Did Suicide Numbers Diverge from Pre-Existing Trends During the First 9-15 Months of the COVID-19 Pandemic? Interrupted Time Series Analyses of Total and Sex- and Age-Specific Suicide Counts in 33 Countries

Background When the COVID-19 pandemic began there were concerns that suicides might rise, but predicted increases were not generally observed in the pandemic’s early months. However, the picture may be changing and patterns may vary across demographic groups. We aimed to provide an up-to-date, granular picture of the impact of COVID-19 on suicides globally.Methods We identified suicide data from official public-sector sources for countries/areas-within-countries. We used interrupted time series (ITS) analyses to model the association between the pandemic’s emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed number of suicides to the expected number in the pandemic’s first nine and first 10-15 months and used meta-regression to explore sources of variation.Findings We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries’ COVID-19 mortality rate, stringency of public health response, level of economic support, or presence of a national suicide prevention strategy. They were also not explained by countries’ income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well.Interpretation Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue.Funding Information: None. Declaration of Interests: L. Appleby discloses Research grant to Manchester University, Health Quality Improvement Partnership on behalf of NHS England and devolved UK Governments, A. Baran discloses grants supported by the EU Erasmus+Strategic Partnership Programme (2019-1-SE01-KA203-060571), L.F. Chan discloses grants from Primary Investigator for pesticide suicide research in Malaysia funded by the Centre of Pestide Suicide Prevention Malaysia, University of Edinburgh, Funding received into institutional research account in the National University in Malaysia, D. Gunnell discloses support from the National Institute of Health Research, UK, received funding support from the NIHR Biomedical Research Centre at University HospitalsBristol and Weston NHS Foundation Trust, N. Kapur is a Member National Suicide Prevention Strategy Advisory Group (England). Topic Advisor for NICE self-harm guidelines and received grants from NIHR, HQIP, DHSC and Research grants paid to my institution for work related to the treatment and prevention of suicidal behavior (but not directly related to the current work), OJK is supported by a Senior Postdoctoral Fellowship from Research Foundation Flanders (FWO 1257821N), Payment made to institution (KU Leuven), OJK reports grants from UCB Community Health Fund, outside the submitted work., The UCB Community Health funds in this case are managed and disbursed by the King Baudouin Foundation (Belgium). Selection is by an independent The UCB Community Health funds in this case are managed and disbursed by the King Baudouin Foundation (Belgium). Selection is by an independent jury and UCB is not involved. Payment is to the institution (KU Leuven), OJK received a waived registration fee for the 2021 International Academy of Suicide Research (IASR) Summit in Barcelona (held online), as an invited speaker (unrelated to the current work), OJK is a member of the Samaritans Research Ethics Board (SREB), OJK is co-chair of the Early Career Group of the International Association for Suicide Prevention (IASP), D. Knipe was supported by Wellcome Trust, All support for the present manuscript (e.g., funding, provision of study materials, medical writing, article processing charges, etc.) , The Wellcome trust has supported the Elizabeth Blackwell Institute with a ISSF grant, grants from Centre for Pesticide Suicide Prevention, Grant to conduct covid-19 related work on self-harm in Sri Lanka, consulting fee from Department of Health and Social Carw, Panel fees for assessing grants, Panel fees for assessing grants, J. Pirkis discloses grants from Grants or contracts from any entity (if not indicated in item #1 above). National Health and Medical Research Council, Payment to my institution, S Platt received consulting fees from, Consulting fees Health Service Executive, Dublin, Ireland, Personal consultancy for support and advice to the National Office for Suicide Prevention, Public Health Scotland, Edinburgh, Scotland, UK Personal consultancy for support and advice, to the National Suicide Prevention Leadership Group and the Scottish Government, G. Portzky discloses support from Flemish Government – Department of Health, Wellbeing and Family, A. Reif discloses grants from the Federal Health Ministry of Germany (BMG), C Reif-Leonhard ,Support by the Federal Health Ministry of Germany (BMG), grant number ZMVI1-2517FSB136, all others have nothing to declare. Ethical Approval: This study was approved by The Swansea University Medical School Research Ethics Sub-Committee approved the study (2020-0054).