Original articleSuicide mortality in Spain in 2020: The impact of the COVID-19 pandemic
Introduction
Suicide constitutes a serious health concern with global impact. The World Health Organization informed that more than 700,000 people died by suicide in 2019.1 There is increasing concern that the COVID-19 pandemic could exacerbate suicide risk.1, 2, 3 However, evidence is quite mixed in the first year of the COVID-19 pandemic. Some studies have not supported such a rising suicide trend.4, 5, 6, 7 A national-data study from Japan did find an upward trend in suicide mortality from July 2020.8
Spain may be an at-risk country for increased suicide risk in the time of COVID-19 pandemic due to high mortality of the first wave, the elevated COVID-19 wave recurrence, early strict lockdown, and elevated mental health impact.3, 9, 10, 11 The lockdown in Spain was one of the most restrictive in Europe. The Government imposed a State of Alarm starting on March 15th that established a national lockdown, including the imposition of distancing measures such as the closure of non-essential customer-facing businesses and educational institutions. A period of five weeks started in which citizens were only allowed to leave their homes for essential work, to buy food and other staple products, or for emergencies. On May 4th, citizens were first authorised to leave their homes to exercise or walk, for a maximum of 1 h a day, under strict conditions. From May 10th to June 21st, a progressive de-escalation occurred. On the other hand, Spain has not implemented a national suicide prevention plan yet, despite the increasing trends of suicide mortality in recent decades.12 Even though, recent studies based on regional records have shown some evidence on an absence of increasing suicide mortality rates during the first months of the COVID-19 pandemic.4, 13 This report aims to expand on suicide mortality trend in the first COVID-19 pandemic year in Spain.
Section snippets
Materials and methods
We used national data based on the National Death Index, annually released by the Spanish National Institute of Statistics (Instituto Nacional de Estadística, INE). Monthly suicide death data from the 52 Spanish provinces were used covering both the years 2019 and 2020. First, annual mortality rate was calculated at a province level under random-effects models due to a large variability between province-specific rates.14, 15 Afterwards, trend decomposition and stationarity analysis (i.e.,
Results
A total of 3671 people died by suicide in 2019 in Spain, with a random-effects mortality rate of 8.3 (CI95 = 7.6, 9.0) per 100,000 inhabitants (fixed-effects mortality = 7.7, CI95 = 7.7, 7.7). In 2020, 3941 people died by suicide and the random-effects mortality rate was 8.9 (CI95 = 8.3, 9.6) cases per 100,000 inhabitants (fixed-effects rate = 8.2, CI95 = 7.7, 7.7). There were no significant differences between the annual mortality rates, z = 1.33, p = .18. Monthly suicide mortality count is displayed in Fig. 1
Discussion
Our results contribute to extend the insight into existing evidence on suicide trends in the first COVID-19 pandemic year in Spain, using national data. Our findings go in line with previous studies on a lack of annual increase in suicide mortality.4, 7, 13, 17 This despite the fact that a rising trend in suicide risk was found upon strict COVID-19 lockdown ease (from May, 2020). This result may go in line with the study by Sakamoto et al.8 on the significant impact of the COVID-19 pandemic in
Funding
This study was supported by the Instituto de Salud Carlos III (grant ref.: PI20/229) and co-funded by the European Regional Development Fund (ERDF); and a Complutense University predoctoral grant (ref. CT82/20-CT83/20).
Conflict of interest
The authors declare that they do not have any conflict of interest to be disclosed.
References (17)
- et al.
Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain
Brain Behav Immun
(2020) - et al.
Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries
Lancet Psychiatry
(2021) - et al.
Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study
Lancet
(2020) - et al.
Suicide mortality trends in Spain, 1980–2016
Rev Psiquiatr Salud Ment
(2020) Suicide prevention in the COVID-19 era: transforming threat into opportunity
JAMA Psychiatry
(2021)- et al.
Suicide mortality and coronavirus disease 2019— a perfect storm?
JAMA Psychiatry
(2020) - et al.
Racial differences in statewide suicide mortality trends in maryland during the Coronavirus disease 2019 (COVID-19) pandemic
JAMA Psychiatry
(2020) - et al.
Suicide reduction in Canada during the COVID-19 pandemic: lessons informing national prevention strategies for suicide reduction
J R Soc Med
(2021)