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Serrano-Gimeno V, Diestre A, Agustin-Alcain M, Portella MJ, de Diego-Adeliño J, Tiana T, Cheddi N, Distefano A, Dominguez G, Arias M, Cardoner V, Puigdemont D, Perez V, Cardoner N. Non-fatal suicide behaviours across phases in the COVID-19 pandemic: a population-based study in a Catalan cohort. Lancet Psychiatry 2024; 11:348-358. [PMID: 38631785 DOI: 10.1016/s2215-0366(24)00065-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The COVID-19 pandemic has been extensively discussed in the context of its effect on mental health. Although global suicide rates have remained stable during the pandemic, the specific effect on non-fatal suicide behaviours during and after the pandemic remains underexplored. This study aims to investigate patterns of non-fatal suicide behaviours before, during, and after the pandemic. METHODS In this cohort study, we used data from all hospitals in Catalonia, Spain, collected through the Catalan Suicide Risk Code, which is a specifically designed suicide attempt surveillance protocol, involving a face-to-face, in-depth psychiatric evaluation, after a Catalan resident presents any suicide risk behaviour in any public health-care setting. This evaluation centralises data from suicide registries across the territory. We included non-fatal suicide behaviours, meaning suicidal ideation or attempts that did not result in death, and excluded self-harm behaviours not judged to be linked with suicidal ideation. We considered three periods: the pre-confinement period (Jan 1, 2018, to the enforcement of the lockdown in Spain on March 14, 2020); the confinement period (March 14, 2020, to the end of lockdown on June 21, 2020); and the post-confinement period (June 21, 2020, to Dec 31, 2022). We used Bayesian structural time series models to assess the effect of pandemic phases on non-fatal suicide behaviours, and we ran stratified analyses by sex and age to identify distinct patterns among demographic cohorts. FINDINGS We obtained 26 482 records from Jan 1, 2018, to Dec 31, 2022. The mean age was 37·94 years (SD 18·07), and the sample included 17 584 (66·4%) women and 8898 (33·6%) men. Data on ethnicity were not collected. Temporal trends showed a mild increase in non-fatal suicide behaviours from Jan 1, 2018, to March 13, 2020; a reduction during the confinement period; and a subsequent rise after confinement. Bayesian models suggested a significant causal effect of lockdown easing, resulting in a 50·77% increase in non-fatal suicide behaviours (95% credible interval [CrI] 26·62-76·58; p<0·0001). Stratified analyses indicated that the easing of lockdown resulted in a significant increase in non-fatal suicide behaviours among women (25·92%; 6·71-44·72; p=0·011) and among individuals aged 18 years and younger (72·75%; 38·81-108·11; p<0·0001). INTERPRETATION This study provides a comprehensive examination of non-fatal suicide behaviours in Catalonia, Spain, emphasising the dynamics of different COVID-19 pandemic phases. The initial reduction during strict lockdown aligns with Joiner's Interpersonal Theory of Suicide, whereas the post-confinement rise reflects complex factors, including social isolation and economic challenges. Sex-specific and age-specific analyses underscore distinct vulnerabilities, emphasising the need for targeted preventive strategies. FUNDING Centro de Investigación Biomédica en Red de Salud Mental annual budget of G21, Agència de Gestió d'Ajuts Universitaris i de Recerca of the Generalitat de Catalunya. TRANSLATIONS For the Catalan and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Víctor Serrano-Gimeno
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alba Diestre
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Maria J Portella
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Javier de Diego-Adeliño
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thaïs Tiana
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Nora Cheddi
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alejandro Distefano
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Guillermo Dominguez
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Dolors Puigdemont
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor Perez
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Narcís Cardoner
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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de la Torre-Luque A, Perez-Diez I, Pemau A, Martinez-Ales G, Borges G, Perez-Sola V, Ayuso-Mateos JL. Suicide mortality in Spain during the COVID-19 pandemic: Longitudinal analysis of sociodemographic factors. Eur Neuropsychopharmacol 2024; 82:29-34. [PMID: 38490082 DOI: 10.1016/j.euroneuro.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/17/2024]
Abstract
The COVID-19 pandemic has compromised public health response across the globe. Several countries reported increasing number of suicides during the pandemic. This study aimed to analyze the suicide mortality series in Spain (2000-2021), with a particular interest in depicting longitudinal trends during the COVID-19 pandemic. Moreover, it intended to identify sociodemographic groups with a higher increase in suicide victims during the pandemic. To do so, suicide cases from the National death index data were used. Weighted annual mortality rate was compared between pre-pandemic and pandemic years. Poisson time series models were used to analyze the trend in suicide mortality, considering sociodemographic variables (sex, age, migration status, marital status, and urbanicity). As a result, weighted mortality rate for 2020 was 8.92 (CI95 = [8.29, 9.57]) and 9.21 for 2021 (CI95 = [8.56, 9.88]). Annual mortality from the pandemic years was significantly higher than mortality from the prepandemic ones (p < .01). Poisson regression revealed a significant increase of cases during the pandemic months, RR = 1.05 (CI95 = [1.02, 1.08]); being significant for both sexes, and migration groups (RR > 1.02, across series). A significantly increased number of suicides was also observed for mid-age adults, large urban areas, and single people (RR > 1.05, across series). To sum up, our study supports an increasing number of suicide victims in Spain during the pandemic. We show that the COVID-19 influence on suicide risk factors (e.g., lack of social support networks) plays a critical role in the increasing trend of specific sociodemographic groups.
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Affiliation(s)
- Alejandro de la Torre-Luque
- Department of Legal Medicine, Psychiatry and Pathology, School of Medicine, Universidad Complutense de Madrid, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain.
| | - Ivan Perez-Diez
- Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Psychiatry. Universidad Autonoma de Madrid, Spain
| | - Andres Pemau
- Department of Personality, Assessment and Clinical Psychology. Universidad Complutense de Madrid, Spain
| | - Gonzalo Martinez-Ales
- Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; CAUSALab, Harvard TH Chan School of Public Health, Boston, MA, USA; La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - Guilherme Borges
- Instituto Nacional de Psiquiatria Ramon de la Fuente Muñiz, Mexico
| | - Victor Perez-Sola
- Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Institut de Salut Mental, Parc de Salut Mar, Spain
| | - Jose Luis Ayuso-Mateos
- Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Psychiatry. Universidad Autonoma de Madrid, Spain
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Aymerich C, Pedruzo B, Salazar de Pablo G, Olazabal N, Catalan A, González-Torres MÁ. Number and nature of psychiatric emergency department visits in a tertiary hospital before, during, and after coronavirus pandemic. Front Psychiatry 2024; 15:1380401. [PMID: 38699456 PMCID: PMC11063275 DOI: 10.3389/fpsyt.2024.1380401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction The COVID-19 pandemic has significantly impacted mental health globally, leading to a deterioration in the overall mental health of the population and changes across all healthcare levels, including emergency departments (ED). However, the evolution of the quantity and nature of psychiatric ED visits in the post-pandemic period remains uncertain. Aims To examine changes in the number and nature of psychiatric emergencies at a general hospital before, during, and after the COVID-19 pandemic. Materials and methods Psychiatric ED visits from a tertiary hospital in the Basque Country (Spain) between January 2019 and November 2023 were investigated. Electronical health registers detailing the number and nature of psychiatric care consultations were analyzed for the study timeframe. Three periods were then compared: pre-pandemic (from January 2019 to February 2020), pandemic (from March 2020 to January 2022), and post-pandemic (from February 2022 onwards). Results 16,969 psychiatric ED visits were recorded for the study period. The number of psychiatric ED visits remained stable from pre-pandemic (269.93 visits/month) to pandemic (264.48 visits/month) periods but experienced a significant rise during the post-pandemic period (330.00 visits/month; t=-6.42; p<0.001), which was not reflected in medical and traumatological visits. The proportion of visits for anxiety (Z=-2.97; p=0.003), suicidal ideation (Z=-5.48; p<0.001), and administrative and social consultations (Z=-5.69; p<0.001) increased over the course of the pandemic. In contrast, visits for schizophrenia and other psychotic disorders (Z=4.85; p<0.001), as well as unspecified behavioral alterations (Z=2.51; p=0.012), significantly decreased. Conclusion The COVID-19 pandemic and its aftermath have altered the patterns of urgent psychiatric care, characterized by a sharp increase of average monthly number of consultations and a shift in their nature. Future efforts should focus on characterizing this surge in demand and enhancing both emergency services and outpatient settings.
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Affiliation(s)
- Claudia Aymerich
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, Organización Sanitaria Integrada (OSI) Bilbao-Basurto, Bilbao, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Neuroscience Department, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Borja Pedruzo
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, Organización Sanitaria Integrada (OSI) Bilbao-Basurto, Bilbao, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Neuroscience Department, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Child and Adolescent Mental Health Services, South London and Maudsley, NHS Foundation Trust, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Nora Olazabal
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, Organización Sanitaria Integrada (OSI) Bilbao-Basurto, Bilbao, Spain
- Neuroscience Department, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Ana Catalan
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, Organización Sanitaria Integrada (OSI) Bilbao-Basurto, Bilbao, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Neuroscience Department, University of the Basque Country (UPV/EHU), Leioa, Spain
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Miguel Ángel González-Torres
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, Organización Sanitaria Integrada (OSI) Bilbao-Basurto, Bilbao, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Neuroscience Department, University of the Basque Country (UPV/EHU), Leioa, Spain
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Der T, Helmke N, Stout JE, Turner NA. Impact of the COVID-19 pandemic on adult mental health-related admissions at a large university health system in North Carolina - one year into the pandemic. PLoS One 2023; 18:e0293831. [PMID: 38127858 PMCID: PMC10734981 DOI: 10.1371/journal.pone.0293831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/19/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Pandemic-associated stress may have exacerbated preexisting mental health and substance use disorders (MH/SUD) and caused new MH/SUD diagnoses which would be expected to lead to an increase in visits to emergency departments and hospital admissions for these conditions. This study assessed whether the proportion of hospital and emergency department encounters for MH/SUD diagnoses increased during the first year of the COVID-19 pandemic in the United States. METHODS We conducted a longitudinal (interrupted time series) analysis of 994,724 eligible encounters identified by electronic query between January 1, 2016 and March 31, 2021. Of these, 55,574 encounters involved MH/SUD diagnosis. The pre-pandemic period was defined as January 1, 2016 to March 31, 2020, and the pandemic period was defined as April 1, 2020 to March 31, 2021. All statistical analyses were performed with R. RESULTS No significant trend in MH/SUD encounters at baseline (rate ratio 1.00, 95% CI 0.99-1.01, p = 0.75) was observed. However, the onset of the pandemic was temporally associated with a significant level increase in the proportion of MH/SUD encounters relative to overall encounters (rate ratio 1.14, 95% CI 1.06-1.21, p<0.001) with no change in the overall trend (rate ratio 0.99, 95% CI 0.90-1.10, p = 0.89). CONCLUSIONS The significant pandemic-associated increase in the proportion of MH/SUD encounters relative to overall encounters was driven largely by sustained numbers of MH/ SUD encounters despite a decrease in total encounters. Increased support for mental health care is needed for these vulnerable patients during pandemics.
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Affiliation(s)
- Tatyana Der
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Nicole Helmke
- Department of Psychiatry and Behavioral Sciences and Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Jason E. Stout
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Nicholas A. Turner
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, United States of America
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