THE RISK OF death by suicide in wealthy countries did not increase during the first wave of the pandemic, an international study has found.

The study of 21 high-income and upper-middle-income countries, published in the Lancet Psychiatry Journal, found no evidence of an increased risk of suicide during spring and early summer last year.

The researchers compared the number of deaths by suicide in the countries between 1 April and 31 July 2020 to the number that would have been expected based on previous years, and found no evidence of an increase in any of the countries.

In 12 countries or regions, there were fewer deaths by suicide than would have been expected, including in Japan, New Zealand, South Korea, Ecuador and parts of Canada, Australia and the US.

Ireland was not included in the study because the way that deaths by suicide are recorded here – a lengthy process that involves an inquest over several months – means that nationally, information is not accessible in real-time.

However, evidence that is available in Cork indicates that within that region, the trend is in line with the patterns seen by the study internationally.

Speaking to The Journal, Professor Ella Arensman – a co-author on the study, the chief scientist of the National Suicide Research Foundation, and Ireland’s first professor of public mental health – said that monitoring patterns and providing mental health supports are of key importance, as is tackling misinformation about suicide figures.

Professor Arensman said that 16 of the countries in the survey are high-income countries, where “we see and we can expect an improved or enhanced infrastructure when it comes to mental health needs and mental health supports, but also capacity and flexibility to adapt mental health services when a pandemic or another public health emergency arrives”.

“When you are, for example, in a low-income country, infrastructure is very limited and then there’s also no flexibility to adapt when a public health emergency arises,” Professor Arensman said.

The study used the World Bank’s country classification, in which Ireland is a high-income country.

Between April and July 2020, there was no indication of an increase in suicide in the countries covered by the study.

Professor Arensman said the researchers believe there is likely a link to the adaptability of mental health services in those countries.

So far, the study has only looked at the first few months of the pandemic.

“My colleagues and I would be concerned at this stage about people with long-term mental health conditions who for a very long time may not have had face-to-face mental health supports or interventions,” Professor Arensman said.

“Ongoing monitoring with real-time suicide data is the key message because what we see in wave one may not be the same for wave two or wave three of Covid,” she said.

Countries, including Ireland, need to have mental health services and community-based services that are ready to respond to people with urgent mental health needs, she said. 

Ireland

In Ireland, there is a specific procedure that has to be followed before a death is determined to have been a suicide.

The cause of death in cases of a suspected suicide is reached through a coroner’s inquest, which is not held until at least six weeks after the person’s death, and inquests can take around six months to reach a verdict.

A pathologist must produce a full pathology report, which can take up to three months, for gardaí and the coroner.

There is a time gap between the occurrence of a death and when the Central Statistics Officer (CSO) publishes data on deaths by suicide so that the process can be followed. 

The most recent official figures on the number of suicide deaths nationally in Ireland are for 2018, and final figures including late registrations are only available for 2017 and previous years. Provisional figures are available for 2019.

Professor Arensman said that the implementation of a real-time system at national level could allow for improved monitoring of patterns, especially during a public health crisis.

In Cork, a regional system was developed in 2018 between the NSRF and the HSE where data on suspected cases of suicide is collected within 10-14 days after the person has died.

“Up to the end of last year, there was not an indication in Co Cork in terms of an increase compared to same period in the previous year,” Professor Arensman said. 

She pointed out that the data is regional, not national, but that the pattern in Cork was “in line with these international findings, which does indicate a real trend”.

“In other words, for the first wave, there’s no indications of an increase in suicide.”

Checking the facts

Misinformation about instances of suicide can be harmful to people with severe depression or anxiety, Professor Arensman said.

“In April or May or June, there were sometimes very worrying headlines in the media – people anticipating an increase in suicide,” she said.

“This data clearly underlines that it’s important for the media and other stakeholders in general public health as well to always verify the data.” 

Last year, some claims picked up significant traction on social media after suggesting that a certain number of people had died by suicide during a particular week or month due to the pandemic.

These claims – which were not backed up by any evidence – were debunked by The Journal.

Professor Arensman said she would be “very concerned” by the spread of misinformation about suicide.

“Regardless of whether it’s social media or mainstream media, I think exactly the same guidelines should apply, because those companies managing social media platforms have an ethical obligation,” she said.

Unverified, incorrect, worrying statements about suicide can certainly impact negatively on people who are currently experiencing severe depression or severe anxiety.

“For them, the negative headlines would be part of the negative thinking and the negative cycle,” Professor Arensman said.

Anyone sharing content about suicide “carries this ethical obligation to always verify their facts”.

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