Adaptation of evidence‐based suicide prevention strategies during and after the COVID‐19 pandemic

Danuta Wasserman; Miriam Iosue; Anika Wuestefeld; Vladimir Carli

doi:10.1002/wps.20801

. 2020 Sep 15;19(3):294–306. doi: 10.1002/wps.20801

Adaptation of evidence‐based suicide prevention strategies during and after the COVID‐19 pandemic

Danuta Wasserman ¹, Miriam Iosue ¹, Anika Wuestefeld ¹, Vladimir Carli ¹

PMCID: PMC7491639 PMID: 32931107

Abstract

Suicide is preventable. Nevertheless, each year 800,000 people die of suicide in the world. While there is evidence indicating that suicide rates de‐crease during times of crises, they are expected to increase once the immediate crisis has passed. The COVID‐19 pandemic affects risk and pro‐tective factors for suicide at each level of the socio‐ecological model. Economic downturn, augmented barriers to accessing health care, increased access to suicidal means, inappropriate media reporting at the societal level; deprioritization of mental health and preventive activities at the community level; interpersonal conflicts, neglect and violence at the relationship level; unemployment, poverty, loneliness and hopelessness at the individual level: all these variables contribute to an increase of depression, anxiety, post‐traumatic stress disorder, harmful use of alcohol, substance abuse, and ultimately suicide risk. Suicide should be prevented by strengthening universal strategies directed to the entire population, including mitigation of unemployment, poverty and inequalities; prioritization of access to mental health care; responsible media reporting, with information about available support; prevention of increased alcohol intake; and restriction of access to lethal means of suicide. Selective interventions should continue to target known vulnerable groups who are socio‐economically disadvantaged, but also new ones such as first responders and health care staff, and the bereaved by COVID‐19 who have been deprived of the final contact with loved ones and funerals. Indicated preventive strategies targeting individuals who display suicidal behaviour should focus on available pharmacological and psychological treatments of mental disorders, ensuring proper follow‐up and chain of care by increased use of telemedicine and other digital means. The scientific community, health care professionals, politicians and decision‐makers will find in this paper a systematic description of the effects of the pandemic on suicide risk at the society, community, family and individual levels, and an overview of how evidence‐based suicide preventive interventions should be adapted. Research is needed to investigate which adaptations are effective and in which con‐texts.

Keywords: Suicide, suicidal behaviour, mental health, COVID‐19, socio‐ecological model, universal prevention, selective prevention, indicated prevention

Approximately 800,000 people die of suicide each year ¹ , with a rate of 10.5 per 100,000 people (males: 13.7 per 100,000; females 7.5 per 100,000) ² . This number is underestimated, due to variations in the methods of monitoring and death registration as well as cultural factors ² . Suicide is the second leading cause of death among people aged 15‐24 worldwide, and for each death by suicide 10 to 20 suicide attempts are estimated1, 3.

It has been reported that, during times of natural disasters, war, or epidemics such as the severe acute respiratory syndrome (SARS), suicide rates may momentarily decrease4, 5, 6. However, after the immediate crisis has passed, suicide rates increase4, 6. The COVID‐19 pandemic poses a special challenge to people around the world, as it affects both physical and mental health7, 8, 9, 10, 11, 12, 13, 14, 15, economy ¹⁶ , and social life17, 18.

Physical distancing19, 20 and lockdown measures ²¹ , work disruptions ²² and school closures23, 24 have suddenly changed social life and daily routines. A major effect of these measures has been the reduction of social contacts, with a consequent increase in social isolation and feelings of loneliness, both in turn associated with increased anxiety, depression and suicidal behaviour25, 26.

Even if some positive outcomes related to staying at home have been highlighted, such as the adoption of healthier eating habits and the increase of sleep hours ²⁷ , reports show that movement restrictions aimed to stop the spread of the virus are causing a worldwide increase in family problems and domestic violence28, 29. A systematic review ³⁰ documented that family conflict is the most commonly reported precipitant of suicidal acts among children. A high prevalence of domestic violence victimization has been reported among people seeking treatment for self‐harm in the UK ³¹ . Furthermore, intimate partner violence ³² and childhood abuse and neglect ³³ have been found to be associated with suicide attempts.

As a consequence of the lockdown and other public health measures implemented in many countries, a global economic crisis at least as bad as the one occurring in 2008 is expected ¹⁶ . In the European Union, the unemployment rate is predicted to rise from 6.7% in 2019 to 9% in 2020 ³⁴ . In the US, more than 20 million people lost their jobs in April 2020. The unemployment rate increased to 14.7%, while it was 3.5% in February 2020, before the spreading of the virus in the country ³⁵ .

According to the United Nations, the pandemic hit the Latin America and the Caribbean in a period in which their economy was already weak and indebted ³⁶ . Consequently, a 3.4% increase in the unemployment rate for 2020 (from an already high 8.1% rate in 2019) is forecast, resulting in an increase of 44.7 million people in poverty or extreme poverty. Furthermore, at least 11 million people will fall into poverty across East Asia and the Pacific ³⁷ , and 27 million people will face extreme poverty in Africa ³⁸ .

There is consistent evidence of an association between economic crises and increased suicide rates, especially in high‐income countries, such as those in Europe and North America ³⁹ , and among men in working age or unemployed ⁴⁰ . Analyzing data between 1970 and 2007 for 26 European Union countries, it has been estimated that every 1% increase in the unemployment rate is associated with a 0.79% rise in suicides at ages below 65, with 60 to 550 potential excess deaths ⁴¹ . An estimate of the impact of the COVID‐19 recession forecasts a 3.3% to 8.4% increase in suicide rate in the US ⁴² . However, previous research also shows that policy responses and governmental expenditures may be able to mitigate the impact of unemployment and economic crises on suicide rates41, 43.

According to the World Health Organization (WHO) ⁴⁴ , as of August 30, 2020, there were more than 838,000 confirmed deaths worldwide attributable to COVID‐19. Other analyses suggest that the real death toll of the pandemic is higher than what official statistics show45, 46, 47. COVID‐19 deaths lead to bereavement overload, because of the frequent multiple deaths within the families, and the impossibility to visit and assist the dying person or even join the funeral or ritual ceremonies due to the prohibition of public gatherings ⁴⁸ . The accumulation of deaths and the fact that COVID‐19 mortality mostly affects the elderly may induce, in the society, indifference and attitudes to overlook the deep pain and distress of bereaved families, further contributing to complicate the grief.

Reports predicting a rise in suicide rates as well as in mental health problems call for appropriate actions during and after the crisis9, 49, 50, 51, 52, 53. Suicide is an unnecessary death and can be prevented by using evidence‐based methods ⁵⁴ . However, a broad approach according to the socio‐ecological model is needed ⁵⁵ .

The aim of this paper is to systematically evaluate the influence of the COVID‐19 pandemic on risk and protective factors for suicide at the societal, community, relationship and individual levels. Adjustments of evidence‐based universal, selective and indicated suicide prevention strategies are recommended to provide guidance to clinicians, public mental health professionals, politicians and decision‐makers.

IMPACT OF THE COVID‐19 PANDEMIC ON RISK AND PROTECTIVE FACTORS FOR SUICIDE

According to the WHO, risk and protective factors for suicidal behaviour are categorized, in line with the socio‐ecological model, into four levels: society, community, relationship and individual ⁵⁵ .

Risk and protective factors are likely to be influenced by the COVID‐19 pandemic in different ways. Some risk factors, such as a family history of suicide ⁵⁵ , will not be affected at all. Many modifiable risk factors may be exacerbated, leading to an increase in the risk of suicide over time ⁵⁶ . The prevalence of stress, sleep disturbances, anxiety, depression, alcohol and drug abuse, with suicide as their utmost consequence, is likely to increase17, 57, 58. Financial problems and worries about the uncertain future and unemployment will also contribute to an increase in suicide rates16, 17, 53.

Protective factors for suicide have been described, such as effective mental health care, strong personal relationships, a supportive social network, life skills and ability to adapt, practice of positive coping strategies, and religious or spiritual beliefs55, 59.

Protective factors may be influenced positively or negatively, depending on the economic and social actions that will be taken by politicians and decision‐makers in response to the COVID‐19 pandemic. Strategies may be of varying effectiveness in different regions or countries. With an adequate and effective response, the pandemic may even represent an opportunity to strengthen suicide preventive efforts50, 52.

The expected effects of the pandemic on each risk and protective factor at the society, community, relationship and individual level are summarized in Tables 1, 2, 3, 4.

Table 1.

Risk and protective factors for suicide at the societal level and possible impact (positive or negative) of the COVID‐19 pandemic on these factors

	Impact of COVID‐19 pandemic
Risk factors
Economic downturn	Increased financial problems, unemployment, worries about the future	–
Barriers to accessing health care	Increased pressure on health care systems Increased delegation of resources towards the acute response to the pandemic Decreased focus on mental health care Reduced help‐seeking due to containment measures Reduced help‐seeking due to fear of being infected Stigma related to the infection or to mental health problems	– – – – – –
Access to suicidal means	Increased buying and stockpiling of medications or firearms	–
Inappropriate media reporting	Speculations on the reasons for specific suicidal acts; sensationalizing of pandemic‐related suicides	–
Protective factors
Effective mental health care	Closure or reduced activity of mental health services Increased resources for telemedicine and digital tools	– +
Legislations concerning economy and social inequalities, welfare measures, health care accessibility, national prevention programs	Decreased emphasis on prevention programs due to the economic impact of the pandemic Increase of government funds for health policies in general Increase of short‐ and/or long‐term welfare measures Opportunities to strengthen mental health care systems	– + + +

Open in a new tab

+ = positive impact, – = negative impact

Table 2.

Risk and protective factors for suicide at the community level and possible impact (positive or negative) of the COVID‐19 pandemic on these factors

	Impact of COVID‐19 pandemic
Risk factors
Discrimination	Deprioritization of mental health	–
Stresses of acculturation and dislocation	Increased stress in individuals currently fleeing from conflicts or staying in refugee camps during the pandemic Decreased effectiveness of containment measures in such settings	– –
Protective factors
Social integration, social living conditions, local prevention, rehabilitation programs	Deprioritization of preventive activities Opportunities to increase resources for preventive activities	– +

Open in a new tab

+ = positive impact, – = negative impact

Table 3.

Risk and protective factors for suicide at the relationship level and possible impact (positive or negative) of the COVID‐19 pandemic on these factors

	Impact of COVID‐19 pandemic
Risk factors
Loneliness	Increased isolation and lack of social ‐support	–
Relationship conflict, discord, loss	Increased conflict and discord as additional strains are put on relationships Decreased opportunities for contact with ‐people outside home who can provide ‐support Loss of significant others	– – –
Trauma and abuse	Increased interpersonal violence and abuse within families or households as people are confined to their homes Decreased access to help	– –
Protective factors
Strong personal relationships	Reduced opportunities for communal ‐experiences and activities Improved relationships through new ways of connecting or having more time available to connect with other people Improved relationships in families due to more time available to do activities together (both children and adults)	– + +
		– + +

Open in a new tab

+ = positive impact, – = negative impact

Table 4.

Risk and protective factors for suicide at the individual level and possible impact (positive or negative) of the COVID‐19 pandemic on these factors

	Impact of COVID‐19 pandemic
Risk factors
Mental disorders (anxiety, depression, post‐traumatic stress disorder)	Increased incidence of mental disorders Worsened symptoms of existing mental disorders Reduced treatment adherence	– – –
Financial problems	Job or financial loss due to the economic crisis	–
Hopelessness	Increased hopelessness through potential loss of friends and family, loss of job, and general uncertainty	–
Harmful use of alcohol/drugs	Increased use of alcohol/drugs	–
Chronic pain	Worsened chronic pain through reduced care and increased stress	–
Protective factors
Life skills and lifestyle practice: problem solving, ‐positive coping, ability to adapt	Increased awareness of self‐care strategies and positive coping through media and Internet support Increased time to practice self‐care Adoption of maladaptive coping strategies (e.g., denial, self‐blame)	+ + –
Religion or spiritual beliefs	Difficulties in participating in religious ceremonies due to containment measures Increase in individual practice of religion or spirituality at home	– +
Food and diet	Increased opportunities for a healthier diet Negative impact on diet through irregular eating patterns and frequent snacking	+ –
Physical activity	Decreased physical activity due to containment measures Increased physical activity due to greater availability of leisure time	– +
Sleep	Improved sleep patterns through new work routines Poor sleep due to worries, increased anxiety and stress	+ –

Open in a new tab

+ = positive impact, – = negative impact

EVIDENCE‐BASED SUICIDE PREVENTION STRATEGIES DURING THE COVID‐19 PANDEMIC

The universal‐selective‐indicated (USI) model, in which different populations are targeted depending on the level of suicide risk, is mostly used for the categorization of suicide preventive interventions60, 61.

Universal suicide preventive strategies target everyone in a defined population (e.g., a nation, a county, a local community). They are aimed at increasing awareness about suicide and mental health, removing barriers to care, promoting help‐seeking behaviours and protective factors such as social support and coping skills, and mitigating the impact of economic downturns. Examples of universal interventions include awareness campaigns and educational programs, limiting access to suicide means, guidelines for responsible media reporting, and governmental measures to address economic crises.

Selective suicide preventive strategies are meant for specific groups who are at increased vulnerability for suicidal behaviour, such as people with mental health problems, alcohol and drug abusers, prisoners, victims of physical and sexual violence, members of the lesbian, gay, bisexual, transgender and queer (LGBTQ) community, migrants, and the bereaved. Screening programs in health care or other facilities, gatekeeper training for frontline helpers, psychological support and treatment of mental health problems and substance abuse in people who do not display signs of suicidality as yet, are all considered selective suicide preventive interventions.

Indicated suicide preventive strategies target high‐risk individuals who are displaying signs of suicidal behaviour, and are aimed at timely and appropriately assessing and dealing with the suicide risk using case management, referral to psychiatric treatment and care, skill‐building interventions and support groups.

The suicide preventive interventions proven to be most effective include: restriction of access to lethal means, policies to reduce harmful use of alcohol, school‐based awareness programs, pharmacological and psychological treatment of depression, chain of care and follow‐up of at‐risk individuals, responsible media reporting, and policy responses to mitigate the impact of economic downturns55, 62, 63. Other interventions, such as gatekeeper training, are also theoretically valid, even if conclusive evidence of their effectiveness on reducing suicidal behaviour is not yet available ⁶⁴ .

All preventive strategies require adjustments and adaptation in the light of the new challenges that are posed by the COVID‐19 pandemic.

Universal interventions

Mitigating the impact of unemployment, poverty and inequalities

Unemployment, poverty and inequalities represent major risk factors for suicide which are considerably exacerbated by the current global crisis. Studies from high‐income countries on the association between social protection policies and suicide rates ⁶⁵ show that the various policies may have a different impact.

Active labour market policies, including job search assistance, job training and subsidized employment, have a positive impact on health and quality of life ⁶⁶ . More specifically, at the individual level, job search assistance programs with a psychological component, such as improving self‐confidence and self‐efficacy, have been found to exert positive effects on mental health, such as reduced depression, anxiety and distress symptoms. At the national level, increases in government spending on active labour market policies have been shown to reduce the effect of unemployment on suicide rates41, 67, 68. It has been calculated ⁴¹ that, for each US$10 per person increased investment in these policies, the effect of unemployment on suicides was reduced by 0.038%. In another study, it has been reported that the same amount of increased spending would correspond to a 0.026% decrease in male suicide rate ⁶⁷ . If spending for active labour market policies were higher than US$190 per person per year, rises in unemployment would have no effect on suicide rates ⁴¹ . These findings advocate for specific governmental actions.

In the US, the maximum allowable unemployment benefit was found to be associated with a reduced impact of economic downturns on suicide rates ⁶⁹ . Similarly, in European countries, the unemployment protection system was reported to mitigate the negative impact of unemployment on suicide rates ⁷⁰ . In this context, the adoption of policies related to universal basic income (UBI) during and in the aftermath of the COVID‐19 pandemic could significantly decrease its social and psychological costs. UBI is defined as “a periodic cash payment unconditionally delivered to all on an individual basis, without means‐test or work requirement” ⁷¹ . Interventions which unconditionally provided substantial cash transfers to individuals or families have been found to have positive effects on educational participation and on some health outcomes, including mental health72, 73. In Indonesia, a cash transfer program providing between $39 and $220 per person annually was found to reduce the yearly suicide rate by 0.36 per 100,000 people, corresponding to an 18% decrease ⁷⁴ .

Housing loss may represent a significant trigger for suicidal crisis. For example, eviction‐ and foreclosure‐related suicides doubled between 2005 and 2010, during the US housing crisis ⁷⁵ , and significantly contributed to the increase of suicide rates ⁷⁶ . Housing interventions, such as relocating disadvantaged people to less deprived areas or improving physical housing conditions, are reported to be successful in reducing mental health problems ⁷⁷ . Policies to subsidize housing costs have been used during the pandemic in some countries and their effect on mental health should be evaluated.

Restricting access to lethal means of suicide

There are few reliable data on suicide methods. One global overview ⁷⁸ showed several differences in preferred suicide means between countries and even between different regions in the same country, with hanging, self‐poisoning and firearms as the most frequently used methods. A recent systematic review ⁷⁹ of 16 studies confirmed that hanging (81.3%), firearms (56.3%), poisoning/overdose (43.7%) and jumping from a height (18.7%) are the most common reported suicide methods.

In most European countries, hanging is reported to be the predominant method of suicide. Pesticide self‐poisoning accounts for around 20% of suicides globally and 48.3% of those in low‐ and middle‐income countries in the Western Pacific region ⁸⁰ . Firearms account for 50.5% of suicide deaths in the US, followed by suffocation (28.6%) and self‐poisoning (12.9%) ⁸¹ . Although jumping from a height is a relatively uncommon method of suicide in most countries, it plays an important role in urban settings such as Hong Kong, Singapore, Luxembourg and Malta78, 82, 83, and is considered a highly lethal method ⁸⁴ .

Restricting access to lethal means of suicide entails various points of application, such as limitations in the size of packs of medications, use of antidepressants which are not dangerous in overdose, safety procedures and safer room design for hospitals and prisons (e.g., not wearing belts or shoes with laces, minimizing the number of suspension points available for hanging), more stringent firearm regulations, installation of barriers and safety nets at jumping sites, and limitation of access to highly lethal pesticides62, 85. The effectiveness of these strategies is supported by robust evidence ⁶³ . Planned suicidal acts may be delayed if people are precluded from implementing the chosen method, increasing the chance of suicide prevention ⁸⁶ . Moreover, in impulsive suicidal acts, people tend to use the most readily accessible method. If there are no lethal methods available, the suicidal crisis may pass or the use of a less lethal method may result in non‐fatal outcomes.

During the COVID‐19 pandemic, policies restricting the access to suicidal means should be reinforced. It is possible that an increase of stockpiling of medications occurs in order to prepare for a possible shortage ⁸⁷ . Furthermore, an increased purchasing of firearms due to worries about an increase in crime generated by the pandemic may take place88, 89.

Governments, at the national and regional level, are advised to restrict and increase monitoring of sales of lethal means for suicide, such as firearms and pesticides. Additionally, temporary restrictions on the amount of some medications (e.g., analgesics) bought per person should be considered. Public awareness strategies and policies to ensure or reinforce safe storage of firearms and medications at home as well as pesticides at warehouses are of importance ⁹⁰ . Public awareness should be increased by informing about the significance of reducing access to lethal means of suicide ⁴⁹ .

Policies to reduce harmful use of alcohol

Evidence exists that alcohol use is associated with increased risk of suicidal behaviour91, 92, 93. Reducing harmful use of alcohol through policies and interventions has been shown to reduce suicide rates effectively94, 95, especially for males. The best example was probably the restructuring of the former Soviet Union (perestroika), when heavy restrictions of alcohol use were introduced: between 1984 and 1990, suicide rates decreased for males by 32%, in comparison with 8% in Europe ⁹⁶ .

The WHO global strategy to reduce the harmful use of alcohol identified ten areas for national action: leadership, awareness and commitment; health services' response; community action; drink‐driving policies and countermeasures; availability of alcohol; marketing of alcoholic beverages; pricing policies; reducing the negative consequences of drinking and alcohol intoxication; reducing the public health impact of illicit alcohol and informally produced alcohol; and monitoring and surveillance ⁹⁷ .

Psychosocial crises boosted by the COVID‐19 pandemic, such as family conflicts, unemployment and financial problems, may trigger alcohol abuse, that in turn enhances suicidal risk by increasing impulsivity, aggressiveness, loneliness and hopelessness ⁹⁸ .

Governments, at the national and regional level, are encouraged to monitor the consumption of alcohol during the pandemic; increase public awareness about the negative outcomes of alcohol use; defuse the myth that alcohol consumption may protect from COVID‐19 infection ⁹⁹ ; and restrict availability if necessary.

Increasing follow‐up consultations of individuals at risk for alcohol abuse, promotion of safe drinking ⁴⁹ , and online tools for monitoring alcohol intake may counteract the increase of harmful alcohol use.

Public awareness about mental health and suicide

Over the last decades, public attitudes have changed, showing improved mental health literacy and higher acceptance of professional help for mental health problems ¹⁰⁰ . This is most probably at least in part due to international, national and local mental health awareness campaigns. Nevertheless, a similar improvement has not been observed in stigma and discrimination related to mental health problems100, 101.

As a result of the increasing concerns for the mental health consequences of the COVID‐19 pandemic, international organizations, such as the WHO ¹⁰² and the United Nations ¹⁰³ , and national and local authorities104, 105 are releasing resources and guidelines for the promotion of mental health and raising awareness about the potential increase of mental health problems and suicide during the pandemic.

Besides increasing mental health knowledge and literacy, key aspects of suicide prevention resources should empower the general population with coping skills by providing useful advice, promoting help‐seeking behaviour and making information avail‐able about where to get help.

School‐based interventions

Young people are a vulnerable group for risk of suicide. Suicide is the second leading cause of death worldwide among the 15‐24 year old ¹ . Evidence suggests that 13.4% of children and adolescents have a diagnosed mental disorder ¹⁰⁶ . A much higher proportion reports mental health symptoms such as depression or anxiety (30.4% and 23.3%, respectively)107, 108.

Strong evidence for the effectiveness of school‐based interventions has been shown in increasing help‐seeking behaviour109, 110, enhancing awareness about mental health and risk and protective factors for suicide110, 111, 112, 113, and decreasing the incidence of suicide attempts and severe suicidal ideation111, 113.

During the COVID‐19 pandemic, schools have frequently been closed or physical attendance has substantially decreased, which has been reducing or completely stopping school‐based mental health interventions23, 24, 114. Schools have a major role in children and adolescents' social development. During the pandemic, peer relationships, which are important to foster autonomy and independence in adolescence, are substantially affected. The increased use of social media, substituting real‐life peer relations, may result in pathological Internet use ¹¹⁵ , a higher risk of cyberbullying ¹¹⁶ and other negative health outcomes, such as anxiety, depression and suicidality ¹¹⁷ . Feelings of anxiety and distress may also arise as a consequence of the uncertainty about final exams and future school re‐opening.

Governments, at the national and regional level, are encouraged to resume school‐based interventions as soon as schools re‐open. Availability of online resources for youth mental health, such as helplines and information about how to get support, should be increased. Additionally, teachers and parents are advised to discuss the pandemic and feelings about it with children and adolescents.

Responsible media reporting

Irresponsible media coverage may promote suicidal behaviours in recipients by sensationalizing suicide or paying unproportioned attention to spectacular suicides118, 119. However, protective effects may be established through responsible reporting of suicide as well as public education63, 120.

Basic principles of responsible media reporting include avoiding to sensationalize or normalize suicide, especially when reporting celebrity suicides, limiting the description of methods and locations, avoiding to show photos, videos and social media links, and providing information about the effectiveness of suicide prevention and where to get help ¹²¹ .

During the COVID‐19 pandemic, specific additional considerations should be made when reporting increased suicide risk, suicide rates, or an individual suicide, especially if it is related to the pandemic ¹²² . In this sense, oversimplifications of the issue and speculations on what is the reason of the specific suicidal act should be avoided. Instead, the public should be informed about the complexity of suicidal behaviour, in which biological, psychological, social and environmental factors interplay, and about preventive and treatment possibilities.

During the pandemic, it is advised to raise awareness of journalists about existing WHO guidelines for responsible media reporting ¹²¹ , and develop and disseminate locally adapted guidelines to reduce sensationalizing of suicide, especially if pandemic‐related49, 122.

The time spent on media to search for information may increase significantly during crisis events, and this increased media exposure has been shown to enhance distress. Thus, it is recommended to limit media exposure during the pandemic ¹²³ .

Access to health care

Appropriate and accessible care for mental disorders, substance use, and physical illnesses is effective in reducing suicide risk55, 124. Due to increased pressure on the health care system during the COVID‐19 pandemic, an adequate care for mental disorders may be deprioritized. An additional reduction in access is likely due to closed practices and increased sick‐leave of mental health care professionals.

The mental health problems and suicidal behaviour of frontline health care professionals, first responders (e.g., ambulance operators) and other health care workers may increase due to their crucial role during the pandemic, associated with high stress5, 17, 125, 126, 127, 128, 129.

Actions are required to provide financial support to mental health services, ensure accessibility, increase staff, develop digital services, and provide tools for self‐care online. Moreover, the local health care systems are encouraged to plan and adjust resources to maintain or improve treatment and follow‐up of patients with mental disorders, and adopt and reinforce the use of telemedicine52, 130.

Selective interventions

Gatekeeper training

Gatekeeper training is a widely used strategy to reduce suicide risk ⁶⁴ , even if supportive evidence for its effectiveness mostly comes from uncontrolled studies ¹³¹ . It entails training of key people, such as teachers, first responders, or human resource managers, to identify suicidal individuals and refer them to appropriate services55, 64.

Most of the already trained gatekeepers probably belong to frontline responders (e.g., general practitioners, nurses, officers) and, for this reason, they are full‐time involved in the emergency battle against the virus or even sick themselves. On the other hand, gatekeepers belonging to the general population (e.g., religious officials, teachers) may be prevented to identify and interact with suicidal individuals due to lockdown measures. Furthermore, a decrease in the availability of gatekeepers may be the result of paused or reduced gatekeeper training during the COVID‐19 pandemic.

During the pandemic, continued training online or in person, in line with local regulations about appropriate physical distance, should be ensured. Also, actions to increase the number of volunteers to participate in the programs is advised. Successful examples of the adaptation of standard gatekeeper training to the current situation are the Alliance Project ¹³² and the Zero Suicide Alliance ¹³³ , that are offering brief online trainings. The Mental Health First Aid ¹³⁴ is an Australian gatekeeper training evolved into global initiatives, and now organizes online courses. It proved to be effective in improving knowledge, attitudes and helping behaviours towards adults with mental health problems ¹³⁵ .

Interventions for vulnerable groups

Individuals with psychiatric conditions are recognized as those most severely impacted by the psychosocial effects of the pandemic136, 137, 138 and, due to the existing association between psychiatric disorders and health risk behaviours (e.g., smoking, obesity, alcohol use, low adherence to precautionary measures), they are also at increased risk of infection and its complications. Outreach interventions and a closer follow‐up of patients with severe psychiatric disorders may allow to enhance treatment adherence and to timely identify and intervene on psychiatric emergencies. The creation of online networks may provide adequate social support and mitigate the temporary unavailability of community services.

Besides increasing the unemployment rate42, 139, the current global crisis is exacerbating existing socio‐economic inequalities. Indeed, migrants, different cultural and ethnic minorities as well as socio‐economically disadvantaged groups have been found to be less able to adhere to “stay at home” recommendations ¹⁴⁰ and, consequently, to be more affected by the virus141, 142, 143. These groups largely overlap with those at increased risk for suicide.

Specific interventions are needed for these vulnerable populations aimed at increasing access to health care and reducing socio‐economic inequalities through labour and welfare policies. Reinforcing crisis helplines may be also pivotal to timely identify and intervene on emerging psychosocial crises potentially leading to suicidal behaviour.

Another important effect of this global crisis is the increase in domestic and intimate partner conflicts and violence ²⁹ . Public health actions to prevent domestic violence are needed and should be adapted to the current situation ¹⁴⁴ . Surveillance methods through text messages, hidden smartphone notifications or other methods that allow victims of domestic violence to safely ask for help should be used. Police and health records can be linked according to local legislation to timely identify individuals at risk. Adequate surveillance should be ensured through routine inquiries and remote consultation with the health care system. To mitigate and prevent the negative mental health impact, victims of domestic and intimate partner violence should be referred to online or in person evidence‐based interventions, such as those based on cognitive behavioural therapy ¹⁴⁵ .

COVID‐19 patients10, 146 and frontline health workers147, 148 are also particularly vulnerable to negative psychological outcomes. Therefore, interventions to increase mental health awareness, promote effective coping skills, reduce primary and secondary post‐traumatic stress disorder (PTSD) symptoms and decrease social isolation should be implemented. Mental health screenings and assessments should be scheduled, and referral to evidence‐based treatments be ensured.

Bereavement from COVID‐19 may be very challenging149, 150, 151, 152. Traumatic death, a lack of preparation for the death, and low social support153, 154 have been described as risk factors for complicated grief, which in turn results in increased risk for suicidal behaviours, independently from other psychiatric disorders such as major depressive disorder and PTSD155, 156.

Finally, the previously described impact of the pandemic in increasing social isolation and loneliness becomes particularly concerning when considering older people. A recent study ¹⁵⁷ reported that being 59‐80 years old was significantly associated with higher levels of depression, anxiety and PTSD symptoms during the pandemic, compared to the younger age groups. Phone calls and online platforms may represent valuable instruments to mitigate the sense of loneliness and social isolation, even if there might be disparities in access to or literacy in digital resources among older people ¹⁵⁸ .

Indicated interventions

Treatment of mental disorders

Strong evidence for the effectiveness of pharmacological and psychological treatment of psychiatric disorders in order to reduce suicidal behaviour exists55, 63, 159, 160, 161, 162, 163. National and regional pharmaco‐epidemiologic studies show a protective effect of the prescription of antidepressants on suicide ¹⁶⁴ . Antidepressants have been reported to decrease suicidal thoughts and behaviours in adult and geriatric patients165, 166. Literature consistently reports anti‐suicidal effects of lithium, both in clinical samples and in the general population167, 168. Other mood stabilizers, such as valproate, lamotrigine and carbamazepine, may also have an anti‐suicidal effect ¹⁶⁹ . It has been reported that second‐generation antipsychotics are effective in reducing suicidal risk in patients with schizophrenia170, 171, 172. Promising results173, 174 are reported for the use of ketamine: a single infusion was found to rapidly reduce suicidal thoughts, within one day and for up to one week, in depressed patients with suicidal ideation ¹⁷⁵ , but long‐term effects are not yet evaluated.

Among psychotherapies, individual cognitive behavioural therapy has been reported to significantly reduce suicidal thoughts and behaviour compared to treatment as usual162, 176. In a recent meta‐analysis ¹⁷⁷ , dialectical behaviour therapy was found to be effective in reducing suicidal behaviour and re‐attempt, especially in females with borderline personality disorder. Brief interventions, focused on the identification of warning signs, coping skills and available social support, professional help and crisis planning, have been shown to be effective in preventing suicidal thoughts and behaviour178, 179. The brief intervention and contact (BIC) implemented in the WHO Multisite Intervention Study on Suicidal Behaviours (SUPRE‐MISS) randomized controlled trial showed a significant decrease in suicide after 18‐month follow‐up in comparison with treatment as usual ¹⁸⁰ .

During the COVID‐19 pandemic, containment measures affect treatment availability, as practices and other psychiatric services may be closed ¹⁸¹ . A worsening of symptoms of mental disorders – such as anxiety, depression and PTSD – among psychiatric patients, and an increase in mental health disorders in the general population, including first responders, may occur13, 14, 17, 49, 182. Consequently, suicidal behaviour may increase ⁹ .

Due to the likely rise in mental disorders, mental health care providers are advised to continue treatment and assessment in person (if possible) or online and increase assessment of at‐risk individuals ⁴⁹ . The local and national health care systems are encouraged to offer guidelines for remote assessment of mental disorders and suicide risk. Since untreated individuals have a higher risk of suicide55, 183, appropriate care should be provided for anxiety, depressive and PTSD symptoms, alcohol and drug abuse, psychotic and other psychiatric disorders. Furthermore, online interventions to manage psychiatric symptoms should be offered.

Chain of care and follow‐up

Chain of care is an integrated model in which the effectiveness of care is ensured by the overall coordination between different services and activities ¹⁸⁴ . In this model, primary care, hospitals and community services are linked and integrated through local agreements to create pathways for the identification, treatment and management of specific disease or long‐term conditions.

A continuous and functioning chain of care, with adequate follow‐up of patients, has been shown to be effective in reducing suicide for at‐risk individuals63, 180. Due to the increasing demands on health care systems during the COVID‐19 pandemic, a disruption of the chain of care and delayed follow‐up of psychiatric patients is likely to occur, with potential negative effects on suicide risk.

Critical in continuity of care is the promotion of treatment engagement. Providing patients with psychoeducation regarding the importance of follow‐up treatment and an outpatient appointment within the first week after discharge185, 186 are recommended strategies for engaging suicidal individuals. Post‐discharge follow‐up contacts, including phone calls, postcards, letters and technology‐based methods (e.g., e‐mails and texting) have showed promising results in enhancing treatment adherence and reducing suicidal behaviour187, 188.

Appropriate actions are required to develop new helplines and reinforce the existing ones for suicidal patients and individuals affected by the pandemic and to increase the training of volunteer workers in mental health. The use of telemedicine appears to be critical in maintaining an effective chain of care surrounding suicidal patients.

TELEMEDICINE DURING THE COVID‐19 PANDEMIC

During the ongoing pandemic, mental health care faces significant challenges related to staff shortages, decrease of resources, and the risk of health care services becoming hotspots for contagion. Telemedicine is one of the best tools to tackle these challenges and simultaneously address the expected increase in demand for mental health care.

Telemedicine is defined as the remote delivery of health care with the aid of technology ¹⁸⁹ . It usually includes two‐way audio and video remote communication ¹⁹⁰ between patients and health care professionals. However, other forms, such as self‐help applications or websites, may support the tele‐mental health care and offer additional opportunities for treatment ¹⁹¹ .

There are several advantages of expanding telemedicine in mental health care. First, psychiatric diagnosis and treatment constitute a reasonable setting for telemedicine because they are conducted through interviews as opposed to physical assessment ¹⁹² . Second, costs of telemedicine may be lower compared to traditional mental health care193, 194. Third, other barriers of traditional approaches to mental health care, such as stigma, are reduced194, 195. The potential to increase care has also been recognized for suicide prevention efforts196, 197.

Barriers that limit the use of telemedicine include the lack of access to the Internet ¹⁹⁸ , the required electronic devices, or the technological capabilities of recipients, especially individuals in old age or with serious mental health illnesses ¹⁹⁹ . The coverage of telemedicine through insurances may be limited ²⁰⁰ , and integration into the health care systems is required to ensure the broad availability of digital medical services to the population201, 202.

Legal and ethical challenges are related to the storage and sharing of sensitive personal data, security of the communication with patients, privacy for the patient at the location where the remote consultation is held, and difficult choices in situations in which a traditional in‐person visit is required to achieve the best treatment effects191, 196. The remote management of patients with acute suicide risk poses very significant ethical questions and should be managed by involving the family and the social network. Direct communication with emergency services should be available when the attempts to motivate the suicidal person to seek help are unsuccessful. Legal regulation for tele‐medicine is missing in most countries and is urgently required.

There is some evidence for the effectiveness of technology‐enhanced suicide preventive interventions ²⁰³ . Unguided digital self‐management interventions have shown to reduce suicidal ideation and suicide‐related symptoms in individuals with severe psychiatric difficulties ¹⁹⁴ or self‐harm ²⁰⁴ , while others showed reductions of suicidal ideation, but not of self‐harm or attempted suicide, compared to wait‐list controls or self‐management interventions205, 206, 207. Technology‐enhanced suicide preventive interventions may be more effective in younger people, due to their higher acceptance and affinity with technology ²⁰⁸ . Brief texting contact has shown potential to reduce re‐attempt after a suicide attempt through initiating contact with crisis support ²⁰⁹ .

The agreement of psychiatric diagnoses between in‐person and telemedicine assessment appears to be high, indicating its potential utility ²¹⁰ . Additionally, telepsychiatry has been found to be cost‐effective ²¹¹ and appears to be useful as crisis intervention ²¹² . Hence, various advantages of implementing telemedicine and some evidence for its use in suicide prevention are available. Due to the limited methodologies used in previous studies about telemedicine ²⁰⁵ , more high‐quality research is required.

During the COVID‐19 pandemic, it has become apparent that a large number of visits can be managed on distance ²¹³ , that the infrastructure for telemedicine is widely available213, 214, and that the pandemic itself represents an opportunity to expand the use of telemedicine ²¹⁵ . It has been reported that telepsychiatry may be efficient to screen for mental health symptoms in COVID‐19 patients and to optimize treatment ²¹⁶ , or that online assessments are helpful prior to appointments and as follow‐up ²¹⁷ . Continued care is, thus, enabled in a time when the health care systems are overwhelmed ²¹⁸ .

Existing and additional challenges to utilizing telemedicine in mental health care have become apparent as well. New protocols for assessment and therapy must be established quickly213, 217. Privacy, confidentiality and access issues remain ²¹⁷ . Quiet places and headphones are required and, in case of limited privacy, yes/no questions should be adopted ²¹⁷ . These issues may affect certain people more than others. For example, lower socio‐economic status may result in smaller living spaces and consequently reduced privacy. Lack of access to electronic devices may occur for elderly patients ²¹⁷ . Disabilities and technology illiteracy pose a major obstacle to access219, 220. Social aspects of traditional medical approaches are lost with telemedicine, and this may be a significant problem for some categories of psychiatric patients ²²¹ .

The continued evaluation of telemedicine is essential. The in‐frastructure requires improvement and growth to counter the unique challenges during the pandemic in the short term. The prospect to sustain these changes in the long term and improve care222, 223 is a valuable opportunity that should guide the efforts of policy‐makers. Even though evidence for telemedicine designed specifically for suicide prevention is limited, some advantages have already been highlighted197, 203.

CONCLUSIONS

The continued and strengthened implementation of suicide preventive measures during and after the COVID‐19 pandemic is of global importance. Suicide prevention should be a priority for policy‐makers and health care professionals alike and should not be postponed while facing this pandemic. This paper aims at informing the scientific community, health care professionals, policy‐makers and politicians about plausible adaptations and/or reinforcements of evidence‐based suicide preventive strategies, which should be undertaken due to the severe impact of the pandemic on everyday life.

The analysis of risk and protective factors shows that most of them are affected and the pandemic may have both positive and negative impacts. However, the negative effect appears to be greater. Thus, the foreseen increase of mental health issues and suicides9, 13, 14, 15, 17, 49, 50, 51, 52, 53, 224 is likely to happen.

Selecting suicide prevention strategies based on strong evidence remains essential throughout this crisis. However, we face unique challenges due to the need of urgent measures and lack of evidence that indicates how interventions should be adapted. The adaptations and reinforcements may be more effective in some regions or countries compared to others, due to differences in local suicide rates, interventions already in place, the status of the local health care and mental health care system, or local and national policies. Confirmatory research is needed to investigate which adaptations are effective taking the different cultural, economic and health care context into account.

REFERENCES

1.World Health Organization. Suicide. https://www.who.int/news‐room/fact‐sheets/detail/suicide.
2. World Health Organization . Suicide in the world – Global health estimates. Geneva: World Health Organization, 2019. [Google Scholar]
3. Nock MK, Borges G, Bromet EJ et al. Cross‐national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry 2008;192:98‐105. [DOI] [PMC free article] [PubMed] [Google Scholar]
4. Kõlves K, Kõlves KE, De Leo D. Natural disasters and suicidal behaviours: a systematic literature review. J Affect Disord 2013;146:1‐14. [DOI] [PubMed] [Google Scholar]
5. Lee SM, Kang WS, Cho AR et al. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry 2018;87:123‐7. [DOI] [PMC free article] [PubMed] [Google Scholar]
6. Lester D. Suicide during war and genocide In: Wasserman D, Wasserman C. (eds). Oxford textbook of suicidology and suicide prevention. Oxford: Oxford University Press, 2009:215‐8. [Google Scholar]
7. Chen P, Mao L, Nassis G et al. Coronavirus disease (COVID‐19): the need to maintain regular physical activity while taking precautions. J Sport Health Sci 2020;9:103‐4. [DOI] [PMC free article] [PubMed] [Google Scholar]
8. Mattioli AV, Ballerini Puviani M, Nasi M et al. COVID‐19 pandemic: the effects of quarantine on cardiovascular risk. Eur J Clin Nutr 2020;74:852‐5. [DOI] [PMC free article] [PubMed] [Google Scholar]
9. Adhanom Ghebreyesus T. Addressing mental health needs: an integral part of COVID‐19 response. World Psychiatry 2020;19:129‐30. [DOI] [PMC free article] [PubMed] [Google Scholar]
10. Bach T. Will suicides rise because of COVID‐19? US News, May 22, 2020. [Google Scholar]
11. Bo H‐X, Li W, Yang Y et al. Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID‐19 in China. Psychol Med (in press). [DOI] [PMC free article] [PubMed] [Google Scholar]
12. Fiorillo A, Gorwood P. The consequences of the COVID‐19 pandemic on mental health and implications for clinical practice. Eur Psychiatry 2020;63:e32. [DOI] [PMC free article] [PubMed] [Google Scholar]
13. Holmes EA, O'Connor RC, Perry VH et al. Multidisciplinary research priorities for the COVID‐19 pandemic: a call for action for mental health science. Lancet Psychiatry 2020;7:547‐60. [DOI] [PMC free article] [PubMed] [Google Scholar]
14. Sher L. COVID‐19, anxiety, sleep disturbances and suicide. Sleep Med 2020;70:124. [DOI] [PMC free article] [PubMed] [Google Scholar]
15. Li J, Yang Z, Qiu H et al. Anxiety and depression among general population in China at the peak of the COVID‐19 pandemic. World Psychiatry 2020;19:249‐50. [DOI] [PMC free article] [PubMed] [Google Scholar]
16.International Monetary Fund. IMF's Georgieva: COVID‐19 economic outlook negative, but rebound in 2021. https://www.imf.org/external/mmedia/view.aspx.
17. Brooks SK, Webster RK, Smith LE et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020;395:912‐20. [DOI] [PMC free article] [PubMed] [Google Scholar]
18. United Nations . Everyone included: social impact of COVID‐19. https://www.un.org/development/desa/dspd/everyone‐included‐covid‐19.html.
19. Wasserman D, van der Gaag R, Wise J. The term “physical distancing” is recommended rather than “social distancing” during the COVID‐19 pandemic for reducing feelings of rejection among people with mental health problems. Eur Psychiatry 2020;63:e52. [DOI] [PMC free article] [PubMed] [Google Scholar]
20. Wasserman D, van der Gaag R, Wise J. Terms ‘physical distancing' and ‘emotional closeness' should be used and not ‘social distancing' when defeating the COVID‐19 pandemic. Science 2020;367:1282.32179702 [Google Scholar]
21. Bouziri H, Smith DRM, Descatha A et al. Working from home in the time of COVID‐19: how to best preserve occupational health? Occup Environ Med 2020;77:509‐10. [DOI] [PMC free article] [PubMed] [Google Scholar]
22. Zhang SX, Wang Y, Rauch A et al. Unprecedented disruption of lives and work: health, distress and life satisfaction of working adults in China one month into the COVID‐19 outbreak. Psychiatry Res 2020;288:112958. [DOI] [PMC free article] [PubMed] [Google Scholar]
23. Lee J. Mental health effects of school closures during COVID‐19. Lancet Child Adolesc Health 2020;4:421. [DOI] [PMC free article] [PubMed] [Google Scholar]
24. Van Lancker W, Parolin Z. COVID‐19, school closures, and child poverty: a social crisis in the making. Lancet Public Health 2020;5:e243‐4. [DOI] [PMC free article] [PubMed] [Google Scholar]
25. Calati R, Ferrari C, Brittner M et al. Suicidal thoughts and behaviors and social isolation: a narrative review of the literature. J Affect Disord 2019;245:653‐67. [DOI] [PubMed] [Google Scholar]
26. Leigh‐Hunt N, Bagguley D, Bash K et al. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health 2017;152:157‐71. [DOI] [PubMed] [Google Scholar]
27. Di Renzo L, Gualtieri P, Pivari F et al. Eating habits and lifestyle changes during COVID‐19 lockdown: an Italian survey. J Transl Med 2020;18:229. [DOI] [PMC free article] [PubMed] [Google Scholar]
28. Usher K, Bhullar N, Durkin J et al. Family violence and COVID‐19: increased vulnerability and reduced options for support. Int J Ment Health Nurs 2020;29:549‐52. [DOI] [PMC free article] [PubMed] [Google Scholar]
29. van Gelder N, Peterman A, Potts A et al. COVID‐19: reducing the risk of infection might increase the risk of intimate partner violence. EClinicalMedicine 2020;21:100348. [DOI] [PMC free article] [PubMed] [Google Scholar]
30. Soole R, Kõlves K, Leo DD. Suicide in children: a systematic review. Arch Suicide Res 2015;19:285‐304. [DOI] [PubMed] [Google Scholar]
31. Dalton TR, Knipe D, Feder G et al. Prevalence and correlates of domestic violence among people seeking treatment for self‐harm: data from a regional self‐harm register. Emerg Med J 2019;36:407‐9. [DOI] [PubMed] [Google Scholar]
32. Devries KM, Mak JY, Bacchus LJ et al. Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. PLoS Med 2013;10:e1001439. [DOI] [PMC free article] [PubMed] [Google Scholar]
33. Zatti C, Rosa V, Barros A et al. Childhood trauma and suicide attempt: a meta‐analysis of longitudinal studies from the last decade. Psychiatry Res 2017;256:353‐8. [DOI] [PubMed] [Google Scholar]
34. European Commission . European economic forecast. Spring 2020. https://ec.europa.eu/info/sites/info/files/economy‐finance/ip125_en.pdf.
35. Rushe D, Holpuch A. 20m Americans lost their jobs in April in worst month since Great Depression. The Guardian, May 8, 2020. [Google Scholar]
36.United Nations Economic Commission for Latin America and the Carribean. Measuring the impact of COVID‐19 with a view to reactivation. https://www.cepal.org/en/publications/45477‐measuring‐impact‐covid‐19‐view‐reactivation.
37.The World Bank. East Asia and the Pacific in the time of COVID‐19. www.worldbank.org/en/region/eap/publication/east-asia-pacific-economic-update.
38.United Nations Economic Commission for Africa. COVID‐19 in Africa: protecting lives and economies. https://www.uneca.org/publications/covid‐19‐africa‐protecting‐lives‐and‐economies.
39. Oyesanya M, Lopez‐Morinigo J, Dutta R. Systematic review of suicide in economic recession. World J Psychiatry 2015;5:243. [DOI] [PMC free article] [PubMed] [Google Scholar]
40. Parmar D, Stavropoulou C, Ioannidis JPA. Health outcomes during the 2008 financial crisis in Europe: systematic literature review. BMJ 2016;354:i4588. [DOI] [PMC free article] [PubMed] [Google Scholar]
41. Stuckler D, Basu S, Suhrcke M et al. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet 2009;374:315‐23. [DOI] [PubMed] [Google Scholar]
42. McIntyre RS, Lee Y. Preventing suicide in the context of the COVID‐19 pandemic. World Psychiatry 2020;19:250‐1. [DOI] [PMC free article] [PubMed] [Google Scholar]
43. Matsubayashi T, Sekijima K, Ueda M. Government spending, recession, and suicide: evidence from Japan. BMC Public Health 2020;20:243. [DOI] [PMC free article] [PubMed] [Google Scholar]
44.World Health Organization. WHO coronavirus disease (COVID‐19) dashboard 2020. https://covid19.who.int.
45. Modi C, Boehm V, Ferraro S et al. How deadly is COVID‐19? A rigorous analysis of excess mortality and age‐dependent fatality rates in Italy. 10.1101/2020.04.15.20067074. [DOI]
46. Dale B, Stylianou N. What is the true death toll of the coronavirus pandemic? BBC News, June 18, 2020. [Google Scholar]
47. Wu J, McCann A, Katz J et al. 107,000 missing deaths: tracking the true toll of the coronavirus outbreak. New York Times, June 23, 2020. [Google Scholar]
48. Kokou‐Kpolou CK, Fernandez‐Alcantara M, Cenat JM. Prolonged grief related to COVID‐19 deaths: do we have to fear a steep rise in traumatic and disenfranchised griefs? Psychol Trauma 2020;12(Suppl. 1):S94‐5. [DOI] [PubMed] [Google Scholar]
49. Gunnell D, Appleby L, Arensman E et al. Suicide risk and prevention during the COVID‐19 pandemic. Lancet Psychiatry 2020;7:468‐71. [DOI] [PMC free article] [PubMed] [Google Scholar]
50. Klomek AB. Suicide prevention during the COVID‐19 outbreak. Lancet Psychiatry 2020;7:390. [DOI] [PMC free article] [PubMed] [Google Scholar]
51. Mamun MA, Griffiths MD. First COVID‐19 suicide case in Bangladesh due to fear of COVID‐19 and xenophobia: possible suicide prevention strategies. Asian J Psychiatry 2020;51:102073. [DOI] [PMC free article] [PubMed] [Google Scholar]
52. Reger MA, Stanley IH, Joiner TE. Suicide mortality and coronavirus disease 2019 – A perfect storm? JAMA Psychiatry (in press). [DOI] [PubMed] [Google Scholar]
53. World Health Organization . Mental health and psychosocial considerations during the COVID‐19 outbreak. Geneva: World Health Organization, 2020. [Google Scholar]
54. Wasserman D. Suicide: an unnecessary death, 2nd ed. Oxford: Oxford University Press, 2016. [Google Scholar]
55. World Health Organization . Preventing suicide: a global imperative. Geneva: World Health Organization, 2014. [Google Scholar]
56. Welton RS. The management of suicidality: assessment and intervention. Psychiatry 2007;4:24‐34. [PMC free article] [PubMed] [Google Scholar]
57. Polizzi C, Lynn SJ, Perry A. Stress and coping in the time of COVID‐19: pathways to resilience and recovery. Clin Neuropsychiatry 2020;17:59‐62. [DOI] [PMC free article] [PubMed] [Google Scholar]
58. Newby J, O'Moore K, Tang S et al. Acute mental health responses during the COVID‐19 pandemic in Australia. https://www.medrxiv.org/content/10.1101/2020.05.03.20089961v1. [DOI] [PMC free article] [PubMed]
59. Suicide Prevention Resource Center . Understanding risk and protective factors for suicide: a primer for preventing suicide. Newton: Education Development Center, Inc, 2011.
60. Goldsmith SK, Pellmar TC, Kleinman AM et al. Reducing suicide: a national imperative. Washington: National Academies Press, 2002. [PubMed] [Google Scholar]
61. Wasserman D, Drurkee T. Strategies in suicide prevention In: Wasserman D, Wasserman C. (eds). Oxford textbook of suicidology and suicide prevention. Oxford: Oxford University Press, 2009:381‐8. [Google Scholar]
62. World Health Organization . National suicide prevention strategies: progress, examples and indicators. Geneva: World Health Organization, 2018. [Google Scholar]
63. Zalsman G, Hawton K, Wasserman D et al. Suicide prevention strategies revisited: 10‐year systematic review. Lancet Psychiatry 2016;3:646‐59. [DOI] [PubMed] [Google Scholar]
64. Isaac M, Elias B, Katz LY et al. Gatekeeper training as a preventative intervention for suicide: a systematic review. Can J Psychiatry 2009;54:260‐8. [DOI] [PubMed] [Google Scholar]
65. Kim C. The impacts of social protection policies and programs on suicide: a literature review. Int J Health Serv 2018;48:512‐34. [DOI] [PubMed] [Google Scholar]
66. Puig‐Barrachina V, Giro P, Artazcoz L et al. The impact of active labour market policies on health outcomes: a scoping review. Eur J Public Health 2020;30:36‐42. [DOI] [PubMed] [Google Scholar]
67. Reeves A, McKee M, Gunnell D et al. Economic shocks, resilience, and male suicides in the Great Recession: cross‐national analysis of 20 EU countries. Eur J Public Health 2015;25:404‐9. [DOI] [PubMed] [Google Scholar]
68. Shibata H. The effect of active labor market policies on suicide rates: a panel data analysis for 26 OECD countries, 1980‐2007. Japanese Sociological Review 2014;65:116‐33. [Google Scholar]
69. Cylus J, Glymour MM, Avendano M. Do generous unemployment benefit programs reduce suicide rates? A state fixed‐effect analysis covering 1968‐2008. Am J Epidemiol 2014;180:45‐52. [DOI] [PMC free article] [PubMed] [Google Scholar]
70. Norström T, Grönqvist H. The Great Recession, unemployment and suicide. J Epidemiol Community Health 2015;69:110‐6. [DOI] [PMC free article] [PubMed] [Google Scholar]
71. Torry M. The United States, basic income, and Covid. BIEN Conversations, June 9, 2020. [Google Scholar]
72. Gibson M, Hearty W, Craig P. Universal basic income – A scoping review of evidence on impacts and study characteristics. https://whatworksscotland.ac.uk.
73. Painter A. A universal basic income: the answer to poverty, insecurity, and health inequality? BMJ 2016;355:i6473. [DOI] [PubMed] [Google Scholar]
74. Christian C, Hensel L, Roth C. Income shocks and suicides: causal evidence from Indonesia. Rev Econ Stat 2019;101:905‐20. [Google Scholar]
75. Fowler KA, Gladden RM, Vagi KJ et al. Increase in suicides associated with home eviction and foreclosure during the US housing crisis: findings from 16 National Violent Death Reporting System States, 2005‐2010. Am J Public Health 2014;105:311‐6. [DOI] [PMC free article] [PubMed] [Google Scholar]
76. Houle JN, Light MT. The home foreclosure crisis and rising suicide rates, 2005 to 2010. Am J Public Health 2014;104:1073‐9. [DOI] [PMC free article] [PubMed] [Google Scholar]
77. Wahlbeck K, Cresswell‐Smith J, Haaramo P et al. Interventions to mitigate the effects of poverty and inequality on mental health. Soc Psychiatry Psychiatr Epidemiol 2017;52:505‐14. [DOI] [PubMed] [Google Scholar]
78. Ajdacic‐Gross V, Weiss MG, Ring M et al. Methods of suicide: international suicide patterns derived from the WHO mortality database. Bull World Health Organ 2008;86:726‐32. [DOI] [PMC free article] [PubMed] [Google Scholar]
79. Cano‐Montalbán I, Quevedo‐Blasco R. Sociodemographic variables most associated with suicidal behaviour and suicide methods in Europe and America. a systematic review. Eur J Psychol Appl L 2018;10:15‐25. [Google Scholar]
80. Mew EJ, Padmanathan P, Konradsen F et al. The global burden of fatal self‐poisoning with pesticides 2006‐15: systematic review. J Affect Disord 2017;219:93‐104. [DOI] [PubMed] [Google Scholar]
81.Centers for Disease and Control Prevention. Leading causes of death reports, 1981‐2018. https://webappa.cdc.gov/sasweb/ncipc/leadcause.html.
82. Chia BH, Chia A, Ng WY et al. Suicide methods in Singapore (2000‐2004): types and associations. Suicide Life Threat Behav 2011;41:574‐83. [DOI] [PubMed] [Google Scholar]
83. Wong PW, Caine ED, Lee CK et al. Suicides by jumping from a height in Hong Kong: a review of coroner court files. Soc Psychiatry Psychiatr Epidemiol 2014;49:211‐9. [DOI] [PubMed] [Google Scholar]
84. Spicer RS, Miller TR. Suicide acts in 8 states: incidence and case fatality rates by demographics and method. Am J Public Health 2000;90:1885‐91. [DOI] [PMC free article] [PubMed] [Google Scholar]
85. Sarchiapone M, Mandelli L, Iosue M et al. Controlling access to suicide means. Int J Environ Res Public Health 2011;8:4550‐62. [DOI] [PMC free article] [PubMed] [Google Scholar]
86. Yip PSF, Caine E, Yousuf S et al. Means restriction for suicide prevention. Lancet 2012;379:2393‐9. [DOI] [PMC free article] [PubMed] [Google Scholar]
87. Romano S, Galante H, Figueira D et al. Time‐trend analysis of medicine sales and shortages during COVID‐19 outbreak: data from community pharmacies. Res Social Adm Pharm (in press). [DOI] [PMC free article] [PubMed] [Google Scholar]
88. Mannix R, Lee LK, Fleegler EW. Coronavirus disease 2019 (COVID‐19) and firearms in the United States: will an epidemic of suicide follow? Ann Intern Med (in press). [DOI] [PubMed] [Google Scholar]
89. Collins K, Yaffe‐Bellany D. About 2 million guns were sold in the U.S. as virus fears spread. New York Times, April 2, 2020.
90. Gunnell D, Knipe D, Chang SS et al. Prevention of suicide with regulations aimed at restricting access to highly hazardous pesticides: a systematic review of the international evidence. Lancet Glob Health 2017;5:e1026‐37. [DOI] [PubMed] [Google Scholar]
91. Darvishi N, Farhadi M, Haghtalab T et al. Alcohol‐related risk of suicidal ideation, suicide attempt, and completed suicide: a meta‐analysis. PLoS One 2015;10:e0126870. [DOI] [PMC free article] [PubMed] [Google Scholar]
92. Wilcox HC, Conner KR, Caine ED. Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug Alcohol Depend 2004;76(Suppl.):S11‐9. [DOI] [PubMed] [Google Scholar]
93. Borges G, Loera CR. Alcohol and drug use in suicidal behaviour. Curr Opin Psychiatry 2010;23:195‐204. [DOI] [PubMed] [Google Scholar]
94. Xuan Z, Naimi TS, Kaplan MS et al. Alcohol policies and suicide: a review of the literature. Alcohol Clin Exp Res 2016;40:2043‐55. [DOI] [PMC free article] [PubMed] [Google Scholar]
95.World Health Organization. mhGAP evidence‐based recommendations for management of self‐harm and suicide in non‐specialized health settings. Reducing the availability of alcohol. Geneva: World Health Organization, 2015.
96. Wasserman D, Värnik A. Suicide‐preventive effects of perestroika in the former USSR: the role of alcohol restriction. Acta Psychiatr Scand 1998;98(Suppl. 394):1‐4. [DOI] [PubMed] [Google Scholar]
97. World Health Organization . Global strategy to reduce harmful use of alcohol. Geneva: World Health Organization, 2010. [DOI] [PMC free article] [PubMed] [Google Scholar]
98. Norström T, Rossow I. Alcohol consumption as a risk factor for suicidal behavior: a systematic review of associations at the individual and at the population level. Arch Suicide Res 2016;20:489‐506. [DOI] [PubMed] [Google Scholar]
99. World Health Organization . Alcohol and COVID‐19: what you need to know. Geneva: World Health Organization, 2020. [Google Scholar]
100. Schomerus G, Schwahn C, Holzinger A et al. Evolution of public attitudes about mental illness: a systematic review and meta‐analysis. Acta Psychiatr Scand 2012;125:440‐52. [DOI] [PubMed] [Google Scholar]
101. Thornicroft G, Mehta N, Clement S et al. Evidence for effective interventions to reduce mental‐health‐related stigma and discrimination. Lancet 2016;387:1123‐32. [DOI] [PubMed] [Google Scholar]
102. World Health Organization Regional Office for Europe . Mental health and COVID‐19. Copenhagen: World Health Organization Regional Office for Europe, 2020. [Google Scholar]
103. United Nations . Policy brief: COVID‐19 and the need for action on mental health. New York: United Nations, 2020. [Google Scholar]
104.Centers for Disease Control and Prevention. Mental health and coping during COVID‐19. Atlanta: Centers for Disease Control and Prevention, 2020.
105.Karolinska Institutet National Centre for Suicide Research and Prevention. The coronavirus: risk for increased suicide and self‐harm in the society after the pandemic. https://ki.se/en/nasp.
106. Polanczyk GV, Salum GA, Sugaya LS et al. Annual research review: a meta‐analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 2015;56:345‐65. [DOI] [PubMed] [Google Scholar]
107. Balazs J, Miklosi M, Kereszteny A et al. Adolescent subthreshold‐depression and anxiety: psychopathology, functional impairment and increased suicide risk. J Child Psychol Psychiatry 2013;54:670‐7. [DOI] [PubMed] [Google Scholar]
108. Carli V, Hoven CW, Wasserman C et al. A newly identified group of adolescents at “invisible” risk for psychopathology and suicidal behavior: findings from the SEYLE study. World Psychiatry 2014;13:78‐86. [DOI] [PMC free article] [PubMed] [Google Scholar]
109. Cusimano MD, Sameem M. The effectiveness of middle and high school‐based suicide prevention programmes for adolescents: a systematic review. Injury Prevention 2011;17:43‐9. [DOI] [PubMed] [Google Scholar]
110. Robinson J, Cox G, Malone A et al. A systematic review of school‐based interventions aimed at preventing, treating, and responding to suicide‐related behavior in young people. Crisis 2013;34:164‐82. [DOI] [PubMed] [Google Scholar]
111. Wasserman D, Hoven CW, Wasserman C et al. School‐based suicide prevention programmes: the SEYLE cluster‐randomised, controlled trial. Lancet 2015;385:1536‐44. [DOI] [PubMed] [Google Scholar]
112. Katz C, Bolton SL, Katz LY et al. A systematic review of school‐based suicide prevention programs. Depress Anxiety 2013;30:1030‐45. [DOI] [PubMed] [Google Scholar]
113. Robinson J, Calear AL, Bailey E. Suicide prevention in educational settings: a review. Australas Psychiatry 2018;26:132‐40. [DOI] [PubMed] [Google Scholar]
114.Editorial. Pandemic school closures: risks and opportunities. Lancet Child Adolesc Health 2020;4:341. [DOI] [PMC free article] [PubMed] [Google Scholar]
115. Durkee T, Kaess M, Carli V et al. Prevalence of pathological internet use among adolescents in Europe: demographic and social factors. Addiction 2012;107:2210‐22. [DOI] [PubMed] [Google Scholar]
116.L1ght. Rising levels of hate speech & online toxicity during this time of crisis. https://l1ght.com/Toxicity_during_coronavirus_Report‐L1ght.pdf.
117. Kaess M, Durkee T, Brunner R et al. Pathological Internet use among European adolescents: psychopathology and self‐destructive behaviours. Eur Child Adolesc Psychiatry 2014;23:1093‐102. [DOI] [PMC free article] [PubMed] [Google Scholar]
118. Sisask M, Värnik A. Media roles in suicide prevention: a systematic review. Int J Environ Res Public Health 2012;9:123‐38. [DOI] [PMC free article] [PubMed] [Google Scholar]
119. Niederkrotenthaler T, Braun M, Pirkis J et al. Association between suicide reporting in the media and suicide: systematic review and meta‐analysis. BMJ 2020;368:m575. [DOI] [PMC free article] [PubMed] [Google Scholar]
120. Bohanna I, Wang X. Media guidelines for the responsible reporting of suicide. Crisis 2012;33:190‐8. [DOI] [PubMed] [Google Scholar]
121. World Health Organization . Preventing suicide: a resource for media professionals. Geneva: World Health Organization, 2017. [Google Scholar]
122.International Association for Suicide Prevention. Reporting on suicide during the COVID‐19 pandemic. https://www.iasp.info.
123. Garfin DR, Silver RC, Holman EA. The novel coronavirus (COVID‐2019) outbreak: amplification of public health consequences by media exposure. Health Psychol 2020;39:355‐7. [DOI] [PMC free article] [PubMed] [Google Scholar]
124. Cho J, Lee WJ, Moon KT et al. Medical care utilization during 1 year prior to death in suicides motivated by physical illnesses. J Prev Med Public Health 2013;46:147‐54. [DOI] [PMC free article] [PubMed] [Google Scholar]
125. Brooks SK, Dunn R, Amlot R et al. A systematic, thematic review of social and occupational factors associated with psychological outcomes in healthcare employees during an infectious disease outbreak. J Occup Environ Med 2018;60:248‐57. [DOI] [PubMed] [Google Scholar]
126. Greenberg N, Docherty M, Gnanapragasam S et al. Managing mental health challenges faced by healthcare workers during covid‐19 pandemic. BMJ 2020;368:m1211. [DOI] [PubMed] [Google Scholar]
127. Huang J, Liu F, Teng Z et al. Care for the psychological status of frontline medical staff fighting against COVID‐19. Clin Infect Dis (in press). [DOI] [PMC free article] [PubMed] [Google Scholar]
128. Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID‐19 pandemic. JAMA (in press). [DOI] [PubMed] [Google Scholar]
129. Wong TW, Yau JKY, Chan CLW et al. The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. Eur J Emerg Med 2005;12:13‐8. [DOI] [PubMed] [Google Scholar]
130. Zero Suicide Institute . Telehealth and suicide care during the COVID‐19 pandemic. http://zerosuicide.edc.org.
131. Yonemoto N, Kawashima Y, Endo K et al. Gatekeeper training for suicidal behaviors: a systematic review. J Affect Disord 2019;246:506‐14. [DOI] [PubMed] [Google Scholar]
132.Mississippi State University. DMH and MSU offer ‘The Alliance Project' suicide prevention training online. Starkville: Mississippi State University, 2020.
133.Zero Suicide Alliance. Zero Suicide Alliance training. https://www.zerosuicidealliance.com.
134.Mental Health First Aid Australia. https://mhfa.com.au.
135. Hadlaczky G, Hökby S, Mkrtchian A et al. Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: a meta‐analysis. Int Rev Psychiatry 2014;26:467‐75. [DOI] [PubMed] [Google Scholar]
136. Druss BG. Addressing the COVID‐19 pandemic in populations with serious mental illness. JAMA Psychiatry (in press). [DOI] [PubMed] [Google Scholar]
137. Hao F, Tan W, Jiang L et al. Do psychiatric patients experience more psychiatric symptoms during COVID‐19 pandemic and lockdown? A case‐control study with service and research implications for immunopsychiatry. Brain Behav Immun 2020;87:100‐6. [DOI] [PMC free article] [PubMed] [Google Scholar]
138. Zhou J, Liu L, Xue P et al. Mental health response to the COVID‐19 outbreak in China. Am J Psychiatry 2020;177:574‐5. [DOI] [PubMed] [Google Scholar]
139. Kawohl W, Nordt C. COVID‐19, unemployment, and suicide. Lancet Psychiatry 2020;7:389‐90. [DOI] [PMC free article] [PubMed] [Google Scholar]
140. Valentino‐DeVries J, Lu D, Dance GJX. Location data says it all: staying at home during coronavirus is a luxury. New York Times, April 3, 2020. [Google Scholar]
141. Azar KMJ, Shen Z, Romanelli RJ et al. Disparities in outcomes among COVID‐19 patients in a large health care system in California. Health Aff 2020;39:1253‐62. [DOI] [PubMed] [Google Scholar]
142. van Dorn A, Cooney RE, Sabin ML. COVID‐19 exacerbating inequalities in the US. Lancet 2020;395:1243‐4. [DOI] [PMC free article] [PubMed] [Google Scholar]
143. Wang Z, Tang K. Combating COVID‐19: health equity matters. Nature Med 2020;26:458. [DOI] [PubMed] [Google Scholar]
144. Chandan JS, Taylor J, Bradbury‐Jones C et al. COVID‐19: a public health approach to manage domestic violence is needed. Lancet Public Health 2020;5:e309. [DOI] [PMC free article] [PubMed] [Google Scholar]
145. Eckhardt CI, Murphy CM, Whitaker DJ et al. The effectiveness of intervention programs for perpetrators and victims of intimate partner violence. Partner Abuse 2013;4:196‐231. [Google Scholar]
146. Davydow DS, Gifford JM, Desai SV et al. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry 2008;30:421‐34. [DOI] [PMC free article] [PubMed] [Google Scholar]
147. Lu W, Wang H, Lin Y et al. Psychological status of medical workforce during the COVID‐19 pandemic: a cross‐sectional study. Psychiatry Res 2020;288:112936. [DOI] [PMC free article] [PubMed] [Google Scholar]
148. Kang L, Ma S, Chen M et al. Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: a cross‐sectional study. Brain Behav Immun 2020;87:11‐7. [DOI] [PMC free article] [PubMed] [Google Scholar]
149. Mayland CR, Harding AJE, Preston N et al. Supporting adults bereaved through COVID‐19: a rapid review of the impact of previous pandemics on grief and bereavement. J Pain Symptom Manage 2020;60:e33‐9. [DOI] [PMC free article] [PubMed] [Google Scholar]
150. Gesi C, Carmassi C, Cerveri G et al. Complicated grief: what to expect after the coronavirus pandemic. Front Psychiatry 2020;11:489. [DOI] [PMC free article] [PubMed] [Google Scholar]
151. Carr D, Boerner K, Moorman S. Bereavement in the time of coronavirus: unprecedented challenges demand novel interventions. J Aging Soc Policy 2020;32:425‐31. [DOI] [PubMed] [Google Scholar]
152. Selman LE, Chao D, Sowden R et al. Bereavement support on the frontline of COVID‐19: recommendations for hospital clinicians. J Pain Symptom Manage 2020;60:e81‐6. [DOI] [PMC free article] [PubMed] [Google Scholar]
153. Burke LA, Neimeyer RA. Prospective risk factors for complicated grief: a review of the empirical literature In: Stroebe M, Schut H, van den Buet J. (eds). Complicated grief: scientific foundations for health care professionals. London: Routledge, 2013:145‐60. [Google Scholar]
154. Lobb EA, Kristjanson LJ, Aoun SM et al. Predictors of complicated grief: a systematic review of empirical studies. Death Stud 2010;34:673‐98. [DOI] [PubMed] [Google Scholar]
155. Latham AE, Prigerson HG. Suicidality and bereavement: complicated grief as psychiatric disorder presenting greatest risk for suicidality. Suicide Life Threat Behav 2004;34:350‐62. [DOI] [PMC free article] [PubMed] [Google Scholar]
156. Mogensen H, Moller J, Hultin H et al. Death of a close relative and the risk of suicide in Sweden – A large scale register‐based case‐crossover study. PLoS One 2016;11:e0164274. [DOI] [PMC free article] [PubMed] [Google Scholar]
157. Gonzalez‐Sanguino C, Ausin B, Castellanos MA et al. Mental health consequences during the initial stage of the 2020 coronavirus pandemic (COVID‐19) in Spain. Brain Behav Immun 2020;87:172‐6. [DOI] [PMC free article] [PubMed] [Google Scholar]
158. Armitage R, Nellums LB. COVID‐19 and the consequences of isolating the elderly. Lancet Public Health 2020;5:e256. [DOI] [PMC free article] [PubMed] [Google Scholar]
159. Baldessarini RJ, Pompili M, Tondo L. Suicidal risk in antidepressant drug trials. Arch Gen Psychiatry 2006;63:246‐8. [DOI] [PubMed] [Google Scholar]
160. Bateman K, Hansen L, Turkington D et al. Cognitive behavioral therapy reduces suicidal ideation in schizophrenia: results from a randomized controlled trial. Suicide Life Threat Behav 2007;37:284‐90. [DOI] [PubMed] [Google Scholar]
161. Cipriani A, Hawton K, Stockton S et al. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta‐analysis. BMJ 2013;346:f3646. [DOI] [PubMed] [Google Scholar]
162. Tarrier N, Taylor K, Gooding P. Cognitive‐behavioral interventions to reduce suicide behavior: a systematic review and meta‐analysis. Behav Modif 2008;32:77‐108. [DOI] [PubMed] [Google Scholar]
163. Weinberg I, Gunderson JG, Hennen J et al. Manual assisted cognitive treatment for deliberate self‐harm in borderline personality disorder patients. J Pers Disord 2006;20:482‐92. [DOI] [PubMed] [Google Scholar]
164. Brent DA. Antidepressants and suicidality. Psychiatr Clin North Am 2016;39:503‐12. [DOI] [PubMed] [Google Scholar]
165. Gibbons RD, Brown CH, Hur K et al. Suicidal thoughts and behavior with antidepressant treatment: reanalysis of the randomized placebo‐controlled studies of fluoxetine and venlafaxine. Arch Gen Psychiatry 2012;69:580‐7. [DOI] [PMC free article] [PubMed] [Google Scholar]
166. Barbui C, Esposito E, Cipriani A. Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies. CMAJ 2009;180:291‐7. [DOI] [PMC free article] [PubMed] [Google Scholar]
167. Del Matto L, Muscas M, Murru A et al. Lithium and suicide prevention in mood disorders and in the general population: a systematic review. Neurosci Biobehav Rev 2020;116:142‐53. [DOI] [PubMed] [Google Scholar]
168. Smith KA, Cipriani A. Lithium and suicide in mood disorders: updated meta‐review of the scientific literature. Bipolar Disord 2017;19:575‐86. [DOI] [PubMed] [Google Scholar]
169. Miller JN, Black DW. Bipolar disorder and suicide: a review. Curr Psychiatry Rep 2020;22:6. [DOI] [PubMed] [Google Scholar]
170. Ringbäck Weitoft G, Berglund M, Lindström EA et al. Mortality, attempted suicide, re‐hospitalisation and prescription refill for clozapine and other antipsychotics in Sweden – a register‐based study. Pharmacoepidem Dr Saf 2014;23:290‐8. [DOI] [PubMed] [Google Scholar]
171. Barak Y, Mirecki I, Knobler H et al. Suicidality and second generation anti‐psychotics in schizophrenia patients: a case‐controlled retrospective study during a 5‐year period. Psychopharmacology 2004;175:215‐9. [DOI] [PubMed] [Google Scholar]
172. Aguilar EJ, Siris SG. Do antipsychotic drugs influence suicidal behavior in schizophrenia? Psychopharmacol Bull 2007;40:128‐42. [PubMed] [Google Scholar]
173. Trivedi MH. Antisuicidal effects of ketamine: a promising first step. Am J Psychiatry 2018;175:97‐9. [DOI] [PubMed] [Google Scholar]
174. Al Jurdi RK, Swann A, Mathew SJ. Psychopharmacological agents and suicide risk reduction: ketamine and other approaches. Curr Psychiatry Rep 2015;17:81. [DOI] [PubMed] [Google Scholar]
175. Wilkinson ST, Ballard ED, Bloch MH et al. The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta‐analysis. Am J Psychiatry 2018;175:150‐8. [DOI] [PMC free article] [PubMed] [Google Scholar]
176. Leavey K, Hawkins R. Is cognitive behavioural therapy effective in reducing suicidal ideation and behaviour when delivered face‐to‐face or via e‐health? A systematic review and meta‐analysis. Cogn Behav Ther 2017;46:353‐74. [DOI] [PubMed] [Google Scholar]
177. DeCou CR, Comtois KA, Landes SJ. Dialectical behavior therapy is effective for the treatment of suicidal behavior: a meta‐analysis. Behav Ther 2019;50:60‐72. [DOI] [PubMed] [Google Scholar]
178. Bryan CJ, Mintz J, Clemans TA et al. Effect of crisis response planning vs. contracts for safety on suicide risk in US Army soldiers: a randomized clinical trial. J Affect Disord 2017;212:64‐72. [DOI] [PubMed] [Google Scholar]
179. Stanley B, Brown GK. Safety planning intervention: a brief intervention to mitigate suicide risk. Cogn Behav Pract 2012;19:256‐64. [Google Scholar]
180. Fleischmann A, Bertolote JM, Wasserman D et al. Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. Bull World Health Organ 2008;86:703‐9. [DOI] [PMC free article] [PubMed] [Google Scholar]
181. Simpson SA, Dumas A, McDowell AK et al. Novel coronavirus and related public health interventions are negatively impacting mental health services. Psychosomatics (in press). [DOI] [PMC free article] [PubMed] [Google Scholar]
182. Chevance A, Gourion D, Hoertel N et al. Ensuring mental health care during the SARS‐CoV‐2 epidemic in France: a narrative review. Encephale 2020;46:193‐201. [DOI] [PMC free article] [PubMed] [Google Scholar]
183. Too LS, Spittal MJ, Bugeja L et al. The association between mental disorders and suicide: a systematic review and meta‐analysis of record linkage studies. J Affect Disord 2019;259:302‐13. [DOI] [PubMed] [Google Scholar]
184. Åhgren B. Chain of care development in Sweden: results of a national study. Int J Integr Care 2003;3:e01. [PMC free article] [PubMed] [Google Scholar]
185. Lizardi D, Stanley B. Treatment engagement: a neglected aspect in the psychiatric care of suicidal patients. Psychiatr Serv 2010;61:1183‐91. [DOI] [PubMed] [Google Scholar]
186.National Action Alliance for Suicide Prevention. Best practices in care transitions for individuals with suicide risk: inpatient care to outpatient care. Washington: Education Development Center, Inc, 2019.
187. Luxton DD, June JD, Comtois KA. Can postdischarge follow‐up contacts prevent suicide and suicidal behavior? Crisis 2013;34:32‐41. [DOI] [PubMed] [Google Scholar]
188. Brown GK, Green KL. A review of evidence‐based follow‐up care for suicide prevention: where do we go from here? Am J Prev Med 2014;47(Suppl. 2):S209‐15. [DOI] [PubMed] [Google Scholar]
189. World Health Organization . Telehealth. Geneva: World Health Organization, 2016. [Google Scholar]
190. Centers for Medicare & Medicaid Services. Telemedicine . Medicaid.gov.
191. Luxton DD, June JD, Kinn JT. Technology‐based suicide prevention: current applications and future directions. Telemed e‐Health 2011;17:50‐4. [DOI] [PubMed] [Google Scholar]
192. Barnett ML, Huskamp HA. Telemedicine for mental health in the United States: making progress, still a long way to go. Psychiatr Serv 2020;71:197‐8. [DOI] [PMC free article] [PubMed] [Google Scholar]
193. Gilmore AK, Ward‐Ciesielski EF. Perceived risks and use of psychotherapy via telemedicine for patients at risk for suicide. J Telemed Telecare 2019;25:59‐63. [DOI] [PMC free article] [PubMed] [Google Scholar]
194. De Jaegere E, van Landschoot R, van Heeringen K et al. The online treatment of suicidal ideation: a randomised controlled trial of an unguided web‐based intervention. Behav Res Ther 2019;119:103406. [DOI] [PubMed] [Google Scholar]
195. Bruffaerts R, Demyttenaere K, Hwang I et al. Treatment of suicidal people around the world. Br J Psychiatry 2011;199:64‐70. [DOI] [PMC free article] [PubMed] [Google Scholar]
196. Berman AL, Carter G. Technological advances and the future of suicide prevention: ethical, legal, and empirical challenges. Suicide Life Threat Behav 2020;50:643‐51. [DOI] [PubMed] [Google Scholar]
197. Ward‐Ciesielski EF, Peros O, Conigliaro A et al. Perceived benefits of psychotherapy via telemedicine based on suicide risk severity. Gen Hosp Psychiatry 2018;55:100‐1. [DOI] [PMC free article] [PubMed] [Google Scholar]
198. Wilcock AD, Rose S, Busch AB et al. Association between broadband Internet availability and telemedicine use. JAMA Intern Med 2019;179:1580‐2. [DOI] [PMC free article] [PubMed] [Google Scholar]
199. Ben‐Zeev D, Davis KE, Kaiser S et al. Mobile technologies among people with serious mental illness: opportunities for future services. Adm Policy Ment Health 2013;40:340‐3. [DOI] [PMC free article] [PubMed] [Google Scholar]
200. Fairchild RM, Ferng‐Kuo S‐F, Rahmouni H et al. Telehealth increases access to care for children dealing with suicidality, depression, and anxiety in rural emergency departments. Telemed e‐Health (in press). [DOI] [PubMed] [Google Scholar]
201. Torous J, Andersson G, Bertagnoli A et al. Towards a consensus around standard for smartphone apps and digital mental health. World Psychiatry 2019;18:97‐8. [DOI] [PMC free article] [PubMed] [Google Scholar]
202. Latifi R, Doarn CR. Perspective on COVID‐19: finally, telemedicine at center stage. Telemed e‐Health (in press). [DOI] [PubMed] [Google Scholar]
203. Meyer B. Internet interventions for suicide prevention: current evidence and future directions. In: Wasserman D, Wasserman C (eds). Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press (in press). [Google Scholar]
204. Franklin JC, Fox KR, Franklin CR et al. A brief mobile app reduces nonsuicidal and suicidal self‐injury: evidence from three randomized controlled trials. J Consult Clin Psychol 2016;84:544‐57. [DOI] [PubMed] [Google Scholar]
205. Witt K, Spittal MJ, Carter G et al. Effectiveness of online and mobile telephone applications (‘apps') for the self‐management of suicidal ideation and self‐harm: a systematic review and meta‐analysis. BMC Psychiatry 2017;17:297. [DOI] [PMC free article] [PubMed] [Google Scholar]
206. Hetrick SE, Yuen HP, Bailey E et al. Internet‐based cognitive behavioural therapy for young people with suicide‐related behaviour (Reframe‐IT): a randomised controlled trial. Evid Based Ment Health 2017;20:76‐82. [DOI] [PMC free article] [PubMed] [Google Scholar]
207. Kreuze E, Jenkins C, Gregoski M et al. Technology‐enhanced suicide prevention interventions: a systematic review. J Telemed Telecare 2016;23:605‐17. [DOI] [PubMed] [Google Scholar]
208. Franco‐Martin MA, Munoz‐Sanchez JL, Sainz‐de‐Abajo B et al. A systematic literature review of technologies for suicidal behavior prevention. J Med Syst 2018;42:71. [DOI] [PubMed] [Google Scholar]
209. Berrouiguet S, Larsen ME, Mesmeur C et al. Toward mhealth brief contact ‐interventions in suicide prevention: case series from the Suicide Interven‐tion Assisted by Messages (SIAM) randomized controlled trial. JMIR Mhealth Uhealth 2018;6:e8. [DOI] [PMC free article] [PubMed] [Google Scholar]
210. Seidel RW, Kilgus MD. Agreement between telepsychiatry assessment and face‐to‐face assessment for emergency department psychiatry patients. J Telemed Telecare 2014;20:59‐62. [DOI] [PubMed] [Google Scholar]
211. Hubley S, Lynch SB, Schneck C et al. Review of key telepsychiatry outcomes. World J Psychiatry 2016;6:269‐82. [DOI] [PMC free article] [PubMed] [Google Scholar]
212. Reinhardt I, Gouzoulis‐Mayfrank E, Zielasek J. Use of telepsychiatry in emer‐gency and crisis intervention: current evidence. Curr Psychiatry Rep 2019;21:63. [DOI] [PubMed] [Google Scholar]
213. Bashshur R, Doarn CR, Frenk JM et al. Telemedicine and the COVID‐19 pandemic, lessons for the future. Telemed e‐Health 2020;26:571‐3. [DOI] [PubMed] [Google Scholar]
214. Giansanti D, Aprile I. Is the COVID‐19 pandemic an opportunity to enlarge the telemedicine boundaries? Telemed e‐Health (in press). [DOI] [PubMed]
215. Scott BK, Miller GT, Fonda SJ et al. Advanced digital health technologies for COVID‐19 and future emergencies. Telemed e‐Health (in press). [DOI] [PubMed] [Google Scholar]
216. Zarghami A, Farjam M, Fakhraei B et al. A report of the telepsychiatric evaluation of SARS‐CoV‐2 patients. Telemed e‐Health (in press). [DOI] [PubMed] [Google Scholar]
217. Barney A, Buckelew S, Mesheriakova V et al. The COVID‐19 pandemic and rapid implementation of adolescent and young adult telemedicine: challenges and opportunities for innovation. J Adolesc Health (in press). [DOI] [PMC free article] [PubMed] [Google Scholar]
218. Watson AR, Wah R, Thamman R. The value of remote monitoring for the COVID‐19 pandemic. Telemed e‐Health (in press). [DOI] [PubMed] [Google Scholar]
219. McIntyre M, Robinson LR, Mayo A. Practical considerations for implementing virtual care in physical medicine and rehabilitation: for the pandemic and beyond. Am J Phys Med Rehabil 2020;99:464‐7. [DOI] [PMC free article] [PubMed] [Google Scholar]
220. Triana AJ, Gusdorf RE, Shah KP et al. Technology literacy as a barrier to tele‐health during COVID‐19. Telemed e‐Health (in press). [DOI] [PubMed] [Google Scholar]
221. Pappot N, Taarnhøj GA, Pappot H. Telemedicine and e‐health solutions for COVID‐19: patients' perspective. Telemed e‐Health 2020;26:847‐9. [DOI] [PubMed] [Google Scholar]
222. Andersson G, Titov N, Dear BF et al. Internet‐delivered psychological treatments: from innovation to implementation. World Psychiatry 2019;18:20‐8. [DOI] [PMC free article] [PubMed] [Google Scholar]
223. Kannampallil T, Ma J. Digital translucence: adapting telemedicine delivery post‐COVID‐19. Telemed e‐Health (in press). [DOI] [PubMed] [Google Scholar]
224.International Association for Suicide Prevention. Briefing statement: the coronavirus disease (COVID‐19) outbreak. https://www.iasp.info.

[wps20801-bib-0001] 1.World Health Organization. Suicide. https://www.who.int/news‐room/fact‐sheets/detail/suicide.

[wps20801-bib-0002] 2. World Health Organization . Suicide in the world – Global health estimates. Geneva: World Health Organization, 2019. [Google Scholar]

[wps20801-bib-0003] 3. Nock MK, Borges G, Bromet EJ et al. Cross‐national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry 2008;192:98‐105. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0004] 4. Kõlves K, Kõlves KE, De Leo D. Natural disasters and suicidal behaviours: a systematic literature review. J Affect Disord 2013;146:1‐14. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0005] 5. Lee SM, Kang WS, Cho AR et al. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry 2018;87:123‐7. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0006] 6. Lester D. Suicide during war and genocide In: Wasserman D, Wasserman C. (eds). Oxford textbook of suicidology and suicide prevention. Oxford: Oxford University Press, 2009:215‐8. [Google Scholar]

[wps20801-bib-0007] 7. Chen P, Mao L, Nassis G et al. Coronavirus disease (COVID‐19): the need to maintain regular physical activity while taking precautions. J Sport Health Sci 2020;9:103‐4. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0008] 8. Mattioli AV, Ballerini Puviani M, Nasi M et al. COVID‐19 pandemic: the effects of quarantine on cardiovascular risk. Eur J Clin Nutr 2020;74:852‐5. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0009] 9. Adhanom Ghebreyesus T. Addressing mental health needs: an integral part of COVID‐19 response. World Psychiatry 2020;19:129‐30. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0010] 10. Bach T. Will suicides rise because of COVID‐19? US News, May 22, 2020. [Google Scholar]

[wps20801-bib-0011] 11. Bo H‐X, Li W, Yang Y et al. Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID‐19 in China. Psychol Med (in press). [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0012] 12. Fiorillo A, Gorwood P. The consequences of the COVID‐19 pandemic on mental health and implications for clinical practice. Eur Psychiatry 2020;63:e32. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0013] 13. Holmes EA, O'Connor RC, Perry VH et al. Multidisciplinary research priorities for the COVID‐19 pandemic: a call for action for mental health science. Lancet Psychiatry 2020;7:547‐60. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0014] 14. Sher L. COVID‐19, anxiety, sleep disturbances and suicide. Sleep Med 2020;70:124. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0015] 15. Li J, Yang Z, Qiu H et al. Anxiety and depression among general population in China at the peak of the COVID‐19 pandemic. World Psychiatry 2020;19:249‐50. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0016] 16.International Monetary Fund. IMF's Georgieva: COVID‐19 economic outlook negative, but rebound in 2021. https://www.imf.org/external/mmedia/view.aspx.

[wps20801-bib-0017] 17. Brooks SK, Webster RK, Smith LE et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020;395:912‐20. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0018] 18. United Nations . Everyone included: social impact of COVID‐19. https://www.un.org/development/desa/dspd/everyone‐included‐covid‐19.html.

[wps20801-bib-0019] 19. Wasserman D, van der Gaag R, Wise J. The term “physical distancing” is recommended rather than “social distancing” during the COVID‐19 pandemic for reducing feelings of rejection among people with mental health problems. Eur Psychiatry 2020;63:e52. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0020] 20. Wasserman D, van der Gaag R, Wise J. Terms ‘physical distancing' and ‘emotional closeness' should be used and not ‘social distancing' when defeating the COVID‐19 pandemic. Science 2020;367:1282.32179702 [Google Scholar]

[wps20801-bib-0021] 21. Bouziri H, Smith DRM, Descatha A et al. Working from home in the time of COVID‐19: how to best preserve occupational health? Occup Environ Med 2020;77:509‐10. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0022] 22. Zhang SX, Wang Y, Rauch A et al. Unprecedented disruption of lives and work: health, distress and life satisfaction of working adults in China one month into the COVID‐19 outbreak. Psychiatry Res 2020;288:112958. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0023] 23. Lee J. Mental health effects of school closures during COVID‐19. Lancet Child Adolesc Health 2020;4:421. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0024] 24. Van Lancker W, Parolin Z. COVID‐19, school closures, and child poverty: a social crisis in the making. Lancet Public Health 2020;5:e243‐4. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0025] 25. Calati R, Ferrari C, Brittner M et al. Suicidal thoughts and behaviors and social isolation: a narrative review of the literature. J Affect Disord 2019;245:653‐67. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0026] 26. Leigh‐Hunt N, Bagguley D, Bash K et al. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health 2017;152:157‐71. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0027] 27. Di Renzo L, Gualtieri P, Pivari F et al. Eating habits and lifestyle changes during COVID‐19 lockdown: an Italian survey. J Transl Med 2020;18:229. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0028] 28. Usher K, Bhullar N, Durkin J et al. Family violence and COVID‐19: increased vulnerability and reduced options for support. Int J Ment Health Nurs 2020;29:549‐52. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0029] 29. van Gelder N, Peterman A, Potts A et al. COVID‐19: reducing the risk of infection might increase the risk of intimate partner violence. EClinicalMedicine 2020;21:100348. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0030] 30. Soole R, Kõlves K, Leo DD. Suicide in children: a systematic review. Arch Suicide Res 2015;19:285‐304. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0031] 31. Dalton TR, Knipe D, Feder G et al. Prevalence and correlates of domestic violence among people seeking treatment for self‐harm: data from a regional self‐harm register. Emerg Med J 2019;36:407‐9. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0032] 32. Devries KM, Mak JY, Bacchus LJ et al. Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. PLoS Med 2013;10:e1001439. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0033] 33. Zatti C, Rosa V, Barros A et al. Childhood trauma and suicide attempt: a meta‐analysis of longitudinal studies from the last decade. Psychiatry Res 2017;256:353‐8. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0034] 34. European Commission . European economic forecast. Spring 2020. https://ec.europa.eu/info/sites/info/files/economy‐finance/ip125_en.pdf.

[wps20801-bib-0035] 35. Rushe D, Holpuch A. 20m Americans lost their jobs in April in worst month since Great Depression. The Guardian, May 8, 2020. [Google Scholar]

[wps20801-bib-0036] 36.United Nations Economic Commission for Latin America and the Carribean. Measuring the impact of COVID‐19 with a view to reactivation. https://www.cepal.org/en/publications/45477‐measuring‐impact‐covid‐19‐view‐reactivation.

[wps20801-bib-0037] 37.The World Bank. East Asia and the Pacific in the time of COVID‐19. www.worldbank.org/en/region/eap/publication/east-asia-pacific-economic-update.

[wps20801-bib-0038] 38.United Nations Economic Commission for Africa. COVID‐19 in Africa: protecting lives and economies. https://www.uneca.org/publications/covid‐19‐africa‐protecting‐lives‐and‐economies.

[wps20801-bib-0039] 39. Oyesanya M, Lopez‐Morinigo J, Dutta R. Systematic review of suicide in economic recession. World J Psychiatry 2015;5:243. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0040] 40. Parmar D, Stavropoulou C, Ioannidis JPA. Health outcomes during the 2008 financial crisis in Europe: systematic literature review. BMJ 2016;354:i4588. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0041] 41. Stuckler D, Basu S, Suhrcke M et al. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet 2009;374:315‐23. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0042] 42. McIntyre RS, Lee Y. Preventing suicide in the context of the COVID‐19 pandemic. World Psychiatry 2020;19:250‐1. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0043] 43. Matsubayashi T, Sekijima K, Ueda M. Government spending, recession, and suicide: evidence from Japan. BMC Public Health 2020;20:243. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0044] 44.World Health Organization. WHO coronavirus disease (COVID‐19) dashboard 2020. https://covid19.who.int.

[wps20801-bib-0045] 45. Modi C, Boehm V, Ferraro S et al. How deadly is COVID‐19? A rigorous analysis of excess mortality and age‐dependent fatality rates in Italy. 10.1101/2020.04.15.20067074. [DOI]

[wps20801-bib-0046] 46. Dale B, Stylianou N. What is the true death toll of the coronavirus pandemic? BBC News, June 18, 2020. [Google Scholar]

[wps20801-bib-0047] 47. Wu J, McCann A, Katz J et al. 107,000 missing deaths: tracking the true toll of the coronavirus outbreak. New York Times, June 23, 2020. [Google Scholar]

[wps20801-bib-0048] 48. Kokou‐Kpolou CK, Fernandez‐Alcantara M, Cenat JM. Prolonged grief related to COVID‐19 deaths: do we have to fear a steep rise in traumatic and disenfranchised griefs? Psychol Trauma 2020;12(Suppl. 1):S94‐5. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0049] 49. Gunnell D, Appleby L, Arensman E et al. Suicide risk and prevention during the COVID‐19 pandemic. Lancet Psychiatry 2020;7:468‐71. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0050] 50. Klomek AB. Suicide prevention during the COVID‐19 outbreak. Lancet Psychiatry 2020;7:390. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0051] 51. Mamun MA, Griffiths MD. First COVID‐19 suicide case in Bangladesh due to fear of COVID‐19 and xenophobia: possible suicide prevention strategies. Asian J Psychiatry 2020;51:102073. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0052] 52. Reger MA, Stanley IH, Joiner TE. Suicide mortality and coronavirus disease 2019 – A perfect storm? JAMA Psychiatry (in press). [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0053] 53. World Health Organization . Mental health and psychosocial considerations during the COVID‐19 outbreak. Geneva: World Health Organization, 2020. [Google Scholar]

[wps20801-bib-0054] 54. Wasserman D. Suicide: an unnecessary death, 2nd ed. Oxford: Oxford University Press, 2016. [Google Scholar]

[wps20801-bib-0055] 55. World Health Organization . Preventing suicide: a global imperative. Geneva: World Health Organization, 2014. [Google Scholar]

[wps20801-bib-0056] 56. Welton RS. The management of suicidality: assessment and intervention. Psychiatry 2007;4:24‐34. [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0057] 57. Polizzi C, Lynn SJ, Perry A. Stress and coping in the time of COVID‐19: pathways to resilience and recovery. Clin Neuropsychiatry 2020;17:59‐62. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0058] 58. Newby J, O'Moore K, Tang S et al. Acute mental health responses during the COVID‐19 pandemic in Australia. https://www.medrxiv.org/content/10.1101/2020.05.03.20089961v1. [DOI] [PMC free article] [PubMed]

[wps20801-bib-0059] 59. Suicide Prevention Resource Center . Understanding risk and protective factors for suicide: a primer for preventing suicide. Newton: Education Development Center, Inc, 2011.

[wps20801-bib-0060] 60. Goldsmith SK, Pellmar TC, Kleinman AM et al. Reducing suicide: a national imperative. Washington: National Academies Press, 2002. [PubMed] [Google Scholar]

[wps20801-bib-0061] 61. Wasserman D, Drurkee T. Strategies in suicide prevention In: Wasserman D, Wasserman C. (eds). Oxford textbook of suicidology and suicide prevention. Oxford: Oxford University Press, 2009:381‐8. [Google Scholar]

[wps20801-bib-0062] 62. World Health Organization . National suicide prevention strategies: progress, examples and indicators. Geneva: World Health Organization, 2018. [Google Scholar]

[wps20801-bib-0063] 63. Zalsman G, Hawton K, Wasserman D et al. Suicide prevention strategies revisited: 10‐year systematic review. Lancet Psychiatry 2016;3:646‐59. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0064] 64. Isaac M, Elias B, Katz LY et al. Gatekeeper training as a preventative intervention for suicide: a systematic review. Can J Psychiatry 2009;54:260‐8. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0065] 65. Kim C. The impacts of social protection policies and programs on suicide: a literature review. Int J Health Serv 2018;48:512‐34. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0066] 66. Puig‐Barrachina V, Giro P, Artazcoz L et al. The impact of active labour market policies on health outcomes: a scoping review. Eur J Public Health 2020;30:36‐42. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0067] 67. Reeves A, McKee M, Gunnell D et al. Economic shocks, resilience, and male suicides in the Great Recession: cross‐national analysis of 20 EU countries. Eur J Public Health 2015;25:404‐9. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0068] 68. Shibata H. The effect of active labor market policies on suicide rates: a panel data analysis for 26 OECD countries, 1980‐2007. Japanese Sociological Review 2014;65:116‐33. [Google Scholar]

[wps20801-bib-0069] 69. Cylus J, Glymour MM, Avendano M. Do generous unemployment benefit programs reduce suicide rates? A state fixed‐effect analysis covering 1968‐2008. Am J Epidemiol 2014;180:45‐52. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0070] 70. Norström T, Grönqvist H. The Great Recession, unemployment and suicide. J Epidemiol Community Health 2015;69:110‐6. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0071] 71. Torry M. The United States, basic income, and Covid. BIEN Conversations, June 9, 2020. [Google Scholar]

[wps20801-bib-0072] 72. Gibson M, Hearty W, Craig P. Universal basic income – A scoping review of evidence on impacts and study characteristics. https://whatworksscotland.ac.uk.

[wps20801-bib-0073] 73. Painter A. A universal basic income: the answer to poverty, insecurity, and health inequality? BMJ 2016;355:i6473. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0074] 74. Christian C, Hensel L, Roth C. Income shocks and suicides: causal evidence from Indonesia. Rev Econ Stat 2019;101:905‐20. [Google Scholar]

[wps20801-bib-0075] 75. Fowler KA, Gladden RM, Vagi KJ et al. Increase in suicides associated with home eviction and foreclosure during the US housing crisis: findings from 16 National Violent Death Reporting System States, 2005‐2010. Am J Public Health 2014;105:311‐6. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0076] 76. Houle JN, Light MT. The home foreclosure crisis and rising suicide rates, 2005 to 2010. Am J Public Health 2014;104:1073‐9. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0077] 77. Wahlbeck K, Cresswell‐Smith J, Haaramo P et al. Interventions to mitigate the effects of poverty and inequality on mental health. Soc Psychiatry Psychiatr Epidemiol 2017;52:505‐14. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0078] 78. Ajdacic‐Gross V, Weiss MG, Ring M et al. Methods of suicide: international suicide patterns derived from the WHO mortality database. Bull World Health Organ 2008;86:726‐32. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0079] 79. Cano‐Montalbán I, Quevedo‐Blasco R. Sociodemographic variables most associated with suicidal behaviour and suicide methods in Europe and America. a systematic review. Eur J Psychol Appl L 2018;10:15‐25. [Google Scholar]

[wps20801-bib-0080] 80. Mew EJ, Padmanathan P, Konradsen F et al. The global burden of fatal self‐poisoning with pesticides 2006‐15: systematic review. J Affect Disord 2017;219:93‐104. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0081] 81.Centers for Disease and Control Prevention. Leading causes of death reports, 1981‐2018. https://webappa.cdc.gov/sasweb/ncipc/leadcause.html.

[wps20801-bib-0082] 82. Chia BH, Chia A, Ng WY et al. Suicide methods in Singapore (2000‐2004): types and associations. Suicide Life Threat Behav 2011;41:574‐83. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0083] 83. Wong PW, Caine ED, Lee CK et al. Suicides by jumping from a height in Hong Kong: a review of coroner court files. Soc Psychiatry Psychiatr Epidemiol 2014;49:211‐9. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0084] 84. Spicer RS, Miller TR. Suicide acts in 8 states: incidence and case fatality rates by demographics and method. Am J Public Health 2000;90:1885‐91. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0085] 85. Sarchiapone M, Mandelli L, Iosue M et al. Controlling access to suicide means. Int J Environ Res Public Health 2011;8:4550‐62. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0086] 86. Yip PSF, Caine E, Yousuf S et al. Means restriction for suicide prevention. Lancet 2012;379:2393‐9. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0087] 87. Romano S, Galante H, Figueira D et al. Time‐trend analysis of medicine sales and shortages during COVID‐19 outbreak: data from community pharmacies. Res Social Adm Pharm (in press). [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0088] 88. Mannix R, Lee LK, Fleegler EW. Coronavirus disease 2019 (COVID‐19) and firearms in the United States: will an epidemic of suicide follow? Ann Intern Med (in press). [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0089] 89. Collins K, Yaffe‐Bellany D. About 2 million guns were sold in the U.S. as virus fears spread. New York Times, April 2, 2020.

[wps20801-bib-0090] 90. Gunnell D, Knipe D, Chang SS et al. Prevention of suicide with regulations aimed at restricting access to highly hazardous pesticides: a systematic review of the international evidence. Lancet Glob Health 2017;5:e1026‐37. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0091] 91. Darvishi N, Farhadi M, Haghtalab T et al. Alcohol‐related risk of suicidal ideation, suicide attempt, and completed suicide: a meta‐analysis. PLoS One 2015;10:e0126870. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0092] 92. Wilcox HC, Conner KR, Caine ED. Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug Alcohol Depend 2004;76(Suppl.):S11‐9. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0093] 93. Borges G, Loera CR. Alcohol and drug use in suicidal behaviour. Curr Opin Psychiatry 2010;23:195‐204. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0094] 94. Xuan Z, Naimi TS, Kaplan MS et al. Alcohol policies and suicide: a review of the literature. Alcohol Clin Exp Res 2016;40:2043‐55. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0095] 95.World Health Organization. mhGAP evidence‐based recommendations for management of self‐harm and suicide in non‐specialized health settings. Reducing the availability of alcohol. Geneva: World Health Organization, 2015.

[wps20801-bib-0096] 96. Wasserman D, Värnik A. Suicide‐preventive effects of perestroika in the former USSR: the role of alcohol restriction. Acta Psychiatr Scand 1998;98(Suppl. 394):1‐4. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0097] 97. World Health Organization . Global strategy to reduce harmful use of alcohol. Geneva: World Health Organization, 2010. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0098] 98. Norström T, Rossow I. Alcohol consumption as a risk factor for suicidal behavior: a systematic review of associations at the individual and at the population level. Arch Suicide Res 2016;20:489‐506. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0099] 99. World Health Organization . Alcohol and COVID‐19: what you need to know. Geneva: World Health Organization, 2020. [Google Scholar]

[wps20801-bib-0100] 100. Schomerus G, Schwahn C, Holzinger A et al. Evolution of public attitudes about mental illness: a systematic review and meta‐analysis. Acta Psychiatr Scand 2012;125:440‐52. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0101] 101. Thornicroft G, Mehta N, Clement S et al. Evidence for effective interventions to reduce mental‐health‐related stigma and discrimination. Lancet 2016;387:1123‐32. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0102] 102. World Health Organization Regional Office for Europe . Mental health and COVID‐19. Copenhagen: World Health Organization Regional Office for Europe, 2020. [Google Scholar]

[wps20801-bib-0103] 103. United Nations . Policy brief: COVID‐19 and the need for action on mental health. New York: United Nations, 2020. [Google Scholar]

[wps20801-bib-0104] 104.Centers for Disease Control and Prevention. Mental health and coping during COVID‐19. Atlanta: Centers for Disease Control and Prevention, 2020.

[wps20801-bib-0105] 105.Karolinska Institutet National Centre for Suicide Research and Prevention. The coronavirus: risk for increased suicide and self‐harm in the society after the pandemic. https://ki.se/en/nasp.

[wps20801-bib-0106] 106. Polanczyk GV, Salum GA, Sugaya LS et al. Annual research review: a meta‐analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 2015;56:345‐65. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0107] 107. Balazs J, Miklosi M, Kereszteny A et al. Adolescent subthreshold‐depression and anxiety: psychopathology, functional impairment and increased suicide risk. J Child Psychol Psychiatry 2013;54:670‐7. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0108] 108. Carli V, Hoven CW, Wasserman C et al. A newly identified group of adolescents at “invisible” risk for psychopathology and suicidal behavior: findings from the SEYLE study. World Psychiatry 2014;13:78‐86. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0109] 109. Cusimano MD, Sameem M. The effectiveness of middle and high school‐based suicide prevention programmes for adolescents: a systematic review. Injury Prevention 2011;17:43‐9. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0110] 110. Robinson J, Cox G, Malone A et al. A systematic review of school‐based interventions aimed at preventing, treating, and responding to suicide‐related behavior in young people. Crisis 2013;34:164‐82. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0111] 111. Wasserman D, Hoven CW, Wasserman C et al. School‐based suicide prevention programmes: the SEYLE cluster‐randomised, controlled trial. Lancet 2015;385:1536‐44. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0112] 112. Katz C, Bolton SL, Katz LY et al. A systematic review of school‐based suicide prevention programs. Depress Anxiety 2013;30:1030‐45. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0113] 113. Robinson J, Calear AL, Bailey E. Suicide prevention in educational settings: a review. Australas Psychiatry 2018;26:132‐40. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0114] 114.Editorial. Pandemic school closures: risks and opportunities. Lancet Child Adolesc Health 2020;4:341. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0115] 115. Durkee T, Kaess M, Carli V et al. Prevalence of pathological internet use among adolescents in Europe: demographic and social factors. Addiction 2012;107:2210‐22. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0116] 116.L1ght. Rising levels of hate speech & online toxicity during this time of crisis. https://l1ght.com/Toxicity_during_coronavirus_Report‐L1ght.pdf.

[wps20801-bib-0117] 117. Kaess M, Durkee T, Brunner R et al. Pathological Internet use among European adolescents: psychopathology and self‐destructive behaviours. Eur Child Adolesc Psychiatry 2014;23:1093‐102. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0118] 118. Sisask M, Värnik A. Media roles in suicide prevention: a systematic review. Int J Environ Res Public Health 2012;9:123‐38. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0119] 119. Niederkrotenthaler T, Braun M, Pirkis J et al. Association between suicide reporting in the media and suicide: systematic review and meta‐analysis. BMJ 2020;368:m575. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0120] 120. Bohanna I, Wang X. Media guidelines for the responsible reporting of suicide. Crisis 2012;33:190‐8. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0121] 121. World Health Organization . Preventing suicide: a resource for media professionals. Geneva: World Health Organization, 2017. [Google Scholar]

[wps20801-bib-0122] 122.International Association for Suicide Prevention. Reporting on suicide during the COVID‐19 pandemic. https://www.iasp.info.

[wps20801-bib-0123] 123. Garfin DR, Silver RC, Holman EA. The novel coronavirus (COVID‐2019) outbreak: amplification of public health consequences by media exposure. Health Psychol 2020;39:355‐7. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0124] 124. Cho J, Lee WJ, Moon KT et al. Medical care utilization during 1 year prior to death in suicides motivated by physical illnesses. J Prev Med Public Health 2013;46:147‐54. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0125] 125. Brooks SK, Dunn R, Amlot R et al. A systematic, thematic review of social and occupational factors associated with psychological outcomes in healthcare employees during an infectious disease outbreak. J Occup Environ Med 2018;60:248‐57. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0126] 126. Greenberg N, Docherty M, Gnanapragasam S et al. Managing mental health challenges faced by healthcare workers during covid‐19 pandemic. BMJ 2020;368:m1211. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0127] 127. Huang J, Liu F, Teng Z et al. Care for the psychological status of frontline medical staff fighting against COVID‐19. Clin Infect Dis (in press). [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0128] 128. Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID‐19 pandemic. JAMA (in press). [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0129] 129. Wong TW, Yau JKY, Chan CLW et al. The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. Eur J Emerg Med 2005;12:13‐8. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0130] 130. Zero Suicide Institute . Telehealth and suicide care during the COVID‐19 pandemic. http://zerosuicide.edc.org.

[wps20801-bib-0131] 131. Yonemoto N, Kawashima Y, Endo K et al. Gatekeeper training for suicidal behaviors: a systematic review. J Affect Disord 2019;246:506‐14. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0132] 132.Mississippi State University. DMH and MSU offer ‘The Alliance Project' suicide prevention training online. Starkville: Mississippi State University, 2020.

[wps20801-bib-0133] 133.Zero Suicide Alliance. Zero Suicide Alliance training. https://www.zerosuicidealliance.com.

[wps20801-bib-0134] 134.Mental Health First Aid Australia. https://mhfa.com.au.

[wps20801-bib-0135] 135. Hadlaczky G, Hökby S, Mkrtchian A et al. Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: a meta‐analysis. Int Rev Psychiatry 2014;26:467‐75. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0136] 136. Druss BG. Addressing the COVID‐19 pandemic in populations with serious mental illness. JAMA Psychiatry (in press). [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0137] 137. Hao F, Tan W, Jiang L et al. Do psychiatric patients experience more psychiatric symptoms during COVID‐19 pandemic and lockdown? A case‐control study with service and research implications for immunopsychiatry. Brain Behav Immun 2020;87:100‐6. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0138] 138. Zhou J, Liu L, Xue P et al. Mental health response to the COVID‐19 outbreak in China. Am J Psychiatry 2020;177:574‐5. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0139] 139. Kawohl W, Nordt C. COVID‐19, unemployment, and suicide. Lancet Psychiatry 2020;7:389‐90. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0140] 140. Valentino‐DeVries J, Lu D, Dance GJX. Location data says it all: staying at home during coronavirus is a luxury. New York Times, April 3, 2020. [Google Scholar]

[wps20801-bib-0141] 141. Azar KMJ, Shen Z, Romanelli RJ et al. Disparities in outcomes among COVID‐19 patients in a large health care system in California. Health Aff 2020;39:1253‐62. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0142] 142. van Dorn A, Cooney RE, Sabin ML. COVID‐19 exacerbating inequalities in the US. Lancet 2020;395:1243‐4. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0143] 143. Wang Z, Tang K. Combating COVID‐19: health equity matters. Nature Med 2020;26:458. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0144] 144. Chandan JS, Taylor J, Bradbury‐Jones C et al. COVID‐19: a public health approach to manage domestic violence is needed. Lancet Public Health 2020;5:e309. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0145] 145. Eckhardt CI, Murphy CM, Whitaker DJ et al. The effectiveness of intervention programs for perpetrators and victims of intimate partner violence. Partner Abuse 2013;4:196‐231. [Google Scholar]

[wps20801-bib-0146] 146. Davydow DS, Gifford JM, Desai SV et al. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry 2008;30:421‐34. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0147] 147. Lu W, Wang H, Lin Y et al. Psychological status of medical workforce during the COVID‐19 pandemic: a cross‐sectional study. Psychiatry Res 2020;288:112936. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0148] 148. Kang L, Ma S, Chen M et al. Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: a cross‐sectional study. Brain Behav Immun 2020;87:11‐7. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0149] 149. Mayland CR, Harding AJE, Preston N et al. Supporting adults bereaved through COVID‐19: a rapid review of the impact of previous pandemics on grief and bereavement. J Pain Symptom Manage 2020;60:e33‐9. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0150] 150. Gesi C, Carmassi C, Cerveri G et al. Complicated grief: what to expect after the coronavirus pandemic. Front Psychiatry 2020;11:489. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0151] 151. Carr D, Boerner K, Moorman S. Bereavement in the time of coronavirus: unprecedented challenges demand novel interventions. J Aging Soc Policy 2020;32:425‐31. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0152] 152. Selman LE, Chao D, Sowden R et al. Bereavement support on the frontline of COVID‐19: recommendations for hospital clinicians. J Pain Symptom Manage 2020;60:e81‐6. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0153] 153. Burke LA, Neimeyer RA. Prospective risk factors for complicated grief: a review of the empirical literature In: Stroebe M, Schut H, van den Buet J. (eds). Complicated grief: scientific foundations for health care professionals. London: Routledge, 2013:145‐60. [Google Scholar]

[wps20801-bib-0154] 154. Lobb EA, Kristjanson LJ, Aoun SM et al. Predictors of complicated grief: a systematic review of empirical studies. Death Stud 2010;34:673‐98. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0155] 155. Latham AE, Prigerson HG. Suicidality and bereavement: complicated grief as psychiatric disorder presenting greatest risk for suicidality. Suicide Life Threat Behav 2004;34:350‐62. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0156] 156. Mogensen H, Moller J, Hultin H et al. Death of a close relative and the risk of suicide in Sweden – A large scale register‐based case‐crossover study. PLoS One 2016;11:e0164274. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0157] 157. Gonzalez‐Sanguino C, Ausin B, Castellanos MA et al. Mental health consequences during the initial stage of the 2020 coronavirus pandemic (COVID‐19) in Spain. Brain Behav Immun 2020;87:172‐6. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0158] 158. Armitage R, Nellums LB. COVID‐19 and the consequences of isolating the elderly. Lancet Public Health 2020;5:e256. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0159] 159. Baldessarini RJ, Pompili M, Tondo L. Suicidal risk in antidepressant drug trials. Arch Gen Psychiatry 2006;63:246‐8. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0160] 160. Bateman K, Hansen L, Turkington D et al. Cognitive behavioral therapy reduces suicidal ideation in schizophrenia: results from a randomized controlled trial. Suicide Life Threat Behav 2007;37:284‐90. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0161] 161. Cipriani A, Hawton K, Stockton S et al. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta‐analysis. BMJ 2013;346:f3646. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0162] 162. Tarrier N, Taylor K, Gooding P. Cognitive‐behavioral interventions to reduce suicide behavior: a systematic review and meta‐analysis. Behav Modif 2008;32:77‐108. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0163] 163. Weinberg I, Gunderson JG, Hennen J et al. Manual assisted cognitive treatment for deliberate self‐harm in borderline personality disorder patients. J Pers Disord 2006;20:482‐92. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0164] 164. Brent DA. Antidepressants and suicidality. Psychiatr Clin North Am 2016;39:503‐12. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0165] 165. Gibbons RD, Brown CH, Hur K et al. Suicidal thoughts and behavior with antidepressant treatment: reanalysis of the randomized placebo‐controlled studies of fluoxetine and venlafaxine. Arch Gen Psychiatry 2012;69:580‐7. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0166] 166. Barbui C, Esposito E, Cipriani A. Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies. CMAJ 2009;180:291‐7. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0167] 167. Del Matto L, Muscas M, Murru A et al. Lithium and suicide prevention in mood disorders and in the general population: a systematic review. Neurosci Biobehav Rev 2020;116:142‐53. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0168] 168. Smith KA, Cipriani A. Lithium and suicide in mood disorders: updated meta‐review of the scientific literature. Bipolar Disord 2017;19:575‐86. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0169] 169. Miller JN, Black DW. Bipolar disorder and suicide: a review. Curr Psychiatry Rep 2020;22:6. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0170] 170. Ringbäck Weitoft G, Berglund M, Lindström EA et al. Mortality, attempted suicide, re‐hospitalisation and prescription refill for clozapine and other antipsychotics in Sweden – a register‐based study. Pharmacoepidem Dr Saf 2014;23:290‐8. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0171] 171. Barak Y, Mirecki I, Knobler H et al. Suicidality and second generation anti‐psychotics in schizophrenia patients: a case‐controlled retrospective study during a 5‐year period. Psychopharmacology 2004;175:215‐9. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0172] 172. Aguilar EJ, Siris SG. Do antipsychotic drugs influence suicidal behavior in schizophrenia? Psychopharmacol Bull 2007;40:128‐42. [PubMed] [Google Scholar]

[wps20801-bib-0173] 173. Trivedi MH. Antisuicidal effects of ketamine: a promising first step. Am J Psychiatry 2018;175:97‐9. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0174] 174. Al Jurdi RK, Swann A, Mathew SJ. Psychopharmacological agents and suicide risk reduction: ketamine and other approaches. Curr Psychiatry Rep 2015;17:81. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0175] 175. Wilkinson ST, Ballard ED, Bloch MH et al. The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta‐analysis. Am J Psychiatry 2018;175:150‐8. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0176] 176. Leavey K, Hawkins R. Is cognitive behavioural therapy effective in reducing suicidal ideation and behaviour when delivered face‐to‐face or via e‐health? A systematic review and meta‐analysis. Cogn Behav Ther 2017;46:353‐74. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0177] 177. DeCou CR, Comtois KA, Landes SJ. Dialectical behavior therapy is effective for the treatment of suicidal behavior: a meta‐analysis. Behav Ther 2019;50:60‐72. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0178] 178. Bryan CJ, Mintz J, Clemans TA et al. Effect of crisis response planning vs. contracts for safety on suicide risk in US Army soldiers: a randomized clinical trial. J Affect Disord 2017;212:64‐72. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0179] 179. Stanley B, Brown GK. Safety planning intervention: a brief intervention to mitigate suicide risk. Cogn Behav Pract 2012;19:256‐64. [Google Scholar]

[wps20801-bib-0180] 180. Fleischmann A, Bertolote JM, Wasserman D et al. Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. Bull World Health Organ 2008;86:703‐9. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0181] 181. Simpson SA, Dumas A, McDowell AK et al. Novel coronavirus and related public health interventions are negatively impacting mental health services. Psychosomatics (in press). [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0182] 182. Chevance A, Gourion D, Hoertel N et al. Ensuring mental health care during the SARS‐CoV‐2 epidemic in France: a narrative review. Encephale 2020;46:193‐201. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0183] 183. Too LS, Spittal MJ, Bugeja L et al. The association between mental disorders and suicide: a systematic review and meta‐analysis of record linkage studies. J Affect Disord 2019;259:302‐13. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0184] 184. Åhgren B. Chain of care development in Sweden: results of a national study. Int J Integr Care 2003;3:e01. [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0185] 185. Lizardi D, Stanley B. Treatment engagement: a neglected aspect in the psychiatric care of suicidal patients. Psychiatr Serv 2010;61:1183‐91. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0186] 186.National Action Alliance for Suicide Prevention. Best practices in care transitions for individuals with suicide risk: inpatient care to outpatient care. Washington: Education Development Center, Inc, 2019.

[wps20801-bib-0187] 187. Luxton DD, June JD, Comtois KA. Can postdischarge follow‐up contacts prevent suicide and suicidal behavior? Crisis 2013;34:32‐41. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0188] 188. Brown GK, Green KL. A review of evidence‐based follow‐up care for suicide prevention: where do we go from here? Am J Prev Med 2014;47(Suppl. 2):S209‐15. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0189] 189. World Health Organization . Telehealth. Geneva: World Health Organization, 2016. [Google Scholar]

[wps20801-bib-0190] 190. Centers for Medicare & Medicaid Services. Telemedicine . Medicaid.gov.

[wps20801-bib-0191] 191. Luxton DD, June JD, Kinn JT. Technology‐based suicide prevention: current applications and future directions. Telemed e‐Health 2011;17:50‐4. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0192] 192. Barnett ML, Huskamp HA. Telemedicine for mental health in the United States: making progress, still a long way to go. Psychiatr Serv 2020;71:197‐8. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0193] 193. Gilmore AK, Ward‐Ciesielski EF. Perceived risks and use of psychotherapy via telemedicine for patients at risk for suicide. J Telemed Telecare 2019;25:59‐63. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0194] 194. De Jaegere E, van Landschoot R, van Heeringen K et al. The online treatment of suicidal ideation: a randomised controlled trial of an unguided web‐based intervention. Behav Res Ther 2019;119:103406. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0195] 195. Bruffaerts R, Demyttenaere K, Hwang I et al. Treatment of suicidal people around the world. Br J Psychiatry 2011;199:64‐70. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0196] 196. Berman AL, Carter G. Technological advances and the future of suicide prevention: ethical, legal, and empirical challenges. Suicide Life Threat Behav 2020;50:643‐51. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0197] 197. Ward‐Ciesielski EF, Peros O, Conigliaro A et al. Perceived benefits of psychotherapy via telemedicine based on suicide risk severity. Gen Hosp Psychiatry 2018;55:100‐1. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0198] 198. Wilcock AD, Rose S, Busch AB et al. Association between broadband Internet availability and telemedicine use. JAMA Intern Med 2019;179:1580‐2. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0199] 199. Ben‐Zeev D, Davis KE, Kaiser S et al. Mobile technologies among people with serious mental illness: opportunities for future services. Adm Policy Ment Health 2013;40:340‐3. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0200] 200. Fairchild RM, Ferng‐Kuo S‐F, Rahmouni H et al. Telehealth increases access to care for children dealing with suicidality, depression, and anxiety in rural emergency departments. Telemed e‐Health (in press). [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0201] 201. Torous J, Andersson G, Bertagnoli A et al. Towards a consensus around standard for smartphone apps and digital mental health. World Psychiatry 2019;18:97‐8. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0202] 202. Latifi R, Doarn CR. Perspective on COVID‐19: finally, telemedicine at center stage. Telemed e‐Health (in press). [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0203] 203. Meyer B. Internet interventions for suicide prevention: current evidence and future directions. In: Wasserman D, Wasserman C (eds). Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press (in press). [Google Scholar]

[wps20801-bib-0204] 204. Franklin JC, Fox KR, Franklin CR et al. A brief mobile app reduces nonsuicidal and suicidal self‐injury: evidence from three randomized controlled trials. J Consult Clin Psychol 2016;84:544‐57. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0205] 205. Witt K, Spittal MJ, Carter G et al. Effectiveness of online and mobile telephone applications (‘apps') for the self‐management of suicidal ideation and self‐harm: a systematic review and meta‐analysis. BMC Psychiatry 2017;17:297. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0206] 206. Hetrick SE, Yuen HP, Bailey E et al. Internet‐based cognitive behavioural therapy for young people with suicide‐related behaviour (Reframe‐IT): a randomised controlled trial. Evid Based Ment Health 2017;20:76‐82. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0207] 207. Kreuze E, Jenkins C, Gregoski M et al. Technology‐enhanced suicide prevention interventions: a systematic review. J Telemed Telecare 2016;23:605‐17. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0208] 208. Franco‐Martin MA, Munoz‐Sanchez JL, Sainz‐de‐Abajo B et al. A systematic literature review of technologies for suicidal behavior prevention. J Med Syst 2018;42:71. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0209] 209. Berrouiguet S, Larsen ME, Mesmeur C et al. Toward mhealth brief contact ‐interventions in suicide prevention: case series from the Suicide Interven‐tion Assisted by Messages (SIAM) randomized controlled trial. JMIR Mhealth Uhealth 2018;6:e8. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0210] 210. Seidel RW, Kilgus MD. Agreement between telepsychiatry assessment and face‐to‐face assessment for emergency department psychiatry patients. J Telemed Telecare 2014;20:59‐62. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0211] 211. Hubley S, Lynch SB, Schneck C et al. Review of key telepsychiatry outcomes. World J Psychiatry 2016;6:269‐82. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0212] 212. Reinhardt I, Gouzoulis‐Mayfrank E, Zielasek J. Use of telepsychiatry in emer‐gency and crisis intervention: current evidence. Curr Psychiatry Rep 2019;21:63. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0213] 213. Bashshur R, Doarn CR, Frenk JM et al. Telemedicine and the COVID‐19 pandemic, lessons for the future. Telemed e‐Health 2020;26:571‐3. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0214] 214. Giansanti D, Aprile I. Is the COVID‐19 pandemic an opportunity to enlarge the telemedicine boundaries? Telemed e‐Health (in press). [DOI] [PubMed]

[wps20801-bib-0215] 215. Scott BK, Miller GT, Fonda SJ et al. Advanced digital health technologies for COVID‐19 and future emergencies. Telemed e‐Health (in press). [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0216] 216. Zarghami A, Farjam M, Fakhraei B et al. A report of the telepsychiatric evaluation of SARS‐CoV‐2 patients. Telemed e‐Health (in press). [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0217] 217. Barney A, Buckelew S, Mesheriakova V et al. The COVID‐19 pandemic and rapid implementation of adolescent and young adult telemedicine: challenges and opportunities for innovation. J Adolesc Health (in press). [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0218] 218. Watson AR, Wah R, Thamman R. The value of remote monitoring for the COVID‐19 pandemic. Telemed e‐Health (in press). [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0219] 219. McIntyre M, Robinson LR, Mayo A. Practical considerations for implementing virtual care in physical medicine and rehabilitation: for the pandemic and beyond. Am J Phys Med Rehabil 2020;99:464‐7. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0220] 220. Triana AJ, Gusdorf RE, Shah KP et al. Technology literacy as a barrier to tele‐health during COVID‐19. Telemed e‐Health (in press). [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0221] 221. Pappot N, Taarnhøj GA, Pappot H. Telemedicine and e‐health solutions for COVID‐19: patients' perspective. Telemed e‐Health 2020;26:847‐9. [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0222] 222. Andersson G, Titov N, Dear BF et al. Internet‐delivered psychological treatments: from innovation to implementation. World Psychiatry 2019;18:20‐8. [DOI] [PMC free article] [PubMed] [Google Scholar]

[wps20801-bib-0223] 223. Kannampallil T, Ma J. Digital translucence: adapting telemedicine delivery post‐COVID‐19. Telemed e‐Health (in press). [DOI] [PubMed] [Google Scholar]

[wps20801-bib-0224] 224.International Association for Suicide Prevention. Briefing statement: the coronavirus disease (COVID‐19) outbreak. https://www.iasp.info.

PERMALINK

Adaptation of evidence‐based suicide prevention strategies during and after the COVID‐19 pandemic

Danuta Wasserman

Miriam Iosue

Anika Wuestefeld

Vladimir Carli

Abstract

IMPACT OF THE COVID‐19 PANDEMIC ON RISK AND PROTECTIVE FACTORS FOR SUICIDE

Table 1.

Table 2.

Table 3.

Table 4.

EVIDENCE‐BASED SUICIDE PREVENTION STRATEGIES DURING THE COVID‐19 PANDEMIC

Universal interventions

Mitigating the impact of unemployment, poverty and inequalities

Restricting access to lethal means of suicide

Policies to reduce harmful use of alcohol

Public awareness about mental health and suicide

School‐based interventions

Responsible media reporting

Access to health care

Selective interventions

Gatekeeper training

Interventions for vulnerable groups

Indicated interventions

Treatment of mental disorders

Chain of care and follow‐up

TELEMEDICINE DURING THE COVID‐19 PANDEMIC

CONCLUSIONS

REFERENCES

OTHER FORMATS

ACTIONS

SHARE

PERMALINK

RESOURCES

Cite

Add to Collections

PERMALINK

Adaptation of evidence‐based suicide prevention strategies during and after the COVID‐19 pandemic

Danuta Wasserman

Miriam Iosue

Anika Wuestefeld

Vladimir Carli

Abstract

IMPACT OF THE COVID‐19 PANDEMIC ON RISK AND PROTECTIVE FACTORS FOR SUICIDE

Table 1.

Table 2.

Table 3.

Table 4.

EVIDENCE‐BASED SUICIDE PREVENTION STRATEGIES DURING THE COVID‐19 PANDEMIC

Universal interventions

Mitigating the impact of unemployment, poverty and inequalities

Restricting access to lethal means of suicide

Policies to reduce harmful use of alcohol

Public awareness about mental health and suicide

School‐based interventions

Responsible media reporting

Access to health care

Selective interventions

Gatekeeper training

Interventions for vulnerable groups

Indicated interventions

Treatment of mental disorders

Chain of care and follow‐up

TELEMEDICINE DURING THE COVID‐19 PANDEMIC

CONCLUSIONS

REFERENCES

OTHER FORMATS

ACTIONS

SHARE

PERMALINK

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases