COVID 19: Preventing the Curve of Suicide
The COVID-19 pandemic as well as the political and social and public health response to it has resulted in an unprecedented assault on health globally. History tells us that epidemics/pandemics result in an increase in mental distress, mental disorders (e.g., major depressive disorder), and substance use disorders. What is unique about COVID-19 is the combination of a biomedical threat, economic/employment hardship, and government mandated stay-at-home orders.
During the Great Recession, it was observed that there was an increase in suicide in the United States, Canada, select European, Asian, and Latin American countries. Rising suicide rates were observed during the Asian financial crisis, as well as the Great Depression. Unfortunately, suicide remains impossible to predict and cannot be explained by any singular factor. Notwithstanding, a highly replicated observation is the association between unemployment, especially when abrupt, and suicide.
The link between unemployment and suicide is most apparent in middle aged males but is seen in other demographic groups as well. The U.S. Department of Labor has reported that more than 30 million Americans have applied for Unemployment Insurance since the beginning of the pandemic. This observation, along with expected contraction of the labor market, is a call to action for mental health care providers, as well as officials in public health.
Candid discussions with the general public, as well as the health-seeking population, with respect to suicidal ideation, planning and/or attempting should be prioritized. Public service announcements with respect to resources (e.g., Depression and Bipolar Support Alliance www.dbsalliance.org) and other high quality credible resources should be provided with respect to basic information on mood and related disorders. National Alliance for the Mentally Ill (www.nami.org)) as well as the National Institute of Health (www.nih.gov) website should also be referred to for additional information. The public should be made aware of crisis hotlines and services, as well as locations for psychiatric first aid.
The use of telehealth and other technology platforms provides an opportunity for timely access to psychological services for support, assessment and where applicable, specific treatment. Inequities, with respect to access to broadband for select populations (e.g., homeless, indigent) those with mental illness as well as those in rural settings, indicate that community “boots on the ground” interventions are also required.
The world has been horrified by the lethality of the COVID-19 disease. Poverty, suicide, and the curve of mental illness will likely result in an increase in mortality unless there is priority given by federal state and local government, the health care community, advocacy, and community services.