If Suicides Were COVID-19... or Why We Still Overlook a Significant Cause of Premature Deaths?

Potential Years of Life Lost

Data from the United States reports officially 550,000 deaths from COVID-19 by the end of March 2021. For comparison − deaths due to suicides were reported at 47,000 for the year 2018. The American Centers for Disease Control and Prevention (CDC) estimated in January that COVID-19 led to 1,591,488 potential years of life lost, while suicides in 2018 resulted in 1,344,552 potential years of life lost.

To explain − potential years of life lost is a metric indicating the total years lost due to premature deaths, calculated as the sum of deaths at each age multiplied by the difference between a set age threshold (usually set at 60−85 years) and the actual age at death. All who die before reaching the set age threshold are considered to have died prematurely.

Viral and Suicidal Epidemics − Context and Parallels

To understand the social impact of these two issues, we must consider the age at which they occur. By the date of analysis, most COVID-19 victims in the USA were over 85 years old and often had other comorbidities, mainly respiratory diseases. In comparison, suicides are the second most common cause of death in the 15−29 age group and up to 90% of victims have a history of psychiatric illness, most commonly depression. Both COVID-19 and suicidal behavior are significant public health issues. COVID-19 has rightly garnered unprecedented attention from healthcare, biomedical research, and media, yet the issue of suicidal behavior remains neglected. COVID-19 is undoubtedly one of the greatest health challenges we have ever faced, but the issue of suicides requires persistent and long-term attention. Over recent decades, this issue has been so neglected that the number of suicides in the USA increased by 35% between 1999 and 2018.

It is common for physical health care to absorb more clinical and research resources than mental health care. This difference in resource allocation is particularly evident in the context of the COVID-19 pandemic. Additionally, increased social isolation and the economic consequences of the pandemic have limited or disrupted mental healthcare and face-to-face expert consultations. While preventive anti-pandemic measures are justified given the severity of the situation and the risk of mass infection, it is necessary to minimize their impact on other areas of healthcare.

Just as we await with hope the results of COVID-19 vaccination and the overall management of the pandemic, it is necessary to seek and implement similarly effective preventive measures for suicide prevention. Specific measures implemented in Denmark, such as restrictions on access to lethal means and specialized clinical programs, have significantly reduced suicide attempts: from 38 attempts per 100,000 people in 1980 to 11.4 per 100,000 people in 2007.

Conclusion

The difference in resources allocated for battling COVID-19 and for suicide prevention demonstrates a discrepancy in the approach to physical and mental health. At the end of the 20th century, HIV infection was one of the largest causes of lost potential years of life in the USA. However, due to advances in antiretroviral therapy, today the life expectancy of HIV patients is nearly identical to the rest of the population. This improvement is evidence that if the healthcare system focuses on addressing a specific health issue, mortality from that cause can dramatically decline. So it is only a question of when society’s attention will turn to resolving the issue of suicidal behavior.

(saz)

Sources:
1. Porras-Segovia A., Baca-García E., Courtet P. et al. If suicide were COVID-19: a neglected cause of premature death. J Clin Psychiatry 2021; 82 (2): 20l13702, 10.4088/JCP.20l13702.
2. Coronavirus Resource Center. Johns Hopkins University, 2021. Available at: https://coronavirus.jhu.edu/map.html