Table 3 Suicide and Covid-19 in subjects with pre-existing mental disorder, cross-sectional studies patients’ sample

Liu et al. 2022

Prevalence of Suicidality and its Association with Quality of Life in Older Patients with Clinically Stable Psychiatric Disorders in China During the COVID-19 Pandemic

China

1063 patients

Clinically stable psychiatric patients. Patients with major depressive disorder were 485 (45.6%); patients with Bipolar disorder were 43 (4%);

patients with

Schizophrenia were 73 (6.9%)

Mean age of the sample: 62.80 years; 347 male (32.6%)

To examine the prevalence of suicidality and its association with quality of life (QOL) among older clinically stable patients with psychiatric disorders during the COVID-19 pandemic

Suicidality during the COVID-19 outbreak was evaluated by 3 “yes” or “no” standardized questions, including (1) suicidal ideation, (2) suicide plan and (3) suicide attempt. Patients who responded “yes” to any of the 3 questions considered “having suicidality.”

Multicenter, cross-sectional study

From May 22 to July 15, 2020

The prevalence of suicidality was 11.8% during the COVID-19 pandemic. Suicidality was common in older patients with clinically stable psychiatric disorders during the COVID-19 pandemic. Of the patients with suicidality, major depressive disorder was the most common psychiatric diagnosis

Kang

et al. 2021

Changes in the pattern of suicide attempters visiting the emergency room after COVID-19 pandemic: an observational cross-sectional study

Busan University Hospital,

South Korea

879 Emergency department patients records

Busan University Hospital emergency room medical records. Patients with previous psychiatric history were 163 (40.8%) in the Pre-pandemic group and

381 (86.6%) in the Pandemic group

Mean age of the sample:

40.68 years

Pre-pandemic group,

40.90 years Pandemic group; Female were 250 (62.5%) in the Pre-pandemic group,

283 (64.30%) in the Pandemic group

To find out the change in the rate and pattern of suicide attempts during severe acute respiratory syndrome in COVID-19 pandemic period

Data collection including, history of mental illness; and suicide attempt, suicide method, and location (i.e., at home or a place other than home) at the time of attempt, and whether the attempt was a mass suicide. Severity of suicide attempt was assessed trough the South Korean triage and acuity scale (KTAS)

Retrospective, Cross-sectional study

Pre-pandemic (January 19 to October 31, 2019) and during pandemic (January 19 to October 31, 2020)

The number of patients who had a history of psychiatric treatment was 163 (40.8%) during the “pre-COVID-19 period” and 381 (86.6%) during the “COVID-19 period”. The increase in the number of patients with a history of psychiatric treatment due to suicide attempts can be interpreted as a result of increased anxiety and depression caused by the lack of mental health treatment. Severity of patients who visited the emergency room following a suicide attempt was higher during the “COVID-19 period”

Grossman

et al. 2021

Trends in suicidal ideation in an emergency department during COVID-19

Academic medical center in Boston, Massachusetts,

USA

339 emergency department patients in the

“comparison series” and 216 emergency department patients in the “COVID-19 series”

Patients presenting with suicidal ideation to a consult liaison service. During December 2018 – February 2019 (comparison pre-period series)

% with any psychotic disorder were 7.1%,

% with any affective disorder were 39.1%,

% with substance use disorder were 50.0%

During December 2019 – February 2020 (COVID-19 pre-period series)

% with any psychotic disorder were 3.2%,

% with any affective disorder were 45.5%,

% with substance use disorder were 48.4%

Mean age of the sample:

36 years in the

“comparison series”,

38 years in the “COVID-19 series”;

female 42.2 (2.9%) in the “comparison series”,

37.2 years (2.9%) in the “COVID-19 series”

To detail changes in presentations at a United States Emergency Department for suicidality before and after the outbreak of COVID-19

Data on suicidality characteristics pulled from notes in the record, regarding patients presenting with suicidality in the emergency department, and received emergency psychiatric consultation

Retrospective, Cross-sectional study

Between December 2018 – May 2019 and December 2019 – May 2020

Pre-period differences did show a lower proportion of presentations for suicidality among people with any psychotic disorder in the COVID-19 pre-period cohort relative to the comparator cohort. Patients visits in the COVID-19 post-period were less likely to be attributed to psychiatric symptoms as a reason for suicidality compared to visits in the comparator post-period (70.5% vs. 50.0%; p-value < 0.001). Conversely, there were also differential increases in the proportion of patients visits to the emergency department with a history of prior suicide attempts in the COVID-19 period relative to the comparison period (13.2 percentage points and 13.0 percentage points, respectively). No significant differences were found between the groups among patients with coexisting psychotic disorder, anxiety disorder, and substance abuse disorder with regard to suicidality presentation in the emergency department during the time considered

Ridout et

al. 2021

Emergency Department Encounters Among Youth with Suicidal Thoughts or Behaviors During the COVID-19 Pandemic

Kaiser Permanente Northern California, USA

2123 youth patients in 2020,

2339 youth patients in 2019

Youth aged 5 to 17 years with suicide-related ED encounters

Age range of the sample: individuals aged 13 to 17 years: 1798 (84.7%) in 2020,

1998 (85.4%) in 2019;

1483 female (69.9%) in 2020, 1542 female (65.9%) in 2019

To characterize population-level and relative change in suicide-related ED encounters among youth during the COVID-19 pandemic compared with 2019

Population-level incidence rate ratios (IRRs) and percent relative effects for suicide-related ED encounters as defined by the US Centers for Disease Control and Prevention recommended (ICD-10-CM)

Retrospective,

Cross-sectional study

Pre-pandemic (January 1, 2019, to December 15, 2019) and during pandemic (January 1, 2020, to December 15, 2020)

Youth with no history of outpatient mental health or suicide encounters and those with comorbid psychiatric conditions documented at the emergency department encounter had a higher risk of presenting with suicide-related problems from September to December 2020 (pandemic) versus the same period in 2019. There was a 6.7% higher risk of having a comorbid psychiatric nonsubstance diagnosis at the time of the suicide-related ED encounter during the fall compared with 2019 levels

Lee et. al 2021

Association of the COVID-19 Pandemic and Low-rescue Suicide Attempts in Patients Visiting the Emergency Department after Attempting Suicide

St. Mary's Hospital, Seoul, South Korea

518 subjects

Patients who made a suicide attempt and visited the emergency department. Subjects with previous psychiatric history were

274 (52.9%)

Mean age of the sample:

38 years;

205 patients (39.6%) were male

To investigate whether the factors affecting the lethality of suicide attempts differed before and during the COVID-19 pandemic using the RRRS in patients who attempted suicide and visited the emergency department

Data on characteristics of the suicide attempt and about the patients from the medical and counseling records. Suicide lethality assessed using the Risk-rescue rating in suicide assessment (RRRS)

Retrospective, Cross-sectional study

From March 2019 to September 2020

Suicide attempts associated with mental disorders were more common in the before COVID-19 group (P < 0.001). COVID-19 pandemic was an independent risk factor for low-rescue suicide attempts. History of previous suicide attempts and previous psychiatric history were not significant independent factors for low-rescue suicide attempts

Berardelli

et. al 2021

The impact of the COVID-19 pandemic on suicide ideation and suicide attempts in a sample of psychiatric inpatients

Sant'Andrea University Hospital, Rome, Italy

632 Psychiatric patients’ clinical records;

315 before the lockdown,

317 during Covid-19 pandemic

Clinical records of psychiatric patients admitted to a public psychiatric clinic. Among the whole sample 22.9% has Bipolar disorder, 13.9% Depressive disorder,

29.4% Schizophrenia and psychoses, 10.4% Personality disorders

Mean age of the sample:

42.25 years;

311 women and 321 men

To see whether the frequency of suicide ideation and suicide attempts differed in psychiatric patients before and during the COVID-19 pandemic and government lockdown restrictions

Suicide attempt investigated at the time of arrival of the patient at the emergency department; suicide ideation investigated according to the definition in the Columbia–Suicide Severity Rating Scale

(C-SSRS)

Retrospective,

Cross-sectional study

Between May 2019 and December 2020

Only suicide attempts, but not suicide ideation, were more frequent in psychiatric patients admitted during the COVID-19 pandemic than before

Mutlu et

al. 2021

Relapse in patients with serious mental disorders during the COVID-19 outbreak: a retrospective chart review from a community mental health center

Community mental health centers Etimesgut, Ankara, Turkey

155 Psychiatric patients

Medical charts of psychiatric patients

131 with schizophrenia/

schizoaffective disorder,

24 with bipolar disorder

Mean age of the sample:

46.6 years;

68% male

To investigate the basic characteristics of patients who experienced relapse during the first trimester (from 10th of March to 10th of June) of the COVID-19 outbreak in Turkey, and to compare main findings with the same period in 2019

Relapse criteria defined including:

new onset of suicidal thoughts or suicide attempt,

non-suicidal self-harm

Retrospective, Cross-sectional study

Pre-pandemic (from 10th of March to 10th of June 2019) and during pandemic (from 10th of March to 10th of June 2020)

The relapse rate of the patients in the first trimester of COVID-19 outbreak was 11% (2 bipolar disorder, 15 schizophrenia). 2 had new onset of suicidal thoughts/suicide attempt, and 3 showed self-harm or violent behavior. The relapse rate of the sample in 2019 was 6.5% (1 bipolar disorder, 9 schizophrenia or schizoaffective disorder), and did not differ from the first trimester of COVID-19

Seifert

et al. 2021

Peripandemic psychiatric emergencies: impact of the COVID-19 pandemic on patients according to diagnostic subgroup

Hannover Medical School, Hannover, Germany

750

374 in 2020; 476 in 2019

Patients presenting in the psychiatric emergency department

In 2020, substance use disorders were 114 (30.5%); schizophrenia, schizotypal, and delusional disorders were 70 (18.7%);

affective disorders were 57 (15.2%);

neurotic, stress-related, and somatoform disorders were 70 (18.7%);

personality and behavioral disorders were 46 (12.3%); others were 17 (4.5%)

In 2019, substance use disorders were 138 (29.0%);

schizophrenia, schizotypal, and delusional disorders were 92 (19.3%);

affective disorders were 106 (22.2%);

neurotic, stress-related, and somatoform disorders were 76 (16%);

personality and behavioral disorders were 37 (7.8%); others were 27 (5.7%)

Mean age of the sample:

43.4 years in 2020,

44.48 years in 2019;

147 females (39.3%) in 2020, 228 females (47.9%) in 2019

To detect the impact of the COVID-19-pandemic on patients within different psychiatric diagnostic subgroups presenting in the psychiatric emergency department

Psychopathological assessment (PPA) according to the “Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie” (AMDP)-System (including suicidality)

Retrospective, Cross-sectional study

Between March 16th and May 24th 2020;

Between March 16th and May 24th 2019

The rate of patients stating suicidal ideation (32.9 vs. 29.6%) and intent (12.3 vs. 9.9%) remained stable between 2019 and 2020

Suicidal ideation stated significantly more often by patients with substance use disorders in 2020 than in 2019. Patients with schizophrenia presenting during the COVID-19 pandemic did not differ in suicidal ideation/intent. Patients stating an association with COVID-19 were nearly three times more likely to have attempted suicide prior to presentation in the psychiatric emergency department compared to the overall rate of suicide attempts leading to presentation in the psychiatric emergency department

Montalbani et al. 2021

The COVID-19 Outbreak and Subjects with Mental Disorders Who Presented to an Italian Psychiatric Emergency Department

Sant'Andrea University Hospital, Rome,

Italy

371 Records for 213

Patients

Patients with psychiatric

disorders who presented for psychiatric counseling

57 had major depressive disorder, 36 bipolar disorder, 56 had generalized

anxiety disorder,

and 27 patients had schizophrenia and other psychotic disorders

9 had a full-blown personality disorder, and the remaining had other diagnoses

Mean age of the sample:

42.9 years,

Range 18–86;

Men 97

To assess the socio-demographic and clinical features of patients who required a psychiatric consultation in the emergency department of an Italian hospital during the COVID-19 outbreak

Suicide risk assessed with the Columbia Suicide Severity

Rating Scale

(C-SSRS)

Retrospective, Cross-sectional study

Between January

1 and May 3, 2020

Before lockdown measures until the 11^th of March compared with after lockdown measures, thus after the 11^th of March

Patients who presented during the lockdown showed greater active suicidal ideation in terms of intentionality and planning. People with mental issue may have experienced an increase in symptoms during pandemic

Jefsen

et al. 2021

COVID‐19‐related self‐harm and suicidality among individuals with mental disorders

Psychiatric services of the Central Denmark Region, Denmark

102 Clinical notes from 74 Psychiatric patients

Clinical notes from the adult psychiatric services. Regarding diagnosis:

12 have

Schizophrenia and other psychotic disorders,

10 have

Mood disorders,

13 have Stress‐related and adjustment disorders,

14 have

Personality disorders, 5 have Autism,

15 Other diagnosis

Mean age of the sample: 29.8 years;

77% were females

Deeper thorough characterization of suicide behavior, detection, and care of patients with pandemic‐related psychopathology

Clinical notes divided according to diagnosis and divided into five different categories according to suicide behavior:

1—thoughts of self‐harm,

2—completed self‐harm, 3—passive wish to die of COVID-19,

4—suicidal thoughts,

5—suicide attempts

Retrospective, Cross-sectional study

From February 1st to March 23rd 2020

There is known ‘high risk’ groups for self‐harm and suicidality composed by: psychotic disorders, mood disorders, stress‐related and adjustment disorders, and personality disorders, which appear to respond to the stress associated with the COVID‐19 pandemic with these symptoms/behaviors. COVID‐19 crisis led to increased self‐harm/suicidality in individuals with mental disorders

Menculini

et al. 2021

Suicidality and COVID-19: Data from an Emergency Setting in Italy

General Hospital of Perugia, Perugia, Italy

447 patients

Patients requiring psychiatric consultations carried out at the emergency department

109 subjects were assessed for suicidality. Regarding diagnosis:

23 had affective disorders (21,1%), 15 schizophrenia spectrum disorders (13,8%),

8 anxiety disorders (7,3%),

6 adjustment disorders (5,5%),

9 substance-related and addictive disorders (8,3%),

1 trauma-related disorders (0,9%),

2 obsessive–compulsive and

related disorders (1,8%),

24 personality disorders

(22%)

Mean age of the sample:

42.44 years, 45.42 years for suicide attempt (SA),

43.28 years for suicide ideation (SI),

39.29 years for non-suicidal self-injury (NSSI); subjects included were mainly females 63 (57.8%)

To analyze the prevalence of suicidality-related phenomena during the COVID-19 pandemic

among people requiring a psychiatric consultation in

an emergency setting

For suicidality, data concerning

suicide attempt (SA),

suicide ideation (SI),

and non-suicidal self-injury (NSSI) were registered

Retrospective, Cross-sectional study

From June 1st, 2020 to January 31st, 2021

A statistically significant association was detected between suicidality-related phenomena and adjustment disorders (p = 0.018). More than one-third of the sample did not report previous psychiatric history. This suggests that a percentage of cases was related to the new onset of suicidality, which is contrasting with previous findings that demonstrated how suicide-related phenomena mainly emerge in subjects affected by serious psychiatric disorders

Almaghrebi et al. 2021

Risk factors for attempting suicide during the COVID-19 lockdown: Identification of the high-risk groups

King Saud Medical City (KSMC), Riyadh, Saudi Arabia

29 suicide patients

Patients aged ≥ 16 years who survived the suicide attempts admitted to King Saud Medical City

24.1% of the suicide attempters have a history of using alcohol or drugs (7),

31% have psychosis or loss of rational thinking (9),

72.4% have Depression or hopelessness (21),

69% have previous suicide attempt or psychiatric care (20)

Age range of the sample:

 < 19 or > 45 years: 13 (44.8%),

19–45 years 16 (55.2%);

Male 10 (34.5%)

Female 19 (65.5%)

To identify the suicide-related risk factors and stressors and to determine the groups at a greater risk of attempting suicide during the COVID-19 lockdown

Modified SAD PERSONS scale (MSPS) to evaluate the suicide risk factors

Retrospective,

Cross-sectional study

From April to June, 2020

Patients with psychiatric disorders accounted for 69% of the cohort. Factors like hopelessness and depression were highly related to suicide attempts, as well as the statement of future intent to repeat the attempt, at 72.4% and 65.5%, respectively. Patients with pre-existing psychiatric disorders carry high risk of attempting suicide during the COVID-19 lockdown