“Suicide risk: causes and prevention“

Quarantine backlash

Prof. Roberto Brugnoli

In the wake of the strong impact sparked globally by covid-19, there are now several studies that have analyzed the effects of the epidemic and its restrictive measures may have on the human psyche. One of these studies, published in the prestigious journal Lancet Psychiatry in April of this year, showed that there are several evidence of increased suicide rates during the quarantine period, thus highlighting the importance of an appropriate prevention for those most at risk.

A research carried out by theAmerican Academy of Family Physicians, compiled by the Well Being Trust, predicts an estimated 75 thousand deaths due to “hopelessness” over the next decade, including suicides and deaths from alcohol and drug abuse. Indeed, the study reports that in the United States in March alone, calls to psychological helpline numbers increased nearly 900 percent over the previous year. The research also showed that those most affected by the psychological effects of quarantine are individuals with economic difficulties or who have lost their jobs due to covid-19.
Similar research was carried out by Link Campus University in Rome and showed that in Italy in 2020 there were 25 suicides during lockdown and 16 in April, to which 36 attempted suicides must be added. This figure finds significance when compared with the 14 suicides in the previous year between March and April.  

Indeed, many studies have found how and how much quarantine containment measures, such as isolation and social distancing, can impact the overall mental health of communities forced to use them. These effects particularly affect the most fragile individuals, risking generating mental disorders or exacerbating already compromised or precarious situations, which can culminate in suicidal episodes. Other categories particularly exposed to these problems turn out to be, due to the observed episodes of social stigma, those considered closest to covid-19, namely the patients and their families and health workers.  

An additional element of risk has been found to be experiencing quarantine bereavement, having to experience the loss in solitude. Therefore, it is essential to provide support networks for these individuals who become increasingly fragile, facilitating and encouraging psychological support from friends or family.

Alcohol abuse, domestic violence, and easy access to potentially dangerous everyday items such as pesticides and drugs accumulated in homes have also been identified as precipitants. These should be sold with particular caution during quarantine periods, paying more attention to customers’ requests, especially if they manifest altered or distressed states.
If these are already risky circumstances in normal situations, surely quarantine is a dangerous trigger, which can amplify the effects by significantly increasing the risk of suicide. 

Job loss and economic instability related to the pandemic are recognized as major stressors and increased risk factors for suicide, as demonstrated by previous economic crises. Also a strong element of concern is the interruption of training for young people, who may develop states of anxiety and uncertainty about their future employment. For this reason, it is important to think about establishing financial support networks that continue even after the emergency and, in this sense, can also be considered public health measures.  

During the quarantine, the media play a key role, the extent of which on people’s mental health they must be fully aware of and responsible for, striking a balance between the right to report and attention to the psychological backlash of the news. Repeated exposure to news of crises, suicides and, in general, danger can have a strong negative impact on the most fragile individuals.   It is therefore useful for government authorities to develop specific guidelines to mitigate this risk while seeking to protect the interests of both parties.

Government and  health care entities are tasked with continuing to provide psychiatric counseling and psychological support, experimenting with alternative modalities to in-person counseling, such as online and telephone counseling, that better meet the new needs imposed by covid-19.

These new work practices need to be implemented and improved, considering the overburdened health care facilities and the possible lack of volunteers in this emergency phase. At the same time, however, it must be kept in mind that not all patients will be comfortable with this type of intervention and may pose privacy issues, particularly sensitive, for example, for individuals with paranoid traits .

Indeed, it is important to ensure ongoing, quality support for all those at-risk individuals who, due to the difficulty of meeting in-person due to lockdown and limitations in the normal operation of health facilities, have found themselves without a concrete reference. Some people may not seek help, frightened by the risk of contagion in hospital facilities, and may therefore abandon or abruptly discontinue paths already started before the pandemic, exposing themselves more to the risk of dangerous psychiatric relapse.

The research of Dr. Gunnel and colleagues  therefore suggests how during the pandemic it is critical to act early in the collection of data to develop the best possible response to an emergency, at least for the West, unprecedented. Such collection will need to systematize data of different kinds, such as records of suicides and incidents of self-harm, testimonies from help lines and health workers, in order to understand how best to channel human and economic resources to cope with the crisis.

Some of the solutions that have been proposed can be applied globally, but will require additional efforts for those resource-poor systems. These are unprecedented times; the pandemic will cause disturbances and leave many people vulnerable and more prone to mental health problems, even at risk of suicide. It is very likely that the psychological effects of quarantine will persist over time, perhaps even peaking after the current pandemic. It is essential to collaborate and systematize the experiences of the strategies adopted by various governments and the scientific research produced in recent months to develop targeted and effective actions to mitigate the negative psychological effects, thereby mitigating the risk of suicide.