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How has COVID-19 affected suicidality in the US?

07 August 2020

Tim Newman :
In many ways, the COVID-19 pandemic is a perfect storm for poor mental health. It has created fear, social isolation, physical distance, financial concerns, and more. It is no surprise this period of our lives has impacted mental health on a global scale.
A new study takes another look at mental health during a pandemic.
All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub and follow our live updates page for the most recent information on the COVID-19 outbreak.
As the pandemic continues, researchers are attempting to quantify the impact on mental health, and plan for a brighter future. The latest study in this vein appears in Suicide and Life-Threatening Behavior.
The authors set out to understand what risk factors, alongside the pandemic, may impact adult mental health in the United States, and how these might affect levels of suicidality.
Suicidality and COVID-19
Suicidality refers to suicidal ideation, where someone thinks about taking their own life, suicide plans, and suicide attempts.
"As the COVID-19 pandemic unfolded, researchers began noting the potential for an unusually high level of susceptibility to extreme mental health consequences, including both suicide ideation and attempts," write the study authors.
They continue: "People are generally fearful of COVID-19 and its devastating impact on families and communities[…], but such fear has become entangled with the added burden of rising unemployment, limited supplies of household goods, long lines at food pantries, and limited access to social and health-related services."
In their investigation in suicidality and associated risk factors, the researchers took questionnaire data from 10,368 adults in the U.S. The 20-minute survey collected information about the participants' fears and anxieties around COVID-19, attitudes and perceptions of the coronavirus, physical and mental health, and food security.
The poll also gathered information about the respondents' race, sex, and home situation, for instance, whether they live with children.
The researchers embedded the Suicide Behavior Questionnaire (SBQ-R) within the questions, which assesses four elements of suicidality:
    lifetime suicide ideation and attempts
    frequency of suicide ideation over the last 12 months
    the threat of suicidal behavior
    self-reported likelihood of suicidal behavior
The responses are coded and generate a score from 3-18, while higher ratings indicate an increased risk of suicidal behavior.
The questionnaire also contained questions from the Center for Epidemiological Studies for Depression (CES-D), which measures depressive symptoms through 20 items.
Finally, the questionnaire captured three other social and psychological variables:
    how connected participants feel to other people in their social network
    each participant's sense of control over their life
    the importance of religion in their life
Overall, the average score on the SBQ-R was 4, which falls into the low risk category. However, 10% scored 5-7, which is classed as moderate risk, and 15% scored more than 7, which indicates a high risk.
The authors compared groups to understand which sections of the population were more likely to fall into the higher risk category. They found that Black people, Indigenous Americans, and Hispanic people were more likely to score above 7 in the SBQ-R than white people.
Similarly, individuals who were born outside the U.S. were more likely to score above 7 than those born in the country.
Also, unmarried people scored higher on average than married people, while families without children under 18 scored higher than families living with children under 18.
The authors also note a significant relationship between food security and suicidality. They write:
    "[P]ersons that report moderate or high levels of food insecurity are four times more likely to be in the high SBQ-R category compared [with] those reporting no or low food insecurity."
In their discussion, the authors report, "food insecurity appears to be an overwhelming circumstance that, for many, is becoming increasingly difficult to bear."
Study limitations
The authors acknowledge that their research has limitations. For instance, they only provide a snapshot of a small portion of the population's mental health at one point in time.
Also, because the study is cross-sectional, it cannot prove cause and effect. Without knowing average SBQ-R scores before the pandemic, it is impossible to show whether COVID-19 has impacted suicidality levels.

They also note that although SBQ-R has been "validated and exhibit[s] strong internal consistency," other tools examine suicidality in more depth, and could potentially provide different results.
Despite the limitations of the study, the findings remind us that these challenging times impact some people more severely than others. The authors call for continued efforts to monitor the mental health of the U.S. population. In their conclusion, the authors write:
"It would seem now is the appropriate time for practitioners, educators, and researchers to start compiling their work with a concerted effort at improving current practices and designing new suicide prevention strategies that specifically aim to address the complicated needs of adults and children during public health crises."
At a time when people are more likely to be physically distant from each other, it is important to be vigilant for signs that a colleague, friend, or family member is struggling. Medical News Today recently published an article that helps identify if remote colleagues are experiencing mental health struggles.

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