Suicide during Covid-19: Need for Swift Public Health Action

1 Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

2 Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

3 Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India

4 INDIGO Project, National Institute of Mental Health and Neurosciences, Bengaluru, India

5 Associate Professor, Department of Mental Health Education, NIMHANS, Bangalore

6 Center for Community Mental Health, Mangaluru, India

7 Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

PDF

COVID-19 was declared as a pandemic by WHO on 11th March 2020, raising its position from that of an epidemic. A pandemic is the worldwide spread of a new disease and with it brings a major public health concern. Apart from leading to an abrupt shift in our lifestyle  and evoking fear, COVID-19, like any other pandemic has also resulted in a series of unfortunate events, which may miss the spotlight- suicide being one of them.[1]Though there is no evidence yet that suggests a change in suicide rates after any disaster in India [2], the direct and indirect impact of disasters on the population as a whole and the possible occurrence of mental health emergencies have been documented throughout the globe[3,4,5]. Around 12 cases of completed suicides have been reported so far in India with reasons including worry about being infected, being tested positive, social isolation, fear of losing their job, current unavailability of alcohol and not able to reach home due to the lockdown.

So, who are at risk? While it is natural for anyone to feel distraught and have forebodings during times like these – especially with the uncertainty and ambiguity that the situation presents itself with – it is vital that preventive actions are taken to ensure the safety of the individuals. The previously found risk factors and vulnerable groups – mental health issues,

 

domestic violence, abuse, disruption of livelihood[6] migration [7] economic difficulties [8] the youth[9] and the elderly[10] – have to be used as a platform to identify the vulnerable groups.COVID-19 has also created novel risk factors such as Economic stress, Social isolation, decreased access to community and religious support, barriers in accessing mental health services and media portrayal of the disease [1] which needs to be considered.

Some simple, yet effective techniques can help in ingeniously tackling the current problem at hand.

  • Awareness programs can play a significant role in aiding suicide prevention [11] The general public need to be aware of the relevant information from the authentic sources and this is the responsibility of all the stakeholders involved. This will include, but will not be limited to – symptoms that are suggestive of COVID-19, the precautionary measures that one needs to take, the efforts taken by the State to handle the pandemic, provisions available to the public during these testing times, mental health implications of the pandemic and the efforts to curb it (such as the lockdown) etc. The Government has to ensure that timely and adequate sources reach the masses. There is also a need for transparency in the way the information is broadcast so as to avoid speculation and spread of misinformation [12]. National and State level helplines can be effective in this regard along with mobile applications catering to specific needs.[13]
  • It should also be made sure that medicines (for both physical and mental health issues) are available. Telemedicine services can come in handy for this endeavor along with adequate support from the District Mental Health Services. The crisis intervention helplines that focus specifically on the mental health issues secondary to the pandemic need to be strengthened. It also has to be ensured that mental health services are provided virtually to those in [12]
  • Separate portals for the groups which are vulnerable to self-harm and suicide, especially the
  • Ensuring that all the citizens of the nation have local access to their basic needs [14].
  • Services to protect individuals from violence or abuse of all forms and its easy
  • Mental Health Educational programs that focus on the to-dos while at home during the
  • Virtual Psychosocial assessment and intervention for individuals who are in quarantine and who have been tested positive for COVID-19.

 

  • Support for healthcare and other professionals actively involved in the treatment of the [15]
  • Reports on the completed suicides should adhere to the guidelines formulated by the WHO to avoid misrepresentation and thus reducing suicide [16]

Suicide is an avoidable public health tragedy[17,18] and hence timely and practical steps taken in the right direction can do wonders.[6]Let’s take all the precautionary measures and do our bit to help curb the spread of Covid-19. But let’s also not forget that our well-being depends on our mental health too. The Government, policy makers, and the health-sector need to work together to develop suicide prevention strategies for the community as enhanced community awareness could reduce stigma and improve suicide outcomes.[19]

References

  • Reger MA, Stanley IH, Joiner TE. Suicide Mortality and Coronavirus Disease 2019—A Perfect Storm? JAMA Psychiatry. 2020 April 10 doi:10.1001/jamapsychiatry.2020.1060

 

  • Vijayakumar, L. Indian research on suicide. Indian Journal of Psychiatry.2010;52(7):291. https://doi.org/10.4103/0019-5545.69255
  • Krug, E. G., Kresnow, M., Peddicord, J. P., Dahlberg, L. L., Powell, K. E., Crosby, A. E., & Annest, J. Suicide after Natural Disasters. New England Journal of Medicine. 1998;338(6): 373–378. https://doi.org/10.1056/NEJM199802053380607
  • Saddichha, S., & Vibha, P. Behavioral Emergencies in India: Would Psychiatric Emergency Services Help? Prehospital and Disaster Medicine. 2011;26(1): 65–70. https://doi.org/10.1017/S1049023X10000038
  • Kar, N., Krishnaraaj, R., & Rameshraj, K. Long-term mental health outcomes following the 2004 Asian tsunami disaster: A comparative study on direct and indirect Disaster Health. 2014;2(1), 35–45. https://doi.org/10.4161/dish.24705
  • World Health Organization.Preventive Suicide: A global imperative (Executive Summary) 2014
  • Rane A & Nadkarni Suicide in India; a systematic review. Shanghai Arch Psychiatry.2014; 26(2): 69–80 doi: 10.3969/j.issn.1002-0829.2014.02.003

 

  • Dandona R, Bertozzi-Villa A , Kumar A, Dandona L. Lessons from a decade of suicide surveillance in India: who, why and how? International Journal of Epidemiology. 2017;46(3): 983–993 doi: 1093/ije/dyw113
  • Ponnudurai R.Suicide in India – changing trends and challenges ahead. Indian J Psychiatry.2015;57:348-54 http://www.indianjpsychiatry.org/text.asp?2015/57/4/348/171835
  • Suresh Kumar P N, Anish P K, George B. Risk factors for suicide in elderly in comparison to younger age groups. Indian J Psychiatry.2015;57:249-54 http://www.indianjpsychiatry.org/text.asp?2015/57/3/249/166614

 

  • Menon V, Subramanian K, Selvakumar N, Kattimani S. Suicide prevention strategies: An overview of current evidence and best practice elements. Int J Adv Med Health Res. 2018; 5:43doi: 4103/IJAMR.IJAMR_71_18

 

  • Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health.2020;17:1729 doi: 3390/ijerph17051729.

 

  • Ho, C. S., Chee, C. Y., & Ho, R. C. Mental Health Strategies to Combat the Psychological Impact of COVID-19 Beyond Paranoia and Panic. Annals of the Academy of Medicine, Singapore. 2020;49(3), 1-3.
  • Alsan MM, Westerhaus M, Herce M, Nakashima K, Farmer PE. Poverty, global health, and infectious disease: lessons from Haiti and Rwanda. Infect Dis Clin N.2011;25:611-22 doi: 1016/j.idc.2011.05.004
  • Cullen W, Gulati G, Kelly BD. Mental health in the COVID-19 pandemic, QJM: An International Journal of Medicine. 2020 https://doi.org/10.1093/qjmed/hcaa110
  • G Armstrong, L Vijayakumar, T Niederkrotenthaler, et al.Assessing the quality of media reporting of suicide news in India against World Health Organization guidelines: a content analysis study of nine major newspapers in Tamil NaduAust NZ J Psychiatry.2018 published online May 4. doi:10.1177/0004867418772343
  • Greydanus, D. E., Bacopoulou, F., & Tsalamanios, E. Suicide in adolescents: a worldwide preventable tragedy. The Keio journal of medicine.2009; 58(2): 95–102. https://doi.org/10.2302/kjm.58.95
  • Patel, V., Ramasundara hettige, C., Vijayakumar, L., Thakur, J. S., Gajalakshmi, V., Gururaj, G., Suraweera, W., Jha, P., & Million Death Study Collaborators. Suicide mortality in India: a nationally representative survey. Lancet (London, England). 2012; 379(9834): 2343–2351. https://doi.org/10.1016/S0140-6736(12)60606-0
  • Cherian, A. V., Lukose, A., Rappai, R., Vijaya Sagar, K. J., & Armstrong, G. Adolescent suicide in India: Significance of public health prevention plan. Asian journal of psychiatry. 2020; 49: 101993. https://doi.org/10.1016/j.ajp.2020.101993