Psychiatric disorders and suicide in the COVID-19 era

The coronavirus disease 2019 (COVID-19) pandemic has a tremendous effect on the psychological state of millions and millions of people around the world.¹ For the general population, the psychological impact of COVID-19 is as critical to address as are the physical health effects. Fear of unknown, uncertainty, social isolation, ambivalent statements by public health and other government officials and dubious reports by mass media lead to high rates of anxiety and depression among the general public and especially among susceptible population groups including individuals with pre-existing psychiatric conditions, low-resilient persons and individuals who live in high COVID-19 prevalence regions.^1–3 A study of a representative sample of the US adults published on 4 June 2020 found that more than 25% of the study participants reported moderate to severe anxiety symptoms.³ Depressive symptoms, on average, were high.³ This study also showed that fear of COVID-19 appeared to be concentrated in regions with the highest numbers of reported COVID-19 cases.³

Sadly, there is a high probability of an increase in suicides during and following the COVID-19 crisis.^4–6 There are multiple reports of COVID-19-related suicides in the psychiatric literature and mass media.^4,5 Individuals with pre-existing psychiatric conditions including mood, psychotic and substance use disorders are at elevated suicide risk.⁷ Most suicides have a diagnosable psychiatric illness.⁷ Healthcare professionals are also at increased suicide risk.⁸ A career in medicine comes with a huge strain in the best of times. Death by suicide is about 70% more likely among male physicians in the USA than among other professionals, and 250–400% higher among female physicians.⁸ The coronavirus pandemic may significantly increase mental health issues and suicides among healthcare professionals. Economic problems caused by the COVID-19 pandemic will probably contribute to an increase in suicides.^9,10 Historically, economic turmoil has always led to a rise in suicide death.⁹ A recently published model shows that job losses due to the COVID-19 crisis will result in between 2135 and 9570 suicides per year worldwide.¹⁰

The world was poorly prepared for the COVID-19 pandemic. The COVID-19 crisis has disrupted the delivery of psychiatric services worldwide.¹¹ This may be especially difficult in many lower-income and middle-income countries where mental health services are weak and fragmented. COVID-19 is a global peril that needs a global response involving all countries and international cooperation.

Mental health consequences of the COVID-19 crisis are very serious. Therefore, I was delighted when Professor Seamas Donnelly, the Editor of the QJM invited me to organize a series of review articles on the mental health effects of the COVID-19 pandemic. I truly believe that this is an issue of utmost importance. It is to be hoped that the review series will help to attract more attention from policy makers, clinicians and researchers to COVID-19-related mental health issues. The first article of the review series is published in this issue of the QJM.² In this review, Serafini et al.² discuss the impact of the COVID-19 pandemic on the mental health in the general population. The authors stress on the importance of implementing effective communication and providing adequate psychological services in order to attenuate the psychosocial impact of the COVID-19 outbreak.² Other review articles will be published in the future issues of the QJM and discuss the effect of the COVID-19 disaster on healthcare professionals, immigrants, racial and ethnic minorities and suicide rates.

The psychiatric effects of the COVID-19 crisis will become progressively evident in the coming months and years as the consequences of chronic anxiety, prolonged distress, physical distancing, loneliness, death of friends and family members and employment losses manifest. It is vital to take proactive steps to minimize the detrimental impact of the coronavirus pandemic on the mental health.

Conflict of interest: None declared.