key: cord-0901883-u60wcicn authors: Dsouza, Deena Dimple; Quadros, Shalini; Hyderabadwala, Zainab Juzer; Mamun, Mohammed A. title: Aggregated COVID-19 suicide incidences in India: Fear of COVID-19 infection is the prominent causative factor date: 2020-05-28 journal: Psychiatry Res DOI: 10.1016/j.psychres.2020.113145 sha: ab502afebb4b0f59f9aca271d0122b73d9cb89fe doc_id: 901883 cord_uid: u60wcicn Many Indian COVID-19 suicide cases are turning the press-media attention and flooding in the social media platforms although, no particular studies assessed the COVID-19 suicide causative factors to a large extent. Therefore, the present study presents 69 COVID-19 suicide cases (aged 19 to 65 years; 63 cases were males). The suicide causalities are included as follows – fear of COVID-19 infection (n=21), followed by financial crisis (n=19), loneliness, social boycott and pressure to be quarantine, COVID-19 positive, COVID-19 work-related stress, unable to come back home due to lockdown, unavailability of alcohol etc. Considering the extreme psychological impacts related to COVID-19, there emerges a need for countrywide extensive tele-mental health care services. The Corona Virus Disease 2019 (COVID-19) has ignited many debates and has undoubtedly shaken up the core foundations of the health-care system worldwide Usman et al., 2020) . Currently, massive transmission rates are observed with the absence of specific treatment . At present, public health measures such as isolation, social distancing, and quarantine are being implemented throughout the world to combat COVID-19 (Bodrud-Doza et al., 2020) . The entire world is arguably under lockdown, which disrupts the normal lifestyle. Studies have found that lockdown, isolation and quarantine elevate psychological symptoms such as depression, anxiety, phobia, trauma, etc. (Brooks et al., 2020; Hawryluck et al., 2004; Sakib et al., 2020; Shammi et al., 2020) . Besides, there is economic fallout and occupational deprivation due to lockdown existing everywhere, which also mediates individuals to have been suffered from psychiatric issues like depression, anxiety, stress, etc. (Rafi et al., 2019; Mamun and Ullah, 2020) . Besides, India, being the second largest populated country in the world with limited mental health care professionals and knowing that professional mental health care may not reach every individual; the psychological distress caused due to COVID-19 may go unnoticed. Consequently, psychological state along with employment and economic status, and lifestyle of individuals are substantially affected in the Indian population. These psychological issues are likely to have accounted for 90% of the suicide causalities Griffiths, 2020b, 2020c) . In the sense of pandemic aftermath, suicide rate dramatically increases as of elevating psychological comorbidities; for instance, higher suicide rates are reported among the elderly in Hong Kong during and aftermath the SARS epidemic in 2003 (Cheung et al., 2008) . Concerning the COVID-19 outbreak (since late January 2020 in India), the first Indian suicide case (occurred on February 12) is stated due to fear of being infected with COVID-19 (Goyal et al., 2020) , followed by two more cases (Sahoo et al., 2020) . Similarly, COVID-19 suicide occurrences were reported as of fear of infection, economic crisis and social boycott in Bangladesh and Pakistan, the most neighboring countries of India Griffiths and Mamun, 2020; . However, many of the suicide cases in India are turning the attention of the press and are being flooded in the social media platforms although, no particular studies assessed the COVID-19 suicide causative factors to a large extent that are indisputably the essential components for ensuring the public mental health wellbeing during the crisis. Hence, the present study aims to summarize the causative factors for suicide in times of COVID-19, as reported in the Indian national newspapers. The present study followed to utilize the press media reported suicide cases like the previous retrospective suicide studies conducted in developing South Asian countries (e.g., India, Armstrong et al., 2019; Bangladesh, Mamun and Griffiths, 2020; Pakistan, Mamun & Ullah, 2020) . We used a purposive sampling method in selecting the seven popular English Indian online newspapers from March to May 24, 2020. Duplicates identified of same news in multiple reports and suicide reports unrelated to COVID-19 were excluded from the study. A total number of 72 suicide cases from 69 newspaper reports met the inclusion criteria for the study. Most of the suicide cases were males (n=63), and the age of the individuals ranged from 19 to 65 years. The most common causative factors reported were fear of COVID-19 infection (n=21), followed by financial crisis (n=19), loneliness, social boycott and pressure to be quarantine, COVID-19 positive, COVID-19 work-related stress, unable to come back home after lockdown was quarantine as there are no available effective treatments or vaccines to combat COVID-19 are being suggested throughout the world. The term 'isolation' is associated with the restriction of the infected cases, whereas 'quarantine' refers to the restriction of social movement in large scales such as group, or community level (Hawryluck et al., 2004) . The quarantine time may be extremely burdensome to some individuals, as reported in 15% of the SARS quarantined persons in Toronto, did not feel the need of quarantine (Hawryluck et al., 2004) . Besides, individuals escaping from the quarantine can be conflictive because quarantine is mandatory to slow down the virus transmission rate. On the other hand, quarantine time without meaningful and purposeful occupations may lead to life-threatening circumstances in the suspected cases (Hawryluck et al., 2004) . Moreover, such a dilemma can impact people emotionally and psychologically, resulting in higher rates of loneliness, fear, anxiety, depression, stress, boredom, etc. (Brooks et al., 2020) . Besides, the fear of infection, the psychological distress due to pandemic also arbitrates by the stressors such as frustration, inadequate information, and financial loss (Brooks et al., 2020; Hossain et al., 2020; Sakib et al., 2020; . Consequently, the unstable mental health conditions may easily lead the individual to suicidality that is more prominent among individuals with preexisting mental illness due to unable to cope with the stressful situation . Besides, a significant proportion of the population in the country reside in rural areas with a lack of literacy and elevated mental health stigma in India (Venkatesh et al., 2015) . The persons with a lack of knowledge on COVID-19 and higher mental health stigma might be prone to psychological distress and, in extreme cases -suicide completion. The analysis of the present 69 Indian suicide cases shows various causes for suicide during the COVID-19 outbreak. Of these causal factors, fear or anticipation of COVID-19 infection was the most prominent suicide causality, although most of the victims were later diagnosed with COVID-19 negative in the autopsy (as being reported in the press media). This presents a significant concern to the community and health-care professionals because most of the COVID-19 suspected cases who had committed suicide is due to fear of infection (even though before the test result announcements -in many of the cases). Non-representative studies report that misinformation is a trigger for suicide completion among the suspected cases as well as among the non-suspected cases. For example, two suicide cases reported in India because of direct contact with a positive case and meeting with a foreign couple, respectively, despite not infected literally (Sahoo et al., 2020) . A similar incident in Bangladesh reported a COVID-19 suicide case, who tested negative for the infection in the autopsy but had a fear of infection . As the country was under lockdown, the restricted movement may have resulted in psychological distress and loneliness, leading to suicide. Nonetheless, the lack of access to addictive substances like alcohol and drugs led to extreme psychological distress, compelling individuals with addiction to carry out self-harm activities in the Indian context (Mamun and Griffiths, 2019) . Besides, other lockdown stressors such as economic crisis and recession, unemployment, poverty, etc. may be highly associated with psychological distress and suicidal behaviors Rafi et al., 2019) . Thus, the factors such as stress of losing job, feelings of hopelessness or helplessness, inability to provide support to the family, etc. are not unusual in simplifying the way of having persistent suicidality and committing suicides and were reported in the COVID-19 suicide context (Bhuiyan et al., 20202; ; . The study was based on a newspaper reports (and only eight newspapers were included); and was extracted with the secondary data that could not be verified; this may not represent the extensive nationwide incidence; some information may be missing in the press reports as all of the suicides are not reported due to existing social and cultural norms and values (i.e., suicide is stigma) in south Asian counties -are the arguable limitations of the present study Venkatesh et al., 2015) . Considering the COVID-19 related extreme psychological impact on individuals, there emerges a need for extensive mental health services. This can be bested through services like Tele-mental health care, where the mental health professionals are required to play an essential role in facilitating psychological and emotional well-being, enhancing problem-solving and health-promoting behaviors in service users Sahoo et al., 2020) . Additionally, appropriate and authentic information regarding COVID-19 and (mental) health-care seeking opportunities is necessary to increase the knowledge of COVID-19 in the public. Furthermore, social media platforms, news media such as televisions, news portals, etc. can take measures to promote positive mental health in combating further COVID-19 suicides. None. The authors involved in this correspondence do not have any relationships with other people or organizations that could inappropriately influence (bias) the findings. Data will be available on request. There is no conflict in submitting the final version. The authors of the paper do not have any conflict of interest. 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