Suicide is the act of intentionally causing one's own death.

Mental disorders—including depression, bipolar
disorder, autism, schizophrenia, personality disorders, anxiety disorders, physical
disorders such as chronic fatigue syndrome, and substance abuse—
including alcoholism and the use of and withdrawal from benzodiazepines—are risk
factors.
 Some suicides are impulsive acts due to stress, such as from financial difficulties,
relationship problems such as breakups, or bullying.
Those who have previously attempted suicide are at a higher risk for future attempts
Effective suicide prevention efforts include limiting access to methods of suicide—such
as firearms, drugs, and poisons; treating mental disorders and substance misuse;
careful media reporting about suicide; and improving economic conditions
Even though crisis hotlines are common.
The most commonly used method of suicide varies between countries, and is partly
related to the availability of effective means
 Common methods of suicide include hanging, pesticide poisoning, and
firearms. Suicides resulted in 828,000 global deaths in 2015, an increase from 712,000
deaths in 1990. This makes suicide the 10th leading cause of death worldwide.
Approximately 1.5% of people die by suicide. In a given year this is roughly 12 per
100,000 people.
Rates of completed suicides are generally higher among men than among women,
ranging from 1.5 times as much in the developing world to 3.5 times in the developed
world 
Suicide is generally most common among those over the age of 70; however, in certain
countries, those aged between 15 and 30 are at the highest risk.
 Europe had the highest rates of suicide by region in 2015. There are an estimated 10 to
20 million non-fatal attempted suicides every year. Non-fatal suicide attempts may lead
to injury and long-term disabilities
 In the Western world, attempts are more common among young people and among
females
Views on suicide have been influenced by broad existential themes such as religion,
honor, and the meaning of life.
The Abrahamic religions traditionally consider suicide as an offense towards God, due
to the belief in the sanctity of life.
During the samurai era in Japan, a form of suicide known as seppuku (harakiri) was
respected as a means of making up for failure or as a form of protest.
Sati, a practice outlawed by the British Raj, expected the Indian widow to kill herself on
her husband's funeral fire, either willingly or under pressure from her family and society.
 Suicide and attempted suicide, while previously illegal, are no longer so in most
Western countries.] It remains a criminal offense in some countries. In the 20th and 21st
centuries, suicide has been used on rare occasions as a form of protest,
and kamikaze and suicide bombings have been used as a military or terrorist tactic
 Suicide is often seen as a major catastrophe for families, relatives and other nearby
supporters, and is viewed negatively almost everywhere around the world.
Causes
While the cause of suicide is unknown, some common risk factors include:

 major psychiatric illness - in particular, mood disorders (e.g., depression, bipolar

disorder, schizophrenia)

 substance abuse (primarily alcohol abuse)

 family history of suicide

 long term difficulties with relationships with friends and family

 losing hope or the will to live

 significant losses in a person's life, such as the death of a loved one, loss of an
important relationship, loss of employment or self-esteem

 unbearable emotional or physical pain

 a family history of mental health issues

 a family history of violence

 a feeling of hopelessness

 a feeling of seclusion or loneliness

 being gay with no family or home support

 being in trouble with the law

 being under the influence of alcohol or drugs

 for children, having disciplinary, social or school problems

 having a problem with substance abuse

 having a psychiatric disorder or mental illness

 having attempted suicide before

  being prone to reckless or impulsive behavior

 possessing a gun

 sleep deprivation

 knowing, identifying, or being associated with someone who has committed

suicide

Conditions that are linked to a higher risk of suicidal ideation include:

 adjustment disorder

 anorexia nervosa

 bipolar disorder

 body dysmorphic disorder

 borderline personality disorder

 dissociative identity disorder

 gender dysphoria, or gender identity disorder

 major depressive disorder

 panic disorder

 post-traumatic stress disorder (PTSD)

 schizophrenia

 social anxiety disorder

 generalized anxiety disorder

 substance abuse

 exposure to suicidal behavior in others

Genetic factors may increase the risk of suicidal ideation. Individuals with
suicidal thoughts tend to have a family history of suicide or suicidal thoughts.

Risk factors
A person who is at risk of committing suicide usually shows signs - whether
consciously or unconsciously - that something is wrong. Keep an eye out for:

 signs of clinical depression

 withdrawal from friends and family

 sadness and hopelessness

 lack of interest in previous activities, or in what is going on around them

 physical changes, such as lack of energy, different sleep patterns, change in

weight or appetite

 loss of self-esteem, negative comments about self-worth

 bringing up death or suicide in discussions or in writing

 previous suicide attempts

 Attempted suicide before

 Feel hopeless, worthless, agitated, socially isolated or lonely

 Experience a stressful life event, such as the loss of a loved one, military service,
a breakup, or financial or legal problems

 Have a substance abuse problem — alcohol and drug abuse can worsen
thoughts of suicide and make you feel reckless or impulsive enough to act on
your thoughts

 Have suicidal thoughts and have access to firearms in your home

 Have an underlying psychiatric disorder, such as major depression, post-

traumatic stress disorder or bipolar disorder

 Have a family history of mental disorders, substance abuse, suicide, or violence,

including physical or sexual abuse
  Have a medical condition that can be linked to depression and suicidal thinking,
such as chronic disease, chronic pain or terminal illness

 Are lesbian, gay, bisexual or transgender with an unsupportive family or in a

hostile environment


Symptoms

Suicide warning signs or suicidal thoughts include:

 Talking about suicide — for example, making statements such as "I'm going to
kill myself," "I wish I were dead" or "I wish I hadn't been born"

 Getting the means to take your own life, such as buying a gun or stockpiling pills

 Withdrawing from social contact and wanting to be left alone

 Having mood swings, such as being emotionally high one day and deeply
discouraged the next

 Being preoccupied with death, dying or violence

 Feeling trapped or hopeless about a situation

 Increasing use of alcohol or drugs

 Changing normal routine, including eating or sleeping patterns

 Doing risky or self-destructive things, such as using drugs or driving recklessly

 Giving away belongings or getting affairs in order when there's no other logical
explanation for doing this

 Saying goodbye to people as if they won't be seen again

 Developing personality changes or being severely anxious or agitated

 getting personal affairs in order, such as giving away possessions, or having a
pressing interest in personal wills or life insurance

 Causes of suicidal thoughts can include depression, anxiety, eating disorders

such as anorexia, and substance abuse.
 People with a family history of mental illness are more likely to have suicidal
thoughts.

 feeling or appearing to feel trapped or hopeless

 feeling intolerable emotional pain

 having or appearing to have an abnormal preoccupation with violence, dying, or

death

 having mood swings, either happy or sad

 talking about revenge, guilt, or shame

 being agitated, or in a heightened state of anxiety

 experiencing changes in personality, routine, or sleeping patterns

 consuming drugs or more alcohol than usual, or starting drinking when they had
not previously done so

 engaging in risky behavior, such as driving carelessly or taking drugs

 getting their affairs in order and giving things away

 getting hold of a gun, medications, or substances that could end a life

 experiencing depression, panic attacks, impaired concentration

 increased isolation

 talking about being a burden to others

 psychomotor agitation, such as pacing around a room, wringing one’s hands, and
removing items of clothing and putting them back on

 saying goodbye to others as if it were the last time

 seeming to be unable to experience pleasurable emotions from normally

pleasurable life events such as eating, exercise, social interaction, or sex

 severe remorse and self criticism

 talking about suicide or dying, expressing regret about being alive or ever having
been born
Children and teenagers

Suicide in children and teenagers can follow stressful life events. What a young person
sees as serious and insurmountable may seem minor to an adult — such as problems
in school or the loss of a friendship. In some cases, a child or teen may feel suicidal due
to certain life circumstances that he or she may not want to talk about, such as:

 Having a psychiatric disorder, including depression

 Loss or conflict with close friends or family members

 History of physical or sexual abuse

 Problems with alcohol or drugs

 Physical or medical issues, for example, becoming pregnant or having a sexually

transmitted infection

 Being the victim of bullying

 Being uncertain of sexual orientation

 Reading or hearing an account of suicide or knowing a peer who died by suicide

Murder and suicide

In rare cases, people who are suicidal are at risk of killing others and then themselves.
Known as a homicide-suicide or murder-suicide, some risk factors include:

 History of conflict with a spouse or romantic partner

 Current family legal or financial problems

 History of mental health problems, particularly depression

 Alcohol or drug abuse

 Having access to a firearm

Getting treatment
When suicidal thoughts are brought on by an immediate interpersonal life event, then
reliving this event or talking with a close friend or family member may resolve the crisis.

Individuals considering suicide should have a professional evaluation by a family

physician or mental health professional to consider any of the following
treatments:

 ongoing psychological counselling (e.g., psychotherapy, marital therapy)

 medical intervention (e.g., more aggressive treatment of a pain syndrome)

 psychiatric treatment (e.g., treatment of a mood disorder, substance abuse, or

schizophrenia)

Reducing the risk

The following may help lower the risk of suicidal ideation and suicide attempts:

 getting family support, for example, talking to them about how you feel and
asking them to meet your health provider and possibly attend sessions with you

 avoiding alcohol and illegal drugs

 avoiding isolation and staying connected to the outside world, as much as

possible

 doing exercise

 eating a well-balanced, healthful diet

 getting at least 7-8 hours continuous sleep in every 24-hour period

 removing any guns, knives, and dangerous drugs, for example, by giving them to
a trusted friend to take care of

 seeking out things that give you pleasure, such as being with friends or family
you like, and focusing on the good things you have
  attending a self-help or support group, where you can discuss issues with people
who understand, get help from others, and help people with similar problems to
get through their difficulties

 seeking and following treatment

Suicide

2 September 2019

Key facts as per WHO

 Close to 800 000 people die due to suicide every year.

 For every suicide there are many more people who attempt suicide every
year. A prior suicide attempt is the single most important risk factor for
suicide in the general population.
 Suicide is the third leading cause of death in 15-19-year-olds.
 79% of global suicides occur in low- and middle-income countries.
 Ingestion of pesticide, hanging and firearms are among the most common
methods of suicide globally.

Every year close to 800 000 people take their own life and there are many more people
who attempt suicide. Every suicide is a tragedy that affects families, communities and
entire countries and has long-lasting effects on the people left behind. Suicide occurs
throughout the lifespan and was the second leading cause of death among 15-29 year-
olds globally in 2016.

Suicide does not just occur in high-income countries, but is a global phenomenon in all
regions of the world. In fact, over 79% of global suicides occurred in low- and middle-
income countries in 2016.

Suicide is a serious public health problem; however, suicides are preventable with
timely, evidence-based and often low-cost interventions. For national responses to be
effective, a comprehensive multisectoral suicide prevention strategy is needed.
Who is at risk?

While the link between suicide and mental disorders (in particular, depression and
alcohol use disorders) is well established in high-income countries, many suicides
happen impulsively in moments of crisis with a breakdown in the ability to deal
with life stresses, such as financial problems, relationship break-up or chronic
pain and illness.

In addition, experiencing conflict, disaster, violence, abuse, or loss and a sense

of isolation are strongly associated with suicidal behaviour. Suicide rates are also
high amongst vulnerable groups who experience discrimination, such as refugees
and migrants; indigenous peoples; lesbian, gay, bisexual, transgender, intersex
(LGBTI) persons; and prisoners. By far the strongest risk factor for suicide is a
previous suicide attempt.

Methods of suicide

It is estimated that around 20% of global suicides are due to pesticide self-poisoning,
most of which occur in rural agricultural areas in low- and middle-income countries.
Other common methods of suicide are hanging and firearms.

Knowledge of the most commonly used suicide methods is important to devise

prevention strategies which have shown to be effective, such as restriction of
access to means of suicide.

Prevention and control

Suicides are preventable. There are a number of measures that can be taken at
population, sub-population and individual levels to prevent suicide and suicide attempts.
These include:

 reducing access to the means of suicide (e.g. pesticides, firearms, certain

medications);
 reporting by media in a responsible way;
 school-based interventions;
 introducing alcohol policies to reduce the harmful use of alcohol;
 early identification, treatment and care of people with mental and
substance use disorders, chronic pain and acute emotional distress;
  training of non-specialized health workers in the assessment and
management of suicidal behaviour;
 follow-up care for people who attempted suicide and provision of
community support.

Suicide is a complex issue and therefore suicide prevention efforts require coordination
and collaboration among multiple sectors of society, including the health sector and
other sectors such as education, labour, agriculture, business, justice, law, defense,
politics, and the media. These efforts must be comprehensive and integrated as no
single approach alone can make an impact on an issue as complex as suicide.

Challenges and obstacles

Stigma and taboo

Stigma, particularly surrounding mental disorders and suicide, means many people
thinking of taking their own life or who have attempted suicide are not seeking help and
are therefore not getting the help they need. The prevention of suicide has not been
adequately addressed due to a lack of awareness of suicide as a major public health
problem and the taboo in many societies to openly discuss it. To date, only a few
countries have included suicide prevention among their health priorities and only 38
countries report having a national suicide prevention strategy.

Raising community awareness and breaking down the taboo is important for countries
to make progress in preventing suicide.

Data quality

Globally, the availability and quality of data on suicide and suicide attempts is poor.
Only 80 Member States have good-quality vital registration data that can be used
directly to estimate suicide rates. This problem of poor-quality mortality data is not
unique to suicide, but given the sensitivity of suicide – and the illegality of suicidal
behaviour in some countries – it is likely that under-reporting and misclassification are
greater problems for suicide than for most other causes of death.

Improved surveillance and monitoring of suicide and suicide attempts is required for
effective suicide prevention strategies. Cross-national differences in the patterns of
suicide, and changes in the rates, characteristics and methods of suicide, highlight the
need for each country to improve the comprehensiveness, quality and timeliness of their
suicide-related data. This includes vital registration of suicide, hospital-based registries
of suicide attempts and nationally-representative surveys collecting information about
self-reported suicide attempts.

WHO response

WHO recognizes suicide as a public health priority. The first WHO World Suicide Report
“Preventing suicide: a global imperative”, published in 2014, aims to increase the
awareness of the public health significance of suicide and suicide attempts and to make
suicide prevention a high priority on the global public health agenda. It also aims to
encourage and support countries to develop or strengthen comprehensive suicide
prevention strategies in a multisectoral public health approach.

Suicide is one of the priority conditions in the WHO Mental Health Gap Action
Programme (mhGAP) launched in 2008, which provides evidence-based technical
guidance to scale up service provision and care in countries for mental, neurological
and substance use disorders. In the WHO Mental Health Action Plan 2013–2020, WHO
Member States have committed themselves to working towards the global target of
reducing the suicide rate in countries by 10% by 2020.

In addition, the suicide mortality rate is an indicator of target 3.4 of the Sustainable
Development Goals: by 2030, to reduce by one third premature mortality from
noncommunicable diseases through prevention and treatment, and promote mental
health and well-being.

Suicide in the Western Pacific

Every year, 200 000 people intentionally take their own lives in the Western Pacific
Region, accounting for 25% of global suicides. Over 75% of all suicides in the region
occur in low- and middle-income countries. Risk factors contributing to suicidal thought
or behaviour include previous suicide attempts, harmful use of alcohol and mental
disorders. However, many suicides are impulsive in moments of crisis where their ability
to deal with financial loss, chronic illness and other life’s stresses breaks down.

Suicide can be prevented by:

  Creating a national response to suicide prevention, including a comprehensive
multisectoral suicide prevention strategy;

 Restricting access to pesticides, firearms, certain medications and other means

of suicide;

 Incorporating suicide prevention as a core component of health-care services;

and

 Mobilizing communities to provide support to vulnerable individuals, overcome

stigma, engage in follow-up care and support those bereaved by suicide

Suicide mortality rate (per 100,000 population) in Mauritius was reported at 7.8 in
2016, according to the World Bank collection of development indicators,
compiled from officially recognized sources. Mauritius - Suicide mortality rate (per
100,000 population) - actual values, historical data, forecasts and projections
were sourced from the World Bank on August of 2020.

The World Health Organisation (WHO) estimates that each year approximately one million
people die from suicide, which represents a global mortality rate of 16 people per 100,000 or
one death every 40 seconds. It is predicted that by 2020 the rate of death will increase to one
every 20 seconds.Mar 20, 2020

The WHO further reports that:

 In the last 45 years suicide rates have increased by 60% worldwide. Suicide is now
among the three leading causes of death among those aged 15-44 (male and female).
Suicide attempts are up to 20 times more frequent than completed suicides.
 Although suicide rates have traditionally been highest amongst elderly males, rates
among young people have been increasing to such an extent that they are now the group at
highest risk in a third of all countries.
 Mental health disorders (particularly depression and substance abuse) are
associated with more than 90% of all cases of suicide.
 However, suicide results from many complex sociocultural factors and is more likely
to occur during periods of socioeconomic, family and individual crisis (e.g. loss of a loved
one, unemployment, sexual orientation, difficulties with developing one's identity,
disassociation from one's community or other social/belief group, and honour).
The WHO also states that:
 In Europe, particularly Eastern Europe, the highest suicide rates are reported for
both men and women.
 The Eastern Mediterranean Region and Central Asia republics have the lowest
suicide rates.
 Nearly 30% of all suicides worldwide occur in India and China.
 Suicides globally by age are as follows: 55% are aged between 15 to 44 years and
45% are aged 45 years and over.
 Youth suicide is increasing at the greatest rate.

In the US, the Centre of Disease Control and Prevention reports that:

 Overall, suicide is the eleventh leading cause of death for all US Americans, and is
the third leading cause of death for young people 15-24 years.
 Although suicide is a serious problem among the young and adults, death rates
continue to be highest among older adults ages 65 years and over.
 Males are four times more likely to die from suicide than are females. However,
females are more likely to attempt suicide than are males.
Suicide within minority groups
Research indicates that suicide rates appear to be increasing within native and indigenous
populations such as the Native Americans in the US and Alaska, and the Aborigines in
Australia and New Zealand.

Suicide rates within migrant communities such as African and East Asian Americans or the
Black British community are, also of growing concern. Statistics show a rise but in some
countries it can be difficult to calculate. For example, in the UK the place of birth is recorded
on the death certificate, not ethnicity, therefore reducing data on suicides amongst minority
groups.

Suicide Prevention

Many countries recognise the need and positive impact of Suicide Prevention Strategies,
and are working to ensure they are in place.

The WHO States:
 Strategies involving restriction of access to common methods of suicide have proved to
be effective in reducing suicide rates. However, there is a need to adopt multi-sectoral
approaches involving other levels of intervention and activities, such as crisis centres.
 There is compelling evidence indicating that adequate prevention and treatment of
depression, alcohol and substance abuse can reduce suicide rates.
 School-based interventions involving crisis management, self-esteem enhancement
and the development of coping skills and healthy decision making have been demonstrated
to reduce the risk of suicide among the youth.
 The International Association for Suicide Prevention
(IASP) www.med.uio.no/iasp/index provides a forum for national and local organisations,
researchers, volunteers, clinicians and professionals to share knowledge, provide support
and to collaborate in suicide prevention around the world.
 Will Suicides Rise Because of COVID-19?
 While suicides can increase during prolonged crises, experts say it’s
not too late to prevent an uptick from the coronavirus.
 By Trevor Bach, Contributor May 22, 2020, at 6:47 a.m.

WHEN THE PANDEMIC seized New York, Dr. Lorna Breen, a 49-year-old
emergency room doctor who worked at New York-Presbyterian Allen
Hospital and Columbia University Medical Center, found herself in the
trenches alongside physicians toiling through 18-hour days and sleeping
in hospital hallways.
 When Breen contracted COVID-19 herself, she took a week and a half off,
only to suffer from exhaustion once she went back to work. Her family
brought her to stay with them in Virginia, where Breen seemed detached,
according to her father. She was also deeply disturbed, he said, after
witnessing so much death and suffering of patients. On the last Sunday in
April, Breen was rushed to the hospital with self-inflicted injuries, and later
pronounced dead.

 "Make sure she's praised as a hero, because she was," her father, Dr.
Philip Breen, told The New York Times. "She's a casualty just as much as
anyone else who has died."

 COVID-19 has been associated with other suicides that drew widespread
media attention, including a German state finance minister who appears to
have taken his own life while worried about economic disaster, a British
teenager distressed by social distancing measures, and an Italian
nurse who feared spreading the virus to other people. One county in
Washington state reported a surge in deaths by suicide, mostly of men in
their 30s and 40s, since the outbreak began.
 Researchers fear the phenomenon could become more widespread: In a
commentary published last month in medical journal The Lancet
Psychiatry, an international group of suicide experts advocated "urgent
consideration" to prevent a rise in suicide rates, especially as COVID-19 –
and its devastatating economic impact – drag on for months.

 "These are unprecedented times," the authors wrote. "The pandemic will
cause distress and leave many people vulnerable to mental health
problems and suicidal behaviour."
 In 2018, the most recent year for which data is available, more than
48,000 Americans died by suicide, according to the Centers for Disease
Control, ranking it the country's 10th-leading cause of death. And while
many countries have seen their suicide rates decline in recent years, in
the U.S. the rate has increased 35% since 1999, from 10.5 deaths per
100,000 people to 14.2, an alarming rise that's also prompted a call to
action among health professionals.
 Study: Possible Mental Health Issues for COVID Survivors ]
 "That's not acceptable," April Foreman, a board member at the American
Association of Suicidology, told USA Today. "We need to start treating
these deaths seriously and respecting these survivors by upping our game
in public health."
 Suicides have previously increased in connection with major crises. There
is evidence that deaths by suicide increased during the 1918 Spanish flu
and 2003 SARS outbreak, the Lancet authors note. The suicide rate in the
United States also rose significantly in the first few years following the
2008 Great Recession, as millions of Americans faced a new level of
financial hardship.

 Yet while on a macro level wide-scale tragedies are clear sources of

stress and psychological pain, on an individual level, experts say, the
reasons behind any particular suicide are typically more nuanced.

 "Suicidal people often have multiple factors that contribute to their risk,"
says Jane Pearson, chair of the Suicide Research Consortium at the
National Institute of Mental Health. "It's not just one thing."

 Suicide data is also notoriously slow to materialize, meaning it will likely be

years before hard numbers are available on the number of deaths by
suicide during the early months of COVID-19. Some suicide crisis lines,
including in the San Francisco Bay Area, have reported a surge in calls
during the pandemic, although Pearson notes that an increase in calls
doesn't necessarily indicate an increase in actual suicides – high volumes
can also be a good sign, if it means more people are reaching out for help.

 "From where we sit, it's just really hard to know about the deaths," she
says, "and we can also imagine that coroners and medical examiners are
overwhelmed, so it might take even longer."

 
 Although some suicide deaths during the pandemic have been associated
with highly specific psychological stress – the front-line medical
professionals facing grueling circumstances, for instance – the more
sweeping consequences of the pandemic, including physical distancing
measures, also may pose a risk to the general public, the Lancet authors
write. People with and without existing psychiatric disorders may
experience exacerbated symptoms because of loneliness or financial
stress. Underlying behavioral contributors, like domestic violence and
alcoholism, also may increase.

 Yet a rise in suicide during the pandemic is not inevitable, the authors
emphasize, if authorities enact vigilant public health measures. In the
U.S., Pearson says, the field of suicide prevention is also working to adapt
practices to better serve people in the age of COVID-19, including with
recommendations for front-line workers and through revised guidelines for
telemedicine treatment. In a way, she adds, the collective nature of the
pandemic also presents a rare chance to educate the public about suicide
prevention and mental health, because so many people are hurting at the
same time.

 "It's an opportunity to be able to talk about this," she says. "We're trying to
see how this broad experience can be used in a favorable way, to help
people understand more about actually improving their mental health and
help them understand (what) they can do to help others, to help
themselves."

Is the Pandemic Sparking Suicide?

Psychiatrists are confronted with an urgent natural experiment, and the outcome is far
from predictable.

The mental health toll of the coronavirus pandemic is only beginning to show itself, and
it is too early to predict the scale of the impact.

The coronavirus pandemic is an altogether different kind of cataclysm — an ongoing,

wavelike, poorly understood threat that seems to be both everywhere and nowhere, a
contagion nearly as psychological as it is physical. Death feels closer, even well away
from the front lines of emergency rooms, and social isolation — which in pre-Covid
times was often a sign of a mind turning in on itself — is the new normal for tens of
millions of people around the world.
The ultimate marker of the virus’s mental toll, some experts say, will show up in the
nation’s suicide rate, in this and coming years. The immediate effect is not at all clear,
despite President Trump’s recent claim that lockdown conditions were causing deaths.
“Just look at what’s happening with drug addiction, look at what’s happening with
suicides,” he said in a press briefing in the White House Rose Garden on Monday.

In fact, doctors won’t know for many months if suicide is spiking in 2020; each death
must be carefully investigated to determine its cause. The rolling impact of Covid-19 on
these rates give scientists a sense of how extended uncertainty and repeating
undercurrents of anxiety affect people’s will to live.

“It’s a natural experiment, in a way,” said Matthew Nock, a psychology professor at

Harvard. “There’s not only an increase in anxiety, but the more important piece is social
isolation.” He added, “We’ve never had anything like this — and we know social isolation
is related to suicide.”

The earliest signs of whether the pandemic is driving up suicides will likely emerge
among those who have had a history of managing persistent waves of self-destructive
distress. Many of these people, who number in the millions worldwide, go through each
day compulsively tuned to the world’s casual cruelties — its suspicious glances and rude
remarks — and are prone to isolate themselves, at times contemplating a final exit plan.

“That’s how I am,” said Josh, 35, a college instructor in North Carolina who has been
consumed in the past with thoughts of suicide. “I see all the bad, the suffering, and I
have a tendency to crawl into a hole. Now, with this Covid threat, we’re being told to
isolate and stay away from others. It’s like, ‘Oh, I was right all along, and the world was
crazy.’”

He added, “I haven’t backslid, I haven’t moved. But longer term — I don’t know.” He
asked that his last name be omitted for privacy.

Research done in the wake of natural disasters offers little guidance as to how this group
will respond. In a widely cited 1999 paper in The New England Journal of Medicine,
researchers from the Centers for Disease Control and Prevention reported that, in
communities hit by an earthquake, flood or hurricane, rates of suicide spiked in the
years after. But the study authors later retracted that finding, after discovering an error
that, when corrected, revealed “no significant increase in suicide rates after natural
disasters, either for all types of disasters combined or for individual types of disasters.”
Other studies have found increases, or decreases, depending on the group and disaster
studied.

The evidence is stronger when it comes to the impact of economic hardship. Suicide
rates in the United States have been rising steadily since 2000 — by 35 percent overall,
across most age groups — but the rate of increase roughly doubled in the wake of the
2008 downturn. Historically, the job losses, evictions and displacements caused by
recessions tend to lead to an increased numbers of suicides.
“I think during the actual crisis, suicide will be lower,” said Dr. Marianne Goodman, a
psychiatrist at the Department of Veterans Affairs, in the Bronx. “And once the longer-
term economic impact is felt, I suspect, suicide will be rising again.”

But the imminent threat of a potentially deadly virus is very different, psychologically,
from the exhausting anxiety of facing a future with few job prospects. The descent of a
pandemic alters the thinking and behavior of distressed people in ways that are simply
not well understood.

For now, many people who have had to manage self-destructive thoughts have found
that their inner dialogue has shifted since the pandemic descended.

“I was in a relatively good place when this started, and I think one of the reasons I’ve
stayed that way is that, having had all this experience with depression and anxiety, you
learn a lot of skills that are applicable in this pandemic,” said Michelle, 37, a New York
teacher with a history of chronic suicidal tendencies, including two attempts.

“It’s interesting, I’m having conversations where everyone is feeling anxious about the
same thing,” she said. “It’s been awhile — since grad school, I think — that I have been a
part of conversations like that, and it’s strangely nice.”

“The fact you could die any minute, that is very different situation from previously,
where you thought, ‘The only way I’m going to die is if I kill myself,’” Dr. Muir said.
“That theoretical struggle is very real now, in peoples’ minds, and what I’m seeing in
many of our patients is that they make sense of it by wanting to help — like, now is the
time to stay healthy and cope with this, for everyone’s sake.”

This is not to say that self-destructive urges are somehow fading, only that they now
compete with adaptations to a broader, outside threat, therapists and researchers say. In
many high-risk people, suicidal thoughts are now more frequent than before, new
research suggests.

In a continuing study, a research team led by Dr. Nock is monitoring smartphone data
of highly suicidal people for six months after they present in a hospital at risk of suicide.
The team has gathered thousands of surveys from people 12 years and older. “From
before to after Covid-19, we’re seeing increases in suicidal thinking, among adults, that
are predicted by increases in feeling isolated,” Dr. Nock said. But preliminary results
suggest that such thoughts are not more frequent among the high-risk adolescent, for
reasons the team is trying to work out.

The relationship between suicidal thoughts, which are fairly common in people with
mental health diagnoses, and completed acts, which are comparatively rare, remains a
subject of intense study. A fear of infection may push over the edge some people who
would otherwise manage.

Dr. Makeda Jones, a New York psychiatrist, said that a colleague recently called because
her teenage daughter tried to hang herself. “For some people who have not learned the
skills to cope, this pandemic makes them feel more vulnerable and out of control,” Dr.
Jones said. “And those two things will make some want to seize back control and say, ‘I
don’t want to die of this disease, I can do it on my own terms.’”

Only careful study — the first pass, in this morbid, real-time experiment — will
determine whether the acute fear of infection outweighs the effects of longer-term
economic anxiety. For now, many people who have had to live with a nihilistic inner
darkness see everyone in the world outside as suddenly having to do the same — a new
experience indeed.

“It’s almost like you’re in the eye of the hurricane, that’s the way it feels,” said Josh, the
college instructor in North Carolina. “I have been sitting with therapists all my life,
telling them that the world is on fire, does anything I do matter? Now the world really is
on fire, sort of, and I’m trying to teach myself to see both the good and the bad, and to
see how I can actually be of help.”