Suicide Trends during the COVID-19 pandemic and the International COVID-19 Suicide Prevention Research Collaboration

Abstract Introduction There was and still is much speculation about the COVID-19 pandemic impact on suicide rates. We aimed to assess the effect of the COVID-19 pandemic on suicide rates around the world. Methods We sourced real-time suicide data from countries or countries areas through a systematic internet search (official websites of Ministries of health, police agencies, and government-run statistics agencies or equivalents), recourse to our networks (e.g. ICSPRC) and the published literature (a living systematic review). We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 in each country or country area, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). We have now updated this work to cover the first 15 months of the pandemic and stratified analyses by age and sex and method. We will present findings from the new updated data (35 countries) at the conference. Results Initially we sourced data from 21 countries (16 high-income and five upper-middle-income countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas. Conclusions This was the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. Early on high-income and upper-middle-income countries, suicide numbers remained largely unchanged or declined compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond as the longer-term mental health and economic effects of the pandemic unfold. We will present updated findings with more recent data.

The recent COVID-19 pandemic confronted many societies with profound public health challenges. Although primarily a 'somatic' health concern, it becomes clear that Covid-19 and its aftermath also proved to have a substantial impact on mental health and wellbeing of the population in general and on vulnerable subgroups, such as young people and the elderly, in particular. An important public mental health concern in this context is the possible adverse influence of this pandemic on suicidality. Recent studies show that during the outbreak of the coronavirus disease the suicide mortality did not rise, rather on the contrary. However, the impact of the increased number of people with mental distress related to Covid-19 on suicidal ideation as well as the long-term impact on suicide rates is unclear. Also the long-term impact of the Covid-19 restriction measures greatly hindering adequate mental healthcare services and suicide prevention initiatives is uncertain. This workshop will focus on suicidality trends since the pandemic onset in different countries, suicide figures, experiences in the field of suicide prevention and on attitudes towards seeking help. Ann John from UK will talk about suicide trends during Covid-19 pandemic and will present suicide data of 35 countries collected by the international Covid-19 Suicide Prevention Research Collaboration. Fabrice Jollant will present data about the impact of Covid-19 pandemic on suicide attempts in France, and will discuss in this context the new national suicide prevention strategy. John Cachia will show the importance of a broad mental public health approach to suicide prevention in Malta. And finally, Saska Roskar from Slovenia will show how prevention of suicidality in individuals working themselves in the field of mental health can be hindered by self-stigma. Key messages: We must remain vigilant about the possible long-term mental health impact (including suicidal behavior) of the

Introduction:
There was and still is much speculation about the COVID-19 pandemic impact on suicide rates. We aimed to assess the effect of the COVID-19 pandemic on suicide rates around the world.

Methods:
We sourced real-time suicide data from countries or countries areas through a systematic internet search (official websites of Ministries of health, police agencies, and government-run statistics agencies or equivalents), recourse to our networks (e.g. ICSPRC) and the published literature (a living systematic review). We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 in each country or country area, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). We have now updated this work to cover the first 15 months of the pandemic and stratified analyses by age and sex and method. We will present findings from the new updated data (35 countries) at the conference.

Results:
Initially we sourced data from 21 countries (16 high-income and five upper-middle-income countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas.

Conclusions:
This was the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. Early on high-income and upper-middle-income countries, suicide numbers remained largely unchanged or declined compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond as the longer-term mental health and economic effects of the pandemic unfold. We will present updated findings with more recent data.