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Spreco A, Dahlström Ö, Nordvall D, Fagerström C, Blomqvist E, Gustafsson F, Andersson C, Sjödahl R, Eriksson O, Hinkula J, Schön T, Timpka T. Integrated Surveillance of Disparities in Vaccination Coverage and Morbidity during the COVID-19 Pandemic: A Cohort Study in Southeast Sweden. Vaccines (Basel) 2024; 12:763. [PMID: 39066401 PMCID: PMC11281347 DOI: 10.3390/vaccines12070763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
We aimed to use the digital platform maintained by the local health service providers in Southeast Sweden for integrated monitoring of disparities in vaccination and morbidity during the COVID-19 pandemic. The monitoring was performed in the adult population of two counties (n = 657,926) between 1 February 2020 and 15 February 2022. The disparities monitored were relocated (internationally displaced), substance users, and suffering from a psychotic disorder. The outcomes monitored were COVID-19 vaccination, SARS-CoV-2 test results, and hospitalization with COVID-19. Relocated residents displayed an increased likelihood of remaining unvaccinated and a decreased likelihood of testing as well as increased risks of primary SARS-CoV-2 infection and hospitalization compared with the general population. Suffering from a major psychiatric disease was associated with an increased risk of remaining unvaccinated and an increased risk of hospitalization but a decreased risk of SARS-CoV-2 infection. From the digital monitoring, we concluded that the relocated minority received insufficient protection during the pandemic, suggesting the necessity for comprehensive promotion of overall social integration. Persons with major psychiatric diseases underused vaccination, while they benefitted from proactively provided testing, implying a need for active encouragement of vaccination. Further research is warranted on legal and ethical frameworks for digital monitoring in vaccination programs.
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Affiliation(s)
- Armin Spreco
- Department of Health, Medicine, and Caring Sciences, Linköping University, 58183 Linköping, Sweden; (A.S.); (D.N.); (C.A.)
- Regional Executive Office, Region Östergötland, 58225 Linköping, Sweden;
| | - Örjan Dahlström
- Department of Behavioral Sciences and Learning, Linköping University, 58183 Linköping, Sweden;
| | - Dennis Nordvall
- Department of Health, Medicine, and Caring Sciences, Linköping University, 58183 Linköping, Sweden; (A.S.); (D.N.); (C.A.)
- Qulturum Development Department, Region Jönköping County, 55305 Jönköping, Sweden;
| | | | - Eva Blomqvist
- Department of Computer and Information Science, Linköping University, 58183 Linköping, Sweden;
| | - Fredrik Gustafsson
- Department of Electrical Engineering, Linköping University, 58183 Linköping, Sweden;
| | - Christer Andersson
- Department of Health, Medicine, and Caring Sciences, Linköping University, 58183 Linköping, Sweden; (A.S.); (D.N.); (C.A.)
- Regional Executive Office, Region Östergötland, 58225 Linköping, Sweden;
| | - Rune Sjödahl
- Regional Executive Office, Region Östergötland, 58225 Linköping, Sweden;
- Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden; (J.H.); (T.S.)
| | - Olle Eriksson
- Qulturum Development Department, Region Jönköping County, 55305 Jönköping, Sweden;
| | - Jorma Hinkula
- Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden; (J.H.); (T.S.)
| | - Thomas Schön
- Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden; (J.H.); (T.S.)
- Department of Infectious Diseases, County of Östergötland and Kalmar, Linköping University, 58183 Linköping, Sweden
| | - Toomas Timpka
- Department of Health, Medicine, and Caring Sciences, Linköping University, 58183 Linköping, Sweden; (A.S.); (D.N.); (C.A.)
- Regional Executive Office, Region Östergötland, 58225 Linköping, Sweden;
- Department of Computer and Information Science, Linköping University, 58183 Linköping, Sweden;
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Pirkis J, Gunnell D, Shin S, Del Pozo-Banos M, Arya V, Aguilar PA, Appleby L, Arafat SMY, Arensman E, Ayuso-Mateos JL, Balhara YPS, Bantjes J, Baran A, Behera C, Bertolote J, Borges G, Bray M, Brečić P, Caine E, Calati R, Carli V, Castelpietra G, Chan LF, Chang SS, Colchester D, Coss-Guzmán M, Crompton D, Ćurković M, Dandona R, De Jaegere E, De Leo D, Deisenhammer EA, Dwyer J, Erlangsen A, Faust JS, Fornaro M, Fortune S, Garrett A, Gentile G, Gerstner R, Gilissen R, Gould M, Gupta SK, Hawton K, Holz F, Kamenshchikov I, Kapur N, Kasal A, Khan M, Kirtley OJ, Knipe D, Kõlves K, Kölzer SC, Krivda H, Leske S, Madeddu F, Marshall A, Memon A, Mittendorfer-Rutz E, Nestadt P, Neznanov N, Niederkrotenthaler T, Nielsen E, Nordentoft M, Oberlerchner H, O'Connor RC, Papsdorf R, Partonen T, Phillips MR, Platt S, Portzky G, Psota G, Qin P, Radeloff D, Reif A, Reif-Leonhard C, Rezaeian M, Román-Vázquez N, Roskar S, Rozanov V, Sara G, Scavacini K, Schneider B, Semenova N, Sinyor M, Tambuzzi S, Townsend E, Ueda M, Wasserman D, Webb RT, Winkler P, Yip PS, Zalsman G, Zoja R, John A, Spittal MJ. Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries. EClinicalMedicine 2022; 51:101573. [PMID: 35935344 PMCID: PMC9344880 DOI: 10.1016/j.eclinm.2022.101573] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 01/02/2023] Open
Abstract
Background Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. Funding None.
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Affiliation(s)
- Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - David Gunnell
- National Institute of Health and care Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, United Kingdom
| | - Sangsoo Shin
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Vikas Arya
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health, University of Manchester, Manchester, United Kingdom
| | - S. M. Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Dhaka, Bangladesh
| | - Ella Arensman
- School of Public Health, National Suicide Research Foundation, University College Cork, Cork, Ireland
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Jose Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid, Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Yatan Pal Singh Balhara
- National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Jason Bantjes
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Anna Baran
- Working Group on Prevention of Suicide and Depression at Public Health Council, Ministry of Health, Warsaw, Poland
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Psychiatry, Blekinge Hospital, Karlshamn, Sweden
| | - Chittaranjan Behera
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - Jose Bertolote
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | - Guilherme Borges
- Department of Global Mental Health, Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Michael Bray
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Petrana Brečić
- Department for Psychiatry, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia
| | - Eric Caine
- University of Rochester Medical Center, Rochester, NY, United States
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
- Department of Psychiatry, Nimes University Hospital, Nimes, France
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Giulio Castelpietra
- Region Friuli Venezia Giulia, Central Health Directorate, Outpatient and Inpatient Care Service, Trieste, Italy
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Maria Coss-Guzmán
- Puerto Rico Department of Health's Commission on Suicide Prevention, San Juan, Puerto Rico
| | - David Crompton
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Marko Ćurković
- Department for Medical Ethics, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia
| | - Rakhi Dandona
- Public Health Foundation of India, Gurugram, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States
| | - Eva De Jaegere
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
| | | | - Eberhard A. Deisenhammer
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology; University Hospital for Psychiatry 2, Medical University of Innsbruck, Innsbruck, Austria
| | - Jeremy Dwyer
- Coroners Court of Victoria, Melbourne, Australia
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Centre for Mental Health, Copenhagen, Denmark
- Centre for Mental Health Research, Australian National University, Canberra, Australia
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jeremy S. Faust
- Brigham and Women's Hospital Department of Emergency Medicine, Harvard Medical School, Boston, United States
| | - Michele Fornaro
- Department of Psychiatry, Neuroscience Institute, Federico II University of Naples, Naples, Italy
| | - Sarah Fortune
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Andrew Garrett
- Coronial Division, Tasmanian Magistrates Court, Hobart, Australia
| | - Guendalina Gentile
- Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Rebekka Gerstner
- Undersecretary of Health Services, Ministry of Public Health, Quito, Ecuador
- Monitoring and Evaluation, German Institute for Medical Mission, Tübingen, Germany
| | - Renske Gilissen
- 113 Suicide Prevention, Research Department, Amsterdam, the Netherlands
| | - Madelyn Gould
- Departments of Psychiatry and Epidemiology, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, United States
| | - Sudhir Kumar Gupta
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Franziska Holz
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Iurii Kamenshchikov
- Udmurtia Republican Clinical Psychiatric Hospital, Izhevsk, Russian Federation
| | - Navneet Kapur
- Centre for Mental Health and Safety and National Institute for Health Research (NIHR) Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Alexandr Kasal
- National Institute of Mental Health, Klecany, Czechia
- Faculty of Social Sciences, Charles University, Prague, Czechia
| | - Murad Khan
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | | | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Sarah C. Kölzer
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Hryhorii Krivda
- Department of Forensic Medicine, Odessa National Medical University, Odessa, Ukraine
| | - Stuart Leske
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Fabio Madeddu
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Andrew Marshall
- Brigham and Women's Hospital, Harvard Medical School, MA, United States
| | - Anjum Memon
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Paul Nestadt
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nikolay Neznanov
- Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Thomas Niederkrotenthaler
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Emma Nielsen
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Herwig Oberlerchner
- Department of Psychiatry and Psychotherapy; Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Rory C. O'Connor
- Suicidal Behaviour Research Lab, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Rainer Papsdorf
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | - Timo Partonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Michael R. Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Departments of Psychiatry and Epidemiology, Columbia University, New York, United States
| | - Steve Platt
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Gwendolyn Portzky
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Georg Psota
- Psychosocial Services in Vienna, Vienna, Austria
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Daniel Radeloff
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Christine Reif-Leonhard
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Mohsen Rezaeian
- Department of Epidemiology and Biostatistics, Occupational Environment Research Center, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Nayda Román-Vázquez
- Puerto Rico Department of Health's Commission on Suicide Prevention, San Juan, Puerto Rico
| | - Saska Roskar
- National Institute of Public Health, Ljubljana, Slovenia
| | - Vsevolod Rozanov
- Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
- Saint Petersburg State University, Saint Petersburg, Russian Federation
| | - Grant Sara
- System Information and Analytics Branch, NSW Ministry of Health, Sydney, Australia
| | | | - Barbara Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
- LVR Klinik Köln, Department of Addictive Disorders, Psychiatry and Psychotherapy, Cologne, Germany
| | - Natalia Semenova
- Organizational-Scientific Department, Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Stefano Tambuzzi
- Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Michiko Ueda
- Waseda University, Faculty of Political Science and Economics, Tokyo, Japan
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Roger T. Webb
- Centre for Mental Health and Safety and National Institute for Health Research (NIHR) Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Petr Winkler
- National Institute of Mental Health, Klecany, Czechia
| | - Paul S.F. Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Gil Zalsman
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Riccardo Zoja
- Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ann John
- Swansea University Medical School, Swansea, United Kingdom
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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