Background
Case reports from countries impacted early on during the COVID-19 pandemic raised concerns for potential worsening behavioral health outcomes, including suicidality, due to infection and/or related psychosocial and structural stressors. Our project offers an examination of the earliest impacts of the COVID-19 pandemic on suicidality in patients hospitalized at a tertiary hospital in a hard-hit urban area of the United States.
Methods
We performed a retrospective chart review of all hospitalized adult patients who required inpatient psychiatric consultation during the first month of the COVID-19 outbreak (March 15, 2020 - April 15, 2020). Charts were reviewed for key demographic factors including COVID-19 infection status, premorbid/active behavioral health and substance use concerns, and presence of suicidality. In addition to key demographic factors, we present five select cases to illustrate general themes observed and explore pandemic suicidal behavior. In our clinical analysis of each case, we utilize Durkheim’s classic sociological framework on suicidality to better accentuate key social forces (societal integration and regulation) contributing to our patients’ behavior (Durkheim, 1951).
Results
We present a series of five cases, outlining potential demographic, psychiatric, psychosocial, and structural risk factors for suicidality in the setting of the ongoing pandemic. We classify these cases within the Durkheim framework for suicidality. We further contextualize the cases with additional data regarding all COVID-19 related consultations for suicidality during this period.
Discussion
Our findings add to the growing literature on mental health implications of the COVID-19 pandemic and offer additional insights into suicidal behavior in vulnerable patient populations as well as in patients with no premorbid psychiatric issues during this time period. Understanding motivation for suicidality, including factors potentially unique to the pandemic, will help us form a better understanding of patients’ behaviors, enhance alliances with the patient and consultees, and assist in identification of appropriate treatment goals. While the scope of this project is limited, real-time changes made by our institution and the local government in parallel to our case series likely helped address some of the needs and risk factors we identify here.
Conclusion
We present a case series on suicidal ideation and behavior coincident with the COVID-19 pandemic in a U.S. tertiary hospital setting and demonstrate how themes apparent in these cases and related to the pandemic map onto a classic framework of suicidality.
Reference
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1.
Durkheim E. Suicide: A Study in Sociology. Spaulding J, Simpson G, trans. Glencoe, Ill: The Free Press; 1951.