Abstract
Aims
Suicide accounts for 2.2% of all years of life lost worldwide. We aimed to establish whether infectious epidemics are associated with any changes in the incidence of suicide or the period prevalence of self-harm, or thoughts of suicide or self-harm, with a secondary objective of establishing the frequency of these outcomes.
Methods
In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO and AMED were searched from inception to September 9, 2020. Studies of infectious epidemics reporting outcomes of (a) death by suicide, (b) self-harm, or (c) thoughts of suicide or self-harm were identified. A random-effects model meta-analysis for the period prevalence of thoughts of suicide or self-harm was conducted.
Results
1354 studies were screened with 57 meeting eligibility criteria, of which 7 described death by suicide, 9 self-harm, and 45 thoughts of suicide or self-harm. Observation period ranged from 1910 to 2020 and included epidemics of Spanish Flu, severe acute respiratory syndrome, human monkeypox, Ebola virus disease and COVID-19.
Regarding death by suicide, data with a clear longitudinal comparison group were available for only two epidemics: SARS in Hong Kong, finding an increase in suicides among the elderly, and COVID-19 in Japan, finding no change in suicides among children and adolescents. In terms of self-harm, five studies examined emergency department attendances in epidemic and non-epidemic periods, of which four found no difference and one showed a reduction during the epidemic. In studies of thoughts of suicide or self-harm, one large survey showed a substantial increase in period prevalence compared to non-epidemic periods, but smaller studies showed no difference. As a secondary objective, a meta-analysis of thoughts of suicide and self-harm found that the pooled prevalence was 8.0% overall (95% CI 5.2 to 12.0%; 14,820 of 99,238 cases in 24 studies) over a time period of between 7 days and 6 months. Quality assessment found 42 studies were of high quality, 9 of moderate quality and 6 of high quality.
Conclusions
There is little robust evidence on the association of infectious epidemics with suicide, self-harm and thoughts of suicide or self-harm. There was an increase in suicides among the elderly in Hong Kong during SARS and no change in suicides among young people in Japan during COVID-19, but it is unclear how far these findings may be generalised. The development of up-to-date self-harm and suicide statistics to monitor the effect of the current pandemic is an urgent priority.
Suicide accounts for 2.2% of all years of life lost worldwide. We aimed to establish whether infectious epidemics are associated with any changes in the incidence of suicide or the period prevalence of self-harm, or thoughts of suicide or self-harm, with a secondary objective of establishing the frequency of these outcomes.
Methods
In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO and AMED were searched from inception to September 9, 2020. Studies of infectious epidemics reporting outcomes of (a) death by suicide, (b) self-harm, or (c) thoughts of suicide or self-harm were identified. A random-effects model meta-analysis for the period prevalence of thoughts of suicide or self-harm was conducted.
Results
1354 studies were screened with 57 meeting eligibility criteria, of which 7 described death by suicide, 9 self-harm, and 45 thoughts of suicide or self-harm. Observation period ranged from 1910 to 2020 and included epidemics of Spanish Flu, severe acute respiratory syndrome, human monkeypox, Ebola virus disease and COVID-19.
Regarding death by suicide, data with a clear longitudinal comparison group were available for only two epidemics: SARS in Hong Kong, finding an increase in suicides among the elderly, and COVID-19 in Japan, finding no change in suicides among children and adolescents. In terms of self-harm, five studies examined emergency department attendances in epidemic and non-epidemic periods, of which four found no difference and one showed a reduction during the epidemic. In studies of thoughts of suicide or self-harm, one large survey showed a substantial increase in period prevalence compared to non-epidemic periods, but smaller studies showed no difference. As a secondary objective, a meta-analysis of thoughts of suicide and self-harm found that the pooled prevalence was 8.0% overall (95% CI 5.2 to 12.0%; 14,820 of 99,238 cases in 24 studies) over a time period of between 7 days and 6 months. Quality assessment found 42 studies were of high quality, 9 of moderate quality and 6 of high quality.
Conclusions
There is little robust evidence on the association of infectious epidemics with suicide, self-harm and thoughts of suicide or self-harm. There was an increase in suicides among the elderly in Hong Kong during SARS and no change in suicides among young people in Japan during COVID-19, but it is unclear how far these findings may be generalised. The development of up-to-date self-harm and suicide statistics to monitor the effect of the current pandemic is an urgent priority.
| Original language | English |
|---|---|
| Journal | Epidemiology And Psychiatric Sciences |
| Publication status | Accepted/In press - 16 Mar 2021 |
