Mitigating suicide risks will require community-wide efforts

The Covid-19 pandemic has had profound effects on not only the physical health of individuals, but their mental health as well. An increasing number of studies and surveys have documented rising distress, anxiety, and depression worldwide. These factors, along with mental health disorders, alcohol and substance use disorders, the possibility of increased domestic violence, and feelings of loss can all contribute to an increased risk of suicide, experts warned.

“Early in the pandemic, a nationally representative survey of U.S. adults found that 21% of those sheltering in place reported that stress and worry about Covid-19 was having a major negative effect on their mental health, compared with 13% of those not sheltering in place. As the pandemic continued, the proportion of respondents who reported detrimental effects on their mental health continued to rise, from 39% in May 2020 to 53% in July 2020,” wrote Christine Moutier, MD, of the American Foundation for Suicide Prevention, New York, NY, in a special communication published in JAMA Psychiatry.

Experts fear that population suicide risks may increase due to pandemic-specific factors such as the deterioration of physical and/or mental health; social disconnectedness; loneliness or less social support; financial worry and loss; the move to remote work and/or school causing significant disruptions in daily, social, and workplace routines; increased alcohol consumption; increased time spent sheltering in place; and the increased availability of lethal means such as firearms, opioids, and other drugs.

To mitigate these risks, there are specific, evidence-based strategies that can guide clinicians, health care systems, and local and federal governing bodies, wrote Moutier. She outlined these, stressing the importance of lessening suicide risks and increasing crisis preparedness in the midst of this pandemic, as well as of setting the tone for future care:

  • Reduce risks for individuals with mental illness or addiction issues: Efforts to meet the needs of individuals with mental illness or those with alcohol and/or substance abuse disorders are of paramount importance, according to Moutier, who called for prioritization of federal investments in mental health and addiction services to increase access to mental health care. Examples of this include bolstering tele-mental health services, community-based crisis intervention resources, and federal research focused on mental health, substance misuse, and suicide.
  • Work to increase social connectedness. Providing vulnerable individuals who may be feeling lonely and socially isolated with a sense of connectedness can be achieved through various means. These include improved access to personal contacts, virtual check-ins with health care personnel, increased community-level services, and using the latest in technology to provide services for the elderly, those living alone, and those who may be marginalized. Government leaders and organizations are also encouraged to launch social media and public campaigns that promote social connectedness. Finally, the use of technology to regularly check in on vulnerable family and friends is encouraged.
  • Address risk at the moment of crisis. The existence of strong crisis response systems can significantly reduce suicide rates. Increased federal investments, as well as less punitive law enforcement responses, and exploration of alternative resources for responding to mental health crises such as mobile crisis units or residential crisis centers are also needed.
  • Reduce access to lethal means. Restricted access to lethal means is one of the most effective strategies to mitigate suicide risk. Improved education efforts focused on individuals who own guns, increased disposal efforts for expired medications, construction of bridge barriers, and improved and aggressive opioid crisis response efforts can all contribute to reduce access to lethal means of suicide.
  • Address increases in alcohol consumption and drug overdoses caused by Covid-19. A recent study documented an 18% increase in US drug overdose deaths during the Covid-19 pandemic. Efforts centered on reducing risks should include more focus on increased educational efforts about safe alcohol consumption, increased virtual access to substance use disorder services, and increased education and distribution of take-home naloxone.
  • Work to lessen financial strain. According to Moutier, economic strain will likely affect suicide risks differently for different populations and naturally change throughout the various phases of the Covid-19 pandemic. In populations that may carry disproportionate financial and health burdens, federal resources creating a fiscal safety net should be created. Workforce training, retraining, and unemployment support can also contribute to lessening financial strain.
  • Address domestic violence and unsafe environments. Well-known suicide risk factors include abuse and trauma, and the COVID-19 stay-at-home orders have heightened concerns of increases in domestic violence. Efforts to promote access to support for victims of domestic violence, such as the National Domestic Violence Hotline and the Crisis Text Line are needed.
  • Work to prevent specific types of messaging carried by media and entertainment outlets that are known to increase suicide risk. “Suicide contagion is a well-established phenomenon with specific types of messaging known to increase risk of suicide,” wrote Moutier. Reporters should be encouraged to use safe reporting guidelines on suicide and entertainment content aligned with safe messaging guidelines on suicide.

“This is a moment in history when suicide prevention must be prioritized as a serious public health concern. If specific strategies can be maximally implemented with Covid-19–specific threats to population mental health and suicide risk in mind, this pandemic may not only provide a sense of urgency, but a path forward to address suicide risk at national and community levels,” concluded Moutier.

  1. In light of the Covid-19 pandemic and its deleterious effects on not only physical health but mental health, suicide prevention must receive prioritization as a serious public health concern.
  2. Specific evidence-based strategies to mitigate the risks of suicide will require the efforts of clinicians, health care systems, and local and federal organizations and governing bodies.

E.C. Meszaros, Contributing Writer, BreakingMED™

Moutier has received grants from Otsuka Pharmaceutical, Pfizer, Netflix, Viacom/CBS, the US Department of Veterans Affairs, the New York City Police Department, and NBCUniversal outside of this work.


Cat ID: 146

Topic ID: 87,146,192,46,146,52,55,925,934