Suicide attempt risks among hotline callers with and without the coronavirus disease 2019 related psychological distress: a case-control study

The Impact of the COVID-19 Pandemic on Calls to a National Suicide Prevention Hotline in Taiwan: An Analysis of Time Trend and Characteristics of Calls

We investigated the impact of the COVID-19 pandemic on call volumes and call characteristics using data from a national crisis helpline. Data were extracted for 215,066 calls to Taiwan's national suicide prevention hotline (January 2018-May 2020). We used negative binomial regression to investigate changes in the weekly number of calls during the early period of the COVID-19 outbreak (January 21, 2020-May 25, 2020), relative to that expected according to the pre-pandemic trend. The call characteristics during the pandemic period (February 18, 2020-May 31, 2020) were compared between COVID-19 related vs unrelated calls. Higher-than-expected call volumes started from the 6th week of the pandemic and reached a peak in the 14th week, which was 38% (rate ratio = 1.38, 95% confidence interval 1.26-1.51) higher than that expected based on the pre-pandemic trend. The higher-than-expected call volumes were mainly attributable to higher-than-expected calls from non-suicidal and male callers. Calls in which COVID-19 was mentioned (13.2%) were more likely to be from male and first-time callers, occur outside 12 am-6 am, last less than 5 min, and were less likely to be from callers who had previous suicide attempts, recent suicidal ideation or suicide plans or actions than COVID-19 unrelated calls. Callers who made COVID-19 related calls were more likely to request information than other callers. Crisis helplines should strategically adapt to the increased need and callers' specific concerns related to the outbreak.

Reinventing Patient Support and Continuity of Care Using Innovative Physician-staffed Hotline: More than 60,000 Patients Served Across 15 Medical and Surgical Specialties During the First Wave of COVID-19 Lockdown in Qatar

Rising disease prevalence early during the COVID-19 pandemic in the State of Qatar led to stoppage of all non-emergency health care services. To maintain continuity of care and information exchanges for non-emergency patients, a physician-operated telephone hotline was set up that involved triage followed by immediate consultation with a specialized physician. We describe the initiation and evaluate the operations of the Urgent Consultation Centre (UCC) hotline manned by 150 physicians and aimed at urgent non-life-threatening consultations at Hamad Medical Corporation, the public health provider in Qatar. UCC established a hotline to triage inbound patient calls related to 15 medical and surgical specialties. For calls between April-August 2020, we describe call volume, distribution by specialty, outcomes, performance of UCC team, as well as demographics of callers. During the study period, UCC received 60229 calls (average 394 calls/day) from Qatari nationals (38%) and expatriates (62%). Maximum total daily calls peaked at 1670 calls on June 14, 2020. Call volumes were the highest from 9 AM to 2 PM. Response rate varied from 89% to 100%. After an initial telephone triage, calls were most often related to and thus directed to internal medicine (24.61%) and geriatrics (11.97%), while the least percentage of calls were for pain management and oncology/hematology (around 2% for each). By outcome of consultation, repeat prescriptions were provided for 60% of calls, new prescriptions (15%), while referrals were to outpatient department (17%), emergency department/pediatric emergency center (5%), and primary health care centres (3%). We conclude that during a pandemic, physician-staffed telephone hotline is feasible and can be employed in innovative ways to conserve medical resources, maintain continuity of care, and serve patients requiring urgent care.

Suicide Attempts Assisted By Firefighters According to Traumatic Brain Injury

Studies worldwide have reported increasing trends in suicides and attempts during the pandemic. The literature shows that improving surveillance and monitoring of suicide and attempts requires broad multisectoral prevention strategies. In Brazil, the São Paulo State Fire Department (CBPMESP) makes up the emergency response team for suicide and suicide attempted calls and public emergencies. Given this context, this paper sought to describe the characteristics of suicide attempts assisted by the CBPMESP according to traumatic brain injury (TBI), between 2018 and 2020, measured by the Glasgow Coma Scale (GCS). For this purpose, a descriptive study of 6,582 suicide attempts attended by CBPMESP was carried out. The factors associated with trauma brain injury according to the Glasgow Coma Scale (dependent variable) were analyzed by a multinomial regression model. Results show a significant increase of 8.0% (p = 0.039) in the number of calls responded by CBPMESP between 2018 and 2020. Men presented a higher prevalence of more violent methods for suicide attempts, namely firearms and hanging, followed by severe TBI; in women, severe TBI occurred mostly by hanging. Despite the increase in fatal suicide attempts during the pandemic, time to attend to victim acted as a protective factor for preventing severe TBI in men and women.

Understanding cultural factors in mental health during the COVID-19 pandemic: when collectivism meets a tight culture

The long-standing pathogen prevalence hypothesis suggests that collectivism can protect from epidemics and pandemics in terms of psychological well-being. However, studies exploring the protective mechanism induced when collectivism meets cultural tightness (the strength of social norms and tolerance for deviant behavior) are few. Therefore, this study aimed to investigate the protective effect of collectivism in detail considering loose and tight cultural contexts. The sample comprised 2001 Chinese participants (M age  = 18.41 ± 2.388 years; 50.2% female). Moderated regression analyses indicated that more perceived risk of COVID-19 predicted severe mental health responses (i.e., depression and anxiety), collectivism moderated this positive relationship but individualism did not. Notably, the protective effect of collectivism is especially evident in tight cultures but ineffective in loose cultures. This study emphasized that the protective effects of collectivism on mental health during a pandemic should be considered within the framework of cultural tightness. This study's findings may advance knowledge about the relationship between cultural type and mental health during epidemics.

Suicide and self-harm in low- and middle- income countries during the COVID-19 pandemic: A systematic review

There is widespread concern over the potential impact of the COVID-19 pandemic on suicide and self-harm globally, particularly in low- and middle-income countries (LMIC) where the burden of these behaviours is greatest. We synthesised the evidence from the published literature on the impact of the pandemic on suicide and self-harm in LMIC. This review is nested within a living systematic review (PROSPERO ID CRD42020183326) that continuously identifies published evidence (all languages) through a comprehensive automated search of multiple databases (PubMed; Scopus; medRxiv, PsyArXiv; SocArXiv; bioRxiv; the WHO COVID-19 database; and the COVID-19 Open Research Dataset by Semantic Scholar (up to 11/2020), including data from Microsoft Academic, Elsevier, arXiv and PubMed Central.) All articles identified by the 4th August 2021 were screened. Papers reporting on data from a LMIC and presenting evidence on the impact of the pandemic on suicide or self-harm were included. Methodological quality was assessed using an appropriate tool, and a narrative synthesis presented. A total of 22 studies from LMIC were identified representing data from 12 countries. There was an absence of data from Africa, the Pacific, and the Caribbean. The reviewed studies mostly report on the early months of COVID-19 and were generally methodologically poor. Few studies directly assessed the impact of the pandemic. The most robust evidence, from time-series studies, indicate either a reduction or no change in suicide and self-harm behaviour. As LMIC continue to experience repeated waves of the virus and increased associated mortality, against a backdrop of vaccine inaccessibility and limited welfare support, continued efforts are needed to track the indirect impact of the pandemic on suicide and self-harm in these countries.