key: cord-0970785-fmzts3hm
authors: de la Torre-Luque, Alejandro; Pemau, Andres; Perez-Sola, Victor; Ayuso-Mateos, Jose Luis
title: Mortalidad por suicidio en España en 2020: el impacto de la pandemia por COVID-19
date: 2022-02-02
journal: Rev Psiquiatr Salud Ment
DOI: 10.1016/j.rpsm.2022.01.003
sha: 58436529abe084569ab9303c3fe0ae337e632060
doc_id: 970785
cord_uid: fmzts3hm

Introduction. Suicide constitutes a major concern with evident contribution to global mortality worldwide. Evidence on suicide trends is mixed in the COVID-19 pandemic era. Spain may be an at-risk country for increased suicide risk in the time of COVID-19 pandemic due to prolonged restrictions and lockdown, elevated COVID-19 wave recurrence and related mental health impact. This brief report aims to provide some insight into the suicide mortality trends in the first COVID-19 pandemic year in Spain, using national data. Material and methods. Data from the National Death Index were used. Annual mortality rate was calculated at a province level under random-effects models for the 2019 and 2020 years. Poisson timeseries regression was used to study the relationship between monthly suicide mortality and COVID-19 pandemic outbreak and lockdown, and second COVID-19 wave peak covariates. Results. 3,671 people died by suicide in 2019 in Spain and 3,941 people died by suicide in 2020. The random-effects mortality rate in 2019 was 8.3 (CI95 = [7.6, 9.0]) per 100,000 inhabitants, and mortality rate in 2020 was 8.9 (CI95 = [8.3, 9.6]). No significant differences between mortality rates were found (p =.18). The Poisson regression showed a significant relationship between the COVID-19 outbreak and suicide mortality trend, with OR = 1.07 (CI95 = [1.02, 1.12]). Conclusions. Although annual mortality rates were not significantly different, an increased suicide risk was found from May, 2020 onwards. Our results claim for action to tackle suicide in the post-pandemic era taking into account the discouraging upcoming scenario. Introducción. El suicidio constituye uno de los problemas de salud pública más importantes a nivel mundial. Los estudios no dejan clara la tendencia de mortalidad por suicidio en la pandemia por COVID-19. España podría registrar tasas crecientes de mortalidad por suicidio, dadas las restricciones prolongadas, la recurrencia de olas del virus y el elevado impacto en salud mental. Este estudio breve pretende proporcionar evidencia de las tendencias de mortalidad en el primer año de pandemia COVID-19 en España. Materiales y método. Se estimaron tasas anuales de mortalidad, usando modelos de efectos aleatorios a partir del índice nacional de mortalidad, para los años 2019 y 2020. Se usaron regresiones poissonianas para estudiar la relación de la mortalidad mensual por suicidio y factores temporales asociados a la pandemia. Resultados. 3.761 personas murieron por suicidio en España en 2019 y 3.941 personas murieron en 2020. La tasa de mortalidad en 2019 fue de 8,3 (IC95 = [7,6, 9,0]) por cada 100.000 habitantes, y de 8,9 (IC95 = [8,3, 9,6]) en 2020. No se encontraron diferencias significativas entre ambas tasas (p = 0,18). La regresión poissoniana reveló una relación significativa entre la tendencia de mortalidad por suicidio y el inicio de la pandemia COVID-19, OR = 1,07 (IC95 = [1,02, 1,12]). Conclusiones. No se observó tasa de mortalidad por suicidio significativamente mayor en 2020 pero sí una tendencia creciente de casos desde mayo del 2020 en adelante. Nuestros resultados pretenden instar a tomar medidas para atajar la conducta suicida en la época post-pandemia.

global mortality worldwide. Evidence on suicide trends is mixed in the COVID-19 pandemic era. Spain may be an at-risk country for increased suicide risk in the time of COVID-19 pandemic due to prolonged restrictions and lockdown, elevated COVID-19 wave recurrence and related mental health impact. This brief report aims to provide some insight into the suicide mortality trends in the first COVID-19 pandemic year in Spain, using national data. Material and methods. Data from the National Death Index were used. Annual mortality rate was calculated at a province level under randomeffects models for the 2019 and 2020 years. Poisson timeseries regression was used to study the relationship between monthly suicide mortality and COVID-19 pandemic outbreak and lockdown, and second COVID-19 wave peak covariates. Results. inhabitants, and mortality rate in 2020 was 8.9 (CI95 = [8.3, 9.6] ). No significant differences between mortality rates were found (p =.18). The Poisson regression showed a significant relationship between the COVID-19 outbreak and suicide mortality trend, with OR = 1.07 (CI95 = [1.02, 1.12]). Conclusions. Although annual mortality rates were not significantly different, an increased suicide risk was found from May, 2020 onwards. Our results claim for action to tackle suicide in the post-pandemic era taking into account the discouraging upcoming scenario. Suicide constitutes a serious health concern with global impact. The World Health Organization informed that more than 700,000 people died by suicide in 2019 1 .

There is increasing concern that the COVID-19 pandemic could exacerbate suicide risk 1-3 . However, evidence is quite mixed in the first year of the COVID-19 pandemic.

Some studies have not supported such a rising suicide trend. 4-7 A national-data study from Japan did find an upward trend in suicide mortality from July 2020. 8 Spain may be an at-risk country for increased suicide risk in the time of COVID-19 pandemic due to high mortality of the first wave, the elevated COVID-19 wave recurrence, early strict lockdown, and elevated mental health impact. 3, [9] [10] [11] The lockdown in Spain was one of the most restrictive in Europe. The Government imposed a State of Alarm starting on March 15 th that established a national lockdown, including the imposition of distancing measures such as the closure of non-essential customer-facing businesses and educational institutions. A period of five weeks started in which citizens were only allowed to leave their homes for essential work, to buy food and other staple products, or for emergencies. On May 4 th , citizens were first authorized to leave their homes to exercise or walk, for a maximum of 1 hour a day, under strict conditions. From May 10 th to June 21 st , a progressive de-escalation occurred. On the other hand, Spain has not implemented a national suicide prevention plan yet, despite the increasing trends of suicide mortality in recent decades. 12 Even though, recent studies based on regional records have shown some evidence on an absence of increasing suicide mortality rates during the first months of the COVID-19 pandemic. 4, 13 This report aims to expand on suicide mortality trend in the first COVID-19 pandemic year in Spain.

We used national data based on the National Death Index, annually released by the Spanish National Institute of Statistics (Instituto Nacional de Estadística, INE).

Monthly suicide death data from the 52 Spanish provinces were used covering both the years 2019 and 2020. First, annual mortality rate was calculated at a province level under random-effects models due to a large variability between province-specific rates. 14, 15 Afterwards, trend decomposition and stationarity analysis (i.e., augmented Dickey-Fuller test) were conducted. Finally, Poisson timeseries regression was used to analyse the relationship between monthly suicide mortality and time-variant covariates: 16 the COVID-19 pandemic outbreak and lockdown (from March 2020) and the second COVID-19 wave peak in Spain (October 2020). The Quasi Information Criterion (QIC) was used for regression model fit. A better covariate model fit is endorsed by a lower QIC, in comparison to an unconstrained model. All the analyses were conducted using the R Core Software (tsglm, meta, metaphor packages). wave.

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Our results contribute to extend the insight into existing evidence on suicide trends in the first COVID-19 pandemic year in Spain, using national data. Our findings go in line with previous studies on a lack of annual increase in suicide mortality. 4, 7, 13, 17 This despite the fact that a rising trend in suicide risk was found upon strict COVID-19 lockdown ease (from May, 2020). This result may go in line with the study by Sakamoto et al. 8 on the significant impact of the COVID-19 pandemic in suicide mortality across 2020. Further analysis should be conducted to identify vulnerable populations and critical risk factors. Our results claim for action to anticipate the discouraging upcoming scenario and enforce preventive strategies to tackle suicide in the post-pandemic era. Finally, we urge to implement a consensus national plan on suicide prevention to mitigate the impact of the COVID-19 pandemic on vulnerable populations and to promote downward suicide trends in Spain. 

Suicide Prevention in the COVID-19 Era: Transforming Threat into Opportunity

SuicideMortality and Coronavirus Disease 2019-A Perfect Storm?

Coronavirus pandemic (COVID-19) in Spain

Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries

Racial Differences in Statewide Suicide Mortality Trends in Maryland During the Coronavirus Disease 2019 (COVID-19) Pandemic

Suicide reduction in Canada during the COVID-19 pandemic: lessons informing national prevention strategies for suicide reduction

Suicide in England in the COVID-19 pandemic: Early observational data from real time surveillance

Assessment of Suicide in Japan During the COVID-19 Pandemic vs Previous Years

Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study

Third wave of COVID-19 in Madrid, Spain

Changes on depression and suicidal ideation under severe lockdown restrictions during the first wave of the COVID-19 pandemic in Spain: A longitudinal study in the general population

Suiciderelated thoughts and behavior and suicide death trends during the COVID-19 in the general population of Catalonia

Modelling and forecasting mortality improvement rates with random effects

Random effects regression models for trends in standardised mortality ratios

Tscount: An R package for analysis of count time series following generalized linear models

Suicide trends varied by agesubgroups during the COVID-19 pandemic in 2020 in Taiwan

The authors declare that they do not have any conflict of interest to be disclosed.