Reactive surveillance of suicides during the COVID-19 epidemic in France, 2020- March 2022

Abstract Background Mitigation actions during the COVID-19 pandemic, in particular lockdowns and curfews, may impact mental health and suicide in general populations. We aimed to analyse the evolution in suicide deaths from January 2020 to March 2022 in France. Methods Using free-text medical causes in death certificates, we built an algorithm, which aimed to identify suicide deaths. We measured its retrospective performances by comparing suicide deaths identified using the algorithm with deaths which had either an ICD10 code for ‘intentional self-harm’ or for ‘external cause of undetermined intent’ as underlying cause. The number of suicide deaths from January 2020 to November 2021 was then compared with the expected number estimated using a generalized additive model. The analysis was stratified by age group and gender. Analysis from December 2021 to March 2022 was conducted using electronic death certificates only. Results The free-text algorithm demonstrated high performances. From January 2020 to November 2021, suicide mortality declined during France's three lockdowns, particularly in men, and remained quite comparable with expected values between and after both of the country's lockdowns. Provisional results based on electronic death certificates suggest that suicide mortality remained stable until March 2022. Conclusions Monitoring suicide mortality is possible in France with a 4-month delay; this will be reduced to two days when electronic death certification is fully deployed. This study highlighted the absence of an increase in suicide mortality during France's COVID-19 pandemic, and a substantial decline during lockdowns periods, something already observed in other countries. Further studies are required to explain the factors for this decline. Key messages • In the absence of reactive coding of medical causes of deaths, the study proposed an approach to reactively identify suicide based on free-text medical causes from death certificates. • Our findings provide reassurance that the COVID-19 pandemic has not had a negative impact on the general population in terms of suicide in France from March 2020 to September 2021.


Background:
New mothers are a particularly vulnerable group during the COVID-19 pandemic, due both to the higher depression and stress levels associated with early child care and to the risk of a COVID-19 infection. We investigated the effects of the pandemic on the childbirth experience, stress and depression levels in this population.

Methods:
This cross-sectional, explorative study included 1964 Austrian and German mothers who gave birth between 16.03.2020 and 01.07.2021 and completed an online survey between 18.05.2021 and 01.07.2021. This contained the Childbirth Experience Questionnaire (CEQ2), the Edinburgh Postnatal Depression Scale (EPDS), and the Perceived Stress Scale (PSS), as well as three custom-made scales: a birth risk score (risk factors for a poor birth outcome), a pandemic repercussions score (perceived effects on different aspects of personal life), and a social support score (how emotionally supported they feel). We computed post-hoc multilinear regression models to evaluate which factors can predict the CEQ2, PSS and EPDS scores.

Results:
Mothers had a worse birth experience, perceived less stress and had more depressive symptoms during the pandemic than previously reported cohorts. The CEQ2 was predicted by the birth risk (negatively), the access to a midwife (positively) and the perception of sufficient access of the visitors in the hospital (positively) (adjusted R2 = 0.26, F(4, 1738) = 155.64, p < 0.001). The PSS was predicted by the pandemic repercussions (positively), the social support (negatively), and the presence of a coping mechanism (negatively) (adjusted R2 = 0.28, F(4, 1959) = 195.1, p < 0.001). The EPDS was similarly predicted by the same factors as the PSS (adjusted R2 = 0.28, F(4, 1959) = 189.59, p < 0.001).

Conclusions:
Social support and strong coping mechanisms can lower the stress and depression scores. Instructing the population about how to improve these factors might be a target for future social policies. Key messages: Compared to historical cohorts, mothers who gave birth during the pandemic had a worse birth experience, and, postnatally, perceived less stress but had more depressive symptoms. The visitors' access to the hospital and the mother's access to a midwife impacted the birth experience, while the social support and the coping mechanisms affected the stress and depression scores.

Background:
Mitigation actions during the COVID-19 pandemic, in particular lockdowns and curfews, may impact mental health and suicide in general populations. We aimed to analyse the evolution in suicide deaths from January 2020 to March 2022 in France.

Methods:
Using free-text medical causes in death certificates, we built an algorithm, which aimed to identify suicide deaths. We measured its retrospective performances by comparing suicide deaths identified using the algorithm with deaths which had either an ICD10 code for 'intentional self-harm' or for 'external cause of undetermined intent' as underlying cause. The number of suicide deaths from January 2020 to November 2021 was then compared with the expected number estimated using a generalized additive model. The analysis was stratified by age group and gender. Analysis from December 2021 to March 2022 was conducted using electronic death certificates only.

Results:
The free-text algorithm demonstrated high performances. From January 2020 to November 2021, suicide mortality declined during France's three lockdowns, particularly in men, and remained quite comparable with expected values between and after both of the country's lockdowns. Provisional results based on electronic death certificates suggest that suicide mortality remained stable until March 2022.

Conclusions:
Monitoring suicide mortality is possible in France with a 4month delay; this will be reduced to two days when electronic death certification is fully deployed. This study highlighted the absence of an increase in suicide mortality during France's COVID-19 pandemic, and a substantial decline during lockdowns periods, something already observed in other countries. Further studies are required to explain the factors for this decline.
Key messages: In the absence of reactive coding of medical causes of deaths, the study proposed an approach to reactively identify suicide based on free-text medical causes from death certificates.

Background:
The extent of the psychological impact of the pandemic is still unfolding. Despite existing literature, most studies lack rigor.
We assessed the longitudinal rate of intra-individual change in maternal depression symptoms from before to after COVID-19 onset among US mothers enrolled in a home visiting program with robust adjustment for family contextual factors. We hypothesize that the rate of change in maternal depression symptoms increased after the pandemic onset.

Methods:
Eligibility included mothers with 1 depression assessment both prior to and after March 16, 2020; thresholds of 13 on the Edinburgh Postnatal Depression Scale and 10 on the Patient Health Questionnaire-9 identified probable depression. We used a generalized linear mixed effects longitudinal model with a random intercept and random slope for time (years) to analyze probable depression (event='Yes') pre-and post-COVID. Covariates for model estimation were based on the literature and theory.

Results:
Our cohort of 3,431 mothers included 43% non-Hispanic White, 21% non-Hispanic Black, and 31% Hispanic races/ ethnicities; 58% from rural/small towns, 18% Spanish-speaking, 63% with one child, median age of 29 and median 2 years follow-up. Households included: 82% low income, 24% low education, 10% insecure housing, 29% single parents, 21% mental illness, 10% substance abuse, and 8% domestic violence. Fourteen percent screened positive for depression pre-COVID, and 10% post-COVID. Depression was significantly higher pre-versus post-COVID, with no significant difference in the rate of change over time. Significant variables (p < 0.05) associated with depression included race/ethnicity, region of the country, number of home visits, mental illness, substance abuse, and domestic violence.

Conclusions:
After controlling for family contextual factors, we did not find a significant increase in maternal depression post-COVID-19. Additional research is needed to examine subgroups and the timing of events.

Key messages:
The extent of the psychological impact from the pandemic is still unfolding. It is difficult to fully articulate its effects without rigorous, longitudinal research designs.