Covid Increasing Suicidality

David Puder, MD, Alec Zane, BA

There are no conflicts of interest for this episode.

The COVID-19 pandemic and subsequent lockdowns have seemed to foster a “sub-epidemic” of suicidality and deteriorating mental health. Suicidal thoughts have spiked across every demographic due to the loss of connection to usual psychosocial supports, normal activities, and in a lot of cases, jobs, leading to significant financial stress. These stressors compound and massively impact the mental resiliency of everyone reached by this pandemic.

The hardest-hit demographic is unpaid caregivers and essential workers. “Mental health conditions are disproportionately affecting specific populations, especially young adults, Hispanic persons, black persons, essential workers, unpaid caregivers for adults, and those receiving treatment for preexisting psychiatric conditions,” according to a study by the CDC. 

The study looked to examine mental health, substance use, and suicidal ideation during the pandemic. Representative panel surveys took data from 5,470 adults aged >18 years across the US from June 24-30, 2020. Symptoms of anxiety and depression were measured using the four-item Patient Health Questionnaire. Symptoms of COVID-related trauma and stressor-related disorder were measured using the six-item Impact of Event Scale. Surveys also asked about recent substance use or suicidal thoughts related to COVID-19. 

Results showed that overall, 40.9% of participants reported an adverse mental or behavioral health condition. 30.9% reported symptoms of anxiety or depression, 26.3% reported trauma or stressor symptoms related to COVID-19, 13.3% reported increased substance use related to COVID-19, and 10.7% reported increased thoughts of suicide within the last 30 days. 

When looking at different subgroups, symptoms of adverse mental or behavioral health conditions varied. 

Here is what the study said:

“The coronavirus disease 2019 (COVID-19) pandemic has been associated with mental health challenges related to the morbidity and mortality caused by the disease and to mitigation activities, including the impact of physical distancing and stay-at-home orders.* Symptoms of anxiety disorder and depressive disorder increased considerably in the United States during April–June of 2020, compared with the same period in 2019 (1,2). To assess mental health, substance use, and suicidal ideation during the pandemic, representative panel surveys were conducted among adults aged ≥18 years across the United States during June 24–30, 2020. Overall, 40.9% of respondents reported at least one adverse mental or behavioral health condition, including symptoms of anxiety disorder or depressive disorder (30.9%), symptoms of a trauma- and stressor-related disorder (TSRD) related to the pandemic† (26.3%), and having started or increased substance use to cope with stress or emotions related to COVID-19 (13.3%). The percentage of respondents who reported having seriously considered suicide in the 30 days before completing the survey (10.7%) was significantly higher among respondents aged 18–24 years (25.5%), minority racial/ethnic groups (Hispanic respondents [18.6%], non-Hispanic black [black] respondents [15.1%]), self-reported unpaid caregivers for adults§ (30.7%), and essential workers¶ (21.7%). Community-level intervention and prevention efforts, including health communication strategies, designed to reach these groups could help address various mental health conditions associated with the COVID-19 pandemic” (CDC, 2020).

As an inherently social species, we are easily impacted by the abrupt loss of our normal structure and support systems. Parents are finding themselves responsible for the education needs of their children along with normal parenting and professional obligations. Our normal, comforting family structures being stressed and strained puts everyone on edge. 

Other studies prior to this CDC report included a study from Bangladesh during the month of April, 2020 that shows people are committing suicide due to financial pressures from unemployment and lack of food (Bhuiyan, Sakib, Pakpour, et al., 2020). A study of 69 Indian COVID-19 suicide cases show that the greatest suicide causalities are due to fear of COVID-19 infection, followed by financial crisis, loneliness, and pressure to quarantine (Dsouza, Quadros, Hyderabadwala, 2020). Studies have also shown that a new concerning type of suicide has presented itself: suicide pacts by couples (Griffiths, Mamun, 2020). Cases have shown that an increased number of couples are dying together due to fear of infection, harassment, and financial issues.  

A May, 2020 study, posted by The Lancet Psychiatry, utilized data from suicide numbers linked to unemployment during years 2000-2011 to estimate an increase of up to 9,570 suicides per year as worldwide unemployment rates increase (Kawohl, Wolfram, and Nordt, 2020). The article also highlights WHO data pointing out that there are 20 suicide attempts for every suicide, which is a staggering figure. 

Our prior episode: Episode 081: The Link Between Unemployment, Depression and Suicide in the COVID-19 Pandemic posted on May 2, 2020 discussed how just from the higher unemployment, we may see 5,000 more deaths, and the social isolation was not even factored in.  

We have never had such a large social event that led to widespread social isolation, unemployment, and increased fear of an illness. 

Here would be my tips specifically for the unpaid caregivers and essential workers:

1. Prize sleep. Try to get to bed at 9:30 to gear up for the next day (that might mean getting young kids to sleep at 7:15)

2. Try to get some exercise every day or at least every other day, such as walking outside in the AM.  Taking your kids into nature is key. I personally do timed relay races with my kids.  Anything to get them and myself moving full speed.

3. Try to find places in nature away from others. Maybe avoid the most famous places and consider looking up lesser-populated trails.  

4. Make a list of your friends and give them a call once a week. Maybe even consider scheduling that time. 

5. Try to eat 3 meals per day and make them as healthy as possible. Brain superfoods include avocado, nuts, olive oil (instead of other oils), greens, salmon, chia seeds, flax seed. 

6. Get into a therapist or psychiatrist if you are feeling at all suicidal. Feeling suicidal is not normal.