Suicide Ideation During the COVID-19 Pandemic

A major outbreak of pneumonia-like disease was first reported in the city of Wuhan in Hubei Province, China, in December 2019 [1]. The global spread of the disease happened rapidly around the world, causing a life-threatening disease called Coronavirus disease 2019 (Covid-19) named by the World Health Organization (WHO) in January 2020 [2]. The Covid-19 outbreak was declared by the WHO as a global public health emergency of international concern (PHEIC) on 11 March 2020 [1]. Online news media reports of 369 cases of suicides and attempted suicides during COVID lockdown vs 220 reports in 2019, a 67.7% increase in suicidal behavior [3].


Introduction
A major outbreak of pneumonia-like disease was first reported in the city of Wuhan in Hubei Province, China, in December 2019 [1]. The global spread of the disease happened rapidly around the world, causing a life-threatening disease called Coronavirus disease 2019 (Covid-19) named by the World Health Organization (WHO) in January 2020 [2]. The Covid-19 outbreak was declared by the WHO as a global public health emergency of international concern (PHEIC) on 11 March 2020 [1]. Online news media reports of 369 cases of suicides and attempted suicides during COVID lockdown vs 220 reports in 2019, a 67.7% increase in suicidal behavior [3].
Poor health care infrastructure can cause concern in densely populated countries such as India and a certain level of panic remains in the population due to inadequate health protection measures around the world [4]. Covid-19 has had a profound impact on the world's population regardless of gender, age, functional differences (normal or disabled) and has created significant economic, psychological and social impacts worldwide [5,6]. In March and April 2020, the first COVID-19-related suicide cases were reported in India and Bangladesh in which two men who feared for their lives committed suicide [7]. The majority of reported victims were adult men as compared to women [8,9]. Viral outbreaks appear to be associated with psychiatric and psychological events (e.g., fear of infection, stigma of being diagnosed with a virus, cancellation of "non-emergency" hospitalizations) that may increase the risk of suicidal ideation and suicide attempts.
The social distancing and quarantine measures that have been enacted to curb the spread of the disease have resulted in increased loneliness, anxiety, stress, and depression in the general population. Virus exhibits neurotrophic properties and can cause serious neurological damage and disorders (e.g., toxic infectious encephalopathy) that can cause mental disorders [10]. In some cases, a viral infection can cause confusion, dysphoria, disorientation, and delirium, leading to suicidal ideation and behavior [11]. COVID-19, caused by the novel coronavirus SARS-CoV-2, has infected more than 118 million people worldwide and 2,662,137 have been died [12].

Factors Associated with Suicidal Behaviors
i.
Fear of getting infection. ii.

Social isolation
iii.

Relapse of mental illnesses
iv.
Concern of being a burden on family. v.

Economic downturn
vi. Domestic and spousal disharmony.

Preventive Measurements
The WHO recommends not to monitor the continuous stream of news which exacerbates stress and there should be specific timing of news updates [13]. The most important measures to improve mental health are as follows-

iii.
Mental health screening and proper support and Psychotherapy via video-conference.

iv.
Regular monitoring of depression, anxiety, posttraumatic stress symptoms, psychotic symptoms and suicidal thoughts.

v.
Ensuring the delivery of essential services hassle-free for the elderly, disabled and those quarantined.

Conclusion
The pandemic of COVID-19 is a threat to the mental wellbeing of most and is a suicidal risk for some. This is a high time to make suicide prevention a major public health concern. There is an urgent need for mental health policies to be applied by various organizations depending on epidemic conditions. The Covid-19 induced suicide is preventable and research should be encouraged in these areas.