The Impact of Infectious Disease-Related Public Health Emergencies on Suicide, Suicidal Behavior, and Suicidal Thoughts

Crisis. 2021 Nov;42(6):474-487. doi: 10.1027/0227-5910/a000753. Epub 2020 Oct 16.


Background: Infectious disease-related public health emergencies (epidemics) may increase suicide risk, and high-quality evidence is needed to guide an international response. Aims: We investigated the potential impacts of epidemics on suicide-related outcomes. Method: We searched MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus, Web of Science, PsyArXiv, medRxiv, and bioRxiv from inception to May 13-16, 2020. Inclusion criteria: primary studies, reviews, and meta-analyses; reporting the impact of epidemics; with a primary outcome of suicide, suicidal behavior, suicidal ideation, and/or self-harm. Exclusion criteria: not concerned with suicide-related outcomes; not suitable for data extraction. PROSPERO registration: #CRD42020187013. Results: Eight primary papers were included, examining the effects of five epidemics on suicide-related outcomes. There was evidence of increased suicide rates among older adults during SARS and in the year following the epidemic (possibly motivated by social disconnectedness, fears of virus infection, and concern about burdening others) and associations between SARS/Ebola exposure and increased suicide attempts. A preprint study reported associations between COVID-19 distress and past-month suicidal ideation. Limitations: Few studies have investigated the topic; these are of relatively low methodological quality. Conclusion: Findings support an association between previous epidemics and increased risk of suicide-related outcomes. Research is needed to investigate the impact of COVID-19 on suicide outcomes.

Keywords: COVID-19; epidemics; pandemics; self-harm; suicide.

MeSH terms

  • Aged
  • COVID-19*
  • Communicable Diseases*
  • Emergencies
  • Humans
  • Public Health
  • SARS-CoV-2
  • Suicidal Ideation

Grants and funding

Funding: This project was supported by: Scottish Government's National Suicide Prevention Leadership Group, Health Services Executive National Office for Suicide Prevention Ireland, Health Research Board Ireland, and Canadian Institutes of Health Research. The funders of this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. All authors had full access to all data in the study and share final responsibility for the decision to submit for publication.