Invited Commentary: Reckoning With the Relationship Between Stressors and Suicide Attempts in a Time of COVID-19

Introversion, Alexithymia, and Hostility: A Path Analysis From Personality to Suicidal Ideation Among University Students

PURPOSE

The aim of the current study was to investigate the relationship between state (i.e., hostility) and trait (i.e., social detachment, alexithymia) psychological constructs associated with suicidal ideation among university students.

METHODS

A group of 190 university students was consecutively recruited in the period between September 2022 and March 2023. After a clinical interview, a series of psychological tests were administered: the Cattell's 16-Personality Factors Questionnaire (16PF), the Toronto Alexithymia Scale (TAS-20), the Symptom Checklist-90-R (SCL-90-R), and the anamnestic form of the Cognitive Behavioral Assessment (CBA2.0), which contains a specific question regarding the suicidal ideation.

RESULTS

The analyses demonstrated that alexithymia fully mediated the relationship between a particular aspect of introversion (social detachment or low warmth) and hostility which, in turn, seemed to be a significant predictor of suicidal ideation.

CONCLUSIONS

The path analysis conducted seemed to highlight the importance of personality traits, such as social detachment and the ability to recognize and express one's internal states, on the mental health of university students in terms of hostility and suicidal ideation. Considering that the reduction of suicide mortality has been prioritized as a global target in the 15-19 age group, identifying the psychological factors associated with it is fundamental.

Correlates of long-COVID-19: the role of demographics, chronic illness, and psychiatric diagnosis in an urban sample

Long-COVID-19 symptoms are an emerging public health issue. This study sought to investigate demographics, chronic illness, and probable psychiatric diagnoses as correlates for long-COVID-19 in an urban adult sample. Self-report Qualtrics surveys were sent to students across City University of New York (CUNY) campuses in New York City in Winter 2021-2022. Binary logistic regressions were used to assess the relation of a range of factors with endorsement of long-COVID-19. Results demonstrated that Latinx participants endorsed higher odds of long-COVID-19, as compared to non-Latinx white participants. Participants who endorsed having a prior chronic illness and those who met the cut-off for probable psychiatric diagnoses all endorsed higher odds of long-COVID-19. Long-COVID-19 may be more likely among specific subpopulations and among persons with other ongoing physical and mental illness.

The impact of the minimum wage on suicide rates in Hong Kong

Increases in minimum wages have been associated with reductions in suicide rates in the United States, but little evidence is available for Asia where social and contextual factors, as well as drivers of suicide, may be different. We investigated the impact of the introduction of the minimum wage in Hong Kong in May 2011 on suicide rates using an interrupted time series design for the period January 2006 to December 2016. We investigated both immediate and gradual changes in monthly suicide rates after the introduction of the minimum wage taking into account secular trends. We conducted stratified analyses by age and gender. In total 9396 suicides were recorded in Hong Kong during the 11-year study period. Introduction of the minimum wage was associated with an immediate decrease of 13.0% in the monthly suicide rate (95% confidence interval (CI) 5.4%-19.9%, P = 0.001). There was an immediate decrease of 15.8% in older working aged (25-64 years) men (95% CI: 4.2%-25.9%, P = 0.009). Point estimates of immediate effect for other subgroups were also in a negative direction, but were not statistically significant. There was no evidence of a gradual effect on suicide rates at the population level or by subgroup other than a small increase in younger working aged men. We estimate that 633 suicides were prevented by the minimum wage legislation for the period from May 2011 to December 2016, the majority in older working aged men. Our results provide new evidence that, similar to findings in Western settings, minimum wages may help to reduce suicide in Asia, particularly for working age men. Our study highlights the importance of examining the health impacts of government economic policy and suggests minimum wages may provide policy makers with an upstream population-based strategy to reduce suicide rates.

Changes in household debt due to COVID-19 and mental health concerns among adults in Ontario, Canada

BACKGROUND

Canadian households experienced unexpected changes in their economic well-being during the COVID-19 pandemic. The extent of the impact of the pandemic on household debt and its effect on health and mental health remains unknown.

AIM

The aim of the study was to examine the associations of change in household debt due to COVID-19 with serious psychological distress (SPD) and general health measures.

METHODS

Data were from the 2020 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The 2020 cycle employed a web-based panel survey of 3,033 adults. The survey included measures of change in household debt due to the COVID-19 pandemic, mental and general health. Odds ratios (OR) were estimated from logistic regression models accounting for sociodemographic factors.

RESULTS

Overall, 17.5% of respondents reported that their household debt increased due to the COVID-19 pandemic. Such an increase in household debt was significantly associated with SPD (OR = 2.92, 95% CI, 2.05-4.16), fair/poor mental health (OR = 2.02, 95% CI, 1.59-2.56), frequent mental distress days (OR = 1.80, 95% CI, 1.31-2.48), fair/poor general health (OR = 1.93, 95% CI, 1.47-2.52), and suicidal ideation (OR = 3.71, 95% CI, 2.41-5.70) after adjusting for potential confounders including education, income and employment.

CONCLUSIONS

Household debt during the COVID-19 pandemic is an important determinant of health. Individuals who reported an increase in household debt due to COVID-19 were more likely to report serious mental health concerns including suicidal ideation. This suggests that debt-related interventions may be needed to alleviate the adverse effects of indebtedness on health.

Long-COVID and comorbid depression and anxiety two years into the COVID-19 pandemic

Long-COVID, or the persistence of COVID-19 symptoms for months after initial infection, has been shown to impact the lives of those affected. The current study sought to investigate the relationships between long-COVID, COVID-19 related stress, depression, anxiety, and comorbid depression and anxiety outcomes. Data were collected in Winter 2021-2022 from a population of adults enrolled in at least one course across multiple City University of New York (CUNY) campuses. Frequencies and chi-square tests were computed to assess for demographics and relationships to probable diagnoses of depression and anxiety, and binary logistic regressions were computed to assess for the odds of probable comorbid depression and anxiety based on demographics, stressors, and long-COVID. Women participants reported higher odds of probable depression outcomes, and stressor levels were significant correlates of probable anxiety outcomes. Women participants, 3.2 [1.5-6.9], as compared to men, lower-SES participants, 2.16 [1.1-4.2], as compared to higher-SES participants, participants with higher COVID-19 related stress levels, 4.8 [2.0-12.0], as compared to those with low levels, and participants with long-COVID, 3.7 [1.9-7.0], as compared to those without, all had higher odds of probable comorbid depression and anxiety. Findings highlight the importance of social location, stress, and long-COVID, in tandem, as correlates of psychological health during the shifting pandemic.

Acute and chronic neuropsychiatric symptoms in novel coronavirus disease 2019 (COVID-19) patients: A qualitative review

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a global pandemic by the World Health Organization (WHO) on March 11th, 2020. It has had unprecedented adverse effects on healthcare systems, economies, and societies globally. SARS-CoV-2 is not only a threat to physical health but has also been shown to have a severe impact on neuropsychiatric health. Many studies and case reports across countries have demonstrated insomnia, depressed mood, anxiety, post-traumatic stress disorder (PTSD), and cognitive change in COVID-19 patients during the acute phase of the infection, as well as in apparently recovered COVID-19 patients. The goal of this narrative review is to synthesize and summarize the emerging literature detailing the neuropsychiatric manifestations of COVID-19 with special emphasis on the long-term implications of COVID-19.

COVID-19 pandemic and mental health problems of adults in United States: mediating roles of cognitive concerns and behavioral changes

OBJECTIVES

We examined the associations of statewide COVID-19 conditions (i.e., state-level case and death rates) with individual-level Generalized Anxiety Disorder (GAD) and Major Depression Disorder (MDD) focusing on the salient mediating roles of individual-level cognitive concerns and behavioral changes.

METHODS

Using a national representative sample of adults in the United States (n = 585,073), we fitted logistic regressions to examine the overall associations between the COVID-19 pandemic and GAD/MDD. We employed a causal mediation analysis with two mediators: cognitive concerns (i.e., concerns on going to the public, loss of income, food insufficiency, housing payment, and the economy) and behavioral changes (i.e., taking fewer trips, avoiding eating-out, more online-purchase, more curbside pick-up, and cancelling doctor's appointments).

RESULTS

We found relationships of statewide COVID-19 cases with GAD (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.05, 1.07) and MDD (OR = 1.08; 95% CI = 1.07, 1.09). The ORs were mediated by cognitive concerns for GAD (OR = 1.02, proportion mediated: 29%) and MDD (OR = 1.01, 17%). Another salient mediator was behavioral changes for GAD (OR = 1.02, 31%) and MDD (OR = 1.01, 15%). Similar associations were found with statewide COVID-19 death.

CONCLUSIONS

Our mediation analyses suggest that cognitive concerns and behavioral changes are important mediators of the relationships between statewide COVID-19 case/death rates and GAD/MDD. COVID-19 pandemic may involve individual-level concerns and behavior changes, and such experiences are likely to affect mental health outcomes. Public health approaches to alleviate adverse mental health consequences should take into account the mediating factors.

Suicide Presentations to an Emergency Department Pre and During the COVID Lockdown, March-May 2020, in Spain

The impact of the COVID-19 pandemic and lockdown may affect suicide risk and behavior. We compared suicide-related presentations during the national quarantine with pre-COVID data. This observational incidence study compared all suicide-related presentations at the University Hospital Reina Sofia emergency department (ED) in Cordoba, Spain, for the lockdown period from 15 March to 15 May 2020, with the same period in 2019. Descriptive and inferential analyses of case characteristics between 2019 and 2020 periods were conducted, and a multivariable logistic regression model developed. Results: Despite a decrease in overall ED cases during the lockdown, the number of suicide-related presentations stayed the same and represented a significantly larger proportion of cases in comparison to the pre-COVID period (0.42 vs. 0.87%, in 2019 and 2020, respectively; p < .001). The number presenting alone more than doubled during the COVID lockdown, increasing to 42.9% compared with 19.4% in 2019 (p = .002). An increase in presentations with a family history of suicide was also found. Conclusions: Suicide cases represented an increased proportion of ED cases during the lockdown. Presenting to ED alone, having a family history of suicide, habitual drug consumption, and hospital admission to ICU differentiated cases between pre and during COVID periods. These findings should be considered in light of the second wave and further implementation of lockdown measures.

Suicidal Behaviours During Covid-19 Pandemic: A Review

Objective

Novel COVID-19 disease has become a major concern worldwide, and a recent line of research warned that the context of the COVID-19 pandemic may be a major risk factor for developing severe suicidal behaviors. A broad systematic review is needed to cover the studies that have already assessed the potential underlying factors for suicidal behaviors in the context of the COVID-19 outbreak.

Method

A total of 52 studies met the inclusion criteria, and data were then described according to the subsequent categories: (1) countries where the studies were carried out; (2) factors impacting suicidal behaviors during the COVID-19 outbreak; and (3) examination of the observed populations.

Results

Findings of the current systematic review suggest that there is a certain amount of heterogeneity in factors impacting suicidal behaviors during the COVID-19 outbreak, with economic downturn, psychiatric vulnerability, isolation and quarantine, health concerns, and relational difficulties being the most prominent reasons for developing suicidal behaviors during the COVID-19 outbreak.

Conclusions

Timely interventions are needed to prevent suicidal behaviors in both the clinical and general populations, and in this regard, the creation of standard procedures may speed up the process.

Suicidal ideation during COVID-19: The contribution of unique and cumulative stressors

The link between large-scale disasters and population-level risk of suicide remains unclear. The present study sought to investigate suicidal ideation (SI) in relation to COVID-19 related stress, including material and social stress, in a predominantly low-SES ethno-racially diverse sample in New York City during a peak in COVID-19 cases in April 2020. Using binary logistic regressions of data collected with self-report surveys, we found that individuals who identified as Asian, as well as those with high total, material, and social stress levels, and persons without access to primary care providers had significantly higher adjusted odds of SI. These results indicate the specific burden faced by Asian participants due to increases in targeted racism, the importance of cumulative stress and specific stressor type, as well as the role of healthcare access on SI during the pandemic. Such findings suggest the need for specific interventions that target individuals who may be at higher risk of suicide after large-scale traumatic events and during the ongoing pandemic.

Factors Associated With Suicide Ideation in Lithuania and Poland Amid the COVID-19 Pandemic

Background: The COVID-19 pandemic had an impact on many risk and protective factors associated with suicide. Aims: The aim of this study was to identify pandemic-related factors associated with suicidal ideation in the two European countries, Lithuania and Poland, amid the COVID-19 pandemic. Method: The sample comprised 2,459 participants in both countries; 57.2% of the respondents were female. The M_age of the participants was 43.45 years (SD = 15.91). Pandemic-related stressors and adjustment problems were measured to assess associations with suicidal ideation. Results: High levels of adjustment problems, loneliness, and burden due to staying at home more during the COVID-19 pandemic were significantly associated with suicide ideation in both Lithuania and Poland. Limitations: This was a cross-sectional online study with different recruitment approaches in the two countries. Conclusion: Adjustment problems, loneliness, and stressors related to staying at home more could be important targets for suicide prevention amid the pandemic.

Coronavirus Disease 2019 (COVID-19) Transmission in the United States Before Versus After Relaxation of Statewide Social Distancing Measures

BACKGROUND

Weeks after issuing social distancing orders to suppress severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission and reduce growth in cases of severe coronavirus disease 2019 (COVID-19), all US states and the District of Columbia partially or fully relaxed these measures.

METHODS

We identified all statewide social distancing measures that were implemented and/or relaxed in the United States between 10 March and 15 July 2020, triangulating data from state government and third-party sources. Using segmented linear regression, we estimated the extent to which relaxation of social distancing affected epidemic control, as indicated by the time-varying, state-specific effective reproduction number (Rt).

RESULTS

In the 8 weeks prior to relaxation, mean Rt declined by 0.012 units per day (95% confidence interval [CI], -.013 to -.012), and 46/51 jurisdictions achieved Rt < 1.0 by the date of relaxation. After relaxation of social distancing, Rt reversed course and began increasing by 0.007 units per day (95% CI, .006-.007), reaching a mean Rt of 1.16. Eight weeks later, the mean Rt was 1.16 and only 9/51 jurisdictions were maintaining an Rt < 1.0. Parallel models showed similar reversals in the growth of COVID-19 cases and deaths. Indicators often used to motivate relaxation at the time of relaxation (eg, test positivity rate <5%) predicted greater postrelaxation epidemic growth.

CONCLUSIONS

We detected an immediate and significant reversal in SARS-CoV-2 epidemic suppression after relaxation of social distancing measures across the United States. Premature relaxation of social distancing measures undermined the country's ability to control the disease burden associated with COVID-19.

Suicidal ideation and thoughts of self-harm during the COVID-19 pandemic: The role of COVID-19-related stress, social isolation, and financial strain

BACKGROUND

There are significant concerns about mental health problems occurring due to the coronavirus disease 2019 (COVID-19) pandemic. To date, there has been limited empirical investigation about thoughts of suicide and self-harm during the COVID-19 pandemic.

METHODS

A national survey was conducted May 2020 to investigate the association between mental health symptoms, social isolation, and financial stressors during the COVID-19 pandemic and thoughts of suicide and self-harm. A total of 6607 US adults completed an online survey; survey criteria included an age minimum of 22 years old and reported annual gross income of $75,000 or below. Statistical raking procedures were conducted to more precisely weight the sample using US Census data on age, geographic region, sex, race, and ethnicity.

RESULTS

COVID-19-related stress symptoms, loneliness, and financial strain were associated with thoughts of suicide/self-harm in multivariable logistic regression analyses, as were younger age, being a military veteran, past homelessness, lifetime severe mental illness, current depressive symptoms, alcohol misuse, and having tested positive for COVID-19. Greater social support was inversely related to thoughts of suicide/self-harm whereas running out of money for basic needs (e.g., food), housing instability (e.g., delaying rent), and filing for unemployment or disability were positively related.

CONCLUSIONS

Public health interventions to decrease risk of suicide and self-harm in the wake of the COVID-19 pandemic should address pandemic-related stress, social isolation, and financial strain experienced including food insecurity, job loss, and risk of eviction/homelessness.

Increasing Cybercrime Since the Pandemic: Concerns for Psychiatry

PURPOSE OF REVIEW

Since the pandemic, the daily activities of many people occur at home. People connect to the Internet for work, school, shopping, entertainment, and doctor visits, including psychiatrists. Concurrently, cybercrime has surged worldwide. This narrative review examines the changing use of technology, societal impacts of the pandemic, how cybercrime is evolving, individual vulnerabilities to cybercrime, and special concerns for those with mental illness.

RECENT FINDINGS

Human factors are a central component of cybersecurity as individual behaviors, personality traits, online activities, and attitudes to technology impact vulnerability. Mental illness may increase vulnerability to cybercrime. The risks of cybercrime should be recognized as victims experience long-term psychological and financial consequences. Patients with mental illness may not be aware of the dangers of cybercrime, of risky online behaviors, or the measures to mitigate risk. Technology provides powerful tools for psychiatry but technology must be used with the appropriate safety measures. Psychiatrists should be aware of the potential aftermath of cybercrime on mental health, and the increased patient risk since the pandemic, including from online mental health services. As a first step to increase patient awareness of cybercrime, psychiatrists should provide a recommended list of trusted sources that educate consumers on cybersecurity.