Evaluating Suicide Risk in a Pandemic

Australia has been one of the most successful countries in containing COVID-19, with fewer than 7,500 confirmed cases and 102 deaths out of a population of 25 million.

But restrictions on travel, public gatherings and retail businesses have had a devastating impact on the economy. The tourism, retail and hospitality sectors have been hardest hit. It is estimated some $4 billion per week has been slashed from economic activity.

The potential mental health and suicide impacts resulting from the massive economic and social dislocation caused by Covid-19 cannot be ignored.

Modelling by the Brain and Mind Centre at Sydney University predicted a spike of 25 to 50 per cent over the 3,000 suicides usually recorded each year in Australia.

Professor Patrick McGorry says,

“We know there’s going to be a surge, Australia already has a suicide rate that’s way too high, and we’re going to see the risk of that rising as we head into an economic downturn.”

And since it will likely take years for the economy to return to normal, elevated suicide rates will likely persist long after the pandemic has faded into memory.

Unemployment is a well-established risk factor for suicide.In fact, 1 in 3 people who die by suicide are unemployed at the time of their deaths.

Earlier international studies modelled the effect of unemployment on suicide based on global public data from 63 countries. They observed that suicide risk was elevated by 20-30% when associated with unemployment during 2000-11.

Experience of financial crises and increased unemployment, such as during the great depression, show us the suicide rate does increase at such times.

According to the Australian Bureau of Statistics, the suicide rate rose during the depression years to peak at 16.8 per 100,000 in 1930. In this period, high suicide rates coincided with high levels of unemployment, particularly among males.

Social historian Dr Janet McCalman has written extensively on the Great Depression. She says,

“When Wall Street crashed in 1929, Australia’s jobless rate skyrocketed as export industries suffered, incomes declined, and the economy went into freefall. By the early 1930s, the unemployment rate among men (who were the primary earners at the time) was a record 30 per cent… the shock of losing work had a dramatic impact on the national psyche.”

Monash University researcher Alex Collie is part of a team of academics tracking the impact of job losses during the pandemic. The team has already garnered some preliminary findings from interviews with around 1,000 people who have lost work hours or their jobs. Collie says,

“The main findings are really high levels of psychological distress…and one of the main causes is financial uncertainty and hardship. We’ve got millions of people in Australia who’ve gone from having an income and having money, to having no income or little almost overnight.”

Unlike other national crises, such as wars (where unemployment and suicide rates generally go down), economic recessions preferentially hurt those who are already most vulnerable.

This is certainly true of young people. The impact of the COVID-19 pandemic on them has been significant.

Many students and younger people working in retail and hospitality have lost their income and are unable to continue their studies and, as such, are vulnerable to experiencing psychological, financial, and housing stress in the short and longer terms.

Headspace CEO Jason Trethowan, whose services target young people, said the economic and social impacts of the pandemic were widespread.

He said many young people were reaching out specifically about their anxiety levels around changed circumstances, altered routines, loss of employment, financial uncertainty, and disconnection from friends.

There are cautionary voices that highlight the challenges in predicting suicide trends. They point to recent government initiatives, both commonwealth and state, in relieving some of the stressors by providing safety nets for those losing their jobs and placing a greater emphasis on mental health support. 

Australia’s new deputy chief medical officer for mental health, Dr Ruth Vine, warns of ‘the difficulty’ of modelling suicide, which she says is ‘always multifactorial’. She says,

“It is typically a combination of biological, psychological, environmental and other factors that renders people vulnerable to suicide.”

Dr Ruth Vine

The experience of Japan illustrates this point. A recent shift in stress factors due to COVID-19, reduced the number of suicides. The report stated,

‘The suicide rate in Japan fell by 20% in April compared with the same time last year, the biggest drop in five years, despite fears the coronavirus pandemic would cause increased stress and many prevention helplines were either not operating or short-staffed.’

The drop in suicides has been attributed to people spending more time at home with their families, fewer people commuting to work and delays to the start of the school year.

Former chair of the Japanese Association for Suicide Prevention, Yukio Saito, explained that at times of national crisis and disasters people traditionally do not think about suicide. He pointed to 2011, the year of the giant earthquake, tsunami, and nuclear meltdowns at Fukushima. There was a drop in suicides in the 13 municipalities affected by the disaster, largely attributed to the attention and concern shown by national and international authorities and to the targeted mental health intervention programs.

Sadly, the drop in suicides did not continue beyond two years. Other factors came into play – increased demoralisation and anxiety, combined with restricted employment and movement of young families to urban areas – triggering a rise in suicides in Fukushima.

Saito acknowledges that economic and work pressures are not to be trivialized. He cites the 1997 Asian financial crisis. The year following the rates of suicide spiked heavily, increasing by nearly 35%. He warns that a prolonged economic downturn caused by the pandemic could lead to a rebound in cases.

While we may not be able to predict accurately how significantly deaths from suicide will rise, we do need to take action to prevent or minimise any increase in suicides in the months and years following the pandemic.

Regarding young people, former national mental health commissioner (2012-18), Professor Ian Hickie AM is quoted as saying,

“Educational and training supports for young people are critical. Preventing further social dislocation, largely by supporting employment, education, and welfare recipients over the longer-term, really matters.”

More generally, successful suicide prevention strategies include

(1) Identifying the groups of people who are at higher risk

The COVID-19 pandemic has challenged our mental health. Some groups of people are impacted more severely.

For example, older citizens have increased fears about their health and safety if infected, as well as their financial security. Therefore, they are at greater risk of mental ill health too.

(2) Understanding the stressors

Being able to identify the stressors that are particular to the COVID-19 pandemic allows us to frame social policies and practical initiatives that address specific needs.

For example, rising household debt, increased social isolation and loneliness are key risk factors for suicide.

(3) Monitoring the nations mental health

The need for accurate data that tells us what is happening in real time.

For example, Professor Patrick McGorry argues that timely suicide data is needed more than ever. He says,

“We need a national suicide register, linking ‘real-time’ data from ambulance crews, hospital emergency departments and police.”

To be sure, this pandemic will pass. The same cannot be said for suicide – ‘the silent epidemic.’

Author: Bruce Rickard

Reflections on Suicide and Staying Alive: My son's suicide changed everything. I felt an obligation to understand why anyone would want to end their life. My regular blog posts explore the causes and prevalence of suicide and what is needed to sustain a healthy mind and a hope-filled future.

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