Will the economic and psychological costs of covid-19 increase suicides?

WHEN AMERICA’S Centres for Disease Control and Prevention (CDC) carried out a survey this summer, it found that one in ten of the 5,400 respondents had seriously considered suicide in the previous month—about twice as many who had thought of taking their lives in 2018. For young adults, aged 18 to 24, the proportion was an astonishing one in four.

The survey, published in August, was one of a growing number of warnings about the toll that the pandemic is taking on the mental health of people. For legions, the coronavirus has upended or outright eliminated work, schooling and religious services. On top of that, lockdowns and other types of social distancing have aggravated loneliness and depression for many.

But are people acting on suicidal thoughts? It is too early to be sure. Almost all countries publish suicide statistics with a lag of a year or two; and in recent years, suicide has been declining in most, with America a notable exception. Information from police, hospitals, coroners, courts and others must be collected and carefully studied, in part because some families report events selectively, or untruthfully, in the hope that a loved one’s probable suicide will be ruled a natural or accidental death. A comprehensive picture of suicide in the time of covid-19 has therefore yet to emerge. But experts have reasons to fear the worst.

For one thing, calls to suicide hotlines are up. Some in America have seen volume multiply eight-fold, says Sally Curtin, a suicide expert at CDC. The number of young people seeking help has risen, as has the proportion in extreme distress, notes Brenda Scofield, chairwoman of Samaritans, a hotline charity, in Hong Kong. Talkspace, a New York firm that provides online therapy, says that video sessions have increased by 250% during the pandemic. The number of patients with severe anxiety is up by 40%, a leap unprecedented in Talkspace’s nine years of business. Neil Leibowitz, its chief medical officer, expects this to translate into what he euphemistically calls “a lot of downstream effects”.

A few preliminary estimates of suicides during the pandemic have emerged. Though the figures will be revised, they bode ill. An initial tally of suicides in Japan in August put the number at 1,849, a jump of 15.3% over the same period last year, the health ministry has reported. Nepal’s national police force has said suicides during the pandemic seem to have climbed by a fifth. Thailand’s health ministry fears that nearly nine out of every 100,000 Thais will have killed themselves this year, up from 6.6 in 2019, says Varoth Chotpitayasunondh, a spokesman. The ministry is setting up a new reporting system to obtain official numbers faster. “We definitely cannot wait,” he says.

The long history of links between epidemics and suicides darkens the outlook further. In the first century AD, Ovid, a Roman poet, wrote of a plague in which some hanged themselves to “kill the fear of death by death’s own hand”. The “biblical destruction” wrought by the Spanish flu, which emerged in 1918 and killed perhaps 50m people, coincided with an increase of nearly a third in Europe’s suicides, says Diego De Leo, head of the Slovene Centre for Suicide Research at Primorska University in Koper. The 2003 outbreak of SARS, a respiratory disease caused by a coronavirus, coincided, he says, with a similar increase in suicides among Hong Kong’s elderly.

History cannot, however, provide a precise guide to the present. Shortly after covid-19 emerged late last year, a forecasting team at Thailand’s health ministry began scouring its archives and scientific literature for data on epidemics and suicide. It proved to be of limited use. Numbers correlating epidemics with suicides are fairly sparse, and no recent disease outbreak has wrought havoc comparable to that from covid-19.

Nonetheless, as the ministry’s Dr Chotpitayasunondh notes, correlations between suicides and unemployment—which in many countries has risen sharply during the pandemic—are strong and abundant. Suicide in any case takes the lives of more men than women (in Russia, an extreme case, the ratio is about six to one). Men turned out of work may thus be especially at risk during the pandemic.

In Italy, for example, nearly four times as many men kill themselves as do women. Monica Vichi of the Italian National Institute of Health, a government body in Rome, reckons that the economic crisis that began in 2008 led, over eight years, to an extra 2,000 or so suicides among Italian men of working age. Job losses at the time, she says, led to similar increases in male suicide across Europe. Asia’s financial crisis of 1997 contributed to increases in male suicides the following year of more than a third in Japan and a breathtaking 45% in South Korea. Female suicides rose less sharply.

A study in the Lancet, a medical journal, equates a 1% rise in unemployment with a 0.79% climb in suicide in Europe and a 0.99% increase in America, where jobless benefits have often been less generous—and guns are readily available (sales have boomed during the pandemic). Those estimates roughly align with other teams’ findings. As the pandemic continues to squeeze economies everywhere, this augurs ill. An econometric model designed by Kyoto University’s Resilience Research Unit forecasts for this year at least 3,000 more suicides in Japan than 2019’s toll of about 20,000. And because it often takes time for lives to unravel fully after severe financial misfortune, for 2021 the model predicts a dreadful 34,000 suicides in Japan, says Fujii Satoshi, head of the research centre.

Staring at the black mirror
Young people are another potentially vulnerable group. Their outlook may even be worsened by the extra time the pandemic has led many to spend with social media and screens in general. Among young Americans, suicide rates have climbed more than 50% since the iPhone was introduced in 2007. Some of the biggest increases have been among middle-school pupils and girls. The CDC’s Ms Curtin says social media contributes to bullying, unflattering comparisons with peers, and the amplification of mistakes.

Over the past decade or so, social media has progressively but gradually reduced the amount of time young people hang out face-to-face. With the pandemic lockdowns and school closures, many kids have seen their face-to-face time with friends and peers dramatically cut. The effect of this is to render those kids’ reliance on social media far greater. Jean Twenge, a psychology professor at San Diego State University who has co-written studies involving more than half a million adolescents, reckons smartphones and social media are the “primary cause” for America’s rise in youth suicide. Alternate hypotheses for the bulk of the blame (such as exposure to school shootings) fall short, says Dr Twenge, author of a book on the subject.

There are diverse reasons for hope. Many governments are increasingly focusing spending on lessening social and economic disruption. More companies are offering employees crisis counselling, says Nelson Vinod Moses of Suicide Prevention India Foundation, which trains suicide counsellors in Bengaluru. Outfits such as iLife Company, a Spanish firm, are developing “sentiment analysis” software to flag signs of suicidal thoughts in social-media posts. People who search online for suicide methods are now commonly presented with hotline numbers and offers of help from charities. Even urbanisation is reducing easy access to the farm pesticides used in a fifth of all suicides worldwide. Most broadly, prevention begins with an inkling of the risk, and the alarm has sounded.