Characteristics of patients treated for suicidal behavior during the pandemic in a psychiatric emergency department in a Spanish provinceCaracterísticas de los pacientes atendidos por conducta suicida durante la pandemia en un servicio de urgencias psiquiátricas de una provincia española

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Abstract

Introduction

Different studies have suggested that psychological, social and economic factors could contribute to an increase in the suicide. That is why the scientific community fear an epidemic of suicides secondary to this crisis. The objective is to evaluate the variables related to suicidal behavior during the two states of alarm and to review if there were sociodemographic or clinical differences with respect to periods prior to the COVID-19 pandemic.

Material and methods

We compared visits to the emergency room and their characteristics of all patients with suicidal behavior before and after the pandemic in Lérida. Information on sociodemographic status, reason for consultation, diagnosis and characteristics of suicidal behavior was obtained from the electronic medical record.

Results

No differences were observed in the percentage of suicidal ideation or attempts in the three periods (p = 0.201). The characteristics in the multiple logistic regression associated with suicidal behavior are: being a woman (OR: 1.81 [1.27–2.56]), living with relatives (OR: 1.55 [1.05–2.32]) and have a diagnosis of non-alcohol related substance use disorder (OR: 1.94 [1.09–3.42]). As protective factors, being visited in the emergency room during the second state of alarm (OR: 0.68 [0.48–0.96]) and having depression (OR: 0.67 [0.47–0.96]).

Conclusions

Emergency care for suicidal behavior did not increase during the pandemic and, in fact, in 2020 completed suicides decreased by almost half in the province. Risk factors for suicide attempt were female gender, living with relatives, and having a substance use disorder diagnosis. Instead, depression was a protective factor.

Resumen

Introducción

Diferentes estudios han sugerido que factores psicológicos, sociales y económicos podrían aumentar la tasa de suicidio. La comunidad científica teme una epidemia de suicidios secundaria a esta crisis. El objetivo es evaluar las variables relacionadas con la conducta suicida durante los 2 estados de alarma y revisar si hubo diferencias sociodemográficas o clínicas respecto a periodos previos a la pandemia de COVID-19.

Material y métodos

Comparamos las visitas a urgencias y sus características de todos los pacientes con conducta suicida antes y después de la pandemia en Lérida. La información sobre el estado sociodemográfico, motivo de consulta, diagnóstico y características de la conducta suicida se obtuvieron de la historia clínica electrónica.

Resultados

No se observaron diferencias en el porcentaje de ideación o intentos suicidas en los 3 períodos (p = 0,201). Las características en la regresión logística múltiple asociadas a la conducta suicida son: ser mujer (OR: 1,81 [1,27-2,56]), vivir con familiares (OR: 1,55 [1,05-2,32]) y tener diagnóstico de trastorno por consumo de sustancias no relacionado con el alcohol(OR: 1,94 [1,09-3,42]). Como factores protectores, ser visitado en urgencias durante el segundo estado de alarma (OR: 0,68 [0,48-0,96]) y tener depresión (OR: 0,67 [0,47-0,96]).

Conclusiones

La atención de emergencia por conducta suicida no aumentó durante la pandemia y, de hecho, en 2020 los suicidios consumados disminuyeron casi a la mitad en la provincia. Los factores de riesgo para el intento de suicidio fueron el sexo femenino, vivir con familiares y tener un diagnóstico de trastorno por uso de sustancias. En cambio, la depresión fue un factor protector.

Introduction

Different studies have suggested that psychological, social and economic factors, such as stress due to fear of infection, depression due to isolation and economic crises, such as declining income and unemployment, could contribute to an increase in the suicide rate.1 In situations of previous infection, such as the Spanish flu outbreak or the severe acute respiratory syndrome outbreak in 2003, mortality due to suicide increased.2 That is why the scientific community and political authorities fear an epidemic of suicides secondary to this crisis3 as has already been shown in Spain with an upturn in the number of suicides in 2020, rising to 3941 suicides compared to 3671 in 2019.4

There are multiple studies carried out on the influence of the COVID-19 pandemic on suicidal behavior. A meta-analysis carried out with data from 54 studies with 308,596 participants stands out. Their results suggested higher rates of suicidal ideation events (10.81%), suicide attempts (4.68%), and self-harm (9.63%) during the COVID-19 pandemic when compared to event rates of pre-pandemic studies. The analysis indicated that younger people, women, and people from democratic countries are more susceptible to suicidal ideation during the COVID-19 pandemic.5 Another review involving 12 studies with 120,076 patients reported a prevalence of suicidal ideation of 12.1% (CI 9.3–15.2). The main risk factors for suicidal ideation were: low social support, high physical and mental exhaustion, and self-reported poorer physical health in frontline medical workers, sleep disturbance, quarantine and exhaustion, loneliness, and mental health problems. Thus, it seems confirmed that the rate of suicidal ideation during the COVID pandemic is higher than that reported in studies on the general population before the pandemic and may result in higher suicide rates in the future.6

Although there are projections about the greater probability of suicide and deaths due to despair due to the COVID-19 pandemic,7 it is necessary to carry out local studies according to the care areas that allow a better identification of the situation and care needs. The objective of this study is to evaluate the variables related to suicidal behavior during the two states of alarm and to review if there were sociodemographic or clinical differences with respect to periods prior to the COVID-19 pandemic.

Section snippets

Sample and procedure

This study was carried out at the Santa Maria University Hospital in Lleida, Spain. This hospital is the only one providing urgent psychiatric care in the province of Lerida, with an area of influence of 431,183 people.8

The data in this study were obtained through a retrospective review of digital medical records extracting all the patients visited in the Psychiatric Emergency Department of Santa Maria University Hospital in Lerida. The observation periods were: (1) before confinement: from

Patients treated for suicidal behavior

We recruited 587 patients with suicidal behavior, which represents 15.4% of all psychiatric emergency visits without significant variations in the three periods studied, although their number increased in the second state of alarm (Table 1). No differences were observed in the percentage of suicidal ideation or attempts in the three periods (p = 0.201). During the second state of alarm, the patients who attended the emergency room due to suicidal behavior were younger (p = 0.005), spent less time

Discussion

In this sample, unlike other studies that warned of an increase in suicidal behavior,13 we did not find a significant increase in emergency care for suicidal behavior compared to the situation prior to the pandemic. Some studies considering only 2020 reported no difference or reduced emergency department attendances for suicidal behaviour.14 Relative to a similar period in 2019, the number of emergency department attendances for suicide attempts remained stable among American youngs during

Conclusions

In our study, we did not observe an increase in emergency care for suicidal behavior during the pandemic and, in fact, in 2020, completed suicides decreased by almost half in our province. Risk factors for suicide attempt were female gender, living with relatives, and having a diagnosis of substance use disorder. Instead, it was a protective factor to have depression.

Conflict of interest

All authors declare that they have no conflict of interest in relation to the performance of this work.

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