Suicide, Stigma and COVID-19: A Call for Action From Low and Middle Income Countries

Factors associated with suicidal ideation among medical residents in Tehran during the COVID-19 pandemic: A multicentric cross-sectional survey

BACKGROUND

The mental health of medical residents, challenged by their intensive training, is of utmost concern. In light of reported suicides among Iranian medical residents in 2021, this study investigates the factors behind suicidal ideation among medical residents during the COVID-19 pandemic in Tehran.

METHODS

This study conducted a cross-sectional online survey among medical residents in various specialties in Tehran, Iran, amidst the COVID-19 pandemic. Suicidal ideation was assessed using the Beck Scale for Suicidal Ideation (BSSI), while depression, anxiety, and stress were measured using the DASS-21. It also collected demographic and clinical data from the participants. The data were analyzed using descriptive statistics, the Chi-square test, and multiple linear regression to examine the prevalence and determinants of suicidal ideation among medical residents.

RESULTS

The study enrolled 353 medical residents and found that 34.3% of them had suicidal ideation, with 10.2% indicating a high risk. The study also found high levels of depression, anxiety, and stress among the participants. The variables that significantly predicted suicidal ideation were depression, history of alcohol/substance use, personal history of suicide attempts, history of self-mutilation, family history of suicide attempts, number of shifts in a month, death of close persons because of COVID-19, and income. Depression was the strongest predictor of suicidal ideation.

CONCLUSION

These findings underscore the urgent need for effective interventions and support systems to address the mental health needs of medical residents in Iran. The strategies should prioritize destigmatizing mental health, promoting access to mental health services, fostering a supportive training environment, and enhancing income opportunities.

A structural vulnerability approach to older adult suicides: Trends and potential impacts of the COVID-19 pandemic in Clark County, NV (2017-2021)

The ongoing SARS-CoV-2 (COVID-19) pandemic has affected all aspects of life in the United States and around the world. This is particularly true for marginalized and vulnerable groups who face disproportionate levels of violence and premature death within their communities. While general impacts of the pandemic have been well-studied overall, little has been done to examine the correlation between COVID-19 and the risk of suicide among older adults. Older adults are particularly at risk because they face challenges including ageism, inadequate support systems, unreliable transportation, and frequent social isolation. Medicolegal casework offers a unique vantage of these issues, as it aims to identify manner of death which may be influenced by underlying structural vulnerabilities. The current research draws upon data collected from the Clark County Office of the Coroner/Medical Examiner. A sample of 871 older adults (aged 50+), whose manner of death was deemed a suicide between the years 2017-2021, were included in this analysis. Statistical analyses investigated differences between adults aged 50-64, 65-84, and 85+ years. Results suggest statistically significant changes in mechanism of death between pre-pandemic and pandemic periods, indicating a shift in risk factors related to social isolation and the home environment. Understanding such changes in trends directly affects the interpretation of skeletal data in forensic anthropology and thus, should be taken into consideration when developing structural vulnerability profiles. Furthermore, the inclusion of a structural vulnerability approach in forensic case reports has the potential to provide additional context for deaths by suicide and may help develop policies and procedures for mitigating future risk.

Cross-cultural adaptation of Nepalese literacy and stigma of suicide scales (LOSS-SF-Nep and SOSS-SF-Nep) among Nepalese medical and nursing students

INTRODUCTION

Nepal is a country in South-east Asia with high suicide. There is ongoing trend of emerging research on suicide from Nepal but there is lack of validated scale in measuring literacy or stigma. In the view of poor media reporting and large treatment gap, this study was conducted. All previous validation studies were done in non-Hindu populations.

METHODS

A cross-sectional study was planned where the short forms of Nepalese literacy of suicide scale (LOSS-SF-Nep) and Stigma of Suicide Scale (SOSS-SF-Nep) were validated using standard procedure at a medical college in southern Nepal. Medical and nursing students of all batches were approached offline after successful pretesting. The psychometric properties of the scales were tested, and the statuses of literacy and stigma were assessed. Patient Health Questionnaire-9 and General Anxiety Disorder Scale-7 were used for revealing depression and generalized anxiety.

RESULTS

Three hundred and nineteen Nepalese students participated and most of them were males, belonged to nuclear family, upper-middle socioeconomic status and represented 46 out of 77 districts of Nepal. The mean score of LOSS-SF-Nep was 6.36 ± 1.92 and literacy ranged from 37.9% to 89.7%. The deeper exposure to suicidal patients was associated with better literacy. Factor analysis of SOSS-SF-Nep revealed three subscales: stigmatization, isolation/depression, and normalization/glorification and had acceptable psychometric properties. Gender, occupation of head of the family, region and years of education, using mental health services, and depression were associated with variable literacy or stigma.

CONCLUSION

Literacy and stigma scales were validated in Nepali, and SOSS factor structures were revealed with modified descriptors. The literacy and stigma levels in medical students were calculated for the first time in Nepal and Hindu majority population.

Stigma Experienced by Patients Who Recovered from COVID-19 in Post-Vaccination Period in Thailand; Prevalence and Associated Factors

Purpose

Social stigma related to coronavirus disease-2019 (COVID-19) has been a public concern since its emergence, especially in the patients who are reintegrating into their society. However, the insights into COVID-19 stigmatization after vaccine availability are limited. This study aimed to estimate the prevalence, severity and associated factors of stigma experienced by patients who recovered from COVID-19 and reintegrated into their communities. The insights gained from this study are not only beneficial to COVID-19 but can also be used as a background information in future epidemics.

Patients and Methods

This study consisted of two phases. The first phase involved the translation and validation of the COVID-19-related stigma questionnaire. The second phase was a questionnaire-based cross-sectional survey conducted between January and February 2022, at the Vajira Hospital, Bangkok, Thailand. A series of questionnaires regarding stigma, negative emotions (Depression Anxiety Stress Scale-21), and personal information were administered to COVID-19 patients who were already discharged and returned to their communities from June 2021 to February 28, 2022 (N = 354).

Results

The prevalence of stigma among the patients who recovered from COVID-19 was 57.9%. These were classified as mild (28.2%), moderate (21.5%), and severe (8.2%). Pearson's correlation analysis revealed that longer admissions (r = - 0.151, p = 0.001) and longer duration from discharge (r = - 0.222, p = 0.001) were related to lower stigma. Higher stigma was associated with higher levels of depression (r = 0.528, p <0.001), anxiety (r = 0.506, p <0.001) and stress (r = 0.583, p <0.001).

Conclusion

Social stigma related to COVID-19 in Thailand declined during the post-vaccination period. However, this issue did not disappear, and still took a toll on mental health. Our findings suggested that providing appropriate assessment and help to the patients who recovered from COVID-19 is essential, even in the post-vaccination period.

Can a brief session of the online coronavirus disease 2019 destigmatization program reduce stigma among survivors? A randomized controlled trial

Background

Stigmatization has taken a heavy toll on the mental health and quality of life of the survivors of coronavirus disease 2019 (COVID-19). To address this issue, we proposed a brief, self-directed, reflective, and practical destigmatization intervention. The current study aimed to investigate the efficacy of the online COVID-19 destigmatization program (OCDP) in mitigating stigma among the survivors of COVID-19.

Methods

This study was conducted on 142 survivors of COVID-19 before their discharge from Vajra Hospital from July 2022 to November 2022. The participants were randomly assigned between the intervention group (n = 71), who attended the 40-min OCDP, and the control group (n = 71), who received standard mental health care. The primary outcome was the efficacy of OCDP in reducing stigmatization. A COVID-19 stigma questionnaire was administered to assess stigmatization in the intervention and control groups immediately before and after the program during follow-up on days 7, 14, and 28. The secondary outcome was the efficacy of the program in alleviating negative emotions according to the Depression Anxiety Stress Scale 21 questionnaire.

Results

Compared with the control group, the intervention group had a more prominent reduction in the overall stigma score on day 7 (p = 0.002) and day 14 (p = 0.028). The intervention group had a more evident reduction in enacted stigma (day 7, p = 0.04), internalized stigma (day 7, p = 0.008; day 14, p < 0.028), and perceived external stigma (day 7, p = 0.002) than the control group. However, there was no significant difference in terms of disclosure concern between the intervention and control groups. Furthermore, the reduction in depression, anxiety, and stress between the two groups did not significantly differ.

Conclusion

Online COVID-19 destigmatization program provided prior to hospital discharge is an effective tool in reducing stigmatization, particularly within the first 2 weeks after reintegration into society, among the survivors of COVID-19.

Stigma as a barrier to suicide prevention efforts in Iran

Suicide and suicide attempt affect a considerable part of the general population, and in spite of their prevalence, the stigma associated with suicide remains an unsolved problem surrounding this important public health problem, especially in lower-income countries such as Iran. Evidence shows that help-seeking from formal mental health services for suicidal people is low in countries like Iran. Previous studies on Iranian survivors of suicide attempts have shown that these people experience fear of stigma due to labels such as loss of faith in God, having forms of severe mental illnesses ("madness"), and being involved in unaccepted sexual relationships. The associated stigma prevents them from seeking appropriate health and social services. Although both self-stigma and public stigma contribute to an unwillingness to seek mental health care and suicide prevention efforts in Iran, public stigma may be of greater consequence, significantly impeding an individual's likelihood of accessing care for their suicidal thoughts or attempts. In such circumstances, many people with suicidal thoughts miss out on social and formal support programs offered by social and healthcare providers. In this perspective article, focusing on the public stigma regarding suicide in Iranian society, we address the challenges and barriers to seeking suicide prevention efforts in Iran and discuss culturally appropriate strategies to improve the current situation.

The Cardiff Self-Injury Inventory (English version): Convergent validity and psychometric properties

Background and Aims

The Cardiff Self-Injury Inventory (CSII) is a short (1 min), relatively nonintrusive, measure of previous self-injury behaviors written in English. It measures self-injury with suicidal intent and without such intent, covers actions versus thoughts, and has two time periods (lifetime vs recent [defined as the last 3 months]). The study aimed to examine its psychometric properties and its relationship to more well-established measures.

Methods

A UK community sample of 184 participants completed the CSII and two other measures of self-harming (Deliberate Self-Harm Inventory [DSHI] and Suicidal Behaviors Questionnaire-Revised [SBQ-R]) in March 2020-May 2020. Fifty participants also repeated these measurements 1-2 weeks later.

Results

The CSII showed strong psychometric properties with internal reliability of 0.87 and a test-retest of 0.82. The subscales also showed strong psychometric properties. The CSII showed strong concurrent validity to the other measures of self-injury (SBQ-R, r = 0.70; DSHI, r = 0.81). A factor analysis supported the idea that there are two distinct components to the overall CSII score arising due to the distinction between suicidal and nonsuicidal behaviors.

Conclusion

The CSII has good psychometric properties in this population and can be used as a fast, nonintrusive, measure of different self-injurious behaviors for clinical or research purposes.