Covid-19 – what does history tell us?

Article in Review: Devitt, P. (2020). Can we expect an increased suicide rate due to Covid-19? Irish Journal of Psychological Medicine, DOI:10.1017/ipm.2020.46

Summary: There has been a lot of conjecture and speculation regarding how COVID-19 may impact our population’s mental health, with government strategies to implement strict social distancing and ‘lockdowns’. While these actions are considered necessary from a physical health perspective, we have a responsibility to better understand how we might mitigate the mental health impacts, including with respect to suicide.

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As 2020 progresses, and with some parts of the nation locked down for an extended period of time, it has not been only the physical health of Australians that has been at front of mind. Job losses, economic downturn, disrupted work patterns and the absence of a COVID-19 vaccine are all factors perceived to be impacting the mental health of Australians.

We have not seen a pandemic like COVID-19 ever before. It is a virus that has reached every corner of the globe. For this reason, when considering the potential impact of a pandemic, we have no exact test case to compare to or consider. An Irish study has looked at significant social and environmental events from our past to try and help us gain insight into the effect of various types of disasters on suicide rates. The characteristics of the COVID-19 pandemic are analysed and compared to other types of disasters with the intent of helping us predict the impact of the pandemic on suicide levels.  The study was received in April 2020 and revised and accepted for publication in May 2020.

Causes of suicide

The narrative study begins by visiting Durkeheim’s seminal 1897 publication, the first to attempt to explain the cause of suicide through theory. Durkheim suggested that the fundamental changes that were occurring to how people lived and worked were weakening familiar and community bonds. Durkheim described four types of suicide, related to either too much or too little social integration or societal regulation.

War and Violence

Durkheim suggested that there was a reduction of suicide during war because of greater social and political integration. In the 1980s, a study was undertaken to review suicide data in the United States between 1933 and 1976 and although the data appeared to indicate a decline in suicides during World War II, other contributing factors make it difficult to confirm the accuracy of wartime records.

Social upheaval

Troubles in Northern Ireland were associated with an increase in suicide once over. It is speculated that a loss of community connection and purpose were influences. It was a time during which outward aggression was more widely accepted; a factor associates with less depression.The influence of the September 11 terrorist attacks was variable.  A decrease in suicide rates in the UK was contrasted by a rise in the Netherlands and no change in Germany. In the United States, a temporary drop was noted in New York, while increases were noted in other states.

Natural disaster

Separate studies found no increase in suicide for six months following neither the Queensland floods of 2011 nor the New Zealand earthquake of the same year. However, Hurricane Katrina was found to have caused an increase in suicidal ideation and suicide planning and in Puerto Rico there was an increase in suicides recorded during the three months after Hurricane Maria.

Epidemics

So what happened to suicide rates in countries that have experienced outbreaks in recent times? Studies in Hong Kong concluded that the SARS outbreak was considered a ‘mental health catastrophe’. An ‘exceptionally high’ rate of suicide in people aged over 65 was associated with a fear of being a burden to their families.

Economic recessions or depressions

The impact of the Great Depression on suicide levels in the United States was significant. A 22.8% increase was noted between 1928 and 1932; the greatest in any four year period from 1938 through to 2007.The Asian Economic Crisis of 1988-1989 is not thought to have had an impact on suicide levels while the impact of recession in Ireland resulted in a 57% higher rate of suicide amongst males.

Conclusion

What conclusions can we draw from these other periods of struggle and strife? Can crises and disasters influence suicide rates? Well, possibly. The most compelling finding from all of the studies cited is that economic downturn as a result of lockdowns and job losses might be the factor most likely to impact an increase in suicide.The study notes that the financial supports offered by governments will mitigate immediate risk, but these measures may be temporary and the road to financial recovery is long and uncertain.

Actions to mitigate the effects of a recession appear to have a positive impact on the overall mental health of populations. The impact of the extreme strain on health professionals must also be considered, they are working long hours, putting themselves at risk and also having to make tough decisions related to patient care and treatment.

An increase in domestic violence, anxiety, higher alcohol consumption rates and the impact of the virus on the availability of mental health services, plus an increasing reluctance to seek support or attend a hospital should also be considered. By looking back thought the dark pages of history we might get some idea about our future, but the factors that we are dealing with as we respond to COVID-19 are unique and ever-changing.