Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
Swansea University Medical School, Swansea, UK.
Lancet Psychiatry. 2021 Jul;8(7):579-588. doi: 10.1016/S2215-0366(21)00091-2. Epub 2021 Apr 13.
BACKGROUND: The COVID-19 pandemic is having profound mental health consequences for many people. Concerns have been expressed that, at their most extreme, these consequences could manifest as increased suicide rates. We aimed to assess the early effect of the COVID-19 pandemic on suicide rates around the world. METHODS: We sourced real-time suicide data from countries or areas within countries through a systematic internet search and recourse to our networks and the published literature. Between Sept 1 and Nov 1, 2020, we searched the official websites of these countries' ministries of health, police agencies, and government-run statistics agencies or equivalents, using the translated search terms "suicide" and "cause of death", before broadening the search in an attempt to identify data through other public sources. Data were included from a given country or area if they came from an official government source and were available at a monthly level from at least Jan 1, 2019, to July 31, 2020. Our internet searches were restricted to countries with more than 3 million residents for pragmatic reasons, but we relaxed this rule for countries identified through the literature and our networks. Areas within countries could also be included with populations of less than 3 million. We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from at least Jan 1, 2019, to March 31, 2020) in each country or area within a country, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). FINDINGS: We sourced data from 21 countries (16 high-income and five upper-middle-income countries), including whole-country data in ten countries and data for various areas in 11 countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas: New South Wales, Australia (RR 0·81 [95% CI 0·72-0·91]); Alberta, Canada (0·80 [0·68-0·93]); British Columbia, Canada (0·76 [0·66-0·87]); Chile (0·85 [0·78-0·94]); Leipzig, Germany (0·49 [0·32-0·74]); Japan (0·94 [0·91-0·96]); New Zealand (0·79 [0·68-0·91]); South Korea (0·94 [0·92-0·97]); California, USA (0·90 [0·85-0·95]); Illinois (Cook County), USA (0·79 [0·67-0·93]); Texas (four counties), USA (0·82 [0·68-0·98]); and Ecuador (0·74 [0·67-0·82]). INTERPRETATION: This is the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. In high-income and upper-middle-income countries, suicide numbers have remained largely unchanged or declined in the early months of the pandemic compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond if the situation changes as the longer-term mental health and economic effects of the pandemic unfold. FUNDING: None.
背景:COVID-19 大流行对许多人的心理健康产生了深远的影响。人们担心,在极端情况下,这些后果可能表现为自杀率的上升。我们旨在评估 COVID-19 大流行对全球自杀率的早期影响。
方法:我们通过系统的互联网搜索以及我们的网络和已发表的文献,从国家或国家内的地区获取实时自杀数据。在 2020 年 9 月 1 日至 11 月 1 日期间,我们使用翻译后的搜索词“自杀”和“死因”,在这些国家的卫生部、警察机构和政府运营的统计机构或同等机构的官方网站上进行搜索,然后扩大搜索范围,试图通过其他公共来源识别数据。如果数据来自官方政府来源,并且从 2019 年 1 月 1 日至 2020 年 7 月 31 日至少每月提供一次,那么我们就会从给定的国家或地区纳入数据。出于实际原因,我们将互联网搜索限制在居民超过 300 万的国家,但对于通过文献和网络确定的国家,我们放宽了这一规定。人口少于 300 万的国家内的地区也可以包括在内。我们使用中断时间序列分析模型来模拟 COVID-19 之前(至少从 2019 年 1 月 1 日至 2020 年 3 月 31 日)每个国家或国家内地区的每月自杀趋势,将模型得出的预期自杀人数与大流行早期(主要分析中为 2020 年 4 月 1 日至 7 月 31 日)观察到的自杀人数进行比较。
结果:我们从 21 个国家(16 个高收入国家和 5 个中上收入国家)获取了数据,其中包括 10 个国家的全国数据和 11 个国家的不同地区数据。基于观察到的与预期自杀人数相比,比率比(RR)和 95%置信区间(CI)没有证据表明自大流行开始以来,任何国家或地区的自杀风险都显著增加。在 12 个国家或地区,与预期数字相比,自杀人数呈统计学下降趋势:新南威尔士州,澳大利亚(RR 0.81 [95%CI 0.72-0.91]);艾伯塔省,加拿大(0.80 [0.68-0.93]);不列颠哥伦比亚省,加拿大(0.76 [0.66-0.87]);智利(0.85 [0.78-0.94]);莱比锡,德国(0.49 [0.32-0.74]);日本(0.94 [0.91-0.96]);新西兰(0.79 [0.68-0.91]);韩国(0.94 [0.92-0.97]);加利福尼亚州,美国(0.90 [0.85-0.95]);伊利诺伊州(库克县),美国(0.79 [0.67-0.93]);德克萨斯州(四个县),美国(0.82 [0.68-0.98]);以及厄瓜多尔(0.74 [0.67-0.82])。
解释:这是第一项研究 COVID-19 大流行期间多个国家自杀情况的研究。在高收入和中上收入国家,与大流行前时期相比,自杀人数在大流行的早期阶段基本保持不变或下降。如果随着大流行的长期心理健康和经济影响的展开,情况发生变化,我们需要保持警惕,并随时准备做出反应。
资金:无。
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