We’ve already seen a steady rise in deaths by suicide over the past two decades and a new report by The Well Being Trust released last month found that 75,000 additional people could die from what they called “deaths of despair,” (which include suicide and substance use) because of Covid-19.

The Risk Factors For Covid-19 Suicides

The physical symptoms of the novel coronavirus have been well-reported for months, but it’s the handful of psychological and sociological factors that are just starting to ring alarm bells. The combination of physical distancing, economic stress, barriers to mental health treatment, pervasive national anxiety, and a spike in gun sales are creating what JAMA Psychiatry referred to as “a perfect storm” for suicide mortality.

“Suicide is likely to become a more pressing concern as the pandemic spreads and has longer-term effects on the general population, the economy, and vulnerable groups,”  according to David Gunnell, professor of epidemiology at the University of Bristol and head of the Bristol Suicide and Self-harm Research Group,  and his research team who recently published their findings in The Lancet Psychiatry.

And these projections are not without precedent. There’s evidence that deaths by suicide increased both after the 1918 flu pandemic and the 2003 SARS outbreak. We’re already seeing this with frontline workers. In the past few weeks, two stories stood out in the media: Dr. Lorna Breen, of New York-Presbyterian Allen Hospital, and New York City E.M.T John Mondello.

Social Distancing and Isolation

The research has been clear on this one for years: isolation and loneliness is bad for our health—both physical and mental. According to a meta-analysis co-authored by Julianne Holt-Lunstad, PhD, a professor of psychology and neuroscience at Brigham Young University, lack of social connection heightens health risks as much as smoking three-quarters of a pack of cigarettes a day…every day. “There is robust evidence that social isolation and loneliness significantly increase risk for premature mortality, and the magnitude of the risk exceeds that of many leading health indicators,” Holt ­Lunstad says.

The coronavirus has obviously exacerbated the problem. Right now (as of May 8), almost 200 million people in the Unites States are under some kind of stay at home order, with most face-to-face socializing limited to members of their own households. That is, if they’re lucky enough to not live alone like 35.7 million Americans do. And, even in states where restrictions have been lifted, many people are still staying at home.

All this alone time is killing our mental health in general. Here’s an in-depth report on how coronavirus affects the most common mental illnesses. One of the biggest concerns is suicide. All of the experts who study suicide for a living agree that social connections play a role in suicide prevention. Both suicidal thoughts and ideation are associated with isolation and loneliness.

 Economic Stress

The unemployment rate shot up to 14.7 percent in April, its highest level since the Great Depression, the Bureau of Labor Statistics reported Friday. And, those numbers may actually be even worse. The government data comes from surveys conducted the second week in April and by now many more could be out of work, and the many self-employed workers and others newly eligible for unemployment benefits aren’t included in that figure. Also, the way the survey works is that it only counts people who are unemployed and looking for work. Given we’re in the middle of a pandemic, not a lot of people are going on job interviews right now. The possible silver lining is that a majority of those people counted in the unemployment number think that it’s only temporary.

Debt is a huge mental health burden. According to research presented by The Aspen Institute 16 percent of suicides in the United States occur in response to a financial problem. Dr. Thomas Richardson, PhD., agrees that there is a strong relationship between debt and mental health problems. He and his research team did a big analysis of existing studies and found debt to be significantly correlated to:

  • Depression
  • Suicide completion
  • Suicide completion or attempt
  • Problem drinking
  • Drug dependence
  • Neurotic disorder
  • Psychotic disorders

None of this is new. After the stock market crashed in 1929, The New York Times reported 100 suicides and suicide attempts from October 24 through the end of the year. In more recent history, researchers estimated that the 2007 economic crisis in Europe and North America led to more than 10,000 extra suicides. Still other research shows that suicide rates increase both in years the stock market big drops—and in the year after.

While no one has a crystal ball, the most respected economists say economic recovery will be long and shaky. For some perspective, Anita Gopinath, the chief economist of the International Monetary Fund wrote on her blog, “The cumulative loss to global GDP over 2020 and 2021 from the pandemic crisis could be around 9 trillion dollars, greater than the economies of Japan and Germany, combined.”

Barriers To Mental Healthcare

There are more friction points than ever to getting help. Doctor’s offices may be partially closed or require temperature checks outside before you go in. And, people may be worried about leaving their homes, especially if they need to take public transportation.

Pre-pandemic, one in eight visits to the emergency room was related to mental health. Granted, that’s not the ideal setting, but it is an important safety net. That net has a large hole in it right now thanks to Covid-19. People see images of ER’s being overrun by Covid-19 patients and they may think the hospital is stretched too thin to help them.

The good news is psychologists, psychiatrists, and social workers had already begun shifting gears to provide remote therapy even before the pandemic, but it hadn’t been widespread in part because of privacy concerns. In early March the US Department of Health and Human Services relaxed their rules around privacy and digital doctor visits.

Since that time, teletherapy platforms and apps have seen increases. Reena Pande, the chief medical officer of AbleTo, a teletherapy platform with over 700 clinicians across the US told MIT Technology Review that they’ve seen requests to connect with a professional increase by 25 percent in a single week. Talkspace also reported a 65 percent spike since mid-February.

There are still some limitations to how connected you can feel via phone or computer versus in person. And, for people who are extremely paranoid or have hallucinations, communicating in these ways may be even more challenging.

Constant and Pervasive Collective Anxiety

According to the JAMA report, “It is possible that the 24/7 news coverage of these unprecedented events could serve as an additional stressor, especially for individuals with preexisting mental health problems.” Our routines have been completely upended and even things like wearing a mask or waiting in lines at the grocery store can make you feel tense.

Some common signs of pandemic-induced stress are:

  • Fear and worry about your own health and the health of your loved ones
  • Changes in sleep or eating patterns
  • Difficulty sleeping or concentrating
  • Worsening of chronic health problems
  • Worsening of mental health conditions
  • Increased use of alcohol, tobacco, or other drugs

Increase In Gun Sales

In the past decade suicide attempts have become more lethal. Some researchers have looked into the connection between these lethality rates and social media, internet use, and availability of guns. According to one study the case fatality rate by firearms is 82.5 percent; cutting, on the other hand, is 1.2 percent. So, it was especially concerning to psychiatrists and other suicide researchers when they saw the news about the surge in gun sales in the past couple of months.

The ammunition website Ammo.com, which ships ammunition across the country (minus four states), saw a 77 percent increase in website visits between February 23 and March 15, and a 222 percent increase in transactions over the same period compared to the first three weeks in February. Another indicator of the increase in gun sales is that federal background checks are also on the rise.

A study by the Harvard School of Public Health reveals a link between rates of firearm ownership. Suicide researchers found that in states where guns were prevalent—like Wyoming, where 63 percent of households reported owning guns—rates of suicide were higher. The inverse was also true: where gun ownership was less common, suicide rates were also lower.

Frontline Workers

Doctors, nurses, ambulance technicians, healthcare facilities directors and more are on the front lines. They’re worried about their own health, exposure to their families, sick colleagues, not having enough personal protective equipment, and feeling that they’re not doing enough for patients. It’s no wonder a recent study from China shows depression, anxiety, insomnia, and distress, especially women, nurses, those in Wuhan, and workers directly involved in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID-19.

What we know from research after the SARS outbreak is that post-traumatic stress (PTS) is also possible. In one particular study, about 10 percent of the hospital employees had had high SARS-related PTS symptoms post-outbreak. And about half of them still had them three years later. Other studies have shown that when a person’s PTS symptoms persist for more than 6 months after an event, they are very likely to continue to persist over the long term.

One thing that seemed to be a protector to frontline workers is knowing they’re doing something good. Framing their work as altruistic had positive effects on their mental health.

How To Help

Suicide is preventable and one of the most important things anyone can do is easy: recognize the signs of suicide:

Emotional Markers can include:

  • Feeling depressed
  • Lack of interest in activities once enjoyed
  • Irritability
  • Anger
  • Anxiety
  • Shame or humiliation
  • Mood swings

Verbal Markers include talking about:

  • Killing themselves
  • Their life having no purpose
  • Feeling like a burden
  • Feeling stuck
  • Not wanting to exist

There are two types of suicidal statements or thoughts. An active statement might be something like, “I’m going to kill myself.” A passive statement might include, “I wish I could go to sleep and not wake up,” or, “I wouldn’t mind if I got hit by a bus.” People often ignore passive statements, but they should be taken just as seriously.

Behavioral Markers can include:

  • Isolating from others
  • Not communicating with friends or family
  • Giving away possessions or writing a will
  • Acting recklessly
  • Increased aggression
  • Increased drug and alcohol use
  • Searching about suicide on the Internet
  • Gathering materials (pills or a weapon)

If a person is thinking of suicide, it’s also important to ask them if they have a plan. If they say yes, assist them in seeking immediately help. They can walk into an emergency room or urgent care clinic, or they can call 911. At any time, they can also call 1-800-273-TALK (8255).

Other Things We Can All Do

Stay connected. Just because we can’t be physically together, doesn’t mean we can’t be interacting with each other. Millions of us are already doing this via telephone, video calls, and social media. In fact, Zoom reported it’s seen a 1,900 percent increase in weekend calls. And, if anyone you know is in one of these risk groups, such as being a healthcare worker, make an extra effort to have a regular check in.

Use online therapy and apps. There’s no reason not to be seeing a professional right now. Most have pivoted their practice to include online sessions and there are platforms like Talkspace that specialize in teletherapy. The new app notOk allows you to alert your trusted contacts if you’re really struggling.

Limit news and social media. You probably already guessed that the death toll ticker plastered across every broadcast and news story might be bad for our mental health, and a recent study validates your hunch. It shows that widespread media coverage of a collective crisis like what we’re going through right now with Covid-19 may amplify distress. It’s also way too easy to get sucked into press conference after press conference and to obsessively check for updates. It’s okay to set a few times a day where you’ll check in for updates. And, stick to reliable news outlets. Rumors spread quickly and feed into the panic.

Change your expectations. You add to your own stress levels by creating goals that are unrealistic. “Be easy on yourself,” advises  Dr. Julie Kolzet, Ph.D., and a licensed psychologist in NYC (who also sees patients remotely). “It’s not an easy time. Do what you can.” Dr. Adam Kaplin, M.D., PhD., a neuroscientist at Johns Hopkins University School of Medicine agrees. “Our culture doesn’t believe in giving people time to recover and react,” he explains.

Do something different. Part of the issue right now for people is the monotony. We don’t know if it’s Monday or Thursday or April—every day is exactly the same. Setting a routine and mixing in some out of the ordinary adventures is a good way to create a rhythm that’s more similar to what we’re used to. Think: themed dinner and a movie night, Zoom happy hours, Wednesday walks, healthcare-worker honks.

Some companies are even doing special packages right now for frontline workers to get them out. The Dunkin’ Joy in Childhood Foundation and First Descents are teaming up to launch a program called Hero Recharge. You can apply for it here. They’ll give 1,000 healthcare workers who have been dealing with Covid-19 a free outdoor adventure.

One of the tips Dr. Kolzet told Psycom is to do benefit finding. There is some good that comes from disasters and tragedies. Here’s one: The climate scored a few points as smog in China decreased. You may have heard about the dolphins and swans in Venice, but it turns out that viral story wasn’t true. (See another reason you can’t always trust what you see on social media.)

And, while there’s this idea that disasters make people trample over each other in a selfish frenzy, the reality is it puts us on our best, most altruistic behavior. That’s not to say people aren’t feeling on edge, we’re less caught up in petty fights and stress. Disaster research (yeah, it’s a thing) shows that when your individual goals align with societal goals like they do in a disaster, the result is a sense of unity and belonging.

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Last Updated: Jul 14, 2020