The COVID-19 pandemic has ‘impacted populations around the world in multiple ways. The fear of being infected and anxiety about an uncertain present and future have impacted mental health severely. Lockdowns have led to isolation, in turn heightening anxiety and causing depression in societies, particularly in vulnerable communities’.
While the novel coronavirus pandemic is ‘unprecedented in its scope and scale, previous studies suggest an elevated risk of suicide during such times’. There is some evidence that ‘deaths by suicide increased in the United States during the 1918-19 influenza pandemic, and among older people in Hong Kong during the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic’. However, it has been noted that a rise in suicides in the wake of the pandemic is not inevitable. In fact, preliminary information from New Zealand, Japan and the United Kingdom suggest lower suicidal behaviour at least in the early phase of the pandemic.
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Before the pandemic, India’s progress as one of the fastest growing economies led to large paradigm shifts in the daily lives of its citizens. Major lifestyle shifts led to the rise of many lifestyle disorders in the last decade. Mental health disorders are one of the disorders of most concern, which have been swept under the carpet of stigma and discrimination. Many suicides are related to psychological disorders and distress.
New normal, consequences
The pandemic’s massive toll on human well-being — in a physical and mental sense — has completely changed the way people live. Necessary precautions such as social distancing, limited interactions and mask usage have become the new normal, with a huge social, physical, economic and mental consequences.
Unfortunately, India has the dubious distinction of reporting the first COVID-19-related suicide in the world, on February 12, 2020 . While the pandemic has affected the entire country, case incidence rates are the worst in States such as Maharashtra, Andhra Pradesh, Tamil Nadu, Karnataka and Uttar Pradesh. A worrying overlap reveals itself as some of these States are also major contributors to suicidal deaths per year — Maharashtra (18,916), followed by Tamil Nadu (13,493), West Bengal (12,665), Madhya Pradesh (12,457) and Karnataka (11,288). Dire socio-economic conditions arising from the pandemic — mass migration, unemployment and economic distress — make at-risk groups even more vulnerable during these times.
Rising stress
While progress on a COVID-19 vaccine is promising, uncertainty as a result of the pandemic is here to stay for the foreseeable future. The fear of getting infected, coupled with a lack of knowledge and the economic fallout has created a new level of stress not seen by many before. This is compounded by isolation from the community, causing high levels of mental duress and ultimately, COVID-19-related suicides for many. This situation is the worse among vulnerable populations who are susceptible to greater risks of infections, such as health-care workers, infected people, the elderly, migrant workers, those from resource-poor backgrounds, women facing domestic violence, individuals with compromised immunity, and those suffering from physical or psychological problems.
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A case series of newspaper reports of suicide in India during the early lockdown phase found that suicide was associated with the fear of infection, social isolation and pandemic-related economic concerns. The findings reveal that one in four of these deaths occurred among hospitalised patients, demonstrating the need for extra care and vigilance during institutional treatment for either COVID-19 or any other illness. The sudden closure of alcohol/liquor outlets resulted in an increase in alcohol-related suicides.
As we continue to fight the novel coronavirus, there is a growing need to make mental health and suicide prevention a priority. At an individual level, any early signs of poor mental health such as a sudden change in behaviour, substance use, anxiety, disturbed sleep and difficulty in communication should not be ignored. While the feeling of uncertainty during this pandemic is normal, being informed and limiting ourselves to authentic sources of information and reducing exposure to distressing news is a good mechanism to help a person cope with the situation.
Also read | Stress and anxiety rise amid coronavirus pandemic
Media’s role
Suicide prevention requires a mix of a top-down and a bottom-up approach, ensuring that all interventions are rooted in empathy. India has created a task force to develop a national suicide prevention strategy. The plan incorporates the three universal strategies, including a ban or reduction in access to highly hazardous pesticides, reduction in consumption and availability of alcohol, and a non-sensationalised and responsible portrayal of suicide by the media. The media would need to follow Press Council of India’s guidelines on reportage of suicide and also create awareness about suicide prevention.
Seeking support is key
There is an urgent need for destigmatising suicide as a phenomenon and ensure there is an increase in the number of functional and accessible helplines and training of gatekeepers. Most importantly, a system intervention can focus on identifying, supporting and referring suicidal individuals at all levels of the health-care system. It is essential that if suicide has been attempted the individual has the required intervention and regular contact support.
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A majority of individuals who are suicidal do not really want to die but find living difficult. Support at the right moment can change this decision. Understanding, compassion and support, at both an individual and the systemic levels, can save a life. On World Mental Health Day (October 10) , there is the most important message for the ones who may be having suicidal thoughts: You are not alone and must reach out for support, as help is available.
Dr. Lakshmi Vijayakumar is Founder, SNEHA, a suicide prevention centre. Dr. Sukriti Chauhan is a public health policy expert and Founder, ETI Foundation
