The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: update of living systematic review: update of living systematic review [version 2; peer review: 1 approved, 2 approved with reservations]

Ann John, Emily Eyles, Roger T Webb, Chukwudi Okolie, Lena Schmidt, Ella Arensman, Keith Hawton, Rory C O'Connor, Nav Kapur, Paul Moran, Siobhan O'Neill, Luke A McGuiness, Babatunde K Olorisade, Dana Dekel, Catherine Macleod-Hall, Hung-Yuan Cheng, Julian P T Higgins, David Gunnell

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Abstract

Background: The COVID-19 pandemic has caused considerable morbidity, mortality and disruption to people's lives around the world. There are concerns that rates of suicide and suicidal behaviour may rise during and in its aftermath. Our living systematic review synthesises findings from emerging literature on incidence and prevalence of suicidal behaviour as well as suicide prevention efforts in relation to COVID-19, with this iteration synthesising relevant evidence up to 19 th October 2020. Method: Automated daily searches feed into a web-based database with screening and data extraction functionalities. Eligibility criteria include incidence/prevalence of suicidal behaviour, exposure-outcome relationships and effects of interventions in relation to the COVID-19 pandemic. Outcomes of interest are suicide, self-harm or attempted suicide and suicidal thoughts. No restrictions are placed on language or study type, except for single-person case reports. We exclude one-off cross-sectional studies without either pre-pandemic measures or comparisons of COVID-19 positive vs. unaffected individuals. Results: Searches identified 6,226 articles. Seventy-eight articles met our inclusion criteria. We identified a further 64 relevant cross-sectional studies that did not meet our revised inclusion criteria. Thirty-four articles were not peer-reviewed (e.g. research letters, pre-prints). All articles were based on observational studies. There was no consistent evidence of a rise in suicide but many studies noted adverse economic effects were evolving. There was evidence of a rise in community distress, fall in hospital presentation for suicidal behaviour and early evidence of an increased frequency of suicidal thoughts in those who had become infected with COVID-19. Conclusions: Research evidence of the impact of COVID-19 on suicidal behaviour is accumulating rapidly. This living review provides a regular synthesis of the most up-to-date research evidence to guide public health and clinical policy to mitigate the impact of COVID-19 on suicide risk as the longer term impacts of the pandemic on suicide risk are researched.

Original languageEnglish
Article number1097
Pages (from-to)1-44
Number of pages44
JournalF1000Research
Volume9
Early online date4 Sep 2020
DOIs
Publication statusPublished - 17 Jun 2021

Bibliographical note

Funding Information:
This work was supported by Swansea University and the University of Bristol. DG, BKO, JPTH are supported by the NIHR Bristol Biomedical Research Centre [IS-BRC-1215-20011]. JPTH and EE are suported by the NIHR Applied Research Collaboration West. LAMcG is by the NIHR through a NIHR Doctoral Research Fellowship [DRF-2018-11-ST2-048]. LS is supported by the NIHR through a NIHR Systematic Reviews Fellowship [RM-SR-2017-09-028]. AJ and CO are supported by the Swansea University Cochrane Satellite for Suicide and Self-Harm Prevention. AJ is supported by the National Centre for Mental Health [HCRW-CA04] NK and RW are supported by the NIHR Greater Manchester Patient Safety Translational Research Centre [PSTRC-2016-003]

Funding Information:
Group. DG has grants from the National Institute for Health Research (NIHR) outside the submitted work and is a member of Samaritans Policy and Research Committee and Movember’s Global Advisory Committee. AJ: chair of the National Advisory Group on Suicide and Self-harm Prevention to Welsh Government and is national lead on suicide prevention for Public Health Wales. She reports grants from Medical Research Council (MRC) and MQ KH: member of the Department of Health and Social Care (England) National Suicide Prevention Strategy Advisory Group. He reports grants for DHSC and the Global Challenges Research Fund. NK: member of the Department of Health and Social Care (England) National Suicide Prevention Strategy Advisory Group and sits on committees for the National Institute for Health and Care Excellence to develop clinical guidelines for depression and self-harm. He reports grants outside the submitted work from NIHR, DHSC, and the Health Care Quality Improvement Partnership.

Funding Information:
NIHR Bristol Biomedical Research Centre [IS-BRC-1215-20011]. JPTH and EE are suported by the NIHR Applied Research Collaboration West. LAMcG is by the NIHR through a NIHR Doctoral Research Fellowship [DRF-2018-11-ST2-048]. LS is supported by the NIHR through a NIHR Systematic Reviews Fellowship [RM-SR-2017-09-028]. AJ and CO are supported by the Swansea University Cochrane Satellite for Suicide and Self-Harm Prevention. AJ is supported by the National Centre for Mental Health [HCRW-CA04] NK and RW are supported by the NIHR Greater Manchester Patient Safety Translational Research Centre [PSTRC-2016-003].

Funding Information:
Grant information: This work was supported by Swansea University and the University of Bristol. DG, BKO, JPTH are supported by the

Publisher Copyright:
© 2021. John A et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Keywords

  • Suicide; Attempted suicide
  • COVID-19
  • Self-harm
  • Suicidal thoughts
  • Pandemics
  • Cross-Sectional Studies
  • Suicidal Ideation
  • Humans
  • Self-Injurious Behavior - epidemiology
  • SARS-CoV-2
  • Living systematic review
  • Suicide
  • Selfharm
  • Attempted suicide
  • Self-Injurious Behavior/epidemiology

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