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Background: The COVID-19 pandemic is having profound mental health consequences for many people. Concerns have been expressed that, at their most extreme, these consequences could manifest as increased suicide rates. We aimed to assess the early effect of the COVID-19 pandemic on suicide rates around the world. Methods: We sourced real-time suicide data from countries or areas within countries through a systematic internet search and recourse to our networks and the published literature. Between Sept 1 and Nov 1, 2020, we searched the official websites of these countries’ ministries of health, police agencies, and government-run statistics agencies or equivalents, using the translated search terms “suicide” and “cause of death”, before broadening the search in an attempt to identify data through other public sources. Data were included from a given country or area if they came from an official government source and were available at a monthly level from at least Jan 1, 2019, to July 31, 2020. Our internet searches were restricted to countries with more than 3 million residents for pragmatic reasons, but we relaxed this rule for countries identified through the literature and our networks. Areas within countries could also be included with populations of less than 3 million. We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from at least Jan 1, 2019, to March 31, 2020) in each country or area within a country, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). Findings: We sourced data from 21 countries (16 high-income and five upper-middle-income countries), including whole-country data in ten countries and data for various areas in 11 countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas: New South Wales, Australia (RR 0·81 [95% CI 0·72–0·91]); Alberta, Canada (0·80 [0·68–0·93]); British Columbia, Canada (0·76 [0·66–0·87]); Chile (0·85 [0·78–0·94]); Leipzig, Germany (0·49 [0·32–0·74]); Japan (0·94 [0·91–0·96]); New Zealand (0·79 [0·68–0·91]); South Korea (0·94 [0·92–0·97]); California, USA (0·90 [0·85–0·95]); Illinois (Cook County), USA (0·79 [0·67–0·93]); Texas (four counties), USA (0·82 [0·68–0·98]); and Ecuador (0·74 [0·67–0·82]). Interpretation: This is the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. In high-income and upper-middle-income countries, suicide numbers have remained largely unchanged or declined in the early months of the pandemic compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond if the situation changes as the longer-term mental health and economic effects of the pandemic unfold. Funding: None.
Centre for Mental Health Melbourne School of Population and Global Health University of Melbourne
Swansea University Medical School
Translational Health Research Institute Western Sydney University
Ministry of Public Health Department of Health Promotion
National Confidential Inquiry into Suicide and Safety in Mental Health University of Manchester
Centre for Mental Health and Safety and National Institute for Health Research Patient Safety Translational Research Centre University of Manchester
School of Public Health National Suicide Research Foundation University College Cork
Australian Institute for Suicide Research and Prevention School of Applied Psychology Griffith University
Institute for Life Course Health Research Department of Global Health Stellenbosch University
Working Group on Prevention of Suicide and Depression at Public Health Council
Department of Psychiatry Blekinge Hospital
Botucatu Medical School Universidade Estadual Paulista
Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz
University of Rochester Medical Center
Region Friuli Venezia Giulia Central Health Directorate Outpatient and Inpatient Care Service
Department of Medicine University of Udine
Institute of Health Behaviors and Community Sciences College of Public Health National Taiwan University
Thames Valley Local Criminal Justice Board
Department of Psychiatry Psychotherapy and Psychosomatics Medical University of Innsbruck
Center for Outcomes Research and Evaluation Yale School of Medicine
Coroners Court of Victoria
Danish Research Institute for Suicide Prevention
Department of Mental Health Johns Hopkins School of Public Health
Centre for Mental Health Research Australian National University
Brigham and Women's Hospital Department of Emergency Medicine
School of Population Health University of Auckland
Magistrates Court of Tasmania (Coronial Division)
Bureau of Vital Records and Statistics Louisiana Office of Public Health
Ministry of Public Health Undersecretary of Health Services
Research Department, 113 Suicide Prevention
Departments of Psychiatry and Epidemiology Columbia University Medical Center/New York State Psychiatric Institute
Centre for Suicide Research University of Oxford
Louisiana Department of Health
Greater Manchester Mental Health NHS Foundation Trust
Department of Psychiatry Aga Khan University
KU Leuven Center for Contextual Psychiatry
Population Health Sciences Bristol Medical School University of Bristol
South Asian Clinical Toxicology Research Collaboration Faculty of Medicine University of Peradeniya
World Health Organization Country Office for Nepal
Karolinska Institutet
Bekhterev National Medical Research Center of Psychiatry and Neurology Pavlov First Saint Petersburg State Medical University
Unit Suicide Research and Mental Health Promotion Department of Social and Preventive Medicine Center for Public Health Medical University of Vienna
Department of Child and Adolescent Psychiatry Medical University of Vienna
School of Psychology University of Nottingham
Self-Harm Research Group School of Psychology University of Nottingham
Mental Health Centre Copenhagen
Department of Psychiatry and Psychotherapy Klinikum Klagenfurt am Wörthersee
Suicidal Behaviour Research Lab University of Glasgow
Preventing Deaths from Poisoning Research Group University of Edinburgh
Usher Institute University of Edinburgh
Suicide Research and Prevention Center Shanghai Mental Health Center Shanghai Jiao Tong University School of Medicine
Departments of Psychiatry and Epidemiology Columbia University
Department of Child and Adolescent Psychiatry and Psychotherapy University of Ulm
Psychosocial Services in Vienna
National Centre for Suicide Research and Prevention Institute of Clinical Medicine University of Oslo
Department of Child and Adolescent Psychiatry Psychotherapy and Psychosomatics University Hospital Leipzig
Department of Psychiatry and Psychotherapeutic Medicine Landeskrankenhaus Villach
Department of Psychiatry Psychosomatic Medicine and Psychotherapy University Hospital Frankfurt
Department of Borderline Disorders and Psychotherapy Bekhterev National Medical Research Center of Psychiatry and Neurology Saint Petersburg State University
Department of Psychiatry Health Authority Frankfurt am Main
Department of Addictive Disorders Psychiatry and Psychotherapy LVR-Klinik Köln
Department of Psychiatry Psychosomatic Medicine and Psychotherapy Goethe-University
Organizational-Scientific Department Bekhterev National Medical Research Center of Psychiatry and Neurology
Department of Psychiatry University of Toronto
Department of Psychiatry Sunnybrook Health Sciences Centre
Waseda University Faculty of Political Science and Economics
Sneha—Suicide Prevention Centre Voluntary Health Services
Department of Community Medicine Faculty of Medicine and Allied Sciences Rajarata University of Sri Lanka
Department of Psychiatry Sackler School of Medicine Tel Aviv University and Geha Mental Health Center
Division of Molecular Imaging and Neuropathology New York State Psychiatric Institute and Department of Psychiatry Columbia University
National Institute of Health Research Biomedical Research Centre University Hospitals Bristol and Weston NHS Foundation Trust University of Bristol
Department for Psychiatry University Psychiatric Hospital Vrapče School of Medicine University of Zagreb
Botucatu Medical School Universidade Estadual Paulista
