Lalasa Doppalapudi, M.D., Steven Lippmann, M.D.

Coronavirus disease (COVID-19) is a coronavirus infection originating in China and spreading globally. By mid-August 2020, over 21 million confirmed COVID cases were reported, with more than 760,000 deaths (1). As the pandemic expanded, psychiatric issues and increasingly frequent suicides became evident. Suicide rates and telephone calls to suicide helplines dramatically escalated (2). Similar adversities were observed previously in the 2009-2011 H1N1virus illness epidemic, with high rates of anxiety, depression, and substance abuse (3). Suicide rates are expected to remain high, based on experience documented in past, similar illness outbreaks.

Fear of infection, loss of loved ones, unemployment, financial insecurities, generalized uncertainty, and social isolation experienced during the pandemic significantly harm wellbeing. Emotional responses to such stresses manifest as more worries, sadness, fears, somatic complaints, sleep disturbances, substance abuse, acute stress disorders, or post-traumatic stress disorders. With hopelessness, these can emerge into suicidal ideas and/or actions. Anxiety about contagious diseases often creates social division. Certain groups are sometimes blamed and/or discriminated against during disease outbreaks; this too can lead to more self-harm. Added to that, quarantines and/or social distancing, to curb disease dissemination, do disrupt social lives. Media dramatization and misinformation compounds this problem.

Early psychological symptom recognition should mitigate the fatalities and injuries of suicide occurrences. Try to identify high-risk individuals who might be prone to psychological morbidity. They include anyone who becomes COVID-19 positive; their family members; anyone quarantined; health workers; and older, unemployed, out of school, or those with medical or psychiatric comorbidities. Suicide attempt and completion incidence differs in various communities based on the availability of lethal methods and accessibility of healthcare. Restricting means for self-injury can prevent some deaths, such as by limiting access to firearms and dangerous pharmaceuticals or poisons. Further benefits come with diminished stigmatization or discrimination against sick people and healthcare workers. Greater mental health awareness through social and conventional media is helpful.

Integrating somatic, psychiatric, and social wellbeing into healthcare is productive. A holistic approach to training of physicians and other health workers augments identifying emotional vulnerabilities. Depression screening and suicide evaluations are to be more routinized. Whenever closure of healthcare facilities occurs, appointments should continue via telemedicine. Once danger of contagion abates, in-person contact is preferred.

Mental health funding by governments ought to be increased. Family and social support and religious beliefs are good at suicide prevention (4). Community groups, healthcare workers, and religious leaders can boost mental health resilience.

References

1. Coronavirus disease (COVID-2019) situation reports [WHO report] April 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200429-sitrep-100-covid-19.pdf?sfvrsn=bbfbf3d1_6. Accessed August 19, 2020.
2. Reger M, Stanley I, Joiner T. Suicide mortality and coronavirus disease 2019-a perfect storm? Journal of American Medical Association Psychiatry. April 2020; Advanced online publication. https://doi.org/10.1001/jamapsychiatry.2020.1060. Accessed August 19, 2020.

3. Pfefferbaum B, Schonfeld D, Flynn W, et al. The H1N1 crisis: A case study of the integration of mental and behavioral health in public health crises. Disaster Medicine and Public Health Preparedness 2012; 6:67-71.
4. Centers for Disease Control and Prevention. Suicide Risk and Protective Factors; January 2020. https://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html. Accessed August 20, 2020.