mental health services. Similarly suicide hotlines should be readily available and advertised. Community and orbitational gatekeepers like first responders, teachers, clergy, caregivers, or pharmacists should identify individuals at risk for suicide and provide proper assistance. Finally, the government should provide financial assistance to those who need it.
A selective approach uses active outreach for those who are at particular risk. Such groups will need increased interaction with health professionals. Telemedicine should be used as well.
An indicated approach is for those who are at especially high risk. Clinicians should follow up with these patients and provide well defined guidelines.