Table 2.
Suicide and/or Self-Harm Thoughts in People With SARS-CoV-2 in Studies With a SARS-CoV-2-Negative Comparator Group.
| Authors | Population and setting | Study design | Exposure measure | Sample size of SARS-CoV-2-infected individuals | COVID-19 status (U = Unclear, R = Recovered, A = Active) | Outcome Questionnaire Used | Outcome time span | Estimates/Findings | Quality assessment overall rating |
|---|---|---|---|---|---|---|---|---|---|
| Iob et al., 2020 12 | General Population in UK March 21 –April 20, 2020 |
Cross-sectional | Self-report | n = 198 | U | PHQ-9 Item 9 | Past week | The proportion of people reporting self-harm/suicidal thoughts
was greater in people who reported a COVID-19 diagnosis n = 66(33.4%) compared to those who did not n = 7918(17.8%) (PR 1.88, 95%CI 1.54–2.29c) |
Fair |
| Paul & Fancourt, 2021 13 | Adults (General Population) in UK April 1–May 17, 2021 |
Cross-sectional | Self-report | Not stated (overall study n = 49,324 participants) | U | PHQ-9 Item 9 | Past week | Having had COVID-19 illness increased risk of self-harm thoughts
in total sample and at ages 18–29, 45–59. For all ages/overall sample: unadjusted (OR 1.17, 95%CI 1.09–1.25) adjusted for anxiety symptoms (OR 1.11, 95%CI 1.03–1.20) adjusted for depressive symptoms (OR 1.05, 95%CI 0.97–1.13) adjusted for physical abuse and psychological abuse (OR 1.16, 95%CI 1.09–1.25) |
Good |
| Perlis et al., 2021 16 | Adults in USA May 2020–February 2021 |
Cross-sectional | Self-report of clinician diagnosis or positive COVID-19 test. | n = 5945 (6.5% of the total sample) | U | PHQ-9 Item 9 | Past 2 weeks | Those with prior COVID-19 had higher suicide/self-harm thought
scores compared to those without: Mean[SD] 1.5[1.06]) vs 0.99[1.09], p < .001) |
Fair |
| Raifman et al., 2020 17 | Adults in USA March 31–April 13, 2020 |
Cross-sectional | Self-report | 12 | U | PHQ-9 Item 9 | Past 2 weeks | Those who had COVID-19 were more likely to report suicidal thoughts compared to those who did not have COVID-19: 66.7% vs 15.9% (PR 4.2, 95%CI 2.8–6.4; aPR 3.5, 95%CI 1.9–6.4) | Good |
| Elbogen et al., (2021)
a
18
Tsai et al., (2021) a 19 Tsai et al., (2021) a 20 |
Low and middle income (<$75,000) Adults ≥22 years) in
USA May-June 2020 |
Cross-sectional | Self-report | 354 | U | Mini-International Neuro-psychiatric Interview “Over the last 2 weeks, how often did you consider hurting yourself, felt suicidal, or wish that you were dead?” | Past 2 weeks |
Bivariate comparisons: The proportion of people who reported suicidal/self-harm thoughts was greater in those with a positive SARS-CoV-2 test compared to those who did not test n = 322(91%) vs. 938(21%)(PR = 4.30, 95%CI 4.03–4.59 c ) and between those who tested positive compared to those who tested negative n = 322(91%) vs. 804(44%) (PR = 2.05, 95%CI 1.94–2.19 b ). Those who tested negative were also more likely to report suicidal/self-harm thoughts compared to those who did not test 804(44%) vs. 938(21%) (PR 2.09, 95%CI 1.94–2.26 b ) Multivariable logistic regression: Infection with SARS-CoV-2 was associated with suicidal/self-harm thoughts in multivariable logistic regression: unweighted OR 1.91, 95% CI 1.15–3.16 weighted OR 1.95, 95% CI 1.20–3.19 |
Fair |
| Mortier et al., 2021 15 | Healthcare workers (from ten hospitals in four autonomous
communities in Spain: the Basque Country, Castile and Leon,
Catalonia, and the Community of Madrid) May 5–July 23, 2020 |
Cross-sectional | Self-report (subcategorized as having been hospitalized for COVID-19, having had a positive SARS-CoV-2 test or medical diagnosis not requiring hospitalization, and all others) | Having been hospitalized for COVID-19 (n = 55); Positive SARS-CoV-2 test or medical COVID-19 diagnosis (n = 845); No COVID-19 diagnosis (n = 4264) | U | Modified self-report version of selected items from the Columbia Suicide Severity Rating Scale measuring suicidal thoughts (“wish you were dead or would go to sleep and never wake up” and “have thoughts of killing yourself” with and without a plan) | Past 30 days |
Bivariate comparisons: No difference in any suicidal thoughts between those who were hospitalized for COVID-19 compared to those with no history of SARS-CoV-2: 12.6% vs 7.9% (PR = 1.61, 95%CI = 0.80–3.24 b ). Difference between those with SARS-CoV-2 infection/COVID-19 disease without hospitalization compared to those with no history of SARS-CoV-2 : 10.0% vs. 7.9% (PR = 1.27, 95%CI = 1.01–1.59 b )*** No difference in passive suicidal ideation only between those who were hospitalized for COVID-19 compared to those with no history of SARS-CoV-2: 4.5% vs 4.7% (PR 0.77, 95%CI 0.20–3.04 b ) or between those with SARS-CoV-2 infection/COVID-19 disease without hospitalization compared to those with no history of SARS-CoV-2: 5.9% vs 4.7% (PR 1.26, 95%CI 0.93–1.70 b ) No difference in active ideation without plan or attempt only between those who were hospitalized for COVID-19 compared to those with no history of SARS-CoV-2: 0.0% vs. 0.8% (PR 1.10, 95%CI 0.07–17.78 c ) and between those with SARS-CoV-2 infection/COVID-19 disease without hospitalization compared to those with no history of SARS-CoV-2: 1.0% vs. 0.8% (PR 1.18, 95%CI 0.55–2.56 c ) Difference in active ideation with a plan or attempt only between those who were hospitalized for COVID-19 compared to those with no history of SARS-CoV-2-: 8.1% vs. 2.5% (PR 2.90, 95%CI 1.11–7.58 b , c ) and no difference between those with SARS-CoV-2 infection/COVID-19 disease without hospitalization compared to those with no history of SARS-CoV-2: 3.2% vs. 2.5% (PR 1.28, 95%CI 0.84–1.97 c ) No differences in any of the above after multivariable logistic regression controlling for demographic, clinical, and work-related factors. |
Good |
| Bruffaerts et al., 2021 21 | Healthcare workers from three professional associations (medical
doctors, practicing psychiatrists, and clinical
psychologists) and 4 hospitals in Leuven-Brussels-Antwerp, Belgium 6 April–14 July 2020 |
Cross-sectional | Self-report | 551 Infected with SARS-CoV-2 and quarantined (n = 525); Infected with COVID and hospitalized (n = 26) |
U | Modified self-report version of selected items from the Columbia Suicide Severity Rating Scale measuring suicidal thoughts (Death wish “In the past 30 days, did you wish you were dead or would go to sleep and never wake up?”; Suicidal ideation “In the past 30 days, did you have thoughts of killing yourself?”); suicide plan (“In the past 30 days, did you think about how you might kill yourself [e.g., taking pills, shooting yourself] or work out a plan of how to kill yourself?”) | Past 30 days |
Individual level associations: No association between infected with SARS-CoV-2 and quarantined: Death wish: aOR 0.8, 95% CI 0.4–1.4 Suicidal ideation: aOR 1.0, 95% CI 0.5–2.2 Suicide plan: aOR 1.3, 95% CI 0.6–2.5 Associations between infected with SARS-CoV-2 and hospitalized &: Death wish: aOR 11.8, 95% CI 2.1–67.6 Suicidal ideation: aOR 7.6, 95% CI 1.4–41.5 Suicide plan: aOR 11.6, 95% CI 2.5–52.7 aOR: Adjusted odds ratios accounting for age, gender, profession, social supports as well as clinical and work-related factors. Society-level association: Being hospitalized because of COVID19 infection accounted for a small (<5%) but significant population attributable risk proportion for suicide outcomes |
Good |
| Na et al., 2021 22 | Military veterans who survived COVID-19 in
USA 2019–2020 |
Cross– sectional | Self-report | 233 | U | Two items adapted from the PHQ-9 Item 9. A positive screen was indicated by a response of “several days,” “more than half the days,” or “nearly every day” to at least one of the following questions: “How often have you been bothered by thoughts that you might be better off dead?” and “How often have you been bothered by thoughts of hurting yourself in some way?” | Past 2 weeks | Veterans with SARS-CoV-2 were more likely to report current suicidal/self-harm ideation in comparison to those who were not infected (12.0% vs 7.6%, PR 1.58, 1.09–2.29 c ) | Fair |
| Na et al., 2021 23 | Military veterans in USA | Repeat cross-sectional | Self-report | 661 | U | Two items adapted from the PHQ-9 Item 9. A positive screen was indicated by a response of “several days,” “more than half the days,” or “nearly every day” to at least one of the following questions: “How often have you been bothered by thoughts that you might be better off dead?” and “How often have you been bothered by thoughts of hurting yourself in some way?” | Past 2 weeks | 27.3% of veterans who were infected with SARS-CoV-2 reported
suicidal/self-harm thoughts compared to 18.2% who were not
infected. Those who were infected with SARS-CoV-2 were more
likely to report current suicidal/self-harm thoughts (PR 1.50,
95%CI, 1.00 to 2.25
c
) Veterans infected with SARS-CoV-2 who were aged 45–59 and 60 + and those in the lowest quartile of pre-pandemic purpose in life had a higher risk of suicidal/self-harm thoughts (p < 0.05). |
Good |
a
Studies used same dataset hence results pooled.
b
Calculations conducted using raw data.
c
Due to a zero value, 0.5 was added to all cells for computation of the relative risk. 24 .
***Note that the three-way comparison reported in this paper was not significant; however, when we converted to bivariate comparisons in order to calculate odds ratios, we identified a significant difference between those with SARS Cov-2 compared to those with no history of SARS-CoV-2.