ER visits for suicidal behavior down 40% in early months of pandemic

While people can expect suicide rates to rise during a global crisis such as the COVID-19 pandemic, a University of Michigan study suggests that the onset of the pandemic and the state of emergency executive orders probably did not increase suicide-related behaviors in the early months of the outbreak.

The report, led by UM researchers Rachel Bergmans and Peter Larson, found that ER visits related to attempted suicide and self-harm fell 40% in the first eight months of Michigan’s lockdown. . Their results are published in the Journal of Epidemiology and Community Health.

The study compared emergency room reports of attempted suicide and intentional self-harm at a Washtenaw County hospital in Michigan during the first 8 months of the COVID-19 pandemic. The researchers used what’s called time series analysis to look at what happened to suicide attempts and self-harm trends before and after the COVID-19 pandemic.

They compared the rate of attempted suicide and self-harm from October 1, 2015 to March 9, 2020 to rates from March 10, 2020 to October 31, 2020 and found that average daily emergency room visits due to suicidal behaviors increased from 8.6 visits per day to 5.5 per day.

Bergmans, a researcher at the Survey Research Center at the UM Institute for Social Research, says a reinforced social structure could be the reason for the drop in such visits.

More research is needed to confirm why there was a decrease, but the earlier phase of the pandemic was accompanied by many community and individual changes, including changes in unemployment. These types of factors can increase the risk of suicide. However, it’s possible that things like the financial aid from stimulus checks, the eviction moratorium, and the student loan support people are receiving may have dampened some of those other effects..”

Rachel Bergmans, researcher at the Survey Research Center, University of Michigan

The specific method used by Bergmans and Larson, called the autoregressive integrated moving average modeling approach, also took into account seasonal variations in suicide rates, which are higher in spring and fall.

“Models are designed to be informative, but sometimes reality can differ from predictions,” said Larson, a researcher at the Survey Research Center at the Institute for Social Research and a lecturer at the UM School of Public Health. “I think the COVID-19 crisis is unique among the crises we’ve had over the past few decades, so we should expect the mental health response to be somewhat unique as well.”

Although the researchers focused on one hospital in Michigan, they say other regions are also reporting a decrease in suicide deaths. Their data also appears to be consistent with data from other hospital systems across the country. In Japan, suicide mortality was 20% lower in April 2020 compared to April 2019 – however, suicide rates in Japan began to rise after the government stopped being proactive on coronavirus measures, the researchers said.

There were a total of 3,002 people in the study data – 62% female and 78% Caucasian, with a median age of 26.4 years. There were 10,753 emergency room visits during the study period, including 1,438 after the start of the pandemic.

The analysis shows that the number of emergency room visits remained constant until March 17, 2020, at an average number of 8.6 per day. After March 17, they dropped to 5.5 a day. Although emergency department visits for attempted suicide and self-harm decreased overall, there were some differences between the groups.

Suicide-related behaviors among men increased compared to women. The proportion of patient encounters decreased among Asians compared to whites and among married patients compared to unmarried patients. Rates of attempted suicide and self-harm among 18-65 year olds have increased compared to under-18s, while behaviors generally related to suicide are higher among under-18s.

Bergmans and Larson suspect this may be because school closures reduced exposure to psychological stressors in schools – and young people had fewer opportunities for suicidal behavior while their parents worked from home.

The researchers say one limitation of their study is the different ways people have sought care during the pandemic, such as through telemedicine.

“This is a small study looking at one type of mental health outcome in a hospital system. Our findings are certainly consistent with other places, but I think this is really just the beginning of the type of work that needs to be done,” Bergmans said. noted. “It also highlights the need for a better understanding of how different populations have been affected. We are also very interested in exploring potential health disparities, as COVID-19 has not treated all communities equally.


Journal reference:

Bergmans, R. S & Larson, P. S (2021) Attempted suicide and intentional self-harm during the earlier phase of the COVID-19 pandemic in Washtenaw County, Michigan. Journal of Epidemiology and Community Health.