Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.
Department of Psychiatry, 7938University of Toronto, Toronto, Canada.
Can J Psychiatry. 2022 Nov;67(11):812-827. doi: 10.1177/07067437221094552. Epub 2022 May 9.
The COVID-19 pandemic has had a complex impact on risks of suicide and non-fatal self-harm worldwide with some evidence of increased risk in specific populations including women, young people, and people from ethnic minority backgrounds. This review aims to systematically address whether SARS-CoV-2 infection and/or COVID-19 disease confer elevated risk directly.
As part of a larger Living Systematic Review examining self-harm and suicide during the pandemic, automated daily searches using a broad list of keywords were performed on a comprehensive set of databases with data from relevant articles published between January 1, 2020 and July 18, 2021. Eligibility criteria for our present review included studies investigating suicide and/or self-harm in people infected with SARS-CoV-2 with or without manifestations of COVID-19 disease with a comparator group who did not have infection or disease. Suicidal and self-harm thoughts and behaviour (STBs) were outcomes of interest. Studies were excluded if they reported data for people who only had potential infection/disease without a confirmed exposure, clinical/molecular diagnosis or self-report of a positive SARS-CoV-2 test result. Studies of news reports, treatment studies, and ecological studies examining rates of both SARS-CoV-2 infections and suicide/self-harm rates across a region were also excluded.
We identified 12 studies examining STBs in nine distinct samples of people with SARS-CoV-2. These studies, which investigated STBs in the general population and in subpopulations, including healthcare workers, generally found positive associations between SARS-CoV-2 infection and/or COVID-19 disease and subsequent suicidal/self-harm thoughts and suicidal/self-harm behaviour.
This review identified some evidence that infection with SARS-CoV-2 and/or COVID-19 disease may be associated with increased risks for suicidal and self-harm thoughts and behaviours but a causal link cannot be inferred. Further research with longer follow-up periods is required to confirm these findings and to establish whether these associations are causal.
新冠疫情对全球范围内自杀和非致命性自伤风险产生了复杂的影响，有证据表明某些特定人群的风险增加，包括女性、年轻人和少数族裔背景的人。本综述旨在系统评估新冠病毒感染和/或新冠疾病是否直接导致风险升高。
作为一项更大的、在疫情期间考察自伤和自杀的实时系统综述的一部分，我们使用广泛的关键词列表，对一系列综合数据库进行了自动每日搜索，这些数据库包含了 2020 年 1 月 1 日至 2021 年 7 月 18 日期间发表的相关文章的数据。我们本综述的纳入标准包括调查新冠病毒感染者自杀和/或自伤的研究，无论感染者是否有新冠疾病表现，同时设置了无感染或疾病的对照组。感兴趣的结局是自杀和自伤想法和行为。如果研究报告的数据仅针对有感染/疾病风险但未确诊暴露、临床/分子诊断或自我报告新冠病毒检测结果阳性的人群，则排除该研究。此外，我们还排除了仅报告新冠病毒感染和自杀/自伤率的新闻报道、治疗研究和生态研究。
我们共确定了 12 项研究，涉及 9 项不同样本的新冠感染者的自杀意念和行为。这些研究调查了普通人群和包括医护人员在内的亚人群中的自杀意念和行为，一般发现新冠病毒感染和/或新冠疾病与随后的自杀/自伤想法和自杀/自伤行为之间存在正相关关系。
本综述发现了一些证据表明，新冠病毒感染和/或新冠疾病可能与自杀和自伤想法和行为的风险增加有关，但不能推断出因果关系。需要进一步进行具有更长随访期的研究，以证实这些发现，并确定这些关联是否具有因果关系。
