Wasserman Danuta, Iosue Miriam, Wuestefeld Anika, Carli Vladimir
National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden.
World Psychiatry. 2020 Oct;19(3):294-306. doi: 10.1002/wps.20801.
Suicide is preventable. Nevertheless, each year 800,000 people die of suicide in the world. While there is evidence indicating that suicide rates de-crease during times of crises, they are expected to increase once the immediate crisis has passed. The COVID-19 pandemic affects risk and pro-tective factors for suicide at each level of the socio-ecological model. Economic downturn, augmented barriers to accessing health care, increased access to suicidal means, inappropriate media reporting at the societal level; deprioritization of mental health and preventive activities at the community level; interpersonal conflicts, neglect and violence at the relationship level; unemployment, poverty, loneliness and hopelessness at the individual level: all these variables contribute to an increase of depression, anxiety, post-traumatic stress disorder, harmful use of alcohol, substance abuse, and ultimately suicide risk. Suicide should be prevented by strengthening universal strategies directed to the entire population, including mitigation of unemployment, poverty and inequalities; prioritization of access to mental health care; responsible media reporting, with information about available support; prevention of increased alcohol intake; and restriction of access to lethal means of suicide. Selective interventions should continue to target known vulnerable groups who are socio-economically disadvantaged, but also new ones such as first responders and health care staff, and the bereaved by COVID-19 who have been deprived of the final contact with loved ones and funerals. Indicated preventive strategies targeting individuals who display suicidal behaviour should focus on available pharmacological and psychological treatments of mental disorders, ensuring proper follow-up and chain of care by increased use of telemedicine and other digital means. The scientific community, health care professionals, politicians and decision-makers will find in this paper a systematic description of the effects of the pandemic on suicide risk at the society, community, family and individual levels, and an overview of how evidence-based suicide preventive interventions should be adapted. Research is needed to investigate which adaptations are effective and in which con-texts.
自杀是可以预防的。然而，全球每年有80万人死于自杀。尽管有证据表明自杀率在危机期间会下降，但预计在直接危机过去后还会上升。新冠疫情在社会生态模型的各个层面影响着自杀的风险因素和保护因素。社会层面的经济衰退、获得医疗保健的障碍增加、自杀手段的获取途径增多、媒体报道不当；社区层面心理健康和预防活动的优先级降低；人际关系层面的人际冲突、忽视和暴力；个人层面的失业、贫困、孤独和绝望：所有这些变量都导致抑郁、焦虑、创伤后应激障碍、有害饮酒、药物滥用增加，最终导致自杀风险上升。应通过加强针对全体人群的普遍策略来预防自杀，包括缓解失业、贫困和不平等；优先提供心理健康护理；媒体进行负责任的报道，并提供有关可用支持的信息；预防酒精摄入量增加；以及限制获取自杀的致命手段。选择性干预应继续针对已知的社会经济弱势群体等易受伤害群体，但也应针对新出现的群体，如急救人员和医护人员，以及因新冠疫情失去与亲人最后接触和葬礼的死者家属。针对有自杀行为的个体的针对性预防策略应侧重于现有的精神障碍药物和心理治疗，通过更多地使用远程医疗和其他数字手段确保适当的随访和连续护理。科学界、医护专业人员、政治家和决策者将在本文中找到对疫情在社会、社区、家庭和个人层面上对自杀风险影响的系统描述，以及对循证自杀预防干预措施应如何调整的概述。需要开展研究以调查哪些调整是有效的以及在哪些背景下有效。
