German Depression Foundation, Leipzig, Germany.
Universität der Bundeswehr München, Institute of Psychology, Neubiberg, Germany.
PLoS One. 2023 Sep 1;18(9):e0289136. doi: 10.1371/journal.pone.0289136. eCollection 2023.
The impact of the COVID-19 pandemic and of measures implemented to curb the spread of the virus on suicidal behavior has been investigated in different regions of the world, but does not yet allow to draw conclusions for Germany. Especially lockdowns might have effects on suicide rates via impact on mental disorders, changes in the choice of suicide method, a decrease in help seeking behavior, or a deterioration in the quality of medical care for people with mental disorders. The following research questions were addressed: i) did suicide rates in Germany in 2020 change during lockdown and non-lockdown periods when compared to a ten-year baseline? ii) was there a change in the proportion of suicide methods during the lockdown compared to baseline? An interrupted time-series analysis based on a linear regression was used. For the comparisons of predicted and observed suicide rates, excess suicide mortality rates (ESMR) were chosen among others. Changes in the choice of method were analyzed by comparing the rates of different methods to those at baseline. Although the mean suicide rate in 2020 was not significantly different from baseline, the weekly analysis of suicide rates revealed a significant difference (χ2 = 64.16; df = 39; p = 0.007), with some weeks showing higher and others lower rates than previous years. The effects for separate weeks were attenuated to non-significance after correction for multiple testing. Suicide mortality during the first lockdown in 2020 was significantly lower than expected (ESMR = 0.933; 95% CI: 0.890; 0.985) whereas, in the post-lockdown period, the registered suicide mortality was not significantly different from the expected one (ESMR = 1.024; 95% CI: 0.997; 1.051). During lockdown, there was a significant increase of the percentage of the suicide method categories jumping and 'other methods' and a decrease of poisoning and lying in front of a moving object. Being able to determine whether the choice of more or less lethal methods during lockdown versus non-lockdown periods partly explains this finding would require a representative assessment of attempted suicides.
新冠疫情及其传播的防控措施对世界各地的自杀行为产生了影响，但目前尚不能对德国的情况做出结论。尤其是封锁措施可能会通过对精神障碍的影响、自杀方法选择的改变、寻求帮助行为的减少或精神障碍患者医疗质量的恶化对自杀率产生影响。本研究旨在回答以下问题：i）与十年基线相比，德国 2020 年在封锁和非封锁期间的自杀率是否发生了变化？ii）与基线相比，封锁期间自杀方法的比例是否发生了变化？采用基于线性回归的中断时间序列分析。在比较预测和观察到的自杀率时，除其他外，选择了超额自杀死亡率（ESMR）。通过比较不同方法与基线时的比率来分析方法选择的变化。尽管 2020 年的平均自杀率与基线无显著差异，但每周自杀率分析显示存在显著差异（χ2=64.16；df=39；p=0.007），有些周的自杀率高于前几年，而有些周的自杀率低于前几年。经过多次检验校正后，个别周的影响减弱至无统计学意义。2020 年首次封锁期间的自杀死亡率明显低于预期（ESMR=0.933；95%CI：0.890；0.985），而在封锁后期间，登记的自杀死亡率与预期值无显著差异（ESMR=1.024；95%CI：0.997；1.051）。封锁期间，自杀方法类别“跳”和“其他方法”的百分比显著增加，而中毒和躺在移动物体前的方法显著减少。如果能够确定在封锁和非封锁期间选择更致命或不那么致命的方法的情况是否部分解释了这一发现，那么需要对尝试自杀进行代表性评估。
