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Suicide and COVID-19: a rapid scoping review

Suicide and COVID-19: a rapid scoping review There is considerable interest in exploring effects of coronavirus disease 2019 (COVID-19) pandemic on mental health. Suicide is one of the leading causes of mortality worldwide and changes in daily life brought by the pandemic may be additional risk factors in people with pre-existing mental disorders. This rapid PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) scoping review aims to identify and analyze current evidence about the relation between COVID-19 pandemic outbreak, along with COVID-19 disease and severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection, and suicide in individuals with previ- ously diagnosed mental disorders. First, we conducted a comprehensive review of the literature, then proceeded to discuss findings in a narrative way. Tables were constructed and articles sorted according to the studies’ methodolo - gies. 53 papers were eventually identified as eligible, among which 33 are cross-sectional studies, 9 are longitudinal studies, and 11 studies using other methodologies. Despite suffering from a mental disorder is a risk factor for suicidal behavior per se, the advent of COVID-19 pandemic may exacerbate this relation. Nevertheless, data addressing a clear correlation between suicidal behavior and the pandemic outbreak are still controversial. Longitudinal analysis using validated suicide scales and multicenter studies could provide deeper insight and knowledge about this topic. Keywords Suicide, Covid-19, Mental disorder, Pandemic psychiatric diseases, and individuals with mental disor- Introduction ders  are at increased risk [2]. Based on the data on sui- The advent of the pandemic has drastically impacted cide rates relating to the previous epidemics, a rise in our daily lives. At the time of writing, more than suicide was observed between 1918 and 1919 during the 505,560,928 million people worldwide have been infected influenza epidemic in the United States [3]. These data with severe acute respiratory syndrome coronavirus 2 are also consistent with increased levels of suicide among (SARS-CoV2), causing 6,226,457 deaths [1]. Suicide is older adults during the 2003 SARS epidemic in Hong a complex multifactorial phenomenon and a leading Kong [4]. During the current pandemic, extraordinary cause of death worldwide. Most suicides are related to measures for treatment and prevention of infection have been put in place by governments, such as quarantines, *Correspondence: lockdowns, and social distancing. An increase in the inci- Tommaso Barlattani dence of mental disorders such as acute stress disorder, tbarlattani@gmail.com Department of Biotechnological and Applied Clinical Sciences (DISCAB), anxiety, irritability, PTSD, elevated psychological dis- University of L’Aquila, Via Vetoio, 67100 Coppito, L’Aquila, Italy tress, depressive symptoms, and insomnia may have been Department of Mental Health Sulmona-Avezzano-L’Aquila, ASL 1, caused by the previously stated measurement [5]. All Abruzzo, Italy Department of Systems Medicine, University of Rome Tor Vergata, Via these  disturbances are related to an increase in suicide Montpellier, 1, 00133 Rome, Italy risk [6]. As already demonstrated by longitudinal studies, © The Author(s) 2023. 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The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 2 of 48 also economic crises and unemployment have been was identified as the best method to carry out the present linked to increased  suicide rates [7]. Therefore, the eco - study [16]. Only articles published between March 2020, nomic downturn resulting from the advent of  the coro- the declaration of the pandemic [17], and April 2022 navirus disease 2019 (COVID-19) pandemic may also be were selected. Papers included examined suicidal behav- considered an additional risk factor for suicidal behavior ior during the pandemic, the correlation between suicide [8]. Moreover, fear of infection, already shown as a prom- rates and the pandemic itself in cross-sectional analyses, inent risk factor [9], social isolation, and grief  may fur- or changes in suicidal behavior in a longitudinal perspec- ther contribute to a robust increase in suicidal behavior. tive; finally, other studies providing useful information SARS-CoV2 infection per se has proven to be a potential on clinically observable suicidal behavior during the pan- risk factor for suicidal behavior [10] and may eventually demic were included. In the present review we included be included within COVID-19 sequelae. Furthermore, not only studies that addressed suicidality in relation during the first phases of the pandemic outbreak, we wit - to COVID-19 pandemic, but also in relation to SARS- nessed a dramatic increase in difficulties in referring to CoV2 infection and in COVID-19 disease. Only studies psychiatric departments [11], along with a drastic reduc- that included subjects with previous mental illness and tion in outpatient medical care accessibility. As a result, assessed suicide behavior and risk were taken into con- patients with pre-existing mental disorders may have sideration.  Specifically, whether the sample included experienced an exacerbation of symptoms such as feel- general population, the study only considered available ings  of loneliness, anxiety, depression, insomnia, and data on suicide assessment in individuals with previously hopelessness,  which  might eventually lead to a decrease diagnosed mental illness.  We excluded studies on top- in treatment compliance, increasing the risk of suicidal ics other than suicide and COVID-19 pandemic, infec- behavior [12]. Although  data on previous epidemics tion and disease, and in languages other than English. demonstrated a correlation with increased suicide rates, Being the present study a scoping review,  the quality of the influence of the COVID-19 pandemic on suicide studies is not necessarily addressed [18]; therefore, meta- trends is still debated and controversial [13]. A recent analysis, reviews, and systematic reviews were excluded. meta-analysis carried out by Dubè et al. [14] highlighted Papers found to be purely narrative papers, editorials, how  the  COVID-19 pandemic had increased suicide books chapter, letters to  editors, comments, and case risk in the general population;  however, data regard- reports with small samples (< 10 subjects) were excluded ing suicide behavior during the COVID-19 pandemic since they would not provide significant insight  into  the in subjects with pre-existing mental disorders are still researched topic. Two independent reviewers screened scarce,  and strong data are lacking. In this scenario, the citations for inclusion. Data extraction was conducted present study aims to highlight current evidence on sui- by one reviewer and verified by a second reviewer. Tables cide and the COVID-19 pandemic, including studies also were then constructed,  and articles  were  sorted out by addressing this relation with SARS-CoV2 infection and authors, title, location of the study, sample size, nature the proper disease (to which we will refer as COVID-19 of the sample, purpose/aim of the study, suicide assess- disease), in subjects with psychiatric disorders and to fill ments measures, type of publishing, time points com- the gaps in the literature regarding this topic. pared/ analyzed in the study, and principal findings. In the narrative overview, studies were categorized by Methods methodological approach (cross-sectional vs. longitudi- A comprehensive review of the literature was carried nal) and type of sample (patients vs. general population). out on Pubmed up to April 2, 2022. Considering the Results were then discussed. extensive aim of the study, we used Medical Subject Headings (MeSH) descriptors (“COVID-19”[Mesh]) Search results AND ”Suicide”[Mesh]). To maximize the sensitivity of The initial Pubmed search yielded a total of 502 results. our study, we did not provide additional terms besides Three additional titles were identified through other “Suicide” and “COVID-19”. Subsequently,  the  studies sources (website searching, citation tracking, and refer- included were discussed with a narrative overview. Aim- ence chaining). 10 records were excluded as not full text. ing to cover a broad literature overview and considering The remaining 495 full-text records titles and abstracts that strong evidence regarding suicide rates in subjects were screened, and 135 were excluded as the article’s with a pre-existing mental disorder during the pan- primary focus was not the correlation between suicide demic  is  still lacking,  a  rapid PRISMA-ScR (Preferred and COVID-19, being therefore irrelevant to the present Reporting Items for Systematic Reviews and Meta-Anal- study’s aim. Among the remaining 360 papers, 84 were yses extension for Scoping Reviews) scoping review, fol- excluded since they did not meet  the  inclusion criteria. lowing the statement guidelines for scoping reviews [15], Specifically, 79 articles were excluded as 16 were reviews, Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 3 of 48 16 case reports, 3 systematic reviews, 18 comments, 23 hospital‐registered rate of suicidal events during the pan- editorials, 2 meta-analyses, and 1 was retracted. 5 arti- demic significantly did not change when compared to the cles were excluded as being published 1 in French, 1 in pre‐pandemic period. For specifics about these studies, Hungarian, 1 in German, 1 in Turkish, 1 in Italian. Of the see Table 1. resulting 276 eligible records, 223 were excluded as they Among longitudinal studies using a general popula- did not provide adequate information about the relation tion sample, 1 was carried out in Greece, 2 in the USA, between COVID-19 and suicide  behavior, or the sample 1 in Australia, and 1 was an international study spanning considered did not include subjects with a pre-existing over 40 countries and including up to 55,589 participants mental condition. 53 papers were finally identified as of [23–27]. Two studies assessed suicidal behavior among particular interest. The selected articles are presented US veterans [24, 25], and 2 studies analyzed national rep- in Tables  1, 2, 3, 4 and 5 and discussed in the narrative resentative samples from Australia (by Batterham et  al.) overview. and Greece (by Fountoulakis et al.), respectively, evaluat- For specifics about the study design, consult Fig. 1. ing suicide risk by means of the suicidal item of PHQ-9 and Risk Assessment Suicidality Scale (RASS); the two Narrative overview studies among veterans used Suicidal Behaviors Ques- Among the 53 articles identified as eligible  for  directly tionnaire-Revised (SBQ-R) and PHQ-9. The international assessing modifications of suicidal behavior during study used the RASS for suicide assessment. Most of the COVID-19 pandemic in patients with pre-existing men- studies demonstrated a correlation between the presence tal disorders, 33 are cross-sectional studies, 9 are longi- of suicidal behavior during the pandemic with previous tudinal studies, and 11 studies employed other methods. mental health conditions. Conversely, the study carried Four longitudinal studies assessed in this review out by Batterham et al. in Australia evidenced that a pre- included patient samples,  and the remaining 5 studied viously diagnosed psychiatric disorder, despite being a this correlation in general population samples. risk factor for suicidal behavior, is not significantly asso - Focusing on longitudinal investigations in patient sam- ciated with incident suicidal ideation during the pan- ples, the 4 articles were carried out in different countries, demic. The study conducted in Greece highlighted how namely 1 in Iran, 1 in Spain, 1 in the USA, and 1 in Den- a previous history of depression, self-harm, and suicidal mark [19–22]. Two studies assessed suicide behavior in attempts represent risk factors for relapsing depression patients previously diagnosed with obsessive–compul- and, eventually, suicidality during the pandemic. The sive disorder (OCD) [19, 20], one in a nationally repre- study carried out by Nichter et al. underlined how a his- sentative cohort of US veterans with pre-existing mental tory of suicide attempt, lifetime post-traumatic stress health conditions [21] and one in individuals admitted disorder and/or depression, and past-year alcohol use to hospitals and Emergency Medical Services presenting disorder severity can be classified as risk factors, among psychopathological symptomatology [22]. In the study COVID-19-related variables, for new-onset suicidal idea- conducted in the USA by Na et al., suicidal behavior was tion. The international study conducted among 40 coun - assessed by means of the Patient Health Questionnaire-9 tries  highlighted how  suffering from a previous mental (PHQ-9); the two studies, carried out in Spain by Alonso condition acted as a risk factor and suicidal behavior et  al. and in Iran by Khosravani et  al., assessing patients resulted increased in those people during pandemic. For with OCD employed Hamilton Depression Rating Scale specifics about these studies, see Table 2. (HDRS) item on suicide and Beck Scale for Suicidal Idea- When screening cross-sectional studies, we identified tion (BSSI), respectively. The Danish study collected 12 conducted on patient’s sample and 21 on general pop- data regarding diagnoses from electronic  health records ulation samples. (EHRs)—including codes for suicide and self‐harm— Among cross-sectional studies analyzing the overstated defined and coded according to the ICD‐10 system by correlation in patients with a pre-existing psychiatric dis- the responsible clinicians. 3 out of 4 studies identified order, one was carried out in China, 3 in Italy, 2 in South mental illness as a risk factor for suicide and addressed Korea, 2 in the USA, 1 in Germany, 1 in Turkey, 1 in Den- a relationship between the outbreak of the pandemic mark, and 1 in Saudi Arabia [8, 28–38]. Most were ser- and an increase in suicidal behavior. Specifically, the vice utilization studies, gaining clinical information from study conducted by Na et al. relates ongoing SARS-CoV2 hospital admission records or clinical records. The study infection with an increased risk of suicidal behavior in conducted in China by Liu et  al. assessed suicide risk subjects already suffering from a mental disorder. The using 3 standardized ("yes"  or  "no") questions in older study conducted in Denmark revealed how most patients clinically stable patents with psychiatric disorders [28]. exhibiting suicidal behavior during the pandemic pre- Two Italian studies were conducted by the same research sented a pre-existing mental disorder. However, the group (from Sant’Andrea Hospital in Rome), one, by Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 4 of 48 Table 1 Suicide and Covid-19 in subjects with pre-existing mental disorder, longitudinal studies patients’ sample. Characteristics of longitudinal studies using patients sample examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 4) Authors, year Title Location of study Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings the sample and the study assessment publishing compared/ gender measures analyzed in the study Rømer et al. 2021 Psychiatric Admis- Denmark, Capital 2,693,924 health Health records Age range of To assess the pat- Diagnoses in the Population‐based From January Most patients exhibiting sions, Referrals, and Region of Denmark records from hospitals and the sample with terns in psychiatric electronic health study, 1, 2016 to suicidal behavior had Suicidal Behavior and Region Zealand Emergency Medical pre-existing mental admissions, referrals, records (EHRs)— Longitudinal study February 28, pre‐existing mental Before and During Services. With disorder: and suicidal behav- including codes for 2021. Regard- disorders. The hospital‐ the COVID‐19 Pan- regard to suicide in 2019: ior before and dur- suicide and self‐ ing pandemic registered rate of suicidal demic in Denmark: attempts, self-harm between 0–17: 262, ing the COVID‐19 harm—defined and during the behavior events during the A Time‐Trend Study episodes and between 18–29: pandemic coded according to first lockdown pandemic did not change suicides registered 238, the ICD‐10 system (March 11, significantly compared to at hospitals in The > 30: 355; by the responsible 2020 – May the pre‐pandemic period; Capital Region in 2020: clinicians 17, 2020), nor did it change during of Denmark and between 0–17: 247, the inter‐ the first lockdown, the Region Zealand between 18–29: lockdown inter‐lockdown period or between 221, period (May second lockdown. This 2019–2021 subjects > 30: 344; 18, 2020– pattern was observed for with pre-existing in 2021 (Jan–Feb) December all people with pre-existing mental disorders between 0–17: 108, 15, 2020), and mental disorder. Moreover, were: between 18–29: 54, the second trend in hospital‐recorded 829 in 2019 (76.8%); > 30: 63; lockdown suicidal behavior dur- 770 in 2020 (76.3%); female in 2019: 676 (December ing the pandemic as a 224 in 2021 (83.3%) (62.6%), female in 16, 2020 – whole showed a relative 2020: 648 (64.2%), February 28, decline compared with female in 2021 2021) the pre‐pandemic trend (Jan–Feb) 190 among patients with (70.6%) pre‐existing mental disorders. In particular, the relative change in rate ratio regarding suicidal behavior during the pandemic vs. pre-pandemic shows a statistically significant decrease in subjects with mood disorder and neurotic, stress-related and somatoform disorders Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 5 of 48 Table 1 (continued) Characteristics of longitudinal studies using patients sample examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 4) Authors, year Title Location of study Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings the sample and the study assessment publishing compared/ gender measures analyzed in the study Khosravani et al. The associations Shahid Beheshti 390 OCD patients Patients referred Mean age of the To examine the Suicide risk Longitudinal study Between 5 The obsessive–compulsive 2021 of obsessive–com- University of for treatment of sample: 35.8 years; effects of obses- assessed using Beck June to 30 symptom dimensions of pulsive symptom Medical Sciences, a primary OCD 126 males, 178 sive–compulsive Scale for Suicidal October 2020 responsibility for harm and dimensions and Teheran, Iran diagnosis. Common females (OC) symptom Ideation (BSSI) unacceptable obsessional general severity comorbid disorders dimensions and thoughts as well as general with suicidal idea- were major depres- OCD severity on severity had indirect tion in patients with sive disorder (MDD), suicidal ideation effects on suicidal ideation obsessive–com- bipolar disorder by considering through the specific stress pulsive disorder: (BD), various anxiety the role of stress responses to COVID-19, The role of specific disorders, and responses in reac- including traumatic stress stress responses to substance use tion to COVID‐19 in and compulsive checking. COVID-19 disorders (SUDs) a clinical sample of The study shows that patients with OCD OCD patients with specific obsessive–compulsive symptom dimensions and severe OCD are more likely to have suicidal ideation during the pandemic Alonso How is COVID-19 Hospital de 364; Participants from Mean age of the To evaluate the Suicidal ideation Naturalistic cohort From April Suicide-related thoughts et al. 2021 affecting patients Bellvitge, Barcelona, 127 OCD patients, the general popula- sample: impact of the assessed according study, 27 to May 25, were more frequent with obsessive– Spain 237 controls tion recruited 42.0 years OCD COVID-19 pan- to the Hamilton Longitudinal study 2020 among the OCD cohort compulsive disor- through social patients; demic on a sample Depression Rating than among healthy der? A longitudinal networks, using a 40.8 years controls of patients with Scale (HDRS; item controls. The current crisis study on the initial snowball method OCD at the initial on suicide) constitutes a risk factor for phase of the pan- Adult outpatients stage of the health a significant worsening demic in a Spanish who had been crisis, assessing not of symptoms and suicidal cohort attending the only changes in ideation specialist for at least OCD severity, but one year before also in pre-existing March 2020 conditions, newly developed condi- tions, treatment, use of mental health resources, develop- ment of obsessive fears of SARS-CoV-2 contamination, and use of emotional regulation and stress coping strategies Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 6 of 48 Table 1 (continued) Characteristics of longitudinal studies using patients sample examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 4) Authors, year Title Location of study Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings the sample and the study assessment publishing compared/ gender measures analyzed in the study Na et al. 2021 Prevalence, risk and USA 661 veterans Data analyzed from Mean age of the To examine Suicidal ideation Prospective, Pre-pandemic Those who were infected protective factors the National Health sample: pre-pandemic, assessed using Longitudinal survey survey: until with SARS-CoV 2 and associated with and Resilience in 55.2 years; 86.8%, COVID-related, and Patient Health cohort, 11/21/2019 aged 45 or older or who suicidal ideation Veterans Study, male changes in risk and Questionnaire-9 Longitudinal study peripandemic reported lower purpose in during the COVID- which surveyed a protective factors (PHQ-9) survey: until life may be at the highest 19 pandemic in U.S. nationally repre- associated with 11/14/2020 risk of suicide and may military veterans sentative cohort of peri-pandemic deserve close clinical atten- with pre-existing U.S. veterans suicidal ideation. tion and monitoring psychiatric condi- Veterans screened To evaluate interac- tions positive for major tions between depressive disorder SARS-CoV2 (MDD), generalized infection and age, anxiety disorder and significant (GAD), post- protective factors, traumatic stress dis- in predicting order (PTSD), and/ suicide ideation or substance use in the examined disorder (SUD) at population the pre-pandemic assessment Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 7 of 48 Montalbani et al., used Columbia Suicide Severity Rating previous suicide attempts and previous psychiatric his- Scale (C-SSRS) for suicide assessment, while the other, tory were not significant independent risk factors for carried out by Berardelli et  al. evaluated suicide attempt low-rescue suicide attempts when compared to COVID- (SA) at the time of hospital admission, and suicide idea- 19 as a risk factor itself [32]. The study conducted in tion (SI) and non-suicidal self-injury (NSSI) by means Germany showed that the rate of patients self-reporting of the C-SSRS as well [29, 30]; in the study conducted suicidal ideation and intent remained stable between by Almaghrebi et  al. in Saudi Arabia suicide risk factors 2019 and 2020. Suicidal ideation was stated significantly were assessed by means of the Modified SAD PERSONS more often by patients with substance use disorders in Scale (MSPS) [8]. The two Korean studies recorded data 2020 than in 2019 [34]. Grossman et al. highlighted how on patients and  assessed suicide lethality with the Risk- accesses to psychiatric care in the COVID-19 post-period Rescue Rating in Suicide assessment (RRRS) and the groups (case and comparator) were less likely to ascribe severity of the suicide attempt on the South Korean Tri- suicidality to psychiatric symptoms compared to visits in age and Acuity Scale (KTAS) [31, 32]. The Turkish study the comparator post-period group [35]. Finally, the Turk- focused on relapse rates defining criteria, including new- ish study underlined how the relapse rate of the sample in onset suicide behavior or ideation, to assess suicide risk 2019 did not differ from the first trimester of COVID-19 during the first trimester since the declaration of the pan - [33]. For specifics about these studies, see Table 3. demic [33]. In the study conducted in Germany, Seifert Among cross-sectional studies conducted on gen- et  al. performed Psychopathological Assessment (PPA) eral population samples, 4 were carried out in Spain, according to the "Arbeitsgemeinschaft für Methodik und 1 in Japan, 1 in Argentina, 1 in Latvia, 1 in Greece, 1 in Dokumentation in der Psychiatrie"  (AMDP)-System on France, 1 in New Zealand, 1 in Canada, 1 in Belgium, patients presenting to the psychiatric emergency depart- 3 in India, 1 in China, 1 in Honk Kong, 1 in the USA, 1 ment [34]. Grossman et  al., in Massachusetts (USA), among Australia and USA, 1 in the UK, 1 in the Czech obtained data from notes in clinical records regard- Republic [39–50]. Many of these studies assessed sui- ing suicidality in patients presenting in the emergency cide behavior among a nationally representative sample; department [35]. A study conducted in Kaiser Perma- three of those focused on suicide among hospital workers nente hospital in Northern California by Ridout et  al. [39–41] two studies analyzed COVID-19-related suicide assessed population-level incidence rate ratios (IRRs) reported by media, respectively [42, 43] and one assessed and percent relative effects for suicide-related emergency suicidal thought through the use of the 22-item Impact of department encounters [36]. Jefsen et  al., in the Dan- Events Scale-Revised (IES-R) among 69.054 students in ish study, categorized clinical notes according to diag- France [44], while the study carried out by Behera et  al. nosis and identified five distinct categories according analyzed autopsies of deaths attributable to suicide [45]. to different clinical presentations of suicidal behavior: The studies conducted in Spain approached this cor - 1—thoughts of self‐harm, 2—completed self‐harm, 3— relation  by  employing different scales to assess suicide passive wish to die of COVID-19, 4—suicidal thoughts, rates [39, 46–48]. Two studies used selected items from a 5—suicide attempts [37]. Slightly more  than  half of modified version of the C-SSRS [39, 46], while two other the considered studies evidenced an increase in sui- Spanish studies, both conducted by Sàiz et  al., investi- cidal  behavior, hospital consults, and admissions among gated suicide behavior by means of the Paykel Suicide patients during the pandemic, underlying the role of Scale (PSS) and by questioning participants on whether pre-existing mental conditions  as  a  risk factor for sui- they experienced  "passive suicidal ideation during the cidal behavior. Interestingly, in the study conducted by past seven days", requiring only yes/, no answers [47, 48]. Liu et  al.,  among the patients exhibiting suicidal behav- The study conducted in Belgium used a modified version ior, Major Depressive Disorder (MDD) was found to be of selected items from the C-SSRS as well [49], while the the most common psychiatric pre-existing diagnosis Argentinian group employed the Inventory of Suicide [28]. Conversely, in the study conducted by Menculini Orientation (ISO-30) [50]. Finally, in Latvia, the authors et  al. in Perugia (Italy), more than one-third of the con- assessed suicidal behavior with RASS [51]. sidered sample (patients  presenting to the emergency Several different studies explored suicidal ideation by room requiring psychiatric consultation) did not report means of the suicidal item of the PHQ-9 [40, 42, 43, 52– any previous psychiatric history. Authors suggest that a 59]. Some studies also evaluated suicide behavior with- percentage of cases were to be considered as new-onset out recurring to a validated questionnaire: Kasal et  al. suicidality, contrasting previously reported findings in assessed the past month’s suicide risk using a separate which suicide and suicidal behavior were  mostly related MINI module consisting of 6 questions [55]; in Japan, sui- to pre-existing severe psychiatric disorders [38]. The cidal ideation was measured through a one-item question study conducted by Lee et al. showed how the history of with different answer options [56]; in the New Zealand Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 8 of 48 ff Table 2 Suicide and Covid-19 in subjects with pre-existing mental disorder, longitudinal studies general population. Characteristics of longitudinal studies using general population examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 5) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Batterham et al. Eects of the Australia 1296 subjects Nationally repre- Mean age of the To assess the Suicidal ideation Longitudinal From late-March Current diagnosis 2022 COVID-19 sentative sample sample: 46.0 years; prevalence of assessed accord- survey to June 2020 of mental illness pandemic on of Australian 50.1% female suicidal ideation ing to the suicidal was associated with suicidal ideation adults. Regarding in a representative item of Patient double the risk of in a representative history of mental population-based Health Question- suicidal ideation, Australian popula- illness 246 (19.0%) sample in the naire, PHQ-9 while past diagnosis tion sample–Lon- had a past diag- first 12 weeks of was associated gitudinal cohort nosis 310 (23.9%) the COVID-19 with a 38% increase study had a current pandemic in in risk. However, diagnosis Australia, to assess past mental health the persistence of diagnosis was not suicidal ideation significantly associ- using long-term ated with incident follow-up data, suicidal ideation and, to assess rela- tionships between indirect effects of the pandemic (financial, social, employment) on suicidal ideation, while accounting for demographic factors Fountoulakis et Results of the 40 countries: 55,589 subjects International gen- Mean age of To investigate Suicide risk Multiple Forward In 2019, data col- Multiple forward al. 2021 COVID-19 mental Argentina, Aus- from 40 countries eral population the sample: the rates of assessed using Stepwise lected from June stepwise linear health interna- tralia, Azerbaijan, sample 35.80 years distress, probable Risk assessment Linear Regression 3 through July 12 regression analysis tional for the gen- Bangladesh, Any mental dis- females, depression and suicidality scale Analysis, In 2020, data revealed that a eral population Belarus, Brazil, order history was 34.90 years males, suicidality and (RASS) Longitudinal collected from broad number of (COMET-G) study Bulgaria, Canada, present in 25.25% other 31.64 years; their changes in study August 3 through variables acted Chile, Croatia, of the sample 64.85% females, the adult popula- November 13 either as risk or as Egypt, France, 7.85% had a prior 34.05% males and tion aged 18–69 protective factors Georgia, Germany, history of an anxi- 1.10% other internationally, accounting for the Greece, Honduras, ety disorder, during the COVID- 4,7% change in Hungary, India, 12.57% of depres- 19 pandemic suicidal behavior. Indonesia, Israel, sion, 1.16% of Suffering from a Italy, Japan, Kyrgyz bipolar disorder, previous mental Republic, Latvia, 0.97% of psychosis condition acted Lithuania, and 2.70% of as a risk factor and Malaysia, Mexico, other mental suicidal behavior Nigeria, disorder. At least resulted increased in Pakistan, Peru, once, 21.44% had those people during Poland, Portugal, hurt themselves pandemic Romania, Russia, in the past and Serbia, Spain, 10.59% had Turkey, Ukraine, attempted at least UK, USA once in the past Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 9 of 48 Table 2 (continued) Characteristics of longitudinal studies using general population examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 5) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Nichter Prevalence and USA 3078 US veterans Population-based Mean age of the To examine longi- Suicide behavior Population-based From November Rates of suicide et al. 2021 Trends in Suicidal cohort of US sample: 63.2 years; tudinal changes in assessed trough prospective 18, 2019, to ideation and suicide Behavior Among military veterans mostly male 2734 suicidal behavior the Suicidal cohort study, December 19, attempts did not US Military In the no suicide (91.6%) from before the Behaviors Ques- Longitudinal 2020 significantly increase Veterans During ideation group: COVID-19 pan- tionnaire-Revised study from pre-pandemic the COVID-19 387 (16,3%) demic to nearly (SBQ-R) to peripandemic Pandemic have a lifetime 10 months into at the population post-traumatic the pandemic and level. However, stress disorder identify risk factors a small propor- (PTSD) and/or and COVID- tion of veterans major depressive related variables (2.6%) developed disorder (MDD), associated with new-onset suicide 1017 (39,3%) have new-onset suicide ideation during the alcohol use disor- ideation (SI) pandemic der (AUD) and/or Among the strong- drug use disorder est risk factors and (DUD) COVID-19-related In the new-onset variables for new- suicide ideation onset suicide idea- group: tion were suicide 34 (52.9%) attempt history, life- have a lifetime time post-traumatic post-traumatic stress disorder and/ stress disorder or depression, and (PTSD) and/or past-year alcohol major depressive use disorder severity disorder (MDD), 52 (63.8%) have alcohol use disor- der (AUD) and/or drug use disorder (DUD) Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 10 of 48 Table 2 (continued) Characteristics of longitudinal studies using general population examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 5) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Na et al. 2021 Mental health and USA 3078 veterans Nationally rep- Mean age of the To date, the preva- Suicidal ideation Prospective, Lon- From pre- Pre-pandemic suicidal ideation resentative, pro- sample: lence, risk and assessed accord- gitudinal survey pandemic survey alcohol use severity, in US military spective cohort of 62.2 years; the protective factors ing to the suicidal cohort, (median comple- past-year suicidal veterans with his- US veterans. 233 majority was male of psychiatric con- item of Patient Longitudinal tion date: 21 ideation, loneli- tories of COVID-19 veterans (8.6%) (90.2%) ditions among US Health Question- study November 2019), ness, impulsivity, infection reported having military veterans naire, PHQ-9 to peripandemic perceived social been infected who survived 1-year follow-up support and hav- with SARS-CoV2. COVID-19 assessment ing a household Relative to veter- (median comple- member infected ans who were not tion date 14 with SARS-CoV2 infected, veterans November 2020) were independent who were infected risk factors for peri- were more likely pandemic suicidal to screen positive ideation, whereas for internalizing greater protec- disorders (major tive psychosocial depressive characteristic disorder, gen- Greater pre-pan- eralized anxiety demic psychiatric disorder and/or symptoms severity, pandemic-related were independ- stress symptoms) ent risk factors for 20.5% vs 13.9%, peripandemic inter- externalizing nalizing psychiatric disorders (alcohol disorders and/or drug use disorder) 23.2% vs 14.8% and current suicidal ideation 12.0% vs 7.6% at peripandemic Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 11 of 48 Table 2 (continued) Characteristics of longitudinal studies using general population examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 5) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Fountoulakis et Self-reported Greece 3399 subjects Nationwide repre- Mean age of the To investigate the Suicide risk Multiple Forward From April 11th to Suicidal thoughts al. 2021 changes in anxi- sentative sample sample: rate of clinical assessed using Stepwise Linear May 1st, 2020 increased in 10.40% ety, depression of the general female depression in the Risk assessment Regression Analy- and decreased in and suicidality population. His- 34.02 years, males adult population suicidality scale sis, Longitudinal 4.42%. Comparison during the COVID- tory of any mental 36.38 years; aged 18–69 in (RASS) study of cases without 19 lockdown in disorder reported 81.08% females, Greece, during vs those with a Greece by 29.60%, with 18.27% males the period of previous history of history of depres- the lockdown. depression in terms sion being the To investigate of the changes in most frequent the changes in suicidal thoughts (26.92%) anxiety, distress, suggested that the Psychotic disor- suicidal ideation two groups differed ders (0.49%), and their relations in any increase in Bipolar disorder with a number suicidal ideation (0.12%), of personal and (8.39% vs. 15.66%). Eating disorders interpersonal/ Comparison of the (0.11%) and social variables. numbers of cases Substance abuse The aim also without vs. those disorder (0.02%) included the with a previous were rather rare, investigation of history of suicide but within the the spreading of attempts in terms of expected range conspiracy theory changes in current beliefs concerning suicidal ideation the COVID-19 suggested that the outbreak two groups differed in any increase in suicidal ideation (9.96% vs. 23.19%). Previous history of depression, self- harm and suicidal attempts act a risk factors in the develop of depres- sion and, eventually, to suicidality Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 12 of 48 Table 3 Suicide and Covid-19 in subjects with pre-existing mental disorder, cross-sectional studies patients’ sample Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Liu et al. 2022 Prevalence of China 1063 patients Clinically stable Mean age of To examine the Suicidality during Multicenter, cross- From May The prevalence of suici- Suicidality and its psychiat- the sample: prevalence of the COVID-19 sectional study 22 to July 15, dality was 11.8% during Association with ric patients. 62.80 years; 347 suicidality and outbreak was 2020 the COVID-19 pandemic. Quality of Life in Patients with male (32.6%) its association evaluated by 3 Suicidality was common Older Patients major depressive with quality of “yes” or “no” stand- in older patients with with Clinically disorder were 485 life (QOL) among ardized questions, clinically stable psychiat- Stable Psychiatric (45.6%); patients older clinically including (1) ric disorders during the Disorders in China with Bipolar stable patients suicidal ideation, COVID-19 pandemic. Of During the COVID- disorder were 43 with psychiatric (2) suicide plan the patients with suici- 19 Pandemic (4%); disorders during and (3) suicide dality, major depressive patients with the COVID-19 attempt. Patients disorder was the most Schizophrenia pandemic who responded common psychiatric were 73 (6.9%) “yes” to any of the diagnosis 3 questions con- sidered “having suicidality.” Kang Changes in the Busan University 879 Emergency Busan University Mean age of the To find out the Data collection Retrospective, Pre- The number of patients et al. 2021 pattern of suicide Hospital, department Hospital emer- sample: change in the rate including, history Cross-sectional pandemic who had a history of attempters visiting South Korea patients records gency room 40.68 years and pattern of of mental illness; study (January 19 psychiatric treatment the emergency medical records. Pre-pandemic suicide attempts and suicide to October was 163 (40.8%) during room after COVID- Patients with pre- group, during severe attempt, suicide 31, 2019) the “pre-COVID-19 19 pandemic: an vious psychiatric 40.90 years acute respiratory method, and loca- and during period” and 381 (86.6%) observational history were 163 Pandemic group; syndrome in tion (i.e., at home pandemic during the “COVID-19 cross-sectional (40.8%) in the Female were 250 COVID-19 pan- or a place other (January 19 period”. The increase in study Pre-pandemic (62.5%) in the demic period than home) at the to October the number of patients group and Pre-pandemic time of attempt, 31, 2020) with a history of psychi- 381 (86.6%) in the group, and whether atric treatment due to Pandemic group 283 (64.30%) in the attempt was suicide attempts can be the Pandemic a mass suicide. interpreted as a result of group Severity of suicide increased anxiety and attempt was depression caused by assessed trough the lack of mental health the South Korean treatment. Severity of triage and acuity patients who visited the scale (KTAS) emergency room fol- lowing a suicide attempt was higher during the “COVID-19 period” Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 13 of 48 Table 3 (continued) Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Grossman Trends in suicidal Academic medical 339 emergency Patients present- Mean age of the To detail changes Data on suicidality Retrospective, Between Pre-period differences et al. 2021 ideation in an center in Boston, department ing with suicidal sample: in presentations characteristics Cross-sectional December did show a lower propor- emergency Massachusetts, patients in the ideation to a con- 36 years in the at a United States pulled from notes study 2018 – May tion of presentations for department dur- USA “comparison sult liaison service. “comparison Emergency in the record, 2019 and suicidality among people ing COVID-19 series” and 216 During December series”, Department regarding patients December with any psychotic disor- emergency 2018 – February 38 years in the for suicidality presenting with 2019 – May der in the COVID-19 pre- department 2019 (comparison “COVID-19 series”; before and after suicidality in 2020 period cohort relative to patients in the pre-period series) female 42.2 (2.9%) the outbreak of the emergency the comparator cohort. “COVID-19 series” % with any in the “compari- COVID-19 department, and Patients visits in the psychotic disorder son series”, received emer- COVID-19 post-period were 7.1%, 37.2 years (2.9%) gency psychiatric were less likely to be % with any affec- in the “COVID-19 consultation attributed to psychiatric tive disorder were series” symptoms as a reason 39.1%, for suicidality compared % with substance to visits in the compara- use disorder were tor post-period (70.5% vs. 50.0% 50.0%; p-value < 0.001). During December Conversely, there were 2019 – February also differential increases 2020 (COVID-19 in the proportion of pre-period series) patients visits to the % with any emergency department psychotic disorder with a history of prior were 3.2%, suicide attempts in the % with any affec- COVID-19 period rela- tive disorder were tive to the comparison 45.5%, period (13.2 percentage % with substance points and 13.0 percent- use disorder were age points, respectively). 48.4% No significant differences were found between the groups among patients with coexisting psy- chotic disorder, anxiety disorder, and substance abuse disorder with regard to suicidality presentation in the emergency depart- ment during the time considered Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 14 of 48 Table 3 (continued) Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Ridout et Emergency Kaiser Perma- 2123 youth Youth aged 5 Age range of To characterize Population-level Retrospective, Pre-pan- Youth with no history of al. 2021 Department nente Northern patients in 2020, to 17 years with the sample: indi- population- incidence rate Cross-sectional demic (Janu- outpatient mental health Encounters California, USA 2339 youth suicide-related ED viduals aged 13 level and ratios (IRRs) study ary 1, 2019, or suicide encounters Among Youth patients in 2019 encounters to 17 years: 1798 relative change and percent to December and those with comor- with Suicidal (84.7%) in 2020, in suicide-related relative effects for 15, 2019) bid psychiatric condi- Thoughts or 1998 (85.4%) in ED encounters suicide-related and during tions documented at the Behaviors During 2019; among youth ED encounters pandemic emergency department the COVID-19 1483 female during the COVID- as defined by the (January encounter had a higher Pandemic (69.9%) in 2020, 19 pandemic US Centers for 1, 2020, to risk of presenting with 1542 female compared with Disease Control December suicide-related problems (65.9%) in 2019 2019 and Prevention 15, 2020) from September to recommended December 2020 (pan- (ICD-10-CM) demic) versus the same period in 2019. There was a 6.7% higher risk of having a comorbid psy- chiatric nonsubstance diagnosis at the time of the suicide-related ED encounter during the fall compared with 2019 levels Lee et. al 2021 Association of St. Mary’s Hospital, 518 subjects Patients who Mean age of the To investigate Data on charac- Retrospective, From March Suicide attempts Seoul, South made a suicide sample: whether the teristics of the sui- Cross-sectional 2019 to associated with mental the COVID-19 Pandemic and Korea attempt and 38 years; factors affecting cide attempt and study September disorders were more visited the emer- 205 patients the lethality of about the patients 2020 common in the before Low-rescue Suicide Attempts gency depart- (39.6%) were male suicide attempts from the medical COVID-19 group ment. Subjects differed before and counseling (P < 0.001). COVID-19 in Patients Visiting the Emergency with previous and during the records. Suicide pandemic was an Department psychiatric history COVID-19 pan- lethality assessed independent risk factor after Attempting were demic using the using the Risk- for low-rescue suicide Suicide 274 (52.9%) RRRS in patients rescue rating in attempts. History of pre- who attempted suicide assess- vious suicide attempts suicide and visited ment (RRRS) and previous psychiatric the emergency history were not signifi- department cant independent factors for low-rescue suicide attempts Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 15 of 48 Table 3 (continued) Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Berardelli The impact of Sant’Andrea Uni- 632 Psychiatric Clinical records Mean age of the To see whether Suicide attempt Retrospective, Between May Only suicide attempts, et. al 2021 the COVID-19 versity Hospital, patients’ clinical of psychiatric sample: the frequency of investigated at Cross-sectional 2019 and but not suicide ideation, pandemic on sui- Rome, Italy records; patients admit- 42.25 years; suicide ideation the time of arrival study December were more frequent cide ideation and 315 before the ted to a public 311 women and and suicide of the patient at 2020 in psychiatric patients suicide attempts lockdown, psychiatric clinic. 321 men attempts differed the emergency admitted during the in a sample of psy- 317 during Covid- Among the whole in psychiatric department; COVID-19 pandemic chiatric inpatients 19 pandemic sample 22.9% has patients before suicide ideation than before Bipolar disorder, and during investigated 13.9% Depressive the COVID-19 according to the disorder, pandemic and definition in the 29.4% Schizophre- government lock- Columbia–Suicide nia and psychoses, down restrictions Severity Rating 10.4% Personality Scale disorders (C-SSRS) Mutlu et Relapse in patients Community men- 155 Psychiatric Medical charts Mean age of the To investigate the Relapse criteria Retrospective, Pre- The relapse rate of the sample: basic character- defined including: Cross-sectional pandemic patients in the first tri- al. 2021 with serious tal health centers patients of psychiatric mental disorders Etimesgut, Ankara, patients 46.6 years; istics of patients new onset of study (from 10th mester of COVID-19 out- 131 with schizo- 68% male who experienced suicidal thoughts of March break was 11% (2 bipolar during the COVID- Turkey 19 outbreak: a phrenia/ relapse during or suicide attempt, to 10th of disorder, 15 schizophre- schizoaffective the first trimester non-suicidal self- June 2019) nia). 2 had new onset of retrospective chart review from disorder, (from 10th of harm and during suicidal thoughts/suicide 24 with bipolar March to 10th pandemic attempt, and 3 showed a community mental health disorder of June) of the (from 10th self-harm or violent COVID-19 out- of March to behavior. The relapse center break in Turkey, 10th of June rate of the sample in and to compare 2020) 2019 was 6.5% (1 bipolar main findings with disorder, 9 schizophrenia the same period or schizoaffective disor - in 2019 der), and did not differ from the first trimester of COVID-19 Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 16 of 48 Table 3 (continued) Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Seifert Peripandemic Hannover Medical 750 Patients present- Mean age of the To detect the Psychopatho- Retrospective, Between The rate of patients stat- et al. 2021 psychiatric emer- School, Hannover, 374 in 2020; 476 ing in the psychi- sample: impact of the logical assessment Cross-sectional March 16th ing suicidal ideation (32.9 gencies: impact Germany in 2019 atric emergency 43.4 years in 2020, COVID-19-pan- (PPA) according to study and May 24th vs. 29.6%) and intent of the COVID-19 department 44.48 years in demic on patients the “Arbeitsge- 2020; (12.3 vs. 9.9%) remained pandemic on In 2020, substance 2019; within different meinschaft für Between stable between 2019 patients according use disorders 147 females psychiatric diag- Methodik und March 16th and 2020 to diagnostic were 114 (30.5%); (39.3%) in 2020, nostic subgroups Dokumentation and May 24th Suicidal ideation stated subgroup schizophrenia, 228 females presenting in in der Psychiatrie” 2019 significantly more schizotypal, (47.9%) in 2019 the psychiatric (AMDP)-System often by patients with and delusional emergency (including suici- substance use disorders disorders were 70 department dality) in 2020 than in 2019. (18.7%); Patients with schizophre- affective disorders nia presenting during were 57 (15.2%); the COVID-19 pandemic neurotic, stress- did not differ in suicidal related, and soma- ideation/intent. Patients toform disorders stating an association were 70 (18.7%); with COVID-19 were personality nearly three times more and behavioral likely to have attempted disorders were 46 suicide prior to presenta- (12.3%); others tion in the psychiatric were 17 (4.5%) emergency department In 2019, substance compared to the overall use disorders were rate of suicide attempts 138 (29.0%); leading to presentation schizophrenia, in the psychiatric emer- schizotypal, gency department and delusional disorders were 92 (19.3%); affective disorders were 106 (22.2%); neurotic, stress- related, and soma- toform disorders were 76 (16%); personality and behavioral disorders were 37 (7.8%); others were 27 (5.7%) Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 17 of 48 Table 3 (continued) Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Montalbani et al. The COVID-19 Sant’Andrea Uni- 371 Records for Patients with Mean age of the To assess the Suicide risk Retrospective, Between Patients who presented 2021 Outbreak and versity Hospital, 213 psychiatric sample: socio-demo- assessed with the Cross-sectional January during the lockdown Subjects with Rome, Patients disorders who 42.9 years, graphic and Columbia Suicide study 1 and May 3, showed greater active Mental Disorders Italy presented for Range 18–86; clinical features Severity 2020 suicidal ideation in terms Who Presented to psychiatric coun- Men 97 of patients who Rating Scale Before of intentionality and an Italian Psychi- seling required a psychi- (C-SSRS) lockdown planning. People with atric Emergency 57 had major atric consultation measures mental issue may have th Department depressive dis- in the emergency until the 11 experienced an increase order, 36 bipolar department of of March in symptoms during disorder, 56 had an Italian hospital compared pandemic generalized during the COVID- with after anxiety disorder, 19 outbreak lockdown and 27 patients measures, had schizophrenia thus after the th and other psy- 11 of March chotic disorders 9 had a full-blown personality disorder, and the remaining had other diagnoses Jefsen COVID‐19‐related Psychiatric 102 Clinical notes Clinical notes Mean age of the Deeper thorough Clinical notes Retrospective, From Febru- There is known ‘high risk’ et al. 2021 self‐harm and services of the from 74 Psychiat- from the adult sample: 29.8 years; characterization of divided according Cross-sectional ary 1st to groups for self‐harm and suicidality among Central Denmark ric patients psychiatric ser- 77% were females suicide behavior, to diagnosis and study March 23rd suicidality composed individuals with Region, Denmark vices. Regarding detection, and divided into five 2020 by: psychotic disorders, mental disorders diagnosis: care of patients different catego - mood disorders, stress‐ 12 have with pandemic‐ ries according to related and adjustment Schizophrenia and related psychopa- suicide behavior: disorders, and personal- other psychotic thology 1—thoughts of ity disorders, which disorders, self‐harm, appear to respond to the 10 have 2—completed stress associated with Mood disorders, self‐harm, 3—pas- the COVID‐19 pandemic 13 have Stress‐ sive wish to die of with these symptoms/ related and adjust- COVID-19, behaviors. COVID‐19 ment disorders, 4—suicidal crisis led to increased 14 have thoughts, self‐harm/suicidality in Personality 5—suicide individuals with mental disorders, 5 have attempts disorders Autism, 15 Other diag- nosis Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 18 of 48 Table 3 (continued) Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Menculini Suicidality and General Hospital 447 patients Patients requiring Mean age of the To analyze the For suicidality, Retrospective, From June A statistically significant et al. 2021 COVID-19: Data of Perugia, Peru- psychiatric consul- sample: prevalence of data concerning Cross-sectional 1st, 2020 to association was detected from an Emer- gia, Italy tations carried out 42.44 years, suicidality-related suicide attempt study January 31st, between suicidality- gency Setting at the emergency 45.42 years for phenomena dur- (SA), 2021 related phenomena and in Italy department suicide attempt ing the COVID-19 suicide ideation adjustment disorders 109 subjects were (SA), pandemic (SI), (p = 0.018). More than assessed for suici- 43.28 years for among people and non-suicidal one-third of the sample dality. Regarding suicide ideation requiring a psychi- self-injury (NSSI) did not report previous diagnosis: (SI), atric consulta- were registered psychiatric history. 23 had affective 39.29 years for tion in This suggests that a disorders (21,1%), non-suicidal an emergency percentage of cases 15 schizophrenia self-injury (NSSI); setting was related to the new spectrum disor- subjects included onset of suicidality, ders (13,8%), were mainly which is contrasting 8 anxiety disorders females 63 with previous findings (7,3%), (57.8%) that demonstrated how 6 adjustment suicide-related phe- disorders (5,5%), nomena mainly emerge 9 substance- in subjects affected related and addic- by serious psychiatric tive disorders disorders (8,3%), 1 trauma-related disorders (0,9%), 2 obsessive–com- pulsive and related disorders (1,8%), 24 personality disorders (22%) Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 19 of 48 Table 3 (continued) Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Almaghrebi et al. Risk factors for King Saud Medi- 29 suicide Patients Age range of the To identify the Modified SAD Retrospective, From April to Patients with psychiatric 2021 attempting cal City (KSMC), patients aged ≥ 16 years sample: suicide-related risk PERSONS scale Cross-sectional June, 2020 disorders accounted suicide during Riyadh, Saudi who survived the < 19 or > 45 years: factors and stress- (MSPS) to evaluate study for 69% of the cohort. the COVID-19 Arabia suicide attempts 13 (44.8%), ors and to deter- the suicide risk Factors like hopeless- lockdown: Iden- admitted to King 19–45 years 16 mine the groups factors ness and depression tification of the Saud Medical City (55.2%); at a greater risk were highly related to high-risk groups 24.1% of the Male 10 (34.5%) of attempting suicide attempts, as suicide attempters Female 19 (65.5%) suicide during well as the statement of have a history of the COVID-19 future intent to repeat using alcohol or lockdown the attempt, at 72.4% drugs (7), and 65.5%, respec- 31% have tively. Patients with psychosis or loss pre-existing psychiatric of rational think- disorders carry high risk ing (9), of attempting suicide 72.4% have during the COVID-19 Depression or lockdown hopelessness (21), 69% have previous suicide attempt or psychi- atric care (20) Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 20 of 48 Table 4 Suicide and Covid-19 in subjects with pre-existing mental disorder, cross-sectional studies general population Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Sáiz et al. 20 2022 Suicidal Ideation Spain Survey 1 (April Spanish general Age range of the To determine the Suicide behavior Cross-sectional Between Personal history of survey April 16–22, suicide attempt, current Trends and Associ- 16–22, 2020) total population sample: prevalence of assessed using ated Factors in sample: 6,108; sample. In the Survey 1 group passive SI (PSI) and Paykel Suicide 2020 peak or past history of mental Scale (PSS) of first wave; disorder are consistent Different Large Survey 2 (October Survey 1 group 45.78 years, active SI (ASI) in Spanish Samples 14 – November 786 (12.9%) had Survey 2 group Spanish general Passive suicidal between risk factors for active ideation (PSI) October 14– suicidal ideation (ASI) During the First 8, 2020) total a past mental 34.71 years, population sur- Year of the COVID- sample: 6,418; disorder and Survey 3 group veys conducted defined as posi- November tive answers to 8, 2020 peak 19 Pandemic Survey 3 (March 510 (8.3%) had a 39,65 years; at 3 points in time 16–31, 2021) current mental 4280 female during the COVID- PSS items 1 and/ of second or 2, wave; Total sample: disorder. In the (70.1%) Survey 1 19 pandemic and 5,654 Survey 2 group group; to characterize the and active suicidal between ideation (ASI), as March 914 (14.2%) had 5731 female main factors asso- a past mental (89.3%) Survey 2 ciated with ASI positive answers 16–31, 2021 to PSS items 3 peak of third disorder and group, 1,490 (23.2%) had 4575 female and/or 4 wave a current mental (80.9%) Survey 3 disorder. In the group Survey 3 group 606 (10.7%) had a past mental disorder and 704 (12.5%) had a current mental disorder Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 21 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Sasaki et al. 2022 Temporary Japan, 12 249 individuals Nationally repre- Mean age of the To assess the asso- Suicidal ideation Retrospective, From August In the subjects with employment and University of sentative cross‐ sample: ciation between measured using Cross‐sectional to Septem- previous psychiatric suicidal ideation Tokyo Gradu- sectional study in 43.3 years; employment con- one item: “Have study ber 2020 history group 386 (23.6%) in COVID‐19 pan- ate School of Japan. Subjects 5154 Female tract and suicidal you ever wanted reported persistent demic in Japan: Medicine with psychiatric (42.1%) ideation or newly to die from April suicidal ideation and 146 A cross‐sectional history were 1636 developed under 2020 to the (8.9%) reported newly nationwide survey (13.4%) COVID‐19 pan- present?” The developed suicidal demic examined response options ideation in the COVID‐19 using a nationally were “1. Experi- pandemic. History of representative enced for the first psychiatric disease was cross‐sectional time,” “2. It has associated with newly study in Japan been around for developed suicidal a long time,” and ideation in COVID‐19 “3. Not”. Persistent pandemic and persistent suicidal ideation suicidal ideation that began prior to the pandemic defined as Yes (2). Newly developed suicidal ideation in the COVID‐19 pandemic defined as Yes (1) Mean age of the To analyze differ - Suicidal risk Cross‐sectional From the This study suggests a Steinmetz Levels and predic- National Univer- 1202 subjects Argentineans et al. 2020 tors of depression, sity of Córdoba, who took part to sample: ences in mental assessed with survey 30th March negative mental health 31.45 years; 1029 health state Inventory of sui- until 23 May impact of quarantine anxiety, and Córdoba, an online survey. suicidal risk Argentina Subjects with female (85.61%) (MHS) indicators cide Orientation 2020 in students and in the (including suicidal (ISO-30) general population during COVID-19 mental disorder pandemic in history were risk), during three Suicidal risk, increasing 302 (25.13%) quarantine sub- from the first to the Argentina: the impacts of quar- periods; assess second/third quarantine multiple relation- extensions, but then antine extensions on mental health ships between maintaining to the fourth each MHS indica- extension state tor and potentially Presence of mental dis- affecting factors order history, and suicide attempt history were predictors of suicidal risk during quarantine sub- periods Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 22 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Mortier et al. 2021 Thirty-day suicidal Spain 3500 subjects Nationally repre- Mean age of the To investigate Suicidal risk Cross-sectional From 1–30 STB was 9.7% among the thoughts and sentative sample sample: the prevalence of assessed with survey June 2020 34.3% of respondents behaviors in the of non-institu- 49.6 years; 51.5% suicidal thoughts a modified ver - with pre-pandemic Spanish adult tionalized Spanish female and behaviors sion of selected lifetime mental disorders, general popula- adults. Among the (STB; suicidal items from the and 1.8% among the tion during the sample 34.3% of ideation, plans Columbia Suicide 65.7% without any first wave of the respondents had or attempts) in Severity Rating pre-pandemic lifetime Spain COVID-19 pre-pandemic the Spanish adult Scale mental disorder. Among pandemic lifetime mental general popula- factors significantly disorders: tion during the associated with STB were 490 have depres- first wave of the pre-pandemic lifetime sion, Spain coronavirus mental disorders and 55 have bipolar disease 2019 current mental disorders. disorder, (COVID-19) pan- Individual-level impact 199 have panic demic (March– was particularly high attacks, July, 2020), and for bipolar disorder 1052 have anxiety, to investigate the while population-level 37 have alcohol individual- and impact was highest for use problems, population-level depression and anxiety. 50 have impact of relevant About 49.1% of any STB drug use prob- distal and proxi- is potentially attributable lems mal STB risk factor to the joint effects of all domains pre-pandemic lifetime mental disorders. 74.1% of suicidal thought and behavior is potentially attributable to mental disorders and adverse events—experiences related to the pandemic. Taken together these two observations suggest a potential increase of suicidal thought and behavior during the pandemic Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 23 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Vrublevska et al. Factors related Latvia 2608 respondents Nationwide repre- Mean age of the To investigate The Risk Assess- Cross-sectional From 6 to 27 Suicidal thoughts 2021 to depression, sentative sample sample: the impact of the ment of Suicidality survey July 2020 increased in 13.30% of distress, and self- of the general men COVID- Scale (RASS) used those with a history of reported changes population. 48.04 years, 19 pandemic on to assess suicidal clinical depression, and in anxiety, depres- 7.82% overall self- women the mental health behavior 27.05% of those with sion, and suicidal reported history of 44.74 years; of the general a history of suicidal thoughts during depression 1260 men, population attempts during the state the COVID-19 6.13% had an his- 1344 women, of Latvia of emergency state of emer- tory of at least one 4 respondent gency in Latvia suicide attempt reported that they were ‘other ’ or did not want to define their gender Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 24 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Papadopoulou et Suicidal ideation Greece 5,748 subjects Adults who Age range of the To investigate Suicidal ideation Cross‐sectional From April Individuals with suicidal al. 2021 during COVID- participated in the sample: the prevalence of assessed accord- survey 7 to May 3, ideation compared to 19 lockdown survey Non-suicidal suicidal ideation in ing to the suicidal 2020 those without suicidal in Greece: Mental health his- ideation group: the community as item of Patient ideation were more likely Prevalence in the tory, reported by 18–24 years: well as the risk Health Question- to have a mental health community, risk 464 patients 653 (13.13%), and protective naire, PHQ-9 history, poorer perceived and protective In the non-suicidal 25–34 years: factors of suicidal quality of physical health, factors ideation group 930 (19.23%), ideation during and belong to a high-risk 399 (8.3%) 35–44 years: 1376 restriction meas- group for SARS-CoV2 reported mental (28.45%), ures in Greece, infection. Participants health history 45–54 years: 1148 after the outbreak with a mental health his- In the suicidal (23.74%), of the COVID- tory had 1.64-fold higher ideation group 65 55–64 years: 19 pandemic and odds of suicidal ideation (24.4%) reported 618 (12.78%) development of Mental health history mental health 65 years and mental health emerged among the history above: symptoms risk factors of suicidal 129 (2.67%); ideation Suicidal ideation group: 18–24 years: 71 (26.69%), 25–34 years: 60 (22.56%), 35–44 years: 60 (22.56%), 45–54 years: 56 (21.05%), 55–64 years: 16 (6.02%), 65 years and above: 3 (1.13%); 1,434 males, 4,217 females and 5 individuals who reported “other ” sex Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 25 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Wathelet et al. Factors Associated France 69 054 students Students who Mean age of the To measure the Self-reported Cross‐sectional From April Among risk factors identi- 2020 With Mental completed it in sample: prevalence of self- suicidal thoughts survey 17 to May 4, fied, reporting at least Health Disorders its entirety the 20 years; reported mental assessed using the 2020 1 outcome, including Among University questionnaire 50 251 Female health symptoms, 22-item Impact suicidal thoughts, was Students in France 7114 respondents (72.8%) to identify of Events Scale– associated with history of Confined During (10.3%) reported associated factors, Revised psychiatric follow-up the COVID-19 a history of psychi- and to assess Pandemic atric follow-up care seeking among university students who experienced the COVID-19 quaran- tine in France Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 26 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Every-Palmer Psychological New Zealand 2416 subjects, Representative Mean age of the To determine: Suicidality Cross‐sectional Between 15 Over half of those with et al. 2020 distress, anxiety, cleaned achieved sample of adult sample: - The state of the assessed using survey and 18 April past mental health diag- family violence, sample of 2010 New Zealanders 45 years; New Zealand questions on 2020 noses were experiencing suicidality, and cases aged between 1063 Female population’s suicidal ideation, moderate or severe psy- wellbeing in New 18 and 90 years (52.9%) wellbeing during suicide plans, chological distress. About Zealand during recruited from the COVID-19 and suicide one-third thought their the COVID-19 a commercial lockdown (stress, attempts during mental health had been lockdown: A cross- survey platform anxiety, depressive the lockdown and worse than usual during sectional study 375 people symptoms, alco- the preceding the lockdown (52.9%), (18.2%) reported hol consumption, 12 months just under half thought previously been family relation- it was the same as usual diagnosed with ships, suicidal (46.1%), and about one a mental health thinking, etc.) in six reported it was condition by a - How the better than usual (17.5%). doctor or psy- lockdown affected Suicidal ideation during chologist specific popula- lockdown reported by Of these, many tions (e.g., essen- 6.1% of participants with had more than tial workers, those 2.1% reporting making one diagnosis, with underlying plans for suicide and with 80.2% report- health conditions, 2.1% also reporting a ing having been and the elderly) suicide attempt diagnosed with a - Whether there For most of those experi- depressive disor- were any positive encing suicidal thoughts, der, 52.6% anxiety psychological these were not new disorder, consequences thoughts– 83.0% of that 5.8% personality associated with group reported having disorder, the lockdown experienced similar idea- 7.6% bipolar tion in the 12 months disorder, prior to lockdown 5.7% an alcohol Vulnerable groups and drug disorder, included those with past 3. 9% a psychotic history of mental illness disorder, and 11.4% another disorder Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 27 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Daly et al. 2021 Associations Canada 3558 subjects Individuals from Age range of the To examine the Suicidal ideation Cross‐sectional between COVID-19 quarantine between periods the Maru Voice sample: relationships and self-harm survey May 14–29, for any reason was associ- of COVID-19 Canada panel and 18–34: 534, between COVID- were assessed 2020 ated with an increase in quarantine and who completed (17.8%); 19 quarantine and by asking partici- the odds of suicidal idea- mental health in the survey 35–54: 1157 mental health, pants, “as a result tion in the group having Canada 18.2% (546) (38.6%); including suicidal of the COVID-19 a pre-existing mental reported having 55 + : 1309 ideation, and self- pandemic, in the health condition a pre-existing (43.6%); harm; previous two mental health 1519 woman and to explore weeks” had they condition (50.6%) whether mental “Experienced health outcomes suicidal thoughts/ differ depending feelings?” or on the specific “Deliberately hurt reason for quar- myself? antine A modified Cross‐sectional Between 6 Prevalence of suicidal Bruffaerts Suicidality among Belgium 6,409 healthcare Healthcare Mean age of the To investigate et al. 2021 healthcare profes- professionals professionals. sample: the 30-day version of the survey April and 14 thoughts and behaviors Columbia Suicidal July 2020 (STB) was 3.6% death sionals during Lifetime problems 41.6 years; prevalence of the first COVID-19 with anxiety/ 72.4% female suicidal thoughts Severity Rating wish, 1.5% suicide idea- Scale used to tion, 1.0% suicide plan, wave nerves endorsed and behaviors by 12.1%, then (STB) and associ- assess STB, and 0.0% suicide attempt. including suicidal Thirty-day suicidal depression (7.7%), ated risk factors panic attacks among clinically ideation. Any STB thoughts and behaviors defined as any (STB) increased among (2.8%), and active healthcare substance use professionals positive answer respondents with lifetime during the first on at least one of mental disorders (mostly problems (0.9%). Any lifetime prob- wave of COVID-19 the STB questions depression) pandemic lem estimated at 19.1% Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 28 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Behera et Trends in deaths New Delhi, India 321 between Autopsies of Mean age of the To assess the Psychological Retrospective, Pre-lock- There was a significant al. 2021 attributable to March–October deaths attribut- sample: impact of situa- autopsy of deaths Cross-sectional down from decline in deaths due to suicide during 2020 able to suicide 28.00 years; tion consequent due to suicides study 25 March suicide during the lock- COVID-19 331 between from two districts majority being to COVID-19 examined to 2019 to 31 down period. Psychologi- pandemic and March–October in New Delhi male (235/321, pandemic on explore factors October cal autopsy suggested its association 2019 73.2%) the deaths due associated with 2019 and mental disorders to be with alcohol to suicide in two suicide during the underlying cause for use and mental districts of New lockdown suicidal behavior in 10.2% disorders: Findings Delhi, India from 25 (33 out of 321) cases. from autopsies March 2020 There was a significantly conducted in two to 31 Octo- greater proportion of districts of India ber 2020 deaths due to suicide attributable to mental illness (12.3% vs. 1.6%, p = 0.01) during the unlock period. There was a significantly lesser number of deaths due to suicide with past history of suicide attempt in the current as compared to the last year Shi et al. 2021 Prevalence and China 56,679 subjects Nationwide sam- Age range of the To explore the Suicidal ideation Cross-sectional Between Suicidal ideation was prevalence of assessed accord- survey February 28, more prevalent in indi- correlates of ple from 34 China sample: suicidal ideation province-level 18–24: suicidal ideation ing to the suicidal 2020 and viduals with pre-existing 3,267 (5.8%), and its risk factors item of Patient March 11, mental disorders (41.6%). among the gen- regions eral population From the entire 25–34: among the gen- Health Question- 2020 Among factors associ- 23,050 (40.7%), eral population in naire, PHQ-9 ated with suicidal idea- in China during sample 161(0.3%) the COVID-19 had a history of 35–44: China during the tion during the COVID-19 21,658 (38.2%), COVID-19 pan- pandemic, a history pandemic mental disorder In this subgroup ≥ 45: demic and further of mental disorders 8,704 (15.4%); provide evidence increased risk of suicidal 67 (0.7%) reported suicidal ideation 27,149 (47.9%) for suicide ideation males and 29,530 prevention under (52.1%) females a public health emergency Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 29 of 48 ff Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Yang et al. 2021 The Differential Chinese University 1070 subjects Population- Age range of the To test the media- Suicidal ideation Cross-sectional Between Being diagnosed with Eects of Social of Hong Kong, based sample. sample: tion effects of assessed accord- survey May 14 and mental health problems Media on Depres- Honk Kong 25 (2.3%) were 18–35: social loneliness ing to the suicidal June 4, 2020 before or during the sive Symptoms diagnosed with 115 (10.7%); and post- item of Patient COVID-19 pandemic and Suicidal mental health 36–55: traumatic stress Health Question- were positively associ- Ideation Among problems before 252 (23.6%); disorder (PTSD) naire, PHQ-9 ated with suicidal the Younger the pandemic; 56–65: symptoms on ideation and Older Adult 20 (1.9%) were 301 (28.1%); > 65: the relationship Population in diagnosed with 383 (35.8%); between social Hong Kong Dur- mental health Male 346 (32.3%); media use and ing the COVID-19 problems during Female 724 (67.7) depressive symp- Pandemic: the pandemic toms and suicidal Population-Based ideation, as well Cross-sectional as the moderation Survey Study effect of age on the mediation models Mean age of the The study Suicidal ideation Cross-sectional From April 4 Suicidal ideation was Al-Humadi et al. Depression, New York, USA 225 physicians The sample was 2021 Suicidal Thoughts, composed of sample: investigates the assessed accord- survey through May associated with history 38.57 years; incidence and ing to the suicidal 1, 2020 of depression/anxiety, and Burnout residents, fellows, Among Physicians and attending 129 female associated factors item of Patient during the COVID-19 (57.3%) of depression, Health Question- pandemic During the COVID- physicians from 19 Pandemic: a 26 specialties suicidal thoughts, naire, PHQ-9 The prominence of and burnout premorbid depression/ Survey-Based working at Stony Cross-Sectional Brook University among physicians anxiety as a relevant fac- during the COVID- tor underscores the need Study Hospital. 65 participants (29%) 19 pandemic to further understand physician mental health previously been diagnosed or and provide early screen- ing and treatment treated for depres- sion or anxiety Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 30 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Sáiz et al. 2020 Prevalence of Spain 21,207 partici- Large general Mean age of the To determine To determine Cross-sectional Between 1,873 responders (8.8%) Passive Suicidal pants population sam- sample: the prevalence independent survey March 19 had experienced passive Ideation in the ple aged 18 years 39.7 years; 14,768 of passive factors associated and 26, 2020 suicidal ideation during Early Stage of the or over 3,665 females (69.6%) suicidal ideation with passive the past 7 days. Risk fac- Coronavirus Dis- (17,3%) suffered in a sample of the suicidal ideation tors for passive suicidal ease 2019 (COVID- a past mental general Spanish subjects involved ideation were having a 19) Pandemic disorder, 2489 population early asked if they had: personal history of past/ and Lockdown in (11,7%) suffered in the COVID-19 “passive suicidal current mental disorder a Large Spanish currently a mental pandemic and ideation during Sample disorder lockdown and past 7 days” (no/ to characterize yes) factors associ- ated with such thoughts Mamun et al. 2020 Indian celebrity India 23 press reports Media reports Mean age of the To assess suicide Google News Retrospective, Between While the 16 celebrity victims based on search engine Cross-sectional 2002–2019 suicides prior to the suicides before The most com- sample: and during the mon cause of 37.94 years a specific high- used to retrieve study and dur- COVID-19 pandemic profile occupation relevant articles. ing the spread over 17 years COVID-19 pan- reported suicide between demic and their during the differ - 2002–2019, (celebrities The search terms first three (2002–2019), the seven working in the included, ‘Indian months of celebrity suicides during associated risk ent time periods 26.43 years during factors: Evidence was depression the first three entertainment cinema celebri- Covid-19 the COVID-19 pandemic industry) and ties’, ‘celebrity pandemic occurred within a from media (17) although fam- months of Covid- reports ily problems (3), 19 pandemic; to examine the suicides’, ‘COVID- 3-month period. Depres- probable causality 19 pandemic’, sion was reported to be bipolar disorder 10 males and 6 (1), and personal females between of suicides both ‘depression’, ‘finan- the most common cause 2002–2019, before and during cial strife’, and of celebrity suicides both reasons (1) along with one case 3 males and 4 the COVID-19 ‘lockdown related before and during the females during pandemic period restriction’ COVID-19 pandemic, but wherein the cause of suicide was the first three the increased incidence months of Covid- of celebrity suicides unreported 19 pandemic during the ongoing pan- demic suggests a pos- sible association between COVID-19-related restrictions and the exac- erbation of pre-existing mental health conditions such as depression that increases the risk of suicidality among Indian celebrities Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 31 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Czeisler et al. 2020 Mental Health, Monash Univer- 5,470 subjects Adults who com- Age range of the To assess mental Respondents also Cross-sectional During Overall, 40.9% of 5,470 Substance Use, sity, pleted web-based sample: health, substance reported whether survey April–June respondents who com- and Suicidal Melbourne, surveys. Among 18–24: use, and suicidal they had seriously of 2020, pleted surveys during Ideation During Australia, subjects receiving 731 (13.4%), ideation during considered sui- compared June reported an adverse the COVID-19 Pan- Harvard Medical treatment for 25–44: the pandemic cide in the 30 days with the mental or behavioral demic — United School Boston, previously diag- 1,911 (34.9%), preceding the same period health condition, includ- States, June Massachusetts, nosed condition: 45–64: survey in 2019 ing having seriously con- 24–30, 2020 USA 536 have Anxiety 1,895 (34.6%), sidered suicide in the pre- (9.8%), ≥ 65: ceding 30 days (10.7%). 540 933 (17.1%); Suicidal ideation was also Depression 2,784 Female elevated; approximately (9.9%), (50.9%) twice as many respond- 251 ents reported serious Posttraumatic consideration of suicide stress disorder in the previous 30 days (4.6%) than did adults in the United States in 2018, referring to the previous 12 months. Mental health conditions are disproportionately affect - ing specific populations including those receiving treatment for pre-existing psychiatric conditions Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 32 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Iob et al. 2020 Abuse, self-harm London United 44 775 subjects Data from Age range of the To address Suicidal ideation Cross‐sectional Between 7984 participants (18%) and suicidal Kingdom University College sample: between evidence gaps assessed accord- survey 21 March reported experiencing ideation in the UK London’s (UCL’s) 18–29 years: by exploring ing to the suicidal and 20 April thoughts of suicide or during the COVID- COVID-19 Social 7835 (17.5%), patterns of abuse, item of Patient 2020 self-harm in the first 19 pandemic Study; between self-harm and Health Question- month of lockdown 8757 received 30–44 years: thoughts of naire, PHQ-9 and 2174 participants a Mental health 10 394 (23.2%), suicide or self- (5%) reported harming diagnosis (19.6%) between harm in the UK themselves at least once 45–59 years: in the first month since the start of the 12 031 (26.9%), of lockdown due UK’s lockdown. In the Over 60 years: the COVID-19 first month of lockdown 14 515 (32.4%); pandemic and in the group of subjects Female 22 846 exploring whether with a mental health (51.0%) those having such diagnosis 3813 reported experiences were self-harm/suicidal accessing formal thoughts 3813 (43.5%); or informal mental 1241 reported self-harm health support behaviors (14.2%). The patterning of thoughts and experiences of self-harm during the first month of lockdown included having a mental disorder Panigrahi et al. COVID-19 and India 151 reports COVID-19 related Mean age of the To analyze reports Search scientific Retrospective, Between The study suggests that literature, govern- Cross-sectional 1st February socio-demographic 2021 suicides in India: suicides (CRS) sample: of COVID-19 A pilot study of reports 38.7 years; related suicides ment websites study 2020 to 30th factors, stigma related to and online news- September a diagnosis of COVID-19, reports in the 7 had a pre-exist- 19.2% (29) were (CRS) to identify media and scien- ing psychiatric females associated factors paper reports 2020 being in quarantine/isola- in English and tion and recent physician tific literature illness, depression with a broader goal to inform nine regional lan- contact are markers of management guages to identify COVID-19 related suicides and prevention relevant COVID-19 CRS strategies related suicides Among the deceased, (CRS) reports majority (89.4%, 135), had no comorbid physical/ mental illness or sub- stance use Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 33 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Kasal et al. 2022 Suicide Risk in Czech Republic May 2020 dataset Data from Mean age of the To assess changes Past month SR Analysis of Three Three Individuals with anxiety Individuals With consisted of 3,021 three nationally sample: 48 years in suicide risk was assessed Nationwide Cross- nationwide disorders exhibited an and Without participants, representative 2017 May sample, (SR) in people using a separate Sectional Surveys, cross- increase of approximately Mental Disorders 2017 dataset cross-sectional 46 years with and without M.I.N.I. module paper and pencil sectional 12% and 20% in SB Before and During consisted of 3,306 surveys of Czech 2020 May mental disorders, consisting of 6 interviewing, surveys: prevalence compared to the COVID-19 respondents, community- Sample, before and during questions (1) while for the two November the baseline, Pandemic: An November 2020 dwelling adults 46 years 2020 the COVID-19 “Think that you 2020 data collec- 2017, major depressive disorder Analysis of Three dataset consisted Subjects with a November pandemic in would be better tions, we used a May and was associated with Nationwide Cross- of 3,000 partici- major depressive Sample; Czechia off dead or wish mixed computer- November higher odds of SR in all Sectional Surveys pants episode were: 2017 May sample: you were dead?”, assisted web 2020 three datasets in Czechia 132 (3.99%) in 1,774 females (2) “ Want to interviewing and 2017 May sample, (53.66%), harm yourself?”, computer-assisted 359 (11.88%) in 2020 May (3) “ Think about telephone inter- 2020 May sample, sample: suicide?”, (4) “Have viewing approach 382 (12.73%) in 1,581 females a suicide plan?”, 2020 November (52.33%), and (5) “Attempt sample; 2020 November suicide?”, (6) “Did Anxiety disorders Sample: 1,534 you ever make a were: 261 (7.89%) females suicide attempt?”. in 2017 May (51.13%) In line with the sample, scoring procedure 408 (13.51%) in proposed by the 2020 May sample, authors of the 398 (13.27%) in instrument, we 2020 November considered a sample positive answer to any question as indicative of past-month SR. A positive answer to any of the first four and last two items was indica- tive of presence of ST and suicidal behavior (SB), respectively Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 34 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Mortier et. al 2021 Thirty‐day suicidal Spain 5450 hospital Cohort of Spanish Mean age of the To examine base- Modified version Cross-sectional From May Thirty‐day suicidal thoughts and workers hospital workers sample: line prevalence of of selected survey 5–July 23, thoughts and behaviors behaviors among 568 had a lifetime 42.9 years in those 30‐day STB and items from the 2020 (STB) prevalence was hospital workers mood disorder, that completed to investigate the Columbia Suicide estimated at 8.4% during the first 1893 had a the STB items, relationship of Severity Rating 6 professionals wave of the lifetime anxiety 42.1 years in those potentially modifi- Scale attempted suicide in Spain COVID‐19 disorder that did not; able contextual the past 30 days. In outbreak females 80.8% factors related to adjusted models, 30‐day in those that hospital workers’ suicidal thoughts and completed the perceived work behaviors (STB) remained STB items, females and financial situ- significantly associated 82.1% in those ation, with 30‐day with pre‐pandemic life- that did not STB time mood and anxiety disorder Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 35 of 48 Table 5 Suicide and Covid-19 in subjects with pre-existing mental disorder, other studies Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study Hedley et The association La Trobe Univer- 111 Autistic Autistic adults Mean age of the To examine Suicide risk Mixed‐method Between The impact of the al. 2021 between COVID- sity, Melbourne, patients aged 20 to sample: potential asso- assessed using survey design October and COVID-19 pandemic 19, personal Australia 71 years during 42.45 years; 58,6% ciations between Suicide Behavior December may be associated with wellbeing, depres- the second wave women and 32,4% COVID-19 impact Questionnaire 2020 poorer wellbeing and sion, and suicide of the COVID-19 men and depres- Revised higher depression but is risk factors in pandemic in sion, personal (SBQ-R) not associated with sui- Australian autistic Australia wellbeing, and cide risk in this autistic adults Co‐occurring suicide risk factors adults’ sample diagnoses of anxi- in Australian ety or depression autistic adults and were reported age and gender by 70% (73, 71, effects respectively) of participants Carlin et. al 2021 Impact of COVID- Trauma Centre of 559 admissions; Patients admitted Mean age of the To analyze how Retrospective Mixed‐method, From 16 The study revealed a 19 lockdown on the Medical Uni- 79 in 2015; 87 in to the trauma sample: many of the data analysis. Case–control, March to significantly higher pro - suicide attempts versity of Vienna, 2016; 110 in 2017; resuscitation 43,2 years in the patients admitted Patients subdi- Cross-sectional 15 May in portion of attempted A retrospec- Vienna, Austria 109 in 2018; 109 room. Number control group; to the trauma vided into trauma study the years suicides in all patients tive analysis of in 2019; 65 in of patients in the 38.7 years in the resuscitation victims and 2015–2019 admitted to the trauma the springtime 2020 control group was study group; major- room of the individuals who resuscitation room admissions to the 37, in the study ity being male in level 1 Trauma had attempted Due to the small num- trauma resuscita- group 23. Patients both groups Centre of the suicide ber of patients in the tion room at the with known psy- Medical University study group an increase Medical University chiatric disease of Vienna during in suicidal behavior of Vienna from were 32 (86.5%) in the COVID-19 isolated for individuals 2015–2020 the control group lockdown in Aus- with previous mental and 19 (82.6%) in tria injured due to health problems could the study group. a suicide attempt not be observed, but Patients with by intentionally more generally an history of previous caused trauma increase in suicidality suicide attempt across different groups were 13 (35.1%) in at risk the control group and 9 (39.1%) in the study group Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 36 of 48 Table 5 (continued) Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study Czeisler et al. 2021 Mental health, Victoria region, 1531 subjects Victorians who Age range of the To analyze the Data collection Mixed‐method During Suicidal ideation was substance use, Australia completed the sample: associations including past- Longitudinal, April 2–8, nearly three times and suicidal surveys Age range in the between adverse month passive cross-sectional 2020 (April- as prevalent among ideation during History of diag- Victorian-April mental and suicidal ideation survey 2020) and respondents with vs a prolonged nosed psychiatric group: behavioral health (i.e., wished to be September without previously COVID-19-related condition was 18–24: 42 (12.8%); symptoms and dead), and past- 15–24, 2020 diagnosed psychiatric lockdown in a present in: 25–44: 123 demographic month serious conditions. Diagnosed region with low 123 subjects (10.6%); characteristics, suicidal ideation psychiatric disorder was SARS-CoV-2 (37.1%) in the 45–64: 105 (31.7%); sleep, and behav- associated with poor prevalence Victorian-April ≥ 65: 61 (18,4%); ioral changes, outcomes, including group; Age range in the with the aim of suicidal ideation, during 435 subjects Victorian-September identifying areas COVID-19 pandemic (37.6%) in the group: for targeted Victorian-Septem- 18–24: 123 (10.6%); interventions to ber group; 25–44: 436 improve mental 38 subjects (37.6%); health (41,4%) in the 45–64: 379 (32.8%); Victorian-Longitu- ≥ 65: 219 (18.9%); dinal group Age range in the Victorian-Longitudi- nal group: 18–24: 11 (12.3%); 25–44: 34 (36.5%); 45–64: 29 (31.1%); ≥ 65: 19 (20.2%) Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 37 of 48 Table 5 (continued) Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study Hyland Predicting risk Ireland 1,032 subjects Nationally repre- Mean age of the To analyze the Three items were Mixed‐method May 2020 and There was no statisti- et al. 2021 along the suicidal- 715 who sentative sample sample: lifetime preva- adapted from Longitudinal, a follow‐up in cally significant change ity continuum: completed the of Irish adults 44.86 years; lence of different the 2014 English cross-sectional August 2020 over time in suicidal A longitudinal, follow-up Some participants 52.1% female indicators of Adult Psychiatric survey behavior. Suicidal idea- nationally rep- reported a history suicidality in the Morbidity Survey tion was not associate resentative of mental health Irish general pop- to measure with been treated for a study of the Irish treatment ulation; whether suicidal and self‐ mental health problem. population during suicidality has harm ideation Those who treated the COVID‐19 increased during for a mental health pandemic the COVID‐19 problem were over pandemic; and twice as likely as those what factors with no such history associated with to have engaged in belonging to dif- non‐suicidal self‐injury ferent points on (NSSI). Among variables a continuum of significantly associated suicidality risk with attempted suicide there was having received treatment for a mental health problem Veldhuis Addressing the USA and more 1567 subjects Longitudinal data Age range of the To better under- Suicide risk was Mixed‐method Baseline sur- Baseline risk for suicide sample: stand the longer- measured using Longitudinal, veys during was associated with et al. 2021 critical need than 50 other from an interna- for long-term countries tional conveni- 18–30: 38.0%; 31–40: term effects of the Suicidal Idea- cross-sectional April 5–19, 12 times higher odds 31.8%; the pandemic on tion Attributes survey 2020; of risk for suicide at mental health ence sample of data during the adults 18 or older 41–50: 14.2%; 51–65: mental health Scale (SIDAS) 5-month 5-month follow-up. living in every US 12.3%; 66 + : 3.7%; which measures follow-up Having received a COVID-19 pan- demic: Changes state and more Women thoughts and (August 28– mental health diagnosis than 50 countries 88.2% behaviors and September was associated with in mental health from April to who completed provides an 11, 2020 suicide risk at 5-month baseline surveys assessment of risk follow-up September 2020 and the 5-month (scores of 21 or follow-up. 58.9% higher are consid- received a mental ered severe risk health diagnosis. and 10 or higher Participants who is considered to reported depres- be some risk) sion, anxiety, or PTSD were con- sidered to have a previous relevant mental health diagnosis Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 38 of 48 Table 5 (continued) Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study Hamm Experiences of Los Angeles, New 73 older adults Community-living Mean age of the To determine Suicidal ideation Multicity, Mixed- Between April Examination of PHQ-9 et al. 2020 American Older York, Pittsburgh, with pre-existing older adults with sample: the effect of assessed accord- Methods Study 1 and April 23, item 9 (thoughts of Adults with Pre- and St Louis, USA Major depressive pre-existing 69 years; the COVID-19 ing to the suicidal 2020 death or self-harm) existing Depres- disorder Major depres- 50 females (68.5%) pandemic on the item of Patient revealed no increase in sion During the sive disorder mental health Health Question- suicidal thoughts. Of Beginnings of the (MDD) recruited of older adults naire, PHQ-9 72 with scores available COVID-19 Pan- among the 743 with pre-existing in the immediate peri- demic: A Multicity, participants in major depressive pandemic period, 59 Mixed-Methods the Optimizing disorder (MDD) (82%) had no thoughts Study Outcomes of of death (score of 0) Treatment-Resist- both beforehand and ant Depression currently; in Older Adults 5 (7%) had current (OPTIMUM) clini- thoughts of death (all cal trial had score of 1) but none beforehand; while 7 (10%) had reduced thoughts of death currently compared to before the pandemic (score of 0 currently vs. 1 beforehand in 5 participants, score of 1 currently vs. 3 before- hand in 2); 1 refused to answer Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 39 of 48 Table 5 (continued) Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study Knipe et Hospital presenta- Teaching Hospital 1401 individuals; Hospital Age range of the To determine the Admission Interrupted time- Before (Jan 1, A sudden drop in al. 2022 tions for self- Peradeniya, Pre-pandemic admissions for sample: Pre-pan- effect of the pan- book data and series analysis 2019–March presentations for self- poisoning during Sri Lanka period (1161) self-poisoning. demic period demic on hospital information from 19, 2020) and poisoning occurred COVID-19 in Sri Pandemic period Subjects with a < 25 years were 603 presentations for bed head tickets during (March at the start of the Lanka: an inter- (240) current psychiatric (51,9%), self-poisoning were used to 20–Aug 31, lockdown period; on rupted time-series diagnosis were Pre-pandemic identify cases of 2020) the average, there were analysis 535 in pre- period ≥ 25 years self-poisoning pandemic more presentations pandemic period were 546 (47,0%); (intentional self- in the pre-pandemic (46,1%) and 110 in Pandemic period harm by ingesting period than in the pandemic period < 25 years were 107 poison). Medical pandemic period. The (45,8%) (44,6%), Pandemic records used time-series analysis period ≥ 25 years to retrieve all indicated that there was 117 (48,8%); relevant informa- a 32% reduction in hos- 761 (54,3%) females tion regarding pital presentations for the patient’s stay, self-poisoning during including any the pandemic period related history. compared with the The overall num- pre-pandemic period. ber of admissions There was no statistical per month were evidence that the collected from impact of the pandemic the admission differed regarding hav- books and used ing a current psychiatric to trace bed diagnosis head tickets for detailed informa- tion regarding admissions (type of poison ingested) Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 40 of 48 Table 5 (continued) Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study McDowell et al. Evaluating the Massachusetts 2018–2019 Psychiatric Mean age of the To estimate The presence Interrupted time- Between 2018 Results estimate signifi- 2021 association General Hospital, Cohort (489) Presentation in sample: the association or absence of series analysis and 2020, cant differential change between COVID- Boston, Mas- 2019–2020 an emergency 38 years in the between suicidal ideation February associated with suicidal 19 and psychiatric sachusetts, United Cohort (467) department 2018–2019 Cohort, COVID-19 and as determined by 26–March 6, ideation and substance presentations, States In the 2018–2019 39 years in the Emergency text in the psychi- 2020 used use disorder (SUD) pres- suicidal ideation Cohort, patients 2019–2020 Cohort; Department atric consultation to define entations following the in an emergency presenting with 281 female (57.5%) (ED) psychiatric note, as well as patterns in outbreak. Specifically, department suicidal Ideation in the 2018–2019 presentations, up to three psy- psychiatric there were a significant were 293 (59.9%), Cohort; 301 female including suicidal chiatric diagnoses presenta- differential increase in substance use (58.0%) in the ideation (not including tions before presentations with sui- disorder were 202 2019–2020 Cohort SUDs), recorded and after the cidal ideation six weeks (41.3%), for each patient coronavirus after the outbreak (36.4 affective disorder presentation outbreak percentage points were 172 (35.2%), change) psychotic disorder For presentations were 83 (17.0%); with SUD, there were In the 2019–2020 a differential increase Cohort, patients in the COVID-19 time presenting with series relative to the suicidal Ideation comparison time series were 274 (58.7%); at all post-outbreak substance use time points and this disorder were 184 differential increase (39.4%); was significant three affective disorder weeks (32.8 percentage were 184 (39.4%); points; 95% CI: 4.0, 61.6) psychotic disorder following the outbreak. were 57 (12.2%) Moreover, SUD presen- tations seem to explain the increase in suicidal ideation presenta- tions in week 3 in the unadjusted models. The results estimate no differential changes significant at the P value < 0.05 level associ- ated with affective disorder or psychotic disorder presentations in the COVID-19 time series relative to the comparator time series Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 41 of 48 Table 5 (continued) Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study Oliè et al. 2021 Psychological France 69 healthy con- Patients with his- Mean age of the To compare in 69 Suicidal ideation Case–control From March, Current suicidal idea- state of a sample trols (HC) tory of depressive sample: healthy controls assessed accord- study 17 to May 11, tion (according to the of patients with 346 patients with episodes and healthy controls (HC) and 346 ing to the suicidal 2020 suicidal item of Patient mood disorders a major depres- healthy controls. (HC) 37 years, patients with a item of Patient Health Questionnaire, during the first sive episode in In the PP group: patients with a major depressive Health Question- PHQ-9) was reported French COVID-19 the two previous 44.5% (50) had major depressive episode in the naire, PHQ-9 by 26.6% of PP (92). Sui- lockdown years (PP) a diagnosis of episode in the two two previous cidal ideation was pre- bipolar disorder, previous years (PP) years (PP) self- dicted by psychotropic 50% (174) lifetime 39 years; reported psycho- drug changes, history history of suicide 16 men (23.2%) logical symptoms of suicide attempt, high attempt, 62% healthy controls(HC) (depression, education level, and (207) lifetime ,83 men (24%) anxiety, insomnia, loneliness. Daily virtual history of anxious patients with a suicidal ideation, contacts were protec- disorder, 22.2% major depressive traumatic stress, tive against suicidal (74) alcohol abuse episode in the two anger) and liv- ideation or dependence, previous years (PP) ing conditions 15.2% (51) illicit during the first substance abuse national French or dependence, lockdown, and and 15.2% ( 51) an identify predictors eating disorder of significant psychological distress in PP The University of 64; Adults diagnosed Mean age of the To compare older Suicide ideation Case control Between The level of suicidal Louie et al. 2021 Suicidal Risk in Older Patients Hong Kong, 31 healthy older with major sample: adults with late- assessed using study March and ideation was signifi- Queen Mary adults, depressive 74.45 years adults life depression Geriatric Suicide April 2020 cantly higher in the LLD with Depression During COVID-19 Hospital, Hong 33 adults with disorder (single or with late-life depres- (LLD) and healthy Ideation Scale group than the healthy Kong late-life depres- recurrent episode) sion (LLD), controls in (GSIS) control group after Pandemic: a Case–Control sion (LLD) as defined by the 71.10 years controls; terms of suicidal adjusting for depres- Study DSM-5 recruited 21 men and 43 ideation during sive symptoms. Older from psychiatric women aged 61 to the COVID-19 people with LLD had clinics or inpatient 89 years pandemic, and to a significantly higher wards, whereas determine predic- suicidal risk during the healthy older tors of suicidal COVID- 19 pandemic adults without a ideation history of depres- sion or other psy- chiatric illnesses were recruited from voluntary organizations or elderly commu- nity centers Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 42 of 48 Table 5 (continued) Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study Hao et al. 2020 Do psychiatric Chongqing, China 76 An online Mean age of the To assess and Structured Case–control The Nine (11.8%) psychiatric patients experi- psychiatric questionnaire was sample: compare the questionnaire study psychiatric patients and 1 (0.9%) ence more psy- patients administered via 32.8 years immediate stress consisted of ques- patients were healthy control chiatric symptoms 109 healthy SMS to psychiatric Psychiatric patients, and psychological tions in which recruited from reported moderate to during COVID-19 control patients from 33.1 years Healthy impact experi- Suicide ideation 19 to 21 Feb- severe suicidal ideation pandemic and the databases of controls; enced by people was evaluated ruary 2020, Specifically, in the lockdown? A the First People’s Psychiatric patients with and without trough: and healthy Psychiatric patients (76) case–control Hospital of 51 Female (37.1%), psychiatric 6- Other psychiat- control par- group: study with service Chongqing Liang Healthy controls 68 illnesses during ric symptoms ticipants were 64 (84.2%) reported No and research Jiang New Area, Female (62.4%) the peak of 2019 recruited suicidal ideation, implications for China coronavirus from 21 to 3 (3.9%) Mild suicidal immunopsy- The healthy con- disease (COVID- 22 February ideation, chiatry trol participants 19) epidemic with 2020 5 (6.6%) Moderate were recruited strict lockdown suicidal ideation, through conveni- measures 3 (3.9%) Serious suicidal ent sampling ideation, For psychiat- 1 (1.3%) Very serious ric patients, suicidal ideation majority of the respondents had mixed anxiety and depressive disorder (59%), followed by other anxiety disorders (25%) and major depressive disor- der (16%) Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 43 of 48 study, participants were interrogated on suicidal ideation, design [63]. Veldhuis et al., 2021, conducted a longitudi- suicide plans, and suicide attempts during the lockdown nal survey in 2021 in the USA  within a cross-sectional and the preceding 12 months [57]. Daly et al. too assessed baseline assessment to obtain a better understand- suicidality during  the COVID-19 pandemic by directly ing of the long-term effects of the pandemic on mental questioning the participants whether they had ever expe- health [59]. The second study conducted in Australia’s rienced suicidal thoughts and feelings or past episodes of Victoria region by Czeisler et  al. utilized mixed meth- NSSI [58]. In a study conducted by Harvard University ods as well, a cross-sectional survey and a longitudi- (Boston, Massachusetts, USA) and Monash University nal follow-up [64]. In Ireland, Hyland et  al. carried out (Melbourne, Australia),  respondents were required to a cross-sectional analysis in May 2020 on a nationally report whether they had seriously considered suicide in representative sample of Irish adults (including 1,032 the 30  days preceding the survey [59]. Two Indian stud- subjects),  followed by a longitudinal reassessment car- ies searched scientific literature, government websites, an ried out in August 2020 [65]. Aiming to estimate the online newspaper, and google news to obtain information association between  the  COVID-19 pandemic and about suicides during the pandemic [42, 43]. Almost all Emergency Department (ED) psychiatric presentations the studies evidenced an increase in suicidal behavior, (that included suicidal ideation),  McDowell et  al., from mostly related to a pre-existing mental health condition. Massachusetts General Hospital in Boston, analyzed In the study carried out by Behera et al., the authors sug- the time frame between 2018 and 2020  by  employing gest that the recurrence of psychiatric symptoms in indi- an interrupted time series analysis [66]. In Hong Kong, viduals already diagnosed with mental conditions, such Louie et al. carried out a study between March and April as depression, was associable with an increase in the risk 2020, where 33 old adults diagnosed with Major Depres- of suicidality among Indian celebrities during the pan- sive Disorder (single or recurrent episode, as defined by demic [45]. Also, Kasal et al. associated Major Depressive DSM-5 criteria) were recruited from psychiatric clinics or Disorder with a higher probability of suicide risk in three inpatient wards and eventually compared with 31 healthy different datasets [55]. Al-Humadi et al. study concluded older adults with no history of depression [61]. In Sri that suicidal ideation was almost entirely associated with Lanka, Knipe et al. carried out an interrupted time-series a history of depression/anxiety during  the  COVID-19 analysis in order to determine the effect of the pandemic pandemic [40]. Moreover, Vrublevska et  al. observed an on hospital presentations, with a focus on self-poisoning increase in suicidal thoughts of about 13.30% in partici- [68]. Carlin et  al. carried out a retrospective analysis in pants with a history of clinically diagnosed depression the Trauma Centre of the Medical University of Vienna and 27.05% in those with a history of suicide attempts to analyze whether the COVID-19 pandemic affected the during a state of emergency [51]. Conversely, Panigrahi rates of hospital admission of patients who attempted sui- et  al. observed that the majority of those deceased by cide by intentionally causing trauma [62]. A retrospective suicide (89.4%, 135) had no comorbid physical/mental ill- case–control study was also conducted in China, where ness or substance use [43]. For specifics about these stud - Hao et al. assessed the immediate stress and psychologi- ies, see Table 4. cal impact of the initial phases of  the  COVID-19 pan- Finally, we included 11 studies with different methodol - demic in 2019 and compared the results between healthy ogies examining the relationship between the COVID-19 controls and individuals affected by psychiatric illnesses pandemic advent and suicide in subjects with pre-exist- [60]. A case–control study conducted in France assessed, ing mental health conditions. Among the selected arti- through a cross-sectional survey, both the presence of cles, three of them are case–control studies, respectively, psychological symptoms and living conditions in two dis- conducted in France, China, and Hong Kong [36, 60, 61]; tinct groups, healthy controls (HC) and patients with a six are mixed-method studies, one carried out in Austria, recent (within the last 2 years) major depressive episode two in Australia, one in Ireland,  and two in the United (PP); results were eventually compared and predictors of States [59, 62–66]; finally, two interrupted time series significant psychological distress in the PP group were analysis, from  the  USA  and Sri Lanka, were included identified [36]. Hamm et  al. evaluated through a multi - [67, 68]. Hedley et  al. conducted one of the two studies city, mixed-methods (both quantitative and qualitative) from Australia and analyzed the impact of the COVID-19 study the effect of the COVID-19 pandemic on 73 Com - pandemic on a sample of adults diagnosed with Autism munity-living older adults with a pre-existing history of Spectrum Disorders by means of a mixed‐method survey Major Depressive Disorder (MDD), aiming to explore (See figure on next page.) Fig.1 PRISMA 2020 flow diagram of included studies Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 44 of 48 Fig.1 (See legend on previous page.) Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 45 of 48 this relationship in an older population with a previously Conclusions, implications, and future directions diagnosed psychiatric condition [69]. In the study carried This study aims to provide an overview of studies inves - out by Veldhuis et al., suicide risk was assessed by means tigating the relationship between suicide and COVID-19 of the Suicidal Ideation Attributes Scale (SIDAS) admin- in subjects with a pre-existing mental disorder. Results istered to 1567 subjects from the USA to obtain measures suggest that suffering from a mental disorder is a risk of suicidal thoughts and behaviors and provide an assess- factor for suicidal behavior, especially during the pan- ment of overall risk [59]. In the study carried out in Hong demic. Some studies have also highlighted an increase in Kong, suicidal ideation was assessed using Geriatric Sui- suicidal behavior that could be potentially addressable to cide Ideation Scale (GSIS) in a sample of adults (healthy the pandemic advent in people already affected by a psy - controls vs. patients with late-life depression diagnosis) chiatric disorder. Precise diagnosis data were not clearly [61]. Two separate studies by Hamm et  al. and by Olié identifiable; however, Major Depressive Disorder out - et  al. assessed suicidal ideation by means of the suicidal stands as a major risk factor for suicidal behavior [70], item of the PHQ-9. [67] [44] Hyland et al. adapted three especially during the pandemic. Other psychopathologi- items from the 2014 English Adult Psychiatric Morbidity cal elements that stand out as risk factors for suicidality Survey to measure suicidal and self‐harm ideation [65]. in this context are social isolation, complicated grief or On the other hand, Hao et  al. assessed suicide ideation loss of loved ones, loneliness, economic issues, decreased by means of a structured questionnaire [60]. In the Aus- accessibility to mental health facilities, substance use dis- tralian study conducted in the Victoria region, authors orders, alcohol abuse, autism spectrum disorder (ASD), collected data that included both past-month pas- PTSD, anxiety, fear of infection and SARS-CoV2 infec- sive suicidal ideation (i.e., wished to be dead) and past- tion or COVID-19 disease [8, 19–21, 23–25, 28, 31–34, month serious suicidal ideation [64]. Admission book 37, 39, 40, 47, 49, 51, 52, 56, 63, 66]. Conversely, although data and information from bedhead tickets were used in most studies suggested an increase in suicidal behav- the Sri Lanka study to identify self-poisoning cases [68]. ior, presumably addressable to  the advent of  COVID-19 McDowell et al. gained data about the eventual presence pandemic, disease or infection, in patients with a men- or absence of suicidal ideation by reading psychiatric tal disorder, several of the works analyzed provided con- consultation notes [66]. Almost half of the studies found troversial data. Different studies did not clearly correlate no correlation between previous mental health diagnoses mental illness and suicide risk during the pandemic but and suicide behavior rate changes during the pandemic. rather described the increase in suicidal behavior as a For instance, Knipe et  al. observed a drop in rates of ER new-onset phenomenon. Although it is of utmost impor- presentation for self-poisoning during the pandemic tance to consider that the results of the studies have period, but no statistical evidence that may correlate several limitations; many studies included were carried this difference with a pre-existing psychiatric condition out employing a cross-sectional method and could not was found [68]. Conversely, Czeisler et al. stated that the address a direct causal relationship between suicide and presence of a previously diagnosed psychiatric disorder COVID-19. The lack of longitudinal studies, especially was usually associated with poorer outcomes, including on subjects with a pre-existing psychiatric condition, suicidal ideation, during the COVID-19 pandemic [69]. stands out as a limitation in obtaining specific and clari - Louie et al. concluded that adults with Late-Life Depres- fying data. Another major inherent limitation is the reli- sion (LLD) showed a significantly higher  suicidal risk ance of most of the studies on a retrospective self-report during the COVID-19 pandemic [61]. Moreover, in the assessment of changes in suicidal behavior. Many studies study by Hyland et  al., several different variables asso - used item 9 of the Patient Health Questionnaire (PHQ) ciated with suicide attempts were identified,  including to evaluate suicide risk, which has already been shown having received treatment for a mental health disorder. as an insufficient assessment tool for suicide risk and Interestingly, the same study demonstrated that patients ideation [71]. Moreover, a complete suicide evaluation treated for mental health problems  display a higher was rarely carried out, and not all studies provided data risk of engaging  in NSSI when compared to people with obtained in a clinical setting. Finally, the majority of the no psychiatric history [65]. Regarding presentations of selected studies focused on  the  general population, and patients with a substance use disorder (SUD), there was most of the data on diagnosis was  self-reported. Longi- a differential increase during  the  COVID-19 period that tudinal studies with homogeneous samples focusing on might explain the rise in suicidal ideation presentations, subjects with an established diagnosis  and  carrying out according to McDowell et  al. Olliè et  al. demonstrating a comprehensive physician-provided suicide assessment how daily virtual contacts were protective factors against could yield better knowledge on this topic. Furthermore, suicidal ideation during the first French lockdown [66], a suicide assessment with suicide-focused scales is nec- 44. For specifics about these studies, see Table 5. essary. In conclusion, future multicenter studies with Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 46 of 48 10. Telles-Garcia N, Zahrli T, Aggarwal G, Bansal S, Richards L, Aggarwal large population samples could clarify cross-country dif- S. Suicide attempt as the presenting symptom in a patient with ferences in suicidal behavior and risk in individuals with COVID-19: a case report from the United States. Case Rep Psychiatry. mental disorders. 2020;2020:8897454. 11. McAndrew J, O’Leary J, Cotter D, Cannon M, MacHale S, Murphy KC, Barry H. Impact of initial COVID-19 restrictions on psychiatry presentations to the emergency department of a large academic teaching hospital. Ir J Author contributions Psychol Med. 2021;38(2):108–15. https:// doi. org/ 10. 1017/ ipm. 2020. 115. Conceptualization and design were performed by T.B., P.S., F.P., A.R and R.R. 12. Chatterjee, S. S., Barikar C, M., & Mukherjee, A. (2020). Impact of COVID-19 Data extraction was conducted by T.B. and verified by C.D.A. V.S. and R.D.S. pandemic on pre-existing mental health problems. Asian J Psychiatry. screened citations for inclusion. T.B. and C.D.A. wrote the main manuscript text https:// doi. org/ 10. 1016/j. ajp. 2020. 102071. and S.M. and F.C. prepared Fig. 1 and Tables 1, 2, 3, 4 and 5. T.B., R.R., A.R. and 13. Travis-Lumer Y, Kodesh A, Goldberg Y, Frangou S, Levine SZ. Attempted F.P. developed methodology, formal analysis, and data curation. All authors suicide rates before and during the COVID-19 pandemic: interrupted contributed equally to the article. All authors read and approved the final time series analysis of a nationally representative sample. Psychol Med. manuscript. 2021;19:1–7. https:// doi. org/ 10. 1017/ S0033 29172 10043 84. 14. Dubé JP, Smith MM, Sherry SB, Hewitt PL, Stewart SH. Suicide behaviors Funding during the COVID-19 pandemic: a meta-analysis of 54 studies. Psychiatry None. Res. 2021;301:113998. https:// doi. org/ 10. 1016/j. psych res. 2021. 113998. 15. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, Moher D, Availability of data and materials Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, All data generated or analyzed during this study are included in this published Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey article [and its additional information files]. CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tunçalp Ö, Straus SE. PRISMA extension for scoping reviews (PRISMA-ScR): Declarations checklist and explanation. Ann Intern Med. 2018;169(7):467–73. https:// doi. org/ 10. 7326/ M18- 0850. Ethics approval and consent to participate 16. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Not applicable. Systematic review or scoping review? Guidance for authors when choos- ing between a systematic or scoping review approach. BMC Med Res Consent for publication Methodol. 2018;18(1):143. https:// doi. org/ 10. 1186/ s12874- 018- 0611-x. Not applicable. PMID. 17. WHO Director-General’s opening remarks at the media briefing on Competing interests COVID19 -March 2020. The authors declare that they have no competing interests. 18. Arksey H, O’Malley L. Scoping studies: towards a methodological frame- work. Int J Soc Res Methodol. 2005;8(1):4–18. 19. Khosravani V, Samimi Ardestani SM, Sharifi Bastan F, McKay D, Asmundson Received: 20 January 2023 Accepted: 3 March 2023 GJG. The associations of obsessive-compulsive symptom dimensions and general severity with suicidal ideation in patients with obsessive- compulsive disorder: the role of specific stress responses to COVID-19. Clin Psychol Psychother. 2021;28(6):1391–402. https:// doi. org/ 10. 1002/ cpp. 2602. References 20. Alonso P, Bertolín S, Segalàs J, Tubío-Fungueiriño M, Real E, Mar-Barrutia 1. Worldometers. https:// www. world omete rs. info/ coron avirus/ Accessed 19 L, Fernández-Prieto M, Carvalho S, Carracedo A, Menchón JM. How is April 2022. COVID-19 affecting patients with obsessive-compulsive disorder? A lon- 2. Bachmann S. Epidemiology of suicide and the psychiatric perspective. Int gitudinal study on the initial phase of the pandemic in a Spanish cohort. J Environ Res Public Health. 2018;15:1425. Eur Psychiatry. 2021;64(1):e45. https:// doi. org/ 10. 1192/j. eurpsy. 2021. 2214. 3. Wasserman IM. The impact of epidemic, war, prohibition and media 21. Na PJ, Tsai J, Hill ML, Nichter B, Norman SB, Southwick SM, Pietrzak RH. on suicide: United States, 1910–1920. Suicide Life Threat Behav. Prevalence, risk and protective factors associated with suicidal ideation 1992;22(2):240–54. during the COVID-19 pandemic in U.S. military veterans with pre-existing 4. Cheung Y T, Chau PH, Yip PS. A revisit on older adults suicides and severe psychiatric conditions. J Psychiatr Res. 2021;137:351–9. https:// doi. org/ 10. acute respiratory syndrome (SARS) epidemic in Hong Kong. Int J Geriatr 1016/j. jpsyc hires. 2021. 03. 021. Psychiatry. 2008;23(12):1231–8. https:// doi. org/ 10. 1002/ gps. 2056. (PMID: 22. Rømer TB, Christensen RHB, Blomberg SN, Folke F, Christensen HC, Benros 18500689). ME. Psychiatric admissions, referrals, and suicidal behavior before and 5. Serafini G, Parmigiani B, Amerio A, Aguglia A, Sher L, Amore M. The during the COVID-19 pandemic in Denmark: a time-trend study. Acta psychological impact of COVID-19 on the mental health in the general Psychiatr Scand. 2021;144(6):553–62. https:// doi. org/ 10. 1111/ acps. 13369. population. QJM. 2020;113(8):531–7. https:// doi. org/ 10. 1093/ qjmed/ 23. Fountoulakis KN, Apostolidou MK, Atsiova MB, Filippidou AK, Florou AK, hcaa2 01. Gousiou DS, Katsara AR, Mantzari SN, Padouva-Markoulaki M, Papatri- 6. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, antafyllou EI, Sacharidi PI, Tonia AI, Tsagalidou EG, Zymara VP, Prezerakos Rubin GJ. The psychological impact of quarantine and how to reduce it: PE, Koupidis SA, Fountoulakis NK, Chrousos GP. Self-reported changes rapid review of the evidence. Lancet. 2020;395(10227):912–20. https:// in anxiety, depression and suicidality during the COVID-19 lockdown in doi. org/ 10. 1016/ S0140- 6736(20) 30460-8. Greece. J Aec ff t Disord. 2021;15(279):624–9. https:// doi. org/ 10. 1016/j. jad. 7. Nordt C, Warnke I, Seifritz E, Kawohl W. Modelling suicide and unemploy-2020. 10. 061. ment: a longitudinal analysis covering 63 countries, 2000–11. Lancet 24. Nichter B, Hill ML, Na PJ, Kline AC, Norman SB, Krystal JH, Southwick Psychiatry. 2015;2(3):239–45. https:// doi. org/ 10. 1016/ S2215- 0366(14) SM, Pietrzak RH. Prevalence and trends in suicidal behavior among 00118-7. US military veterans during the COVID-19 pandemic. JAMA Psychiat. 8. Almaghrebi AH. Risk factors for attempting suicide during the COVID-19 2021;78(11):1218–27. https:// doi. org/ 10. 1001/ jamap sychi atry. 2021. 2332. lockdown: identification of the high-risk groups. J Taibah Univ Med Sci. PMID: 34431 973; PMCID: PMC83 87942. 2021;16(4):605–11. https:// doi. org/ 10. 1016/j. jtumed. 2021. 04. 010. 25. Na P, Tsai J, Harpaz-Rotem I, Pietrzak R. Mental health and suicidal idea- 9. Dsouza DD, Quadros S, Hyderabadwala ZJ, Mamun MA. Aggregated tion in US military veterans with histories of COVID-19 infection. BMJ Mil COVID-19 suicide incidences in India: fear of COVID-19 infection is the Health. 2022 Feb;168(1):15–19. doi: https:// doi. org/ 10. 1136/ bmjmi litary- prominent causative factor. Psychiatry Res. 2020;290:113145. https:// doi. 2021- 001846. Epub 2021 May 25. PMID: 34035155; PMCID: PMC8154290. org/ 10. 1016/j. psych res. 2020. 113145. Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 47 of 48 26. Batterham PJ, Calear AL, Shou Y, Farrer LM, Gulliver A, McCallum SM, in an emergency department during COVID-19. J Psychosom Res. Dawel A. Eec ff ts of the COVID-19 pandemic on suicidal ideation in a 2021;150:110619. https:// doi. org/ 10. 1016/j. jpsyc hores. 2021. 110619. representative Australian population sample-Longitudinal cohort study. 36. Ridout KK, Alavi M, Ridout SJ, Koshy MT, Awsare S, Harris B, Vinson DR, J Aec ff t Disord. 2022;1(300):385–91. https:// doi. org/ 10. 1016/j. jad. 2022. 01. Weisner CM, Sterling S, Iturralde E. Emergency department encounters 022. among youth with suicidal thoughts or behaviors during the COVID-19 27. Fountoulakis KN, Karakatsoulis G, Abraham S, Adorjan K, Ahmed HU, pandemic. JAMA Psychiat. 2021;78(12):1319–28. https:// doi. org/ 10. 1001/ Alarcón RD, Arai K, Auwal SS, Berk M, Bjedov S, Bobes J, Bobes-Bascaran jamap sychi atry. 2021. 2457. PMID: 34468 724; PMCID: PMC84 11357. T, Bourgin-Duchesnay J, Bredicean CA, Bukelskis L, Burkadze A, Abud IIC, 37. Jefsen OH, Rohde C, Nørremark B, Østergaard SD. COVID-19-related Castilla-Puentes R, Cetkovich M, Colon-Rivera H, Corral R, Cortez-Vergara self-harm and suicidality among individuals with mental disorders. Acta C, Crepin P, De Berardis D, Zamora Delgado S, De Lucena D, De Sousa A, Psychiatr Scand. 2020;142(2):152–3. https:// doi. org/ 10. 1111/ acps. 13214. Stefano RD, Dodd S, Elek LP, Elissa A, Erdelyi-Hamza B, Erzin G, Etchevers 38. Menculini G, Moretti P, Pandolfi LM, Bianchi S, Valentini E, Gatto M, MJ, Falkai P, Farcas A, Fedotov I, Filatova V, Fountoulakis NK, Frankova I, Amantini K, Tortorella A. Suicidality and COVID-19: data from an emer- Franza F, Frias P, Galako T, Garay CJ, Garcia-Álvarez L, García-Portilla MP, gency setting in Italy. Psychiatr Danub. 2021;33(Suppl 9):158–63 (PMID: Gonda X, Gondek TM, González DM, Gould H, Grandinetti P, Grau A, 34559796). Groudeva V, Hagin M, Harada T, Hasan MT, Hashim NA, Hilbig J, Hossain 39. Mortier P, Vilagut G, Ferrer M, Serra C, Molina JD, López-Fresneña N, S, Iakimova R, Ibrahim M, Iftene F, Ignatenko Y, Irarrazaval M, Ismail Z, Puig T, Pelayo-Terán JM, Pijoan JI, Emparanza JI, Espuga M, Plana N, Ismayilova J, Jacobs A, Jakovljević M, Jakšić N, Javed A, Kafali HY, Karia S, González-Pinto A, Ortí-Lucas RM, de Salázar AM, Rius C, Aragonès E, Del Kazakova O, Khalifa D, Khaustova O, Koh S, Kopishinskaia S, Kosenko K, Cura-González I, Aragón-Peña A, Campos M, Parellada M, Pérez-Zapata Koupidis SA, Kovacs I, Kulig B, Lalljee A, Liewig J, Majid A, Malashonkova A, Forjaz MJ, Sanz F, Haro JM, Vieta E, Pérez-Solà V, Kessler RC, Bruffaerts R, E, Malik K, Malik NI, Mammadzada G, Mandalia B, Marazziti D, Marčinko D, Alonso J, MINDCOVID Working group. Thirty-day suicidal thoughts and Martinez S, Matiekus E, Mejia G, Memon RS, Martínez XEM, Mickevičiūtė behaviors among hospital workers during the first wave of the Spain D, Milev R, Mohammed M, Molina-López A, Morozov P, Muhammad NS, COVID-19 outbreak. Depress Anxiety. 2021;38(5):528–44. https:// doi. org/ Mustač F, Naor MS, Nassieb A, Navickas A, Okasha T, Pandova M, Panfil AL, 10. 1002/ da. 23129. Panteleeva L, Papava I, Patsali ME, Pavlichenko A, Pejuskovic B, Pinto Da 40. Al-Humadi S, Bronson B, Muhlrad S, Paulus M, Hong H, Cáceda R. Costa M, Popkov M, Popovic D, Raduan NJN, Ramírez FV, Rancans E, Razali Depression, Suicidal Thoughts, and Burnout Among Physicians During S, Rebok F, Rewekant A, Flores ENR, Rivera-Encinas MT, Saiz P, de Carmona the COVID-19 Pandemic: a Survey-Based Cross-Sectional Study. Acad MS, Martínez DS, Saw JA, Saygili G, Schneidereit P, Shah B, Shirasaka T, Psychiatry. 2021;45(5):557–65. Silagadze K, Sitanggang S, Skugarevsky O, Spikina A, Mahalingappa SS, 41. Bruffaerts R, Voorspoels W, Jansen L, Kessler RC, Mortier P, Vilagut G, De Stoyanova M, Szczegielniak A, Tamasan SC, Tavormina G, Tavormina MGM, Vocht J, Alonso J. Suicidality among healthcare professionals during the Theodorakis PN, Tohen M, Tsapakis EM, Tukhvatullina D, Ullah I, Vaidya first COVID19 wave. J Aec ff t Disord. 2021;15(283):66–70. https:// doi. org/ R, Vega-Dienstmaier JM, Vrublevska J, Vukovic O, Vysotska O, Widiasih N, 10. 1016/j. jad. 2021. 01. 013. Yashikhina A, Prezerakos PE, Smirnova D. Results of the COVID-19 mental 42. Mamun MA, Syed NK, Griffiths MD. Indian celebrity suicides before health international for the general population (COMET-G) study. Eur and during the COVID-19 pandemic and their associated risk factors: Neuropsychopharmacol. 2022;54:21–40. https:// doi. org/ 10. 1016/j. euron evidence from media reports. J Psychiatr Res. 2020;131:177–9. https:// doi. euro. 2021. 10. 004.org/ 10. 1016/j. jpsyc hires. 2020. 09. 002. 28. Liu R, Xu X, Zou S, Li Y, Wang H, Yan X, Du X, Zhang L, Zhang Q, Li W, 43. Panigrahi M, Pattnaik JI, Padhy SK, Menon V, Patra S, Rina K, Padhy SS, Cheung T, Ungvari GS, Ng CH, Xiang Y T. Prevalence of suicidality and Patro B. COVID-19 and suicides in India: a pilot study of reports in the its association with quality of life in older patients with clinically stable media and scientific literature. Asian J Psychiatr. 2021;57:102560. https:// psychiatric disorders in China during the COVID-19 pandemic. J Geriatr doi. org/ 10. 1016/j. ajp. 2021. 102560. Psychiatry Neurol. 2022;35(2):237–44. https:// doi. org/ 10. 1177/ 08919 44. Olié E, Dubois J, Benramdane M, Guillaume S, Courtet P. Psychological 88722 10785 57. PMID: 35246 000; PMCID: PMC88 99831. state of a sample of patients with mood disorders during the first French 29. Montalbani B, Bargagna P, Mastrangelo M, Sarubbi S, Imbastaro B, De COVID-19 lockdown. Sci Rep. 2021;11(1):23711. https:// doi. org/ 10. 1038/ Luca GP, Anibaldi G, Erbuto D, Pompili M, Comparelli A. The COVID-19 s41598- 021- 03037-w. PMID: 34887 481; PMCID: PMC86 60817. outbreak and subjects with mental disorders who presented to an Italian 45. Behera C, Gupta SK, Singh S, Balhara YPS. Trends in deaths attributable to psychiatric emergency department. J Nerv Ment Dis. 2021;209(4):246–50. suicide during COVID-19 pandemic and its association with alcohol use https:// doi. org/ 10. 1097/ NMD. 00000 00000 001289. and mental disorders: Findings from autopsies conducted in two districts 30. Berardelli I, Sarubbi S, Rogante E, Cifrodelli M, Erbuto D, Innamorati M, of India. Asian J Psychiatr. 2021;58:102597. https:// doi. org/ 10. 1016/j. ajp. Lester D, Pompili M. The impact of the COVID-19 pandemic on suicide 2021. 102597. ideation and suicide attempts in a sample of psychiatric inpatients. 46. Mortier P, Vilagut G, Ferrer M, Alayo I, Bruffaerts R, Cristóbal-Narváez P, Del Psychiatry Res. 2021;303:114072. https:// doi. org/ 10. 1016/j. psych res. 2021. Cura-González I, Domènech-Abella J, Felez-Nobrega M, Olaya B, Pijoan 114072. JI, Vieta E, Pérez-Solà V, Kessler RC, Haro JM, Alonso J, MINDCOVID Work- 31. Kang JH, Lee SW, Ji JG, Yu JK, Jang YD, Kim SJ, Kim YW. Changes in the ing group. Thirty-day suicidal thoughts and behaviours in the Spanish pattern of suicide attempters visiting the emergency room after COVID- adult general population during the first wave of the Spain COVID-19 19 pandemic: an observational cross-sectional study. BMC Psychiatry. pandemic. Epidemiol Psychiatr Sci. 2021;30:e19. https:// doi. org/ 10. 1017/ 2021;21(1):571. https:// doi. org/ 10. 1186/ s12888- 021- 03570-y. PMID: 34781 S2045 79602 10000 93. 918; PMCID: PMC85 91586. 47. Sáiz PA, de la Fuente-Tomas L, García-Alvarez L, Bobes-Bascarán MT, 32. Lee J, Kim D, Lee WJ, Woo SH, Jeong S, Kim SH. Association of the COVID- Moya-Lacasa C, García-Portilla MP, Bobes J. Prevalence of Passive Suicidal 19 pandemic and low-rescue suicide attempts in patients visiting the Ideation in the Early Stage of the Coronavirus Disease 2019 (COVID-19) emergency department after attempting suicide. J Korean Med Sci. Pandemic and Lockdown in a Large Spanish Sample. J Clin Psychiatry. 2021;36(34):e243. https:// doi. org/ 10. 3346/ jkms. 2021. 36. e243. 2020. 33. Mutlu E, Anıl Yağcıoğlu AE. Relapse in patients with serious mental dis- 48. Sáiz PA, Dal Santo F, García-Alvarez L, Bobes-Bascarán MT, Jiménez-Treviño orders during the COVID-19 outbreak: a retrospective chart review from L, Seijo-Zazo E, Rodríguez-Revuelta J, González-Blanco L, García-Portilla a community mental health center. Eur Arch Psychiatry Clin Neurosci. MP, Bobes J. Suicidal ideation trends and associated factors in different 2021;271(2):381–3. https:// doi. org/ 10. 1007/ s00406- 020- 01203-1. large Spanish samples during the first year of the COVID-19 pandemic. J 34. Seifert J, Meissner C, Birkenstock A, Bleich S, Toto S, Ihlefeld C, Zindler Clin Psychiatry. 2022;83(2):21br14061. https:// doi. org/ 10. 4088/ JCP. 21br1 T. Peripandemic psychiatric emergencies: impact of the COVID-19 4061. pandemic on patients according to diagnostic subgroup. Eur Arch 49. Wathelet M, Duhem S, Vaiva G, et al. Factors associated with mental Psychiatry Clin Neurosci. 2021;271(2):259–70. https:// doi. org/ 10. 1007/ health disorders among university students in France confined during s00406- 020- 01228-6. the COVID-19 pandemic. JAMA Netw Open. 2020;3(10):e2025591. https:// 35. Grossman MN, Fry CE, Sorg E, MacLean RL, Nisavic M, McDowell doi. org/ 10. 1001/ jaman etwor kopen. 2020. 25591. MJ, Masaki C, Bird S, Smith F, Beach SR. Trends in suicidal ideation Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 48 of 48 50. López Steinmetz LC, Dutto Florio MA, Leyes CA, Fong SB, Rigalli A, Godoy 65. Hyland P, Rochford S, Munnelly A, Dodd P, Fox R, Vallières F, McBride O, JC. Levels and predictors of depression, anxiety, and suicidal risk during Shevlin M, Bentall RP, Butter S, Karatzias T, Murphy J. Predicting risk along COVID-19 pandemic in Argentina: the impacts of quarantine extensions the suicidality continuum: A longitudinal, nationally representative study on mental health state. Psychol Health Med. 2022;27(1):13–29. https:// of the Irish population during the COVID-19 pandemic. Suicide Life doi. org/ 10. 1080/ 13548 506. 2020. Threat Behav. 2022;52(1):83–98. https:// doi. org/ 10. 1111/ sltb. 12783. 51. Vrublevska J, Sibalova A, Aleskere I, Rezgale B, Smirnova D, Fountoulakis 66. McDowell MJ, Fry CE, Nisavic M, Grossman M, Masaki C, Sorg E, Bird S, KN, Rancans E. Factors related to depression, distress, and self-reported Smith F, Beach SR. Evaluating the association between COVID-19 and changes in anxiety, depression, and suicidal thoughts during the COVID- psychiatric presentations, suicidal ideation in an emergency department. 19 state of emergency in Latvia. Nord J Psychiatry. 2021;75(8):614–23. PLoS ONE. 2021;16(6):e0253805. https:// doi. org/ 10. 1371/ journ al. pone. https:// doi. org/ 10. 1080/ 08039 488. 2021.02538 05. 52. Papadopoulou A, Efstathiou V, Yotsidi V, Pomini V, Michopoulos I, Marko- 67. Hamm ME, Brown PJ, Karp JF, Lenard E, Cameron F, Dawdani A, Lavretsky poulou E, Papadopoulou M, Tsigkaropoulou E, Kalemi G, Tournikioti K, H, Miller JP, Mulsant BH, Pham VT, Reynolds CF, Roose SP, Lenze EJ. Experi- Douzenis A, Gournellis R. Suicidal ideation during COVID-19 lockdown in ences of American older adults with pre-existing depression during the Greece: prevalence in the community, risk and protective factors. Psychia- beginnings of the COVID-19 pandemic: a multicity mixed-methods study. try Res. 2021;297:113713. https:// doi. org/ 10. 1016/j. psych res. 2021. 113713. Am J Geriatr Psychiatr. 2020;28(9):924–32. https:// doi. org/ 10. 1016/j. jagp. 53. Shi L, Que JY, Lu ZA, Gong YM, Liu L, Wang YH, Ran MS, Ravindran N, 2020. 06. 013. Ravindran AV, Fazel S, Bao YP, Shi J, Lu L. Prevalence and correlates of 68. Knipe D, Silva T, Aroos A, Senarathna L, Hettiarachchi NM, Galappaththi suicidal ideation among the general population in China during the SR, Spittal MJ, Gunnell D, Metcalfe C, Rajapakse T. Hospital presentations COVID-19 pandemic. Eur Psychiatry. 2021;64(1):e18. https:// doi. org/ 10. for self-poisoning during COVID-19 in Sri Lanka: an interrupted time- 1192/j. eurpsy. 2021.5. series analysis. Lancet Psychiatry. 2021;8(10):892–900. https:// doi. org/ 10. 54. Iob E, Steptoe A, Fancourt D. Abuse, self-harm and suicidal ideation in the 1016/ S2215- 0366(21) 00242-X. UK during the COVID-19 pandemic. Br J Psychiatry. 2020;217(4):543–6. 69. Czeisler MÉ, Wiley JF, Facer-Childs ER, Robbins R, Weaver MD, Barger LK, https:// doi. org/ 10. 1192/ bjp. 2020. 130. PMID: 32654 678; PMCID: PMC73 Czeisler CA, Howard ME, Rajaratnam SMW. Mental health, substance use, 60935. and suicidal ideation during a prolonged COVID-19-related lockdown in a 55. Kasal A, Kuklová M, Kågström A, Winkler P, Formánek T. Suicide risk in region with low SARS-CoV-2 prevalence. J Psychiatr Res. 2021;140:533–44. individuals with and without mental disorders before and during the https:// doi. org/ 10. 1016/j. jpsyc hires. 2021. 05. 080. COVID-19 pandemic: an analysis of three nationwide cross-sectional 70. Bertolote JM, Fleischmann A. Suicide and psychiatric diagnosis: a world- surveys in Czechia. Arch Suicide Res. 2022;24:1–15. https:// doi. org/ 10. wide perspective. World Psychiatr. 2002;1:181–5. 1080/ 13811 118. 2022. 20516 53. 71. Na PJ, Yaramala SR, Kim JA, Kim H, Goes FS, Zandi PP, Vande Voort JL, Sutor 56. Sasaki N, Tabuchi T, Okubo R, Ishimaru T, Kataoka M, Nishi D. Temporary B, Croarkin P, Bobo WV. The PHQ-9 Item 9 based screening for suicide employment and suicidal ideation in COVID-19 pandemic in Japan: a risk: a validation study of the patient health questionnaire (PHQ)-9 Item 9 cross-sectional nationwide survey. J Occup Health. 2022;64(1):e12319. with the Columbia suicide severity rating scale (C-SSRS). J Aec ff t Disord. https:// doi. org/ 10. 1002/ 1348- 9585. 12319. 2018;232:34–40. https:// doi. org/ 10. 1016/j. jad. 2018. 02. 045. 57. Every-Palmer S, Jenkins M, Gendall P, et al. Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand Publisher’s Note during the COVID-19 lockdown: A cross-sectional study. PLoS ONE. Springer Nature remains neutral with regard to jurisdictional claims in pub- 2020;15(11):e0241658. https:// doi. org/ 10. 1371/ journ al. pone. 02416 58. lished maps and institutional affiliations. 58. Daly Z, Slemon A, Richardson CG, Salway T, McAuliffe C, Gadermann AM, Thomson KC, Hirani S, Jenkins EK. Associations between periods of COVID-19 quarantine and mental health in Canada. Psychiatry Res. 2021;295:113631. https:// doi. org/ 10. 1016/j. psych res. 2020. 113631. 59. Veldhuis CB, Nesoff ED, McKowen ALW, Rice DR, Ghoneima H, Wootton AR, Papautsky EL, Arigo D, Goldberg S, Anderson JC. Addressing the critical need for long-term mental health data during the COVID-19 pandemic: changes in mental health from april to september 2020. Prev Med. 2021;146:106465. https:// doi. org/ 10. 1016/j. ypmed. 2021. 106465. 60. Hao F, Tan W, Jiang L, Zhang L, Zhao X, Zou Y, Hu Y, Luo X, Jiang X, McIn- tyre RS, Tran B, Sun J, Zhang Z, Ho R, Ho C, Tam W. Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry. Brain Behav Immun. 2020;87:100–6. https:// doi. org/ 10. 1016/j. bbi. 2020. 04. 069. 61. Louie LLC, Chan WC, Cheng CPW. Suicidal risk in older patients with depression during COVID-19 pandemic: a case-control study. East Asian Arch Psychiatry. 2021;31(1):3–8. https:// doi. org/ 10. 12809/ eaap2 055. 62. Carlin GL, Baumgartner JS, Moftakhar T, König D, Negrin LL. Impact of COVID-19 lockdown on suicide attempts : a retrospective analysis of Re Read ady y to to submit y submit your our re researc search h ? Choose BMC and benefit fr ? Choose BMC and benefit from om: : the springtime admissions to the trauma resuscitation room at the medical university of Vienna from 2015–2020. 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Abstract

There is considerable interest in exploring effects of coronavirus disease 2019 (COVID-19) pandemic on mental health. Suicide is one of the leading causes of mortality worldwide and changes in daily life brought by the pandemic may be additional risk factors in people with pre-existing mental disorders. This rapid PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) scoping review aims to identify and analyze current evidence about the relation between COVID-19 pandemic outbreak, along with COVID-19 disease and severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection, and suicide in individuals with previ- ously diagnosed mental disorders. First, we conducted a comprehensive review of the literature, then proceeded to discuss findings in a narrative way. Tables were constructed and articles sorted according to the studies’ methodolo - gies. 53 papers were eventually identified as eligible, among which 33 are cross-sectional studies, 9 are longitudinal studies, and 11 studies using other methodologies. Despite suffering from a mental disorder is a risk factor for suicidal behavior per se, the advent of COVID-19 pandemic may exacerbate this relation. Nevertheless, data addressing a clear correlation between suicidal behavior and the pandemic outbreak are still controversial. Longitudinal analysis using validated suicide scales and multicenter studies could provide deeper insight and knowledge about this topic. Keywords Suicide, Covid-19, Mental disorder, Pandemic psychiatric diseases, and individuals with mental disor- Introduction ders  are at increased risk [2]. Based on the data on sui- The advent of the pandemic has drastically impacted cide rates relating to the previous epidemics, a rise in our daily lives. At the time of writing, more than suicide was observed between 1918 and 1919 during the 505,560,928 million people worldwide have been infected influenza epidemic in the United States [3]. These data with severe acute respiratory syndrome coronavirus 2 are also consistent with increased levels of suicide among (SARS-CoV2), causing 6,226,457 deaths [1]. Suicide is older adults during the 2003 SARS epidemic in Hong a complex multifactorial phenomenon and a leading Kong [4]. During the current pandemic, extraordinary cause of death worldwide. Most suicides are related to measures for treatment and prevention of infection have been put in place by governments, such as quarantines, *Correspondence: lockdowns, and social distancing. An increase in the inci- Tommaso Barlattani dence of mental disorders such as acute stress disorder, tbarlattani@gmail.com Department of Biotechnological and Applied Clinical Sciences (DISCAB), anxiety, irritability, PTSD, elevated psychological dis- University of L’Aquila, Via Vetoio, 67100 Coppito, L’Aquila, Italy tress, depressive symptoms, and insomnia may have been Department of Mental Health Sulmona-Avezzano-L’Aquila, ASL 1, caused by the previously stated measurement [5]. All Abruzzo, Italy Department of Systems Medicine, University of Rome Tor Vergata, Via these  disturbances are related to an increase in suicide Montpellier, 1, 00133 Rome, Italy risk [6]. As already demonstrated by longitudinal studies, © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 2 of 48 also economic crises and unemployment have been was identified as the best method to carry out the present linked to increased  suicide rates [7]. Therefore, the eco - study [16]. Only articles published between March 2020, nomic downturn resulting from the advent of  the coro- the declaration of the pandemic [17], and April 2022 navirus disease 2019 (COVID-19) pandemic may also be were selected. Papers included examined suicidal behav- considered an additional risk factor for suicidal behavior ior during the pandemic, the correlation between suicide [8]. Moreover, fear of infection, already shown as a prom- rates and the pandemic itself in cross-sectional analyses, inent risk factor [9], social isolation, and grief  may fur- or changes in suicidal behavior in a longitudinal perspec- ther contribute to a robust increase in suicidal behavior. tive; finally, other studies providing useful information SARS-CoV2 infection per se has proven to be a potential on clinically observable suicidal behavior during the pan- risk factor for suicidal behavior [10] and may eventually demic were included. In the present review we included be included within COVID-19 sequelae. Furthermore, not only studies that addressed suicidality in relation during the first phases of the pandemic outbreak, we wit - to COVID-19 pandemic, but also in relation to SARS- nessed a dramatic increase in difficulties in referring to CoV2 infection and in COVID-19 disease. Only studies psychiatric departments [11], along with a drastic reduc- that included subjects with previous mental illness and tion in outpatient medical care accessibility. As a result, assessed suicide behavior and risk were taken into con- patients with pre-existing mental disorders may have sideration.  Specifically, whether the sample included experienced an exacerbation of symptoms such as feel- general population, the study only considered available ings  of loneliness, anxiety, depression, insomnia, and data on suicide assessment in individuals with previously hopelessness,  which  might eventually lead to a decrease diagnosed mental illness.  We excluded studies on top- in treatment compliance, increasing the risk of suicidal ics other than suicide and COVID-19 pandemic, infec- behavior [12]. Although  data on previous epidemics tion and disease, and in languages other than English. demonstrated a correlation with increased suicide rates, Being the present study a scoping review,  the quality of the influence of the COVID-19 pandemic on suicide studies is not necessarily addressed [18]; therefore, meta- trends is still debated and controversial [13]. A recent analysis, reviews, and systematic reviews were excluded. meta-analysis carried out by Dubè et al. [14] highlighted Papers found to be purely narrative papers, editorials, how  the  COVID-19 pandemic had increased suicide books chapter, letters to  editors, comments, and case risk in the general population;  however, data regard- reports with small samples (< 10 subjects) were excluded ing suicide behavior during the COVID-19 pandemic since they would not provide significant insight  into  the in subjects with pre-existing mental disorders are still researched topic. Two independent reviewers screened scarce,  and strong data are lacking. In this scenario, the citations for inclusion. Data extraction was conducted present study aims to highlight current evidence on sui- by one reviewer and verified by a second reviewer. Tables cide and the COVID-19 pandemic, including studies also were then constructed,  and articles  were  sorted out by addressing this relation with SARS-CoV2 infection and authors, title, location of the study, sample size, nature the proper disease (to which we will refer as COVID-19 of the sample, purpose/aim of the study, suicide assess- disease), in subjects with psychiatric disorders and to fill ments measures, type of publishing, time points com- the gaps in the literature regarding this topic. pared/ analyzed in the study, and principal findings. In the narrative overview, studies were categorized by Methods methodological approach (cross-sectional vs. longitudi- A comprehensive review of the literature was carried nal) and type of sample (patients vs. general population). out on Pubmed up to April 2, 2022. Considering the Results were then discussed. extensive aim of the study, we used Medical Subject Headings (MeSH) descriptors (“COVID-19”[Mesh]) Search results AND ”Suicide”[Mesh]). To maximize the sensitivity of The initial Pubmed search yielded a total of 502 results. our study, we did not provide additional terms besides Three additional titles were identified through other “Suicide” and “COVID-19”. Subsequently,  the  studies sources (website searching, citation tracking, and refer- included were discussed with a narrative overview. Aim- ence chaining). 10 records were excluded as not full text. ing to cover a broad literature overview and considering The remaining 495 full-text records titles and abstracts that strong evidence regarding suicide rates in subjects were screened, and 135 were excluded as the article’s with a pre-existing mental disorder during the pan- primary focus was not the correlation between suicide demic  is  still lacking,  a  rapid PRISMA-ScR (Preferred and COVID-19, being therefore irrelevant to the present Reporting Items for Systematic Reviews and Meta-Anal- study’s aim. Among the remaining 360 papers, 84 were yses extension for Scoping Reviews) scoping review, fol- excluded since they did not meet  the  inclusion criteria. lowing the statement guidelines for scoping reviews [15], Specifically, 79 articles were excluded as 16 were reviews, Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 3 of 48 16 case reports, 3 systematic reviews, 18 comments, 23 hospital‐registered rate of suicidal events during the pan- editorials, 2 meta-analyses, and 1 was retracted. 5 arti- demic significantly did not change when compared to the cles were excluded as being published 1 in French, 1 in pre‐pandemic period. For specifics about these studies, Hungarian, 1 in German, 1 in Turkish, 1 in Italian. Of the see Table 1. resulting 276 eligible records, 223 were excluded as they Among longitudinal studies using a general popula- did not provide adequate information about the relation tion sample, 1 was carried out in Greece, 2 in the USA, between COVID-19 and suicide  behavior, or the sample 1 in Australia, and 1 was an international study spanning considered did not include subjects with a pre-existing over 40 countries and including up to 55,589 participants mental condition. 53 papers were finally identified as of [23–27]. Two studies assessed suicidal behavior among particular interest. The selected articles are presented US veterans [24, 25], and 2 studies analyzed national rep- in Tables  1, 2, 3, 4 and 5 and discussed in the narrative resentative samples from Australia (by Batterham et  al.) overview. and Greece (by Fountoulakis et al.), respectively, evaluat- For specifics about the study design, consult Fig. 1. ing suicide risk by means of the suicidal item of PHQ-9 and Risk Assessment Suicidality Scale (RASS); the two Narrative overview studies among veterans used Suicidal Behaviors Ques- Among the 53 articles identified as eligible  for  directly tionnaire-Revised (SBQ-R) and PHQ-9. The international assessing modifications of suicidal behavior during study used the RASS for suicide assessment. Most of the COVID-19 pandemic in patients with pre-existing men- studies demonstrated a correlation between the presence tal disorders, 33 are cross-sectional studies, 9 are longi- of suicidal behavior during the pandemic with previous tudinal studies, and 11 studies employed other methods. mental health conditions. Conversely, the study carried Four longitudinal studies assessed in this review out by Batterham et al. in Australia evidenced that a pre- included patient samples,  and the remaining 5 studied viously diagnosed psychiatric disorder, despite being a this correlation in general population samples. risk factor for suicidal behavior, is not significantly asso - Focusing on longitudinal investigations in patient sam- ciated with incident suicidal ideation during the pan- ples, the 4 articles were carried out in different countries, demic. The study conducted in Greece highlighted how namely 1 in Iran, 1 in Spain, 1 in the USA, and 1 in Den- a previous history of depression, self-harm, and suicidal mark [19–22]. Two studies assessed suicide behavior in attempts represent risk factors for relapsing depression patients previously diagnosed with obsessive–compul- and, eventually, suicidality during the pandemic. The sive disorder (OCD) [19, 20], one in a nationally repre- study carried out by Nichter et al. underlined how a his- sentative cohort of US veterans with pre-existing mental tory of suicide attempt, lifetime post-traumatic stress health conditions [21] and one in individuals admitted disorder and/or depression, and past-year alcohol use to hospitals and Emergency Medical Services presenting disorder severity can be classified as risk factors, among psychopathological symptomatology [22]. In the study COVID-19-related variables, for new-onset suicidal idea- conducted in the USA by Na et al., suicidal behavior was tion. The international study conducted among 40 coun - assessed by means of the Patient Health Questionnaire-9 tries  highlighted how  suffering from a previous mental (PHQ-9); the two studies, carried out in Spain by Alonso condition acted as a risk factor and suicidal behavior et  al. and in Iran by Khosravani et  al., assessing patients resulted increased in those people during pandemic. For with OCD employed Hamilton Depression Rating Scale specifics about these studies, see Table 2. (HDRS) item on suicide and Beck Scale for Suicidal Idea- When screening cross-sectional studies, we identified tion (BSSI), respectively. The Danish study collected 12 conducted on patient’s sample and 21 on general pop- data regarding diagnoses from electronic  health records ulation samples. (EHRs)—including codes for suicide and self‐harm— Among cross-sectional studies analyzing the overstated defined and coded according to the ICD‐10 system by correlation in patients with a pre-existing psychiatric dis- the responsible clinicians. 3 out of 4 studies identified order, one was carried out in China, 3 in Italy, 2 in South mental illness as a risk factor for suicide and addressed Korea, 2 in the USA, 1 in Germany, 1 in Turkey, 1 in Den- a relationship between the outbreak of the pandemic mark, and 1 in Saudi Arabia [8, 28–38]. Most were ser- and an increase in suicidal behavior. Specifically, the vice utilization studies, gaining clinical information from study conducted by Na et al. relates ongoing SARS-CoV2 hospital admission records or clinical records. The study infection with an increased risk of suicidal behavior in conducted in China by Liu et  al. assessed suicide risk subjects already suffering from a mental disorder. The using 3 standardized ("yes"  or  "no") questions in older study conducted in Denmark revealed how most patients clinically stable patents with psychiatric disorders [28]. exhibiting suicidal behavior during the pandemic pre- Two Italian studies were conducted by the same research sented a pre-existing mental disorder. However, the group (from Sant’Andrea Hospital in Rome), one, by Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 4 of 48 Table 1 Suicide and Covid-19 in subjects with pre-existing mental disorder, longitudinal studies patients’ sample. Characteristics of longitudinal studies using patients sample examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 4) Authors, year Title Location of study Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings the sample and the study assessment publishing compared/ gender measures analyzed in the study Rømer et al. 2021 Psychiatric Admis- Denmark, Capital 2,693,924 health Health records Age range of To assess the pat- Diagnoses in the Population‐based From January Most patients exhibiting sions, Referrals, and Region of Denmark records from hospitals and the sample with terns in psychiatric electronic health study, 1, 2016 to suicidal behavior had Suicidal Behavior and Region Zealand Emergency Medical pre-existing mental admissions, referrals, records (EHRs)— Longitudinal study February 28, pre‐existing mental Before and During Services. With disorder: and suicidal behav- including codes for 2021. Regard- disorders. The hospital‐ the COVID‐19 Pan- regard to suicide in 2019: ior before and dur- suicide and self‐ ing pandemic registered rate of suicidal demic in Denmark: attempts, self-harm between 0–17: 262, ing the COVID‐19 harm—defined and during the behavior events during the A Time‐Trend Study episodes and between 18–29: pandemic coded according to first lockdown pandemic did not change suicides registered 238, the ICD‐10 system (March 11, significantly compared to at hospitals in The > 30: 355; by the responsible 2020 – May the pre‐pandemic period; Capital Region in 2020: clinicians 17, 2020), nor did it change during of Denmark and between 0–17: 247, the inter‐ the first lockdown, the Region Zealand between 18–29: lockdown inter‐lockdown period or between 221, period (May second lockdown. This 2019–2021 subjects > 30: 344; 18, 2020– pattern was observed for with pre-existing in 2021 (Jan–Feb) December all people with pre-existing mental disorders between 0–17: 108, 15, 2020), and mental disorder. Moreover, were: between 18–29: 54, the second trend in hospital‐recorded 829 in 2019 (76.8%); > 30: 63; lockdown suicidal behavior dur- 770 in 2020 (76.3%); female in 2019: 676 (December ing the pandemic as a 224 in 2021 (83.3%) (62.6%), female in 16, 2020 – whole showed a relative 2020: 648 (64.2%), February 28, decline compared with female in 2021 2021) the pre‐pandemic trend (Jan–Feb) 190 among patients with (70.6%) pre‐existing mental disorders. In particular, the relative change in rate ratio regarding suicidal behavior during the pandemic vs. pre-pandemic shows a statistically significant decrease in subjects with mood disorder and neurotic, stress-related and somatoform disorders Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 5 of 48 Table 1 (continued) Characteristics of longitudinal studies using patients sample examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 4) Authors, year Title Location of study Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings the sample and the study assessment publishing compared/ gender measures analyzed in the study Khosravani et al. The associations Shahid Beheshti 390 OCD patients Patients referred Mean age of the To examine the Suicide risk Longitudinal study Between 5 The obsessive–compulsive 2021 of obsessive–com- University of for treatment of sample: 35.8 years; effects of obses- assessed using Beck June to 30 symptom dimensions of pulsive symptom Medical Sciences, a primary OCD 126 males, 178 sive–compulsive Scale for Suicidal October 2020 responsibility for harm and dimensions and Teheran, Iran diagnosis. Common females (OC) symptom Ideation (BSSI) unacceptable obsessional general severity comorbid disorders dimensions and thoughts as well as general with suicidal idea- were major depres- OCD severity on severity had indirect tion in patients with sive disorder (MDD), suicidal ideation effects on suicidal ideation obsessive–com- bipolar disorder by considering through the specific stress pulsive disorder: (BD), various anxiety the role of stress responses to COVID-19, The role of specific disorders, and responses in reac- including traumatic stress stress responses to substance use tion to COVID‐19 in and compulsive checking. COVID-19 disorders (SUDs) a clinical sample of The study shows that patients with OCD OCD patients with specific obsessive–compulsive symptom dimensions and severe OCD are more likely to have suicidal ideation during the pandemic Alonso How is COVID-19 Hospital de 364; Participants from Mean age of the To evaluate the Suicidal ideation Naturalistic cohort From April Suicide-related thoughts et al. 2021 affecting patients Bellvitge, Barcelona, 127 OCD patients, the general popula- sample: impact of the assessed according study, 27 to May 25, were more frequent with obsessive– Spain 237 controls tion recruited 42.0 years OCD COVID-19 pan- to the Hamilton Longitudinal study 2020 among the OCD cohort compulsive disor- through social patients; demic on a sample Depression Rating than among healthy der? A longitudinal networks, using a 40.8 years controls of patients with Scale (HDRS; item controls. The current crisis study on the initial snowball method OCD at the initial on suicide) constitutes a risk factor for phase of the pan- Adult outpatients stage of the health a significant worsening demic in a Spanish who had been crisis, assessing not of symptoms and suicidal cohort attending the only changes in ideation specialist for at least OCD severity, but one year before also in pre-existing March 2020 conditions, newly developed condi- tions, treatment, use of mental health resources, develop- ment of obsessive fears of SARS-CoV-2 contamination, and use of emotional regulation and stress coping strategies Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 6 of 48 Table 1 (continued) Characteristics of longitudinal studies using patients sample examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 4) Authors, year Title Location of study Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings the sample and the study assessment publishing compared/ gender measures analyzed in the study Na et al. 2021 Prevalence, risk and USA 661 veterans Data analyzed from Mean age of the To examine Suicidal ideation Prospective, Pre-pandemic Those who were infected protective factors the National Health sample: pre-pandemic, assessed using Longitudinal survey survey: until with SARS-CoV 2 and associated with and Resilience in 55.2 years; 86.8%, COVID-related, and Patient Health cohort, 11/21/2019 aged 45 or older or who suicidal ideation Veterans Study, male changes in risk and Questionnaire-9 Longitudinal study peripandemic reported lower purpose in during the COVID- which surveyed a protective factors (PHQ-9) survey: until life may be at the highest 19 pandemic in U.S. nationally repre- associated with 11/14/2020 risk of suicide and may military veterans sentative cohort of peri-pandemic deserve close clinical atten- with pre-existing U.S. veterans suicidal ideation. tion and monitoring psychiatric condi- Veterans screened To evaluate interac- tions positive for major tions between depressive disorder SARS-CoV2 (MDD), generalized infection and age, anxiety disorder and significant (GAD), post- protective factors, traumatic stress dis- in predicting order (PTSD), and/ suicide ideation or substance use in the examined disorder (SUD) at population the pre-pandemic assessment Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 7 of 48 Montalbani et al., used Columbia Suicide Severity Rating previous suicide attempts and previous psychiatric his- Scale (C-SSRS) for suicide assessment, while the other, tory were not significant independent risk factors for carried out by Berardelli et  al. evaluated suicide attempt low-rescue suicide attempts when compared to COVID- (SA) at the time of hospital admission, and suicide idea- 19 as a risk factor itself [32]. The study conducted in tion (SI) and non-suicidal self-injury (NSSI) by means Germany showed that the rate of patients self-reporting of the C-SSRS as well [29, 30]; in the study conducted suicidal ideation and intent remained stable between by Almaghrebi et  al. in Saudi Arabia suicide risk factors 2019 and 2020. Suicidal ideation was stated significantly were assessed by means of the Modified SAD PERSONS more often by patients with substance use disorders in Scale (MSPS) [8]. The two Korean studies recorded data 2020 than in 2019 [34]. Grossman et al. highlighted how on patients and  assessed suicide lethality with the Risk- accesses to psychiatric care in the COVID-19 post-period Rescue Rating in Suicide assessment (RRRS) and the groups (case and comparator) were less likely to ascribe severity of the suicide attempt on the South Korean Tri- suicidality to psychiatric symptoms compared to visits in age and Acuity Scale (KTAS) [31, 32]. The Turkish study the comparator post-period group [35]. Finally, the Turk- focused on relapse rates defining criteria, including new- ish study underlined how the relapse rate of the sample in onset suicide behavior or ideation, to assess suicide risk 2019 did not differ from the first trimester of COVID-19 during the first trimester since the declaration of the pan - [33]. For specifics about these studies, see Table 3. demic [33]. In the study conducted in Germany, Seifert Among cross-sectional studies conducted on gen- et  al. performed Psychopathological Assessment (PPA) eral population samples, 4 were carried out in Spain, according to the "Arbeitsgemeinschaft für Methodik und 1 in Japan, 1 in Argentina, 1 in Latvia, 1 in Greece, 1 in Dokumentation in der Psychiatrie"  (AMDP)-System on France, 1 in New Zealand, 1 in Canada, 1 in Belgium, patients presenting to the psychiatric emergency depart- 3 in India, 1 in China, 1 in Honk Kong, 1 in the USA, 1 ment [34]. Grossman et  al., in Massachusetts (USA), among Australia and USA, 1 in the UK, 1 in the Czech obtained data from notes in clinical records regard- Republic [39–50]. Many of these studies assessed sui- ing suicidality in patients presenting in the emergency cide behavior among a nationally representative sample; department [35]. A study conducted in Kaiser Perma- three of those focused on suicide among hospital workers nente hospital in Northern California by Ridout et  al. [39–41] two studies analyzed COVID-19-related suicide assessed population-level incidence rate ratios (IRRs) reported by media, respectively [42, 43] and one assessed and percent relative effects for suicide-related emergency suicidal thought through the use of the 22-item Impact of department encounters [36]. Jefsen et  al., in the Dan- Events Scale-Revised (IES-R) among 69.054 students in ish study, categorized clinical notes according to diag- France [44], while the study carried out by Behera et  al. nosis and identified five distinct categories according analyzed autopsies of deaths attributable to suicide [45]. to different clinical presentations of suicidal behavior: The studies conducted in Spain approached this cor - 1—thoughts of self‐harm, 2—completed self‐harm, 3— relation  by  employing different scales to assess suicide passive wish to die of COVID-19, 4—suicidal thoughts, rates [39, 46–48]. Two studies used selected items from a 5—suicide attempts [37]. Slightly more  than  half of modified version of the C-SSRS [39, 46], while two other the considered studies evidenced an increase in sui- Spanish studies, both conducted by Sàiz et  al., investi- cidal  behavior, hospital consults, and admissions among gated suicide behavior by means of the Paykel Suicide patients during the pandemic, underlying the role of Scale (PSS) and by questioning participants on whether pre-existing mental conditions  as  a  risk factor for sui- they experienced  "passive suicidal ideation during the cidal behavior. Interestingly, in the study conducted by past seven days", requiring only yes/, no answers [47, 48]. Liu et  al.,  among the patients exhibiting suicidal behav- The study conducted in Belgium used a modified version ior, Major Depressive Disorder (MDD) was found to be of selected items from the C-SSRS as well [49], while the the most common psychiatric pre-existing diagnosis Argentinian group employed the Inventory of Suicide [28]. Conversely, in the study conducted by Menculini Orientation (ISO-30) [50]. Finally, in Latvia, the authors et  al. in Perugia (Italy), more than one-third of the con- assessed suicidal behavior with RASS [51]. sidered sample (patients  presenting to the emergency Several different studies explored suicidal ideation by room requiring psychiatric consultation) did not report means of the suicidal item of the PHQ-9 [40, 42, 43, 52– any previous psychiatric history. Authors suggest that a 59]. Some studies also evaluated suicide behavior with- percentage of cases were to be considered as new-onset out recurring to a validated questionnaire: Kasal et  al. suicidality, contrasting previously reported findings in assessed the past month’s suicide risk using a separate which suicide and suicidal behavior were  mostly related MINI module consisting of 6 questions [55]; in Japan, sui- to pre-existing severe psychiatric disorders [38]. The cidal ideation was measured through a one-item question study conducted by Lee et al. showed how the history of with different answer options [56]; in the New Zealand Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 8 of 48 ff Table 2 Suicide and Covid-19 in subjects with pre-existing mental disorder, longitudinal studies general population. Characteristics of longitudinal studies using general population examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 5) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Batterham et al. Eects of the Australia 1296 subjects Nationally repre- Mean age of the To assess the Suicidal ideation Longitudinal From late-March Current diagnosis 2022 COVID-19 sentative sample sample: 46.0 years; prevalence of assessed accord- survey to June 2020 of mental illness pandemic on of Australian 50.1% female suicidal ideation ing to the suicidal was associated with suicidal ideation adults. Regarding in a representative item of Patient double the risk of in a representative history of mental population-based Health Question- suicidal ideation, Australian popula- illness 246 (19.0%) sample in the naire, PHQ-9 while past diagnosis tion sample–Lon- had a past diag- first 12 weeks of was associated gitudinal cohort nosis 310 (23.9%) the COVID-19 with a 38% increase study had a current pandemic in in risk. However, diagnosis Australia, to assess past mental health the persistence of diagnosis was not suicidal ideation significantly associ- using long-term ated with incident follow-up data, suicidal ideation and, to assess rela- tionships between indirect effects of the pandemic (financial, social, employment) on suicidal ideation, while accounting for demographic factors Fountoulakis et Results of the 40 countries: 55,589 subjects International gen- Mean age of To investigate Suicide risk Multiple Forward In 2019, data col- Multiple forward al. 2021 COVID-19 mental Argentina, Aus- from 40 countries eral population the sample: the rates of assessed using Stepwise lected from June stepwise linear health interna- tralia, Azerbaijan, sample 35.80 years distress, probable Risk assessment Linear Regression 3 through July 12 regression analysis tional for the gen- Bangladesh, Any mental dis- females, depression and suicidality scale Analysis, In 2020, data revealed that a eral population Belarus, Brazil, order history was 34.90 years males, suicidality and (RASS) Longitudinal collected from broad number of (COMET-G) study Bulgaria, Canada, present in 25.25% other 31.64 years; their changes in study August 3 through variables acted Chile, Croatia, of the sample 64.85% females, the adult popula- November 13 either as risk or as Egypt, France, 7.85% had a prior 34.05% males and tion aged 18–69 protective factors Georgia, Germany, history of an anxi- 1.10% other internationally, accounting for the Greece, Honduras, ety disorder, during the COVID- 4,7% change in Hungary, India, 12.57% of depres- 19 pandemic suicidal behavior. Indonesia, Israel, sion, 1.16% of Suffering from a Italy, Japan, Kyrgyz bipolar disorder, previous mental Republic, Latvia, 0.97% of psychosis condition acted Lithuania, and 2.70% of as a risk factor and Malaysia, Mexico, other mental suicidal behavior Nigeria, disorder. At least resulted increased in Pakistan, Peru, once, 21.44% had those people during Poland, Portugal, hurt themselves pandemic Romania, Russia, in the past and Serbia, Spain, 10.59% had Turkey, Ukraine, attempted at least UK, USA once in the past Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 9 of 48 Table 2 (continued) Characteristics of longitudinal studies using general population examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 5) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Nichter Prevalence and USA 3078 US veterans Population-based Mean age of the To examine longi- Suicide behavior Population-based From November Rates of suicide et al. 2021 Trends in Suicidal cohort of US sample: 63.2 years; tudinal changes in assessed trough prospective 18, 2019, to ideation and suicide Behavior Among military veterans mostly male 2734 suicidal behavior the Suicidal cohort study, December 19, attempts did not US Military In the no suicide (91.6%) from before the Behaviors Ques- Longitudinal 2020 significantly increase Veterans During ideation group: COVID-19 pan- tionnaire-Revised study from pre-pandemic the COVID-19 387 (16,3%) demic to nearly (SBQ-R) to peripandemic Pandemic have a lifetime 10 months into at the population post-traumatic the pandemic and level. However, stress disorder identify risk factors a small propor- (PTSD) and/or and COVID- tion of veterans major depressive related variables (2.6%) developed disorder (MDD), associated with new-onset suicide 1017 (39,3%) have new-onset suicide ideation during the alcohol use disor- ideation (SI) pandemic der (AUD) and/or Among the strong- drug use disorder est risk factors and (DUD) COVID-19-related In the new-onset variables for new- suicide ideation onset suicide idea- group: tion were suicide 34 (52.9%) attempt history, life- have a lifetime time post-traumatic post-traumatic stress disorder and/ stress disorder or depression, and (PTSD) and/or past-year alcohol major depressive use disorder severity disorder (MDD), 52 (63.8%) have alcohol use disor- der (AUD) and/or drug use disorder (DUD) Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 10 of 48 Table 2 (continued) Characteristics of longitudinal studies using general population examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 5) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Na et al. 2021 Mental health and USA 3078 veterans Nationally rep- Mean age of the To date, the preva- Suicidal ideation Prospective, Lon- From pre- Pre-pandemic suicidal ideation resentative, pro- sample: lence, risk and assessed accord- gitudinal survey pandemic survey alcohol use severity, in US military spective cohort of 62.2 years; the protective factors ing to the suicidal cohort, (median comple- past-year suicidal veterans with his- US veterans. 233 majority was male of psychiatric con- item of Patient Longitudinal tion date: 21 ideation, loneli- tories of COVID-19 veterans (8.6%) (90.2%) ditions among US Health Question- study November 2019), ness, impulsivity, infection reported having military veterans naire, PHQ-9 to peripandemic perceived social been infected who survived 1-year follow-up support and hav- with SARS-CoV2. COVID-19 assessment ing a household Relative to veter- (median comple- member infected ans who were not tion date 14 with SARS-CoV2 infected, veterans November 2020) were independent who were infected risk factors for peri- were more likely pandemic suicidal to screen positive ideation, whereas for internalizing greater protec- disorders (major tive psychosocial depressive characteristic disorder, gen- Greater pre-pan- eralized anxiety demic psychiatric disorder and/or symptoms severity, pandemic-related were independ- stress symptoms) ent risk factors for 20.5% vs 13.9%, peripandemic inter- externalizing nalizing psychiatric disorders (alcohol disorders and/or drug use disorder) 23.2% vs 14.8% and current suicidal ideation 12.0% vs 7.6% at peripandemic Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 11 of 48 Table 2 (continued) Characteristics of longitudinal studies using general population examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 5) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Fountoulakis et Self-reported Greece 3399 subjects Nationwide repre- Mean age of the To investigate the Suicide risk Multiple Forward From April 11th to Suicidal thoughts al. 2021 changes in anxi- sentative sample sample: rate of clinical assessed using Stepwise Linear May 1st, 2020 increased in 10.40% ety, depression of the general female depression in the Risk assessment Regression Analy- and decreased in and suicidality population. His- 34.02 years, males adult population suicidality scale sis, Longitudinal 4.42%. Comparison during the COVID- tory of any mental 36.38 years; aged 18–69 in (RASS) study of cases without 19 lockdown in disorder reported 81.08% females, Greece, during vs those with a Greece by 29.60%, with 18.27% males the period of previous history of history of depres- the lockdown. depression in terms sion being the To investigate of the changes in most frequent the changes in suicidal thoughts (26.92%) anxiety, distress, suggested that the Psychotic disor- suicidal ideation two groups differed ders (0.49%), and their relations in any increase in Bipolar disorder with a number suicidal ideation (0.12%), of personal and (8.39% vs. 15.66%). Eating disorders interpersonal/ Comparison of the (0.11%) and social variables. numbers of cases Substance abuse The aim also without vs. those disorder (0.02%) included the with a previous were rather rare, investigation of history of suicide but within the the spreading of attempts in terms of expected range conspiracy theory changes in current beliefs concerning suicidal ideation the COVID-19 suggested that the outbreak two groups differed in any increase in suicidal ideation (9.96% vs. 23.19%). Previous history of depression, self- harm and suicidal attempts act a risk factors in the develop of depres- sion and, eventually, to suicidality Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 12 of 48 Table 3 Suicide and Covid-19 in subjects with pre-existing mental disorder, cross-sectional studies patients’ sample Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Liu et al. 2022 Prevalence of China 1063 patients Clinically stable Mean age of To examine the Suicidality during Multicenter, cross- From May The prevalence of suici- Suicidality and its psychiat- the sample: prevalence of the COVID-19 sectional study 22 to July 15, dality was 11.8% during Association with ric patients. 62.80 years; 347 suicidality and outbreak was 2020 the COVID-19 pandemic. Quality of Life in Patients with male (32.6%) its association evaluated by 3 Suicidality was common Older Patients major depressive with quality of “yes” or “no” stand- in older patients with with Clinically disorder were 485 life (QOL) among ardized questions, clinically stable psychiat- Stable Psychiatric (45.6%); patients older clinically including (1) ric disorders during the Disorders in China with Bipolar stable patients suicidal ideation, COVID-19 pandemic. Of During the COVID- disorder were 43 with psychiatric (2) suicide plan the patients with suici- 19 Pandemic (4%); disorders during and (3) suicide dality, major depressive patients with the COVID-19 attempt. Patients disorder was the most Schizophrenia pandemic who responded common psychiatric were 73 (6.9%) “yes” to any of the diagnosis 3 questions con- sidered “having suicidality.” Kang Changes in the Busan University 879 Emergency Busan University Mean age of the To find out the Data collection Retrospective, Pre- The number of patients et al. 2021 pattern of suicide Hospital, department Hospital emer- sample: change in the rate including, history Cross-sectional pandemic who had a history of attempters visiting South Korea patients records gency room 40.68 years and pattern of of mental illness; study (January 19 psychiatric treatment the emergency medical records. Pre-pandemic suicide attempts and suicide to October was 163 (40.8%) during room after COVID- Patients with pre- group, during severe attempt, suicide 31, 2019) the “pre-COVID-19 19 pandemic: an vious psychiatric 40.90 years acute respiratory method, and loca- and during period” and 381 (86.6%) observational history were 163 Pandemic group; syndrome in tion (i.e., at home pandemic during the “COVID-19 cross-sectional (40.8%) in the Female were 250 COVID-19 pan- or a place other (January 19 period”. The increase in study Pre-pandemic (62.5%) in the demic period than home) at the to October the number of patients group and Pre-pandemic time of attempt, 31, 2020) with a history of psychi- 381 (86.6%) in the group, and whether atric treatment due to Pandemic group 283 (64.30%) in the attempt was suicide attempts can be the Pandemic a mass suicide. interpreted as a result of group Severity of suicide increased anxiety and attempt was depression caused by assessed trough the lack of mental health the South Korean treatment. Severity of triage and acuity patients who visited the scale (KTAS) emergency room fol- lowing a suicide attempt was higher during the “COVID-19 period” Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 13 of 48 Table 3 (continued) Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Grossman Trends in suicidal Academic medical 339 emergency Patients present- Mean age of the To detail changes Data on suicidality Retrospective, Between Pre-period differences et al. 2021 ideation in an center in Boston, department ing with suicidal sample: in presentations characteristics Cross-sectional December did show a lower propor- emergency Massachusetts, patients in the ideation to a con- 36 years in the at a United States pulled from notes study 2018 – May tion of presentations for department dur- USA “comparison sult liaison service. “comparison Emergency in the record, 2019 and suicidality among people ing COVID-19 series” and 216 During December series”, Department regarding patients December with any psychotic disor- emergency 2018 – February 38 years in the for suicidality presenting with 2019 – May der in the COVID-19 pre- department 2019 (comparison “COVID-19 series”; before and after suicidality in 2020 period cohort relative to patients in the pre-period series) female 42.2 (2.9%) the outbreak of the emergency the comparator cohort. “COVID-19 series” % with any in the “compari- COVID-19 department, and Patients visits in the psychotic disorder son series”, received emer- COVID-19 post-period were 7.1%, 37.2 years (2.9%) gency psychiatric were less likely to be % with any affec- in the “COVID-19 consultation attributed to psychiatric tive disorder were series” symptoms as a reason 39.1%, for suicidality compared % with substance to visits in the compara- use disorder were tor post-period (70.5% vs. 50.0% 50.0%; p-value < 0.001). During December Conversely, there were 2019 – February also differential increases 2020 (COVID-19 in the proportion of pre-period series) patients visits to the % with any emergency department psychotic disorder with a history of prior were 3.2%, suicide attempts in the % with any affec- COVID-19 period rela- tive disorder were tive to the comparison 45.5%, period (13.2 percentage % with substance points and 13.0 percent- use disorder were age points, respectively). 48.4% No significant differences were found between the groups among patients with coexisting psy- chotic disorder, anxiety disorder, and substance abuse disorder with regard to suicidality presentation in the emergency depart- ment during the time considered Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 14 of 48 Table 3 (continued) Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Ridout et Emergency Kaiser Perma- 2123 youth Youth aged 5 Age range of To characterize Population-level Retrospective, Pre-pan- Youth with no history of al. 2021 Department nente Northern patients in 2020, to 17 years with the sample: indi- population- incidence rate Cross-sectional demic (Janu- outpatient mental health Encounters California, USA 2339 youth suicide-related ED viduals aged 13 level and ratios (IRRs) study ary 1, 2019, or suicide encounters Among Youth patients in 2019 encounters to 17 years: 1798 relative change and percent to December and those with comor- with Suicidal (84.7%) in 2020, in suicide-related relative effects for 15, 2019) bid psychiatric condi- Thoughts or 1998 (85.4%) in ED encounters suicide-related and during tions documented at the Behaviors During 2019; among youth ED encounters pandemic emergency department the COVID-19 1483 female during the COVID- as defined by the (January encounter had a higher Pandemic (69.9%) in 2020, 19 pandemic US Centers for 1, 2020, to risk of presenting with 1542 female compared with Disease Control December suicide-related problems (65.9%) in 2019 2019 and Prevention 15, 2020) from September to recommended December 2020 (pan- (ICD-10-CM) demic) versus the same period in 2019. There was a 6.7% higher risk of having a comorbid psy- chiatric nonsubstance diagnosis at the time of the suicide-related ED encounter during the fall compared with 2019 levels Lee et. al 2021 Association of St. Mary’s Hospital, 518 subjects Patients who Mean age of the To investigate Data on charac- Retrospective, From March Suicide attempts Seoul, South made a suicide sample: whether the teristics of the sui- Cross-sectional 2019 to associated with mental the COVID-19 Pandemic and Korea attempt and 38 years; factors affecting cide attempt and study September disorders were more visited the emer- 205 patients the lethality of about the patients 2020 common in the before Low-rescue Suicide Attempts gency depart- (39.6%) were male suicide attempts from the medical COVID-19 group ment. Subjects differed before and counseling (P < 0.001). COVID-19 in Patients Visiting the Emergency with previous and during the records. Suicide pandemic was an Department psychiatric history COVID-19 pan- lethality assessed independent risk factor after Attempting were demic using the using the Risk- for low-rescue suicide Suicide 274 (52.9%) RRRS in patients rescue rating in attempts. History of pre- who attempted suicide assess- vious suicide attempts suicide and visited ment (RRRS) and previous psychiatric the emergency history were not signifi- department cant independent factors for low-rescue suicide attempts Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 15 of 48 Table 3 (continued) Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Berardelli The impact of Sant’Andrea Uni- 632 Psychiatric Clinical records Mean age of the To see whether Suicide attempt Retrospective, Between May Only suicide attempts, et. al 2021 the COVID-19 versity Hospital, patients’ clinical of psychiatric sample: the frequency of investigated at Cross-sectional 2019 and but not suicide ideation, pandemic on sui- Rome, Italy records; patients admit- 42.25 years; suicide ideation the time of arrival study December were more frequent cide ideation and 315 before the ted to a public 311 women and and suicide of the patient at 2020 in psychiatric patients suicide attempts lockdown, psychiatric clinic. 321 men attempts differed the emergency admitted during the in a sample of psy- 317 during Covid- Among the whole in psychiatric department; COVID-19 pandemic chiatric inpatients 19 pandemic sample 22.9% has patients before suicide ideation than before Bipolar disorder, and during investigated 13.9% Depressive the COVID-19 according to the disorder, pandemic and definition in the 29.4% Schizophre- government lock- Columbia–Suicide nia and psychoses, down restrictions Severity Rating 10.4% Personality Scale disorders (C-SSRS) Mutlu et Relapse in patients Community men- 155 Psychiatric Medical charts Mean age of the To investigate the Relapse criteria Retrospective, Pre- The relapse rate of the sample: basic character- defined including: Cross-sectional pandemic patients in the first tri- al. 2021 with serious tal health centers patients of psychiatric mental disorders Etimesgut, Ankara, patients 46.6 years; istics of patients new onset of study (from 10th mester of COVID-19 out- 131 with schizo- 68% male who experienced suicidal thoughts of March break was 11% (2 bipolar during the COVID- Turkey 19 outbreak: a phrenia/ relapse during or suicide attempt, to 10th of disorder, 15 schizophre- schizoaffective the first trimester non-suicidal self- June 2019) nia). 2 had new onset of retrospective chart review from disorder, (from 10th of harm and during suicidal thoughts/suicide 24 with bipolar March to 10th pandemic attempt, and 3 showed a community mental health disorder of June) of the (from 10th self-harm or violent COVID-19 out- of March to behavior. The relapse center break in Turkey, 10th of June rate of the sample in and to compare 2020) 2019 was 6.5% (1 bipolar main findings with disorder, 9 schizophrenia the same period or schizoaffective disor - in 2019 der), and did not differ from the first trimester of COVID-19 Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 16 of 48 Table 3 (continued) Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Seifert Peripandemic Hannover Medical 750 Patients present- Mean age of the To detect the Psychopatho- Retrospective, Between The rate of patients stat- et al. 2021 psychiatric emer- School, Hannover, 374 in 2020; 476 ing in the psychi- sample: impact of the logical assessment Cross-sectional March 16th ing suicidal ideation (32.9 gencies: impact Germany in 2019 atric emergency 43.4 years in 2020, COVID-19-pan- (PPA) according to study and May 24th vs. 29.6%) and intent of the COVID-19 department 44.48 years in demic on patients the “Arbeitsge- 2020; (12.3 vs. 9.9%) remained pandemic on In 2020, substance 2019; within different meinschaft für Between stable between 2019 patients according use disorders 147 females psychiatric diag- Methodik und March 16th and 2020 to diagnostic were 114 (30.5%); (39.3%) in 2020, nostic subgroups Dokumentation and May 24th Suicidal ideation stated subgroup schizophrenia, 228 females presenting in in der Psychiatrie” 2019 significantly more schizotypal, (47.9%) in 2019 the psychiatric (AMDP)-System often by patients with and delusional emergency (including suici- substance use disorders disorders were 70 department dality) in 2020 than in 2019. (18.7%); Patients with schizophre- affective disorders nia presenting during were 57 (15.2%); the COVID-19 pandemic neurotic, stress- did not differ in suicidal related, and soma- ideation/intent. Patients toform disorders stating an association were 70 (18.7%); with COVID-19 were personality nearly three times more and behavioral likely to have attempted disorders were 46 suicide prior to presenta- (12.3%); others tion in the psychiatric were 17 (4.5%) emergency department In 2019, substance compared to the overall use disorders were rate of suicide attempts 138 (29.0%); leading to presentation schizophrenia, in the psychiatric emer- schizotypal, gency department and delusional disorders were 92 (19.3%); affective disorders were 106 (22.2%); neurotic, stress- related, and soma- toform disorders were 76 (16%); personality and behavioral disorders were 37 (7.8%); others were 27 (5.7%) Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 17 of 48 Table 3 (continued) Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Montalbani et al. The COVID-19 Sant’Andrea Uni- 371 Records for Patients with Mean age of the To assess the Suicide risk Retrospective, Between Patients who presented 2021 Outbreak and versity Hospital, 213 psychiatric sample: socio-demo- assessed with the Cross-sectional January during the lockdown Subjects with Rome, Patients disorders who 42.9 years, graphic and Columbia Suicide study 1 and May 3, showed greater active Mental Disorders Italy presented for Range 18–86; clinical features Severity 2020 suicidal ideation in terms Who Presented to psychiatric coun- Men 97 of patients who Rating Scale Before of intentionality and an Italian Psychi- seling required a psychi- (C-SSRS) lockdown planning. People with atric Emergency 57 had major atric consultation measures mental issue may have th Department depressive dis- in the emergency until the 11 experienced an increase order, 36 bipolar department of of March in symptoms during disorder, 56 had an Italian hospital compared pandemic generalized during the COVID- with after anxiety disorder, 19 outbreak lockdown and 27 patients measures, had schizophrenia thus after the th and other psy- 11 of March chotic disorders 9 had a full-blown personality disorder, and the remaining had other diagnoses Jefsen COVID‐19‐related Psychiatric 102 Clinical notes Clinical notes Mean age of the Deeper thorough Clinical notes Retrospective, From Febru- There is known ‘high risk’ et al. 2021 self‐harm and services of the from 74 Psychiat- from the adult sample: 29.8 years; characterization of divided according Cross-sectional ary 1st to groups for self‐harm and suicidality among Central Denmark ric patients psychiatric ser- 77% were females suicide behavior, to diagnosis and study March 23rd suicidality composed individuals with Region, Denmark vices. Regarding detection, and divided into five 2020 by: psychotic disorders, mental disorders diagnosis: care of patients different catego - mood disorders, stress‐ 12 have with pandemic‐ ries according to related and adjustment Schizophrenia and related psychopa- suicide behavior: disorders, and personal- other psychotic thology 1—thoughts of ity disorders, which disorders, self‐harm, appear to respond to the 10 have 2—completed stress associated with Mood disorders, self‐harm, 3—pas- the COVID‐19 pandemic 13 have Stress‐ sive wish to die of with these symptoms/ related and adjust- COVID-19, behaviors. COVID‐19 ment disorders, 4—suicidal crisis led to increased 14 have thoughts, self‐harm/suicidality in Personality 5—suicide individuals with mental disorders, 5 have attempts disorders Autism, 15 Other diag- nosis Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 18 of 48 Table 3 (continued) Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Menculini Suicidality and General Hospital 447 patients Patients requiring Mean age of the To analyze the For suicidality, Retrospective, From June A statistically significant et al. 2021 COVID-19: Data of Perugia, Peru- psychiatric consul- sample: prevalence of data concerning Cross-sectional 1st, 2020 to association was detected from an Emer- gia, Italy tations carried out 42.44 years, suicidality-related suicide attempt study January 31st, between suicidality- gency Setting at the emergency 45.42 years for phenomena dur- (SA), 2021 related phenomena and in Italy department suicide attempt ing the COVID-19 suicide ideation adjustment disorders 109 subjects were (SA), pandemic (SI), (p = 0.018). More than assessed for suici- 43.28 years for among people and non-suicidal one-third of the sample dality. Regarding suicide ideation requiring a psychi- self-injury (NSSI) did not report previous diagnosis: (SI), atric consulta- were registered psychiatric history. 23 had affective 39.29 years for tion in This suggests that a disorders (21,1%), non-suicidal an emergency percentage of cases 15 schizophrenia self-injury (NSSI); setting was related to the new spectrum disor- subjects included onset of suicidality, ders (13,8%), were mainly which is contrasting 8 anxiety disorders females 63 with previous findings (7,3%), (57.8%) that demonstrated how 6 adjustment suicide-related phe- disorders (5,5%), nomena mainly emerge 9 substance- in subjects affected related and addic- by serious psychiatric tive disorders disorders (8,3%), 1 trauma-related disorders (0,9%), 2 obsessive–com- pulsive and related disorders (1,8%), 24 personality disorders (22%) Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 19 of 48 Table 3 (continued) Characteristics of cross-sectional studies including patients’ sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 12) Authors, Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings year study the sample and the study assessment publishing compared/ gender measures analyzed in the study Almaghrebi et al. Risk factors for King Saud Medi- 29 suicide Patients Age range of the To identify the Modified SAD Retrospective, From April to Patients with psychiatric 2021 attempting cal City (KSMC), patients aged ≥ 16 years sample: suicide-related risk PERSONS scale Cross-sectional June, 2020 disorders accounted suicide during Riyadh, Saudi who survived the < 19 or > 45 years: factors and stress- (MSPS) to evaluate study for 69% of the cohort. the COVID-19 Arabia suicide attempts 13 (44.8%), ors and to deter- the suicide risk Factors like hopeless- lockdown: Iden- admitted to King 19–45 years 16 mine the groups factors ness and depression tification of the Saud Medical City (55.2%); at a greater risk were highly related to high-risk groups 24.1% of the Male 10 (34.5%) of attempting suicide attempts, as suicide attempters Female 19 (65.5%) suicide during well as the statement of have a history of the COVID-19 future intent to repeat using alcohol or lockdown the attempt, at 72.4% drugs (7), and 65.5%, respec- 31% have tively. Patients with psychosis or loss pre-existing psychiatric of rational think- disorders carry high risk ing (9), of attempting suicide 72.4% have during the COVID-19 Depression or lockdown hopelessness (21), 69% have previous suicide attempt or psychi- atric care (20) Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 20 of 48 Table 4 Suicide and Covid-19 in subjects with pre-existing mental disorder, cross-sectional studies general population Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Sáiz et al. 20 2022 Suicidal Ideation Spain Survey 1 (April Spanish general Age range of the To determine the Suicide behavior Cross-sectional Between Personal history of survey April 16–22, suicide attempt, current Trends and Associ- 16–22, 2020) total population sample: prevalence of assessed using ated Factors in sample: 6,108; sample. In the Survey 1 group passive SI (PSI) and Paykel Suicide 2020 peak or past history of mental Scale (PSS) of first wave; disorder are consistent Different Large Survey 2 (October Survey 1 group 45.78 years, active SI (ASI) in Spanish Samples 14 – November 786 (12.9%) had Survey 2 group Spanish general Passive suicidal between risk factors for active ideation (PSI) October 14– suicidal ideation (ASI) During the First 8, 2020) total a past mental 34.71 years, population sur- Year of the COVID- sample: 6,418; disorder and Survey 3 group veys conducted defined as posi- November tive answers to 8, 2020 peak 19 Pandemic Survey 3 (March 510 (8.3%) had a 39,65 years; at 3 points in time 16–31, 2021) current mental 4280 female during the COVID- PSS items 1 and/ of second or 2, wave; Total sample: disorder. In the (70.1%) Survey 1 19 pandemic and 5,654 Survey 2 group group; to characterize the and active suicidal between ideation (ASI), as March 914 (14.2%) had 5731 female main factors asso- a past mental (89.3%) Survey 2 ciated with ASI positive answers 16–31, 2021 to PSS items 3 peak of third disorder and group, 1,490 (23.2%) had 4575 female and/or 4 wave a current mental (80.9%) Survey 3 disorder. In the group Survey 3 group 606 (10.7%) had a past mental disorder and 704 (12.5%) had a current mental disorder Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 21 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Sasaki et al. 2022 Temporary Japan, 12 249 individuals Nationally repre- Mean age of the To assess the asso- Suicidal ideation Retrospective, From August In the subjects with employment and University of sentative cross‐ sample: ciation between measured using Cross‐sectional to Septem- previous psychiatric suicidal ideation Tokyo Gradu- sectional study in 43.3 years; employment con- one item: “Have study ber 2020 history group 386 (23.6%) in COVID‐19 pan- ate School of Japan. Subjects 5154 Female tract and suicidal you ever wanted reported persistent demic in Japan: Medicine with psychiatric (42.1%) ideation or newly to die from April suicidal ideation and 146 A cross‐sectional history were 1636 developed under 2020 to the (8.9%) reported newly nationwide survey (13.4%) COVID‐19 pan- present?” The developed suicidal demic examined response options ideation in the COVID‐19 using a nationally were “1. Experi- pandemic. History of representative enced for the first psychiatric disease was cross‐sectional time,” “2. It has associated with newly study in Japan been around for developed suicidal a long time,” and ideation in COVID‐19 “3. Not”. Persistent pandemic and persistent suicidal ideation suicidal ideation that began prior to the pandemic defined as Yes (2). Newly developed suicidal ideation in the COVID‐19 pandemic defined as Yes (1) Mean age of the To analyze differ - Suicidal risk Cross‐sectional From the This study suggests a Steinmetz Levels and predic- National Univer- 1202 subjects Argentineans et al. 2020 tors of depression, sity of Córdoba, who took part to sample: ences in mental assessed with survey 30th March negative mental health 31.45 years; 1029 health state Inventory of sui- until 23 May impact of quarantine anxiety, and Córdoba, an online survey. suicidal risk Argentina Subjects with female (85.61%) (MHS) indicators cide Orientation 2020 in students and in the (including suicidal (ISO-30) general population during COVID-19 mental disorder pandemic in history were risk), during three Suicidal risk, increasing 302 (25.13%) quarantine sub- from the first to the Argentina: the impacts of quar- periods; assess second/third quarantine multiple relation- extensions, but then antine extensions on mental health ships between maintaining to the fourth each MHS indica- extension state tor and potentially Presence of mental dis- affecting factors order history, and suicide attempt history were predictors of suicidal risk during quarantine sub- periods Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 22 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Mortier et al. 2021 Thirty-day suicidal Spain 3500 subjects Nationally repre- Mean age of the To investigate Suicidal risk Cross-sectional From 1–30 STB was 9.7% among the thoughts and sentative sample sample: the prevalence of assessed with survey June 2020 34.3% of respondents behaviors in the of non-institu- 49.6 years; 51.5% suicidal thoughts a modified ver - with pre-pandemic Spanish adult tionalized Spanish female and behaviors sion of selected lifetime mental disorders, general popula- adults. Among the (STB; suicidal items from the and 1.8% among the tion during the sample 34.3% of ideation, plans Columbia Suicide 65.7% without any first wave of the respondents had or attempts) in Severity Rating pre-pandemic lifetime Spain COVID-19 pre-pandemic the Spanish adult Scale mental disorder. Among pandemic lifetime mental general popula- factors significantly disorders: tion during the associated with STB were 490 have depres- first wave of the pre-pandemic lifetime sion, Spain coronavirus mental disorders and 55 have bipolar disease 2019 current mental disorders. disorder, (COVID-19) pan- Individual-level impact 199 have panic demic (March– was particularly high attacks, July, 2020), and for bipolar disorder 1052 have anxiety, to investigate the while population-level 37 have alcohol individual- and impact was highest for use problems, population-level depression and anxiety. 50 have impact of relevant About 49.1% of any STB drug use prob- distal and proxi- is potentially attributable lems mal STB risk factor to the joint effects of all domains pre-pandemic lifetime mental disorders. 74.1% of suicidal thought and behavior is potentially attributable to mental disorders and adverse events—experiences related to the pandemic. Taken together these two observations suggest a potential increase of suicidal thought and behavior during the pandemic Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 23 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Vrublevska et al. Factors related Latvia 2608 respondents Nationwide repre- Mean age of the To investigate The Risk Assess- Cross-sectional From 6 to 27 Suicidal thoughts 2021 to depression, sentative sample sample: the impact of the ment of Suicidality survey July 2020 increased in 13.30% of distress, and self- of the general men COVID- Scale (RASS) used those with a history of reported changes population. 48.04 years, 19 pandemic on to assess suicidal clinical depression, and in anxiety, depres- 7.82% overall self- women the mental health behavior 27.05% of those with sion, and suicidal reported history of 44.74 years; of the general a history of suicidal thoughts during depression 1260 men, population attempts during the state the COVID-19 6.13% had an his- 1344 women, of Latvia of emergency state of emer- tory of at least one 4 respondent gency in Latvia suicide attempt reported that they were ‘other ’ or did not want to define their gender Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 24 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Papadopoulou et Suicidal ideation Greece 5,748 subjects Adults who Age range of the To investigate Suicidal ideation Cross‐sectional From April Individuals with suicidal al. 2021 during COVID- participated in the sample: the prevalence of assessed accord- survey 7 to May 3, ideation compared to 19 lockdown survey Non-suicidal suicidal ideation in ing to the suicidal 2020 those without suicidal in Greece: Mental health his- ideation group: the community as item of Patient ideation were more likely Prevalence in the tory, reported by 18–24 years: well as the risk Health Question- to have a mental health community, risk 464 patients 653 (13.13%), and protective naire, PHQ-9 history, poorer perceived and protective In the non-suicidal 25–34 years: factors of suicidal quality of physical health, factors ideation group 930 (19.23%), ideation during and belong to a high-risk 399 (8.3%) 35–44 years: 1376 restriction meas- group for SARS-CoV2 reported mental (28.45%), ures in Greece, infection. Participants health history 45–54 years: 1148 after the outbreak with a mental health his- In the suicidal (23.74%), of the COVID- tory had 1.64-fold higher ideation group 65 55–64 years: 19 pandemic and odds of suicidal ideation (24.4%) reported 618 (12.78%) development of Mental health history mental health 65 years and mental health emerged among the history above: symptoms risk factors of suicidal 129 (2.67%); ideation Suicidal ideation group: 18–24 years: 71 (26.69%), 25–34 years: 60 (22.56%), 35–44 years: 60 (22.56%), 45–54 years: 56 (21.05%), 55–64 years: 16 (6.02%), 65 years and above: 3 (1.13%); 1,434 males, 4,217 females and 5 individuals who reported “other ” sex Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 25 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Wathelet et al. Factors Associated France 69 054 students Students who Mean age of the To measure the Self-reported Cross‐sectional From April Among risk factors identi- 2020 With Mental completed it in sample: prevalence of self- suicidal thoughts survey 17 to May 4, fied, reporting at least Health Disorders its entirety the 20 years; reported mental assessed using the 2020 1 outcome, including Among University questionnaire 50 251 Female health symptoms, 22-item Impact suicidal thoughts, was Students in France 7114 respondents (72.8%) to identify of Events Scale– associated with history of Confined During (10.3%) reported associated factors, Revised psychiatric follow-up the COVID-19 a history of psychi- and to assess Pandemic atric follow-up care seeking among university students who experienced the COVID-19 quaran- tine in France Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 26 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Every-Palmer Psychological New Zealand 2416 subjects, Representative Mean age of the To determine: Suicidality Cross‐sectional Between 15 Over half of those with et al. 2020 distress, anxiety, cleaned achieved sample of adult sample: - The state of the assessed using survey and 18 April past mental health diag- family violence, sample of 2010 New Zealanders 45 years; New Zealand questions on 2020 noses were experiencing suicidality, and cases aged between 1063 Female population’s suicidal ideation, moderate or severe psy- wellbeing in New 18 and 90 years (52.9%) wellbeing during suicide plans, chological distress. About Zealand during recruited from the COVID-19 and suicide one-third thought their the COVID-19 a commercial lockdown (stress, attempts during mental health had been lockdown: A cross- survey platform anxiety, depressive the lockdown and worse than usual during sectional study 375 people symptoms, alco- the preceding the lockdown (52.9%), (18.2%) reported hol consumption, 12 months just under half thought previously been family relation- it was the same as usual diagnosed with ships, suicidal (46.1%), and about one a mental health thinking, etc.) in six reported it was condition by a - How the better than usual (17.5%). doctor or psy- lockdown affected Suicidal ideation during chologist specific popula- lockdown reported by Of these, many tions (e.g., essen- 6.1% of participants with had more than tial workers, those 2.1% reporting making one diagnosis, with underlying plans for suicide and with 80.2% report- health conditions, 2.1% also reporting a ing having been and the elderly) suicide attempt diagnosed with a - Whether there For most of those experi- depressive disor- were any positive encing suicidal thoughts, der, 52.6% anxiety psychological these were not new disorder, consequences thoughts– 83.0% of that 5.8% personality associated with group reported having disorder, the lockdown experienced similar idea- 7.6% bipolar tion in the 12 months disorder, prior to lockdown 5.7% an alcohol Vulnerable groups and drug disorder, included those with past 3. 9% a psychotic history of mental illness disorder, and 11.4% another disorder Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 27 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Daly et al. 2021 Associations Canada 3558 subjects Individuals from Age range of the To examine the Suicidal ideation Cross‐sectional between COVID-19 quarantine between periods the Maru Voice sample: relationships and self-harm survey May 14–29, for any reason was associ- of COVID-19 Canada panel and 18–34: 534, between COVID- were assessed 2020 ated with an increase in quarantine and who completed (17.8%); 19 quarantine and by asking partici- the odds of suicidal idea- mental health in the survey 35–54: 1157 mental health, pants, “as a result tion in the group having Canada 18.2% (546) (38.6%); including suicidal of the COVID-19 a pre-existing mental reported having 55 + : 1309 ideation, and self- pandemic, in the health condition a pre-existing (43.6%); harm; previous two mental health 1519 woman and to explore weeks” had they condition (50.6%) whether mental “Experienced health outcomes suicidal thoughts/ differ depending feelings?” or on the specific “Deliberately hurt reason for quar- myself? antine A modified Cross‐sectional Between 6 Prevalence of suicidal Bruffaerts Suicidality among Belgium 6,409 healthcare Healthcare Mean age of the To investigate et al. 2021 healthcare profes- professionals professionals. sample: the 30-day version of the survey April and 14 thoughts and behaviors Columbia Suicidal July 2020 (STB) was 3.6% death sionals during Lifetime problems 41.6 years; prevalence of the first COVID-19 with anxiety/ 72.4% female suicidal thoughts Severity Rating wish, 1.5% suicide idea- Scale used to tion, 1.0% suicide plan, wave nerves endorsed and behaviors by 12.1%, then (STB) and associ- assess STB, and 0.0% suicide attempt. including suicidal Thirty-day suicidal depression (7.7%), ated risk factors panic attacks among clinically ideation. Any STB thoughts and behaviors defined as any (STB) increased among (2.8%), and active healthcare substance use professionals positive answer respondents with lifetime during the first on at least one of mental disorders (mostly problems (0.9%). Any lifetime prob- wave of COVID-19 the STB questions depression) pandemic lem estimated at 19.1% Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 28 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Behera et Trends in deaths New Delhi, India 321 between Autopsies of Mean age of the To assess the Psychological Retrospective, Pre-lock- There was a significant al. 2021 attributable to March–October deaths attribut- sample: impact of situa- autopsy of deaths Cross-sectional down from decline in deaths due to suicide during 2020 able to suicide 28.00 years; tion consequent due to suicides study 25 March suicide during the lock- COVID-19 331 between from two districts majority being to COVID-19 examined to 2019 to 31 down period. Psychologi- pandemic and March–October in New Delhi male (235/321, pandemic on explore factors October cal autopsy suggested its association 2019 73.2%) the deaths due associated with 2019 and mental disorders to be with alcohol to suicide in two suicide during the underlying cause for use and mental districts of New lockdown suicidal behavior in 10.2% disorders: Findings Delhi, India from 25 (33 out of 321) cases. from autopsies March 2020 There was a significantly conducted in two to 31 Octo- greater proportion of districts of India ber 2020 deaths due to suicide attributable to mental illness (12.3% vs. 1.6%, p = 0.01) during the unlock period. There was a significantly lesser number of deaths due to suicide with past history of suicide attempt in the current as compared to the last year Shi et al. 2021 Prevalence and China 56,679 subjects Nationwide sam- Age range of the To explore the Suicidal ideation Cross-sectional Between Suicidal ideation was prevalence of assessed accord- survey February 28, more prevalent in indi- correlates of ple from 34 China sample: suicidal ideation province-level 18–24: suicidal ideation ing to the suicidal 2020 and viduals with pre-existing 3,267 (5.8%), and its risk factors item of Patient March 11, mental disorders (41.6%). among the gen- regions eral population From the entire 25–34: among the gen- Health Question- 2020 Among factors associ- 23,050 (40.7%), eral population in naire, PHQ-9 ated with suicidal idea- in China during sample 161(0.3%) the COVID-19 had a history of 35–44: China during the tion during the COVID-19 21,658 (38.2%), COVID-19 pan- pandemic, a history pandemic mental disorder In this subgroup ≥ 45: demic and further of mental disorders 8,704 (15.4%); provide evidence increased risk of suicidal 67 (0.7%) reported suicidal ideation 27,149 (47.9%) for suicide ideation males and 29,530 prevention under (52.1%) females a public health emergency Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 29 of 48 ff Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Yang et al. 2021 The Differential Chinese University 1070 subjects Population- Age range of the To test the media- Suicidal ideation Cross-sectional Between Being diagnosed with Eects of Social of Hong Kong, based sample. sample: tion effects of assessed accord- survey May 14 and mental health problems Media on Depres- Honk Kong 25 (2.3%) were 18–35: social loneliness ing to the suicidal June 4, 2020 before or during the sive Symptoms diagnosed with 115 (10.7%); and post- item of Patient COVID-19 pandemic and Suicidal mental health 36–55: traumatic stress Health Question- were positively associ- Ideation Among problems before 252 (23.6%); disorder (PTSD) naire, PHQ-9 ated with suicidal the Younger the pandemic; 56–65: symptoms on ideation and Older Adult 20 (1.9%) were 301 (28.1%); > 65: the relationship Population in diagnosed with 383 (35.8%); between social Hong Kong Dur- mental health Male 346 (32.3%); media use and ing the COVID-19 problems during Female 724 (67.7) depressive symp- Pandemic: the pandemic toms and suicidal Population-Based ideation, as well Cross-sectional as the moderation Survey Study effect of age on the mediation models Mean age of the The study Suicidal ideation Cross-sectional From April 4 Suicidal ideation was Al-Humadi et al. Depression, New York, USA 225 physicians The sample was 2021 Suicidal Thoughts, composed of sample: investigates the assessed accord- survey through May associated with history 38.57 years; incidence and ing to the suicidal 1, 2020 of depression/anxiety, and Burnout residents, fellows, Among Physicians and attending 129 female associated factors item of Patient during the COVID-19 (57.3%) of depression, Health Question- pandemic During the COVID- physicians from 19 Pandemic: a 26 specialties suicidal thoughts, naire, PHQ-9 The prominence of and burnout premorbid depression/ Survey-Based working at Stony Cross-Sectional Brook University among physicians anxiety as a relevant fac- during the COVID- tor underscores the need Study Hospital. 65 participants (29%) 19 pandemic to further understand physician mental health previously been diagnosed or and provide early screen- ing and treatment treated for depres- sion or anxiety Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 30 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Sáiz et al. 2020 Prevalence of Spain 21,207 partici- Large general Mean age of the To determine To determine Cross-sectional Between 1,873 responders (8.8%) Passive Suicidal pants population sam- sample: the prevalence independent survey March 19 had experienced passive Ideation in the ple aged 18 years 39.7 years; 14,768 of passive factors associated and 26, 2020 suicidal ideation during Early Stage of the or over 3,665 females (69.6%) suicidal ideation with passive the past 7 days. Risk fac- Coronavirus Dis- (17,3%) suffered in a sample of the suicidal ideation tors for passive suicidal ease 2019 (COVID- a past mental general Spanish subjects involved ideation were having a 19) Pandemic disorder, 2489 population early asked if they had: personal history of past/ and Lockdown in (11,7%) suffered in the COVID-19 “passive suicidal current mental disorder a Large Spanish currently a mental pandemic and ideation during Sample disorder lockdown and past 7 days” (no/ to characterize yes) factors associ- ated with such thoughts Mamun et al. 2020 Indian celebrity India 23 press reports Media reports Mean age of the To assess suicide Google News Retrospective, Between While the 16 celebrity victims based on search engine Cross-sectional 2002–2019 suicides prior to the suicides before The most com- sample: and during the mon cause of 37.94 years a specific high- used to retrieve study and dur- COVID-19 pandemic profile occupation relevant articles. ing the spread over 17 years COVID-19 pan- reported suicide between demic and their during the differ - 2002–2019, (celebrities The search terms first three (2002–2019), the seven working in the included, ‘Indian months of celebrity suicides during associated risk ent time periods 26.43 years during factors: Evidence was depression the first three entertainment cinema celebri- Covid-19 the COVID-19 pandemic industry) and ties’, ‘celebrity pandemic occurred within a from media (17) although fam- months of Covid- reports ily problems (3), 19 pandemic; to examine the suicides’, ‘COVID- 3-month period. Depres- probable causality 19 pandemic’, sion was reported to be bipolar disorder 10 males and 6 (1), and personal females between of suicides both ‘depression’, ‘finan- the most common cause 2002–2019, before and during cial strife’, and of celebrity suicides both reasons (1) along with one case 3 males and 4 the COVID-19 ‘lockdown related before and during the females during pandemic period restriction’ COVID-19 pandemic, but wherein the cause of suicide was the first three the increased incidence months of Covid- of celebrity suicides unreported 19 pandemic during the ongoing pan- demic suggests a pos- sible association between COVID-19-related restrictions and the exac- erbation of pre-existing mental health conditions such as depression that increases the risk of suicidality among Indian celebrities Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 31 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Czeisler et al. 2020 Mental Health, Monash Univer- 5,470 subjects Adults who com- Age range of the To assess mental Respondents also Cross-sectional During Overall, 40.9% of 5,470 Substance Use, sity, pleted web-based sample: health, substance reported whether survey April–June respondents who com- and Suicidal Melbourne, surveys. Among 18–24: use, and suicidal they had seriously of 2020, pleted surveys during Ideation During Australia, subjects receiving 731 (13.4%), ideation during considered sui- compared June reported an adverse the COVID-19 Pan- Harvard Medical treatment for 25–44: the pandemic cide in the 30 days with the mental or behavioral demic — United School Boston, previously diag- 1,911 (34.9%), preceding the same period health condition, includ- States, June Massachusetts, nosed condition: 45–64: survey in 2019 ing having seriously con- 24–30, 2020 USA 536 have Anxiety 1,895 (34.6%), sidered suicide in the pre- (9.8%), ≥ 65: ceding 30 days (10.7%). 540 933 (17.1%); Suicidal ideation was also Depression 2,784 Female elevated; approximately (9.9%), (50.9%) twice as many respond- 251 ents reported serious Posttraumatic consideration of suicide stress disorder in the previous 30 days (4.6%) than did adults in the United States in 2018, referring to the previous 12 months. Mental health conditions are disproportionately affect - ing specific populations including those receiving treatment for pre-existing psychiatric conditions Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 32 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Iob et al. 2020 Abuse, self-harm London United 44 775 subjects Data from Age range of the To address Suicidal ideation Cross‐sectional Between 7984 participants (18%) and suicidal Kingdom University College sample: between evidence gaps assessed accord- survey 21 March reported experiencing ideation in the UK London’s (UCL’s) 18–29 years: by exploring ing to the suicidal and 20 April thoughts of suicide or during the COVID- COVID-19 Social 7835 (17.5%), patterns of abuse, item of Patient 2020 self-harm in the first 19 pandemic Study; between self-harm and Health Question- month of lockdown 8757 received 30–44 years: thoughts of naire, PHQ-9 and 2174 participants a Mental health 10 394 (23.2%), suicide or self- (5%) reported harming diagnosis (19.6%) between harm in the UK themselves at least once 45–59 years: in the first month since the start of the 12 031 (26.9%), of lockdown due UK’s lockdown. In the Over 60 years: the COVID-19 first month of lockdown 14 515 (32.4%); pandemic and in the group of subjects Female 22 846 exploring whether with a mental health (51.0%) those having such diagnosis 3813 reported experiences were self-harm/suicidal accessing formal thoughts 3813 (43.5%); or informal mental 1241 reported self-harm health support behaviors (14.2%). The patterning of thoughts and experiences of self-harm during the first month of lockdown included having a mental disorder Panigrahi et al. COVID-19 and India 151 reports COVID-19 related Mean age of the To analyze reports Search scientific Retrospective, Between The study suggests that literature, govern- Cross-sectional 1st February socio-demographic 2021 suicides in India: suicides (CRS) sample: of COVID-19 A pilot study of reports 38.7 years; related suicides ment websites study 2020 to 30th factors, stigma related to and online news- September a diagnosis of COVID-19, reports in the 7 had a pre-exist- 19.2% (29) were (CRS) to identify media and scien- ing psychiatric females associated factors paper reports 2020 being in quarantine/isola- in English and tion and recent physician tific literature illness, depression with a broader goal to inform nine regional lan- contact are markers of management guages to identify COVID-19 related suicides and prevention relevant COVID-19 CRS strategies related suicides Among the deceased, (CRS) reports majority (89.4%, 135), had no comorbid physical/ mental illness or sub- stance use Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 33 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Kasal et al. 2022 Suicide Risk in Czech Republic May 2020 dataset Data from Mean age of the To assess changes Past month SR Analysis of Three Three Individuals with anxiety Individuals With consisted of 3,021 three nationally sample: 48 years in suicide risk was assessed Nationwide Cross- nationwide disorders exhibited an and Without participants, representative 2017 May sample, (SR) in people using a separate Sectional Surveys, cross- increase of approximately Mental Disorders 2017 dataset cross-sectional 46 years with and without M.I.N.I. module paper and pencil sectional 12% and 20% in SB Before and During consisted of 3,306 surveys of Czech 2020 May mental disorders, consisting of 6 interviewing, surveys: prevalence compared to the COVID-19 respondents, community- Sample, before and during questions (1) while for the two November the baseline, Pandemic: An November 2020 dwelling adults 46 years 2020 the COVID-19 “Think that you 2020 data collec- 2017, major depressive disorder Analysis of Three dataset consisted Subjects with a November pandemic in would be better tions, we used a May and was associated with Nationwide Cross- of 3,000 partici- major depressive Sample; Czechia off dead or wish mixed computer- November higher odds of SR in all Sectional Surveys pants episode were: 2017 May sample: you were dead?”, assisted web 2020 three datasets in Czechia 132 (3.99%) in 1,774 females (2) “ Want to interviewing and 2017 May sample, (53.66%), harm yourself?”, computer-assisted 359 (11.88%) in 2020 May (3) “ Think about telephone inter- 2020 May sample, sample: suicide?”, (4) “Have viewing approach 382 (12.73%) in 1,581 females a suicide plan?”, 2020 November (52.33%), and (5) “Attempt sample; 2020 November suicide?”, (6) “Did Anxiety disorders Sample: 1,534 you ever make a were: 261 (7.89%) females suicide attempt?”. in 2017 May (51.13%) In line with the sample, scoring procedure 408 (13.51%) in proposed by the 2020 May sample, authors of the 398 (13.27%) in instrument, we 2020 November considered a sample positive answer to any question as indicative of past-month SR. A positive answer to any of the first four and last two items was indica- tive of presence of ST and suicidal behavior (SB), respectively Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 34 of 48 Table 4 (continued) Characteristics of cross-sectional studies using general population sample, examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 21) Authors, year Title Location of Sample size Nature of sample Age range of Purpose/aim of Suicide Type of Time points Principal findings study the sample and the study assessment publishing compared/ gender measures analyzed in the study Mortier et. al 2021 Thirty‐day suicidal Spain 5450 hospital Cohort of Spanish Mean age of the To examine base- Modified version Cross-sectional From May Thirty‐day suicidal thoughts and workers hospital workers sample: line prevalence of of selected survey 5–July 23, thoughts and behaviors behaviors among 568 had a lifetime 42.9 years in those 30‐day STB and items from the 2020 (STB) prevalence was hospital workers mood disorder, that completed to investigate the Columbia Suicide estimated at 8.4% during the first 1893 had a the STB items, relationship of Severity Rating 6 professionals wave of the lifetime anxiety 42.1 years in those potentially modifi- Scale attempted suicide in Spain COVID‐19 disorder that did not; able contextual the past 30 days. In outbreak females 80.8% factors related to adjusted models, 30‐day in those that hospital workers’ suicidal thoughts and completed the perceived work behaviors (STB) remained STB items, females and financial situ- significantly associated 82.1% in those ation, with 30‐day with pre‐pandemic life- that did not STB time mood and anxiety disorder Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 35 of 48 Table 5 Suicide and Covid-19 in subjects with pre-existing mental disorder, other studies Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study Hedley et The association La Trobe Univer- 111 Autistic Autistic adults Mean age of the To examine Suicide risk Mixed‐method Between The impact of the al. 2021 between COVID- sity, Melbourne, patients aged 20 to sample: potential asso- assessed using survey design October and COVID-19 pandemic 19, personal Australia 71 years during 42.45 years; 58,6% ciations between Suicide Behavior December may be associated with wellbeing, depres- the second wave women and 32,4% COVID-19 impact Questionnaire 2020 poorer wellbeing and sion, and suicide of the COVID-19 men and depres- Revised higher depression but is risk factors in pandemic in sion, personal (SBQ-R) not associated with sui- Australian autistic Australia wellbeing, and cide risk in this autistic adults Co‐occurring suicide risk factors adults’ sample diagnoses of anxi- in Australian ety or depression autistic adults and were reported age and gender by 70% (73, 71, effects respectively) of participants Carlin et. al 2021 Impact of COVID- Trauma Centre of 559 admissions; Patients admitted Mean age of the To analyze how Retrospective Mixed‐method, From 16 The study revealed a 19 lockdown on the Medical Uni- 79 in 2015; 87 in to the trauma sample: many of the data analysis. Case–control, March to significantly higher pro - suicide attempts versity of Vienna, 2016; 110 in 2017; resuscitation 43,2 years in the patients admitted Patients subdi- Cross-sectional 15 May in portion of attempted A retrospec- Vienna, Austria 109 in 2018; 109 room. Number control group; to the trauma vided into trauma study the years suicides in all patients tive analysis of in 2019; 65 in of patients in the 38.7 years in the resuscitation victims and 2015–2019 admitted to the trauma the springtime 2020 control group was study group; major- room of the individuals who resuscitation room admissions to the 37, in the study ity being male in level 1 Trauma had attempted Due to the small num- trauma resuscita- group 23. Patients both groups Centre of the suicide ber of patients in the tion room at the with known psy- Medical University study group an increase Medical University chiatric disease of Vienna during in suicidal behavior of Vienna from were 32 (86.5%) in the COVID-19 isolated for individuals 2015–2020 the control group lockdown in Aus- with previous mental and 19 (82.6%) in tria injured due to health problems could the study group. a suicide attempt not be observed, but Patients with by intentionally more generally an history of previous caused trauma increase in suicidality suicide attempt across different groups were 13 (35.1%) in at risk the control group and 9 (39.1%) in the study group Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 36 of 48 Table 5 (continued) Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study Czeisler et al. 2021 Mental health, Victoria region, 1531 subjects Victorians who Age range of the To analyze the Data collection Mixed‐method During Suicidal ideation was substance use, Australia completed the sample: associations including past- Longitudinal, April 2–8, nearly three times and suicidal surveys Age range in the between adverse month passive cross-sectional 2020 (April- as prevalent among ideation during History of diag- Victorian-April mental and suicidal ideation survey 2020) and respondents with vs a prolonged nosed psychiatric group: behavioral health (i.e., wished to be September without previously COVID-19-related condition was 18–24: 42 (12.8%); symptoms and dead), and past- 15–24, 2020 diagnosed psychiatric lockdown in a present in: 25–44: 123 demographic month serious conditions. Diagnosed region with low 123 subjects (10.6%); characteristics, suicidal ideation psychiatric disorder was SARS-CoV-2 (37.1%) in the 45–64: 105 (31.7%); sleep, and behav- associated with poor prevalence Victorian-April ≥ 65: 61 (18,4%); ioral changes, outcomes, including group; Age range in the with the aim of suicidal ideation, during 435 subjects Victorian-September identifying areas COVID-19 pandemic (37.6%) in the group: for targeted Victorian-Septem- 18–24: 123 (10.6%); interventions to ber group; 25–44: 436 improve mental 38 subjects (37.6%); health (41,4%) in the 45–64: 379 (32.8%); Victorian-Longitu- ≥ 65: 219 (18.9%); dinal group Age range in the Victorian-Longitudi- nal group: 18–24: 11 (12.3%); 25–44: 34 (36.5%); 45–64: 29 (31.1%); ≥ 65: 19 (20.2%) Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 37 of 48 Table 5 (continued) Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study Hyland Predicting risk Ireland 1,032 subjects Nationally repre- Mean age of the To analyze the Three items were Mixed‐method May 2020 and There was no statisti- et al. 2021 along the suicidal- 715 who sentative sample sample: lifetime preva- adapted from Longitudinal, a follow‐up in cally significant change ity continuum: completed the of Irish adults 44.86 years; lence of different the 2014 English cross-sectional August 2020 over time in suicidal A longitudinal, follow-up Some participants 52.1% female indicators of Adult Psychiatric survey behavior. Suicidal idea- nationally rep- reported a history suicidality in the Morbidity Survey tion was not associate resentative of mental health Irish general pop- to measure with been treated for a study of the Irish treatment ulation; whether suicidal and self‐ mental health problem. population during suicidality has harm ideation Those who treated the COVID‐19 increased during for a mental health pandemic the COVID‐19 problem were over pandemic; and twice as likely as those what factors with no such history associated with to have engaged in belonging to dif- non‐suicidal self‐injury ferent points on (NSSI). Among variables a continuum of significantly associated suicidality risk with attempted suicide there was having received treatment for a mental health problem Veldhuis Addressing the USA and more 1567 subjects Longitudinal data Age range of the To better under- Suicide risk was Mixed‐method Baseline sur- Baseline risk for suicide sample: stand the longer- measured using Longitudinal, veys during was associated with et al. 2021 critical need than 50 other from an interna- for long-term countries tional conveni- 18–30: 38.0%; 31–40: term effects of the Suicidal Idea- cross-sectional April 5–19, 12 times higher odds 31.8%; the pandemic on tion Attributes survey 2020; of risk for suicide at mental health ence sample of data during the adults 18 or older 41–50: 14.2%; 51–65: mental health Scale (SIDAS) 5-month 5-month follow-up. living in every US 12.3%; 66 + : 3.7%; which measures follow-up Having received a COVID-19 pan- demic: Changes state and more Women thoughts and (August 28– mental health diagnosis than 50 countries 88.2% behaviors and September was associated with in mental health from April to who completed provides an 11, 2020 suicide risk at 5-month baseline surveys assessment of risk follow-up September 2020 and the 5-month (scores of 21 or follow-up. 58.9% higher are consid- received a mental ered severe risk health diagnosis. and 10 or higher Participants who is considered to reported depres- be some risk) sion, anxiety, or PTSD were con- sidered to have a previous relevant mental health diagnosis Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 38 of 48 Table 5 (continued) Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study Hamm Experiences of Los Angeles, New 73 older adults Community-living Mean age of the To determine Suicidal ideation Multicity, Mixed- Between April Examination of PHQ-9 et al. 2020 American Older York, Pittsburgh, with pre-existing older adults with sample: the effect of assessed accord- Methods Study 1 and April 23, item 9 (thoughts of Adults with Pre- and St Louis, USA Major depressive pre-existing 69 years; the COVID-19 ing to the suicidal 2020 death or self-harm) existing Depres- disorder Major depres- 50 females (68.5%) pandemic on the item of Patient revealed no increase in sion During the sive disorder mental health Health Question- suicidal thoughts. Of Beginnings of the (MDD) recruited of older adults naire, PHQ-9 72 with scores available COVID-19 Pan- among the 743 with pre-existing in the immediate peri- demic: A Multicity, participants in major depressive pandemic period, 59 Mixed-Methods the Optimizing disorder (MDD) (82%) had no thoughts Study Outcomes of of death (score of 0) Treatment-Resist- both beforehand and ant Depression currently; in Older Adults 5 (7%) had current (OPTIMUM) clini- thoughts of death (all cal trial had score of 1) but none beforehand; while 7 (10%) had reduced thoughts of death currently compared to before the pandemic (score of 0 currently vs. 1 beforehand in 5 participants, score of 1 currently vs. 3 before- hand in 2); 1 refused to answer Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 39 of 48 Table 5 (continued) Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study Knipe et Hospital presenta- Teaching Hospital 1401 individuals; Hospital Age range of the To determine the Admission Interrupted time- Before (Jan 1, A sudden drop in al. 2022 tions for self- Peradeniya, Pre-pandemic admissions for sample: Pre-pan- effect of the pan- book data and series analysis 2019–March presentations for self- poisoning during Sri Lanka period (1161) self-poisoning. demic period demic on hospital information from 19, 2020) and poisoning occurred COVID-19 in Sri Pandemic period Subjects with a < 25 years were 603 presentations for bed head tickets during (March at the start of the Lanka: an inter- (240) current psychiatric (51,9%), self-poisoning were used to 20–Aug 31, lockdown period; on rupted time-series diagnosis were Pre-pandemic identify cases of 2020) the average, there were analysis 535 in pre- period ≥ 25 years self-poisoning pandemic more presentations pandemic period were 546 (47,0%); (intentional self- in the pre-pandemic (46,1%) and 110 in Pandemic period harm by ingesting period than in the pandemic period < 25 years were 107 poison). Medical pandemic period. The (45,8%) (44,6%), Pandemic records used time-series analysis period ≥ 25 years to retrieve all indicated that there was 117 (48,8%); relevant informa- a 32% reduction in hos- 761 (54,3%) females tion regarding pital presentations for the patient’s stay, self-poisoning during including any the pandemic period related history. compared with the The overall num- pre-pandemic period. ber of admissions There was no statistical per month were evidence that the collected from impact of the pandemic the admission differed regarding hav- books and used ing a current psychiatric to trace bed diagnosis head tickets for detailed informa- tion regarding admissions (type of poison ingested) Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 40 of 48 Table 5 (continued) Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study McDowell et al. Evaluating the Massachusetts 2018–2019 Psychiatric Mean age of the To estimate The presence Interrupted time- Between 2018 Results estimate signifi- 2021 association General Hospital, Cohort (489) Presentation in sample: the association or absence of series analysis and 2020, cant differential change between COVID- Boston, Mas- 2019–2020 an emergency 38 years in the between suicidal ideation February associated with suicidal 19 and psychiatric sachusetts, United Cohort (467) department 2018–2019 Cohort, COVID-19 and as determined by 26–March 6, ideation and substance presentations, States In the 2018–2019 39 years in the Emergency text in the psychi- 2020 used use disorder (SUD) pres- suicidal ideation Cohort, patients 2019–2020 Cohort; Department atric consultation to define entations following the in an emergency presenting with 281 female (57.5%) (ED) psychiatric note, as well as patterns in outbreak. Specifically, department suicidal Ideation in the 2018–2019 presentations, up to three psy- psychiatric there were a significant were 293 (59.9%), Cohort; 301 female including suicidal chiatric diagnoses presenta- differential increase in substance use (58.0%) in the ideation (not including tions before presentations with sui- disorder were 202 2019–2020 Cohort SUDs), recorded and after the cidal ideation six weeks (41.3%), for each patient coronavirus after the outbreak (36.4 affective disorder presentation outbreak percentage points were 172 (35.2%), change) psychotic disorder For presentations were 83 (17.0%); with SUD, there were In the 2019–2020 a differential increase Cohort, patients in the COVID-19 time presenting with series relative to the suicidal Ideation comparison time series were 274 (58.7%); at all post-outbreak substance use time points and this disorder were 184 differential increase (39.4%); was significant three affective disorder weeks (32.8 percentage were 184 (39.4%); points; 95% CI: 4.0, 61.6) psychotic disorder following the outbreak. were 57 (12.2%) Moreover, SUD presen- tations seem to explain the increase in suicidal ideation presenta- tions in week 3 in the unadjusted models. The results estimate no differential changes significant at the P value < 0.05 level associ- ated with affective disorder or psychotic disorder presentations in the COVID-19 time series relative to the comparator time series Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 41 of 48 Table 5 (continued) Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study Oliè et al. 2021 Psychological France 69 healthy con- Patients with his- Mean age of the To compare in 69 Suicidal ideation Case–control From March, Current suicidal idea- state of a sample trols (HC) tory of depressive sample: healthy controls assessed accord- study 17 to May 11, tion (according to the of patients with 346 patients with episodes and healthy controls (HC) and 346 ing to the suicidal 2020 suicidal item of Patient mood disorders a major depres- healthy controls. (HC) 37 years, patients with a item of Patient Health Questionnaire, during the first sive episode in In the PP group: patients with a major depressive Health Question- PHQ-9) was reported French COVID-19 the two previous 44.5% (50) had major depressive episode in the naire, PHQ-9 by 26.6% of PP (92). Sui- lockdown years (PP) a diagnosis of episode in the two two previous cidal ideation was pre- bipolar disorder, previous years (PP) years (PP) self- dicted by psychotropic 50% (174) lifetime 39 years; reported psycho- drug changes, history history of suicide 16 men (23.2%) logical symptoms of suicide attempt, high attempt, 62% healthy controls(HC) (depression, education level, and (207) lifetime ,83 men (24%) anxiety, insomnia, loneliness. Daily virtual history of anxious patients with a suicidal ideation, contacts were protec- disorder, 22.2% major depressive traumatic stress, tive against suicidal (74) alcohol abuse episode in the two anger) and liv- ideation or dependence, previous years (PP) ing conditions 15.2% (51) illicit during the first substance abuse national French or dependence, lockdown, and and 15.2% ( 51) an identify predictors eating disorder of significant psychological distress in PP The University of 64; Adults diagnosed Mean age of the To compare older Suicide ideation Case control Between The level of suicidal Louie et al. 2021 Suicidal Risk in Older Patients Hong Kong, 31 healthy older with major sample: adults with late- assessed using study March and ideation was signifi- Queen Mary adults, depressive 74.45 years adults life depression Geriatric Suicide April 2020 cantly higher in the LLD with Depression During COVID-19 Hospital, Hong 33 adults with disorder (single or with late-life depres- (LLD) and healthy Ideation Scale group than the healthy Kong late-life depres- recurrent episode) sion (LLD), controls in (GSIS) control group after Pandemic: a Case–Control sion (LLD) as defined by the 71.10 years controls; terms of suicidal adjusting for depres- Study DSM-5 recruited 21 men and 43 ideation during sive symptoms. Older from psychiatric women aged 61 to the COVID-19 people with LLD had clinics or inpatient 89 years pandemic, and to a significantly higher wards, whereas determine predic- suicidal risk during the healthy older tors of suicidal COVID- 19 pandemic adults without a ideation history of depres- sion or other psy- chiatric illnesses were recruited from voluntary organizations or elderly commu- nity centers Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 42 of 48 Table 5 (continued) Characteristics of other studies examining Covid-19 and suicide in subjects with pre‐existing mental health conditions (n = 11) Authors, Title Location of Sample size Nature of sample Age range of the Purpose/aim of Suicide Type of Time points Principal findings year study sample and gender the study assessment publishing compared/ measures analyzed in the study Hao et al. 2020 Do psychiatric Chongqing, China 76 An online Mean age of the To assess and Structured Case–control The Nine (11.8%) psychiatric patients experi- psychiatric questionnaire was sample: compare the questionnaire study psychiatric patients and 1 (0.9%) ence more psy- patients administered via 32.8 years immediate stress consisted of ques- patients were healthy control chiatric symptoms 109 healthy SMS to psychiatric Psychiatric patients, and psychological tions in which recruited from reported moderate to during COVID-19 control patients from 33.1 years Healthy impact experi- Suicide ideation 19 to 21 Feb- severe suicidal ideation pandemic and the databases of controls; enced by people was evaluated ruary 2020, Specifically, in the lockdown? A the First People’s Psychiatric patients with and without trough: and healthy Psychiatric patients (76) case–control Hospital of 51 Female (37.1%), psychiatric 6- Other psychiat- control par- group: study with service Chongqing Liang Healthy controls 68 illnesses during ric symptoms ticipants were 64 (84.2%) reported No and research Jiang New Area, Female (62.4%) the peak of 2019 recruited suicidal ideation, implications for China coronavirus from 21 to 3 (3.9%) Mild suicidal immunopsy- The healthy con- disease (COVID- 22 February ideation, chiatry trol participants 19) epidemic with 2020 5 (6.6%) Moderate were recruited strict lockdown suicidal ideation, through conveni- measures 3 (3.9%) Serious suicidal ent sampling ideation, For psychiat- 1 (1.3%) Very serious ric patients, suicidal ideation majority of the respondents had mixed anxiety and depressive disorder (59%), followed by other anxiety disorders (25%) and major depressive disor- der (16%) Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 43 of 48 study, participants were interrogated on suicidal ideation, design [63]. Veldhuis et al., 2021, conducted a longitudi- suicide plans, and suicide attempts during the lockdown nal survey in 2021 in the USA  within a cross-sectional and the preceding 12 months [57]. Daly et al. too assessed baseline assessment to obtain a better understand- suicidality during  the COVID-19 pandemic by directly ing of the long-term effects of the pandemic on mental questioning the participants whether they had ever expe- health [59]. The second study conducted in Australia’s rienced suicidal thoughts and feelings or past episodes of Victoria region by Czeisler et  al. utilized mixed meth- NSSI [58]. In a study conducted by Harvard University ods as well, a cross-sectional survey and a longitudi- (Boston, Massachusetts, USA) and Monash University nal follow-up [64]. In Ireland, Hyland et  al. carried out (Melbourne, Australia),  respondents were required to a cross-sectional analysis in May 2020 on a nationally report whether they had seriously considered suicide in representative sample of Irish adults (including 1,032 the 30  days preceding the survey [59]. Two Indian stud- subjects),  followed by a longitudinal reassessment car- ies searched scientific literature, government websites, an ried out in August 2020 [65]. Aiming to estimate the online newspaper, and google news to obtain information association between  the  COVID-19 pandemic and about suicides during the pandemic [42, 43]. Almost all Emergency Department (ED) psychiatric presentations the studies evidenced an increase in suicidal behavior, (that included suicidal ideation),  McDowell et  al., from mostly related to a pre-existing mental health condition. Massachusetts General Hospital in Boston, analyzed In the study carried out by Behera et al., the authors sug- the time frame between 2018 and 2020  by  employing gest that the recurrence of psychiatric symptoms in indi- an interrupted time series analysis [66]. In Hong Kong, viduals already diagnosed with mental conditions, such Louie et al. carried out a study between March and April as depression, was associable with an increase in the risk 2020, where 33 old adults diagnosed with Major Depres- of suicidality among Indian celebrities during the pan- sive Disorder (single or recurrent episode, as defined by demic [45]. Also, Kasal et al. associated Major Depressive DSM-5 criteria) were recruited from psychiatric clinics or Disorder with a higher probability of suicide risk in three inpatient wards and eventually compared with 31 healthy different datasets [55]. Al-Humadi et al. study concluded older adults with no history of depression [61]. In Sri that suicidal ideation was almost entirely associated with Lanka, Knipe et al. carried out an interrupted time-series a history of depression/anxiety during  the  COVID-19 analysis in order to determine the effect of the pandemic pandemic [40]. Moreover, Vrublevska et  al. observed an on hospital presentations, with a focus on self-poisoning increase in suicidal thoughts of about 13.30% in partici- [68]. Carlin et  al. carried out a retrospective analysis in pants with a history of clinically diagnosed depression the Trauma Centre of the Medical University of Vienna and 27.05% in those with a history of suicide attempts to analyze whether the COVID-19 pandemic affected the during a state of emergency [51]. Conversely, Panigrahi rates of hospital admission of patients who attempted sui- et  al. observed that the majority of those deceased by cide by intentionally causing trauma [62]. A retrospective suicide (89.4%, 135) had no comorbid physical/mental ill- case–control study was also conducted in China, where ness or substance use [43]. For specifics about these stud - Hao et al. assessed the immediate stress and psychologi- ies, see Table 4. cal impact of the initial phases of  the  COVID-19 pan- Finally, we included 11 studies with different methodol - demic in 2019 and compared the results between healthy ogies examining the relationship between the COVID-19 controls and individuals affected by psychiatric illnesses pandemic advent and suicide in subjects with pre-exist- [60]. A case–control study conducted in France assessed, ing mental health conditions. Among the selected arti- through a cross-sectional survey, both the presence of cles, three of them are case–control studies, respectively, psychological symptoms and living conditions in two dis- conducted in France, China, and Hong Kong [36, 60, 61]; tinct groups, healthy controls (HC) and patients with a six are mixed-method studies, one carried out in Austria, recent (within the last 2 years) major depressive episode two in Australia, one in Ireland,  and two in the United (PP); results were eventually compared and predictors of States [59, 62–66]; finally, two interrupted time series significant psychological distress in the PP group were analysis, from  the  USA  and Sri Lanka, were included identified [36]. Hamm et  al. evaluated through a multi - [67, 68]. Hedley et  al. conducted one of the two studies city, mixed-methods (both quantitative and qualitative) from Australia and analyzed the impact of the COVID-19 study the effect of the COVID-19 pandemic on 73 Com - pandemic on a sample of adults diagnosed with Autism munity-living older adults with a pre-existing history of Spectrum Disorders by means of a mixed‐method survey Major Depressive Disorder (MDD), aiming to explore (See figure on next page.) Fig.1 PRISMA 2020 flow diagram of included studies Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 44 of 48 Fig.1 (See legend on previous page.) Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 45 of 48 this relationship in an older population with a previously Conclusions, implications, and future directions diagnosed psychiatric condition [69]. In the study carried This study aims to provide an overview of studies inves - out by Veldhuis et al., suicide risk was assessed by means tigating the relationship between suicide and COVID-19 of the Suicidal Ideation Attributes Scale (SIDAS) admin- in subjects with a pre-existing mental disorder. Results istered to 1567 subjects from the USA to obtain measures suggest that suffering from a mental disorder is a risk of suicidal thoughts and behaviors and provide an assess- factor for suicidal behavior, especially during the pan- ment of overall risk [59]. In the study carried out in Hong demic. Some studies have also highlighted an increase in Kong, suicidal ideation was assessed using Geriatric Sui- suicidal behavior that could be potentially addressable to cide Ideation Scale (GSIS) in a sample of adults (healthy the pandemic advent in people already affected by a psy - controls vs. patients with late-life depression diagnosis) chiatric disorder. Precise diagnosis data were not clearly [61]. Two separate studies by Hamm et  al. and by Olié identifiable; however, Major Depressive Disorder out - et  al. assessed suicidal ideation by means of the suicidal stands as a major risk factor for suicidal behavior [70], item of the PHQ-9. [67] [44] Hyland et al. adapted three especially during the pandemic. Other psychopathologi- items from the 2014 English Adult Psychiatric Morbidity cal elements that stand out as risk factors for suicidality Survey to measure suicidal and self‐harm ideation [65]. in this context are social isolation, complicated grief or On the other hand, Hao et  al. assessed suicide ideation loss of loved ones, loneliness, economic issues, decreased by means of a structured questionnaire [60]. In the Aus- accessibility to mental health facilities, substance use dis- tralian study conducted in the Victoria region, authors orders, alcohol abuse, autism spectrum disorder (ASD), collected data that included both past-month pas- PTSD, anxiety, fear of infection and SARS-CoV2 infec- sive suicidal ideation (i.e., wished to be dead) and past- tion or COVID-19 disease [8, 19–21, 23–25, 28, 31–34, month serious suicidal ideation [64]. Admission book 37, 39, 40, 47, 49, 51, 52, 56, 63, 66]. Conversely, although data and information from bedhead tickets were used in most studies suggested an increase in suicidal behav- the Sri Lanka study to identify self-poisoning cases [68]. ior, presumably addressable to  the advent of  COVID-19 McDowell et al. gained data about the eventual presence pandemic, disease or infection, in patients with a men- or absence of suicidal ideation by reading psychiatric tal disorder, several of the works analyzed provided con- consultation notes [66]. Almost half of the studies found troversial data. Different studies did not clearly correlate no correlation between previous mental health diagnoses mental illness and suicide risk during the pandemic but and suicide behavior rate changes during the pandemic. rather described the increase in suicidal behavior as a For instance, Knipe et  al. observed a drop in rates of ER new-onset phenomenon. Although it is of utmost impor- presentation for self-poisoning during the pandemic tance to consider that the results of the studies have period, but no statistical evidence that may correlate several limitations; many studies included were carried this difference with a pre-existing psychiatric condition out employing a cross-sectional method and could not was found [68]. Conversely, Czeisler et al. stated that the address a direct causal relationship between suicide and presence of a previously diagnosed psychiatric disorder COVID-19. The lack of longitudinal studies, especially was usually associated with poorer outcomes, including on subjects with a pre-existing psychiatric condition, suicidal ideation, during the COVID-19 pandemic [69]. stands out as a limitation in obtaining specific and clari - Louie et al. concluded that adults with Late-Life Depres- fying data. Another major inherent limitation is the reli- sion (LLD) showed a significantly higher  suicidal risk ance of most of the studies on a retrospective self-report during the COVID-19 pandemic [61]. Moreover, in the assessment of changes in suicidal behavior. Many studies study by Hyland et  al., several different variables asso - used item 9 of the Patient Health Questionnaire (PHQ) ciated with suicide attempts were identified,  including to evaluate suicide risk, which has already been shown having received treatment for a mental health disorder. as an insufficient assessment tool for suicide risk and Interestingly, the same study demonstrated that patients ideation [71]. Moreover, a complete suicide evaluation treated for mental health problems  display a higher was rarely carried out, and not all studies provided data risk of engaging  in NSSI when compared to people with obtained in a clinical setting. Finally, the majority of the no psychiatric history [65]. Regarding presentations of selected studies focused on  the  general population, and patients with a substance use disorder (SUD), there was most of the data on diagnosis was  self-reported. Longi- a differential increase during  the  COVID-19 period that tudinal studies with homogeneous samples focusing on might explain the rise in suicidal ideation presentations, subjects with an established diagnosis  and  carrying out according to McDowell et  al. Olliè et  al. demonstrating a comprehensive physician-provided suicide assessment how daily virtual contacts were protective factors against could yield better knowledge on this topic. Furthermore, suicidal ideation during the first French lockdown [66], a suicide assessment with suicide-focused scales is nec- 44. For specifics about these studies, see Table 5. essary. In conclusion, future multicenter studies with Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 46 of 48 10. Telles-Garcia N, Zahrli T, Aggarwal G, Bansal S, Richards L, Aggarwal large population samples could clarify cross-country dif- S. Suicide attempt as the presenting symptom in a patient with ferences in suicidal behavior and risk in individuals with COVID-19: a case report from the United States. Case Rep Psychiatry. mental disorders. 2020;2020:8897454. 11. McAndrew J, O’Leary J, Cotter D, Cannon M, MacHale S, Murphy KC, Barry H. Impact of initial COVID-19 restrictions on psychiatry presentations to the emergency department of a large academic teaching hospital. Ir J Author contributions Psychol Med. 2021;38(2):108–15. https:// doi. org/ 10. 1017/ ipm. 2020. 115. Conceptualization and design were performed by T.B., P.S., F.P., A.R and R.R. 12. Chatterjee, S. S., Barikar C, M., & Mukherjee, A. (2020). Impact of COVID-19 Data extraction was conducted by T.B. and verified by C.D.A. V.S. and R.D.S. pandemic on pre-existing mental health problems. Asian J Psychiatry. screened citations for inclusion. T.B. and C.D.A. wrote the main manuscript text https:// doi. org/ 10. 1016/j. ajp. 2020. 102071. and S.M. and F.C. prepared Fig. 1 and Tables 1, 2, 3, 4 and 5. T.B., R.R., A.R. and 13. Travis-Lumer Y, Kodesh A, Goldberg Y, Frangou S, Levine SZ. Attempted F.P. developed methodology, formal analysis, and data curation. All authors suicide rates before and during the COVID-19 pandemic: interrupted contributed equally to the article. All authors read and approved the final time series analysis of a nationally representative sample. Psychol Med. manuscript. 2021;19:1–7. https:// doi. org/ 10. 1017/ S0033 29172 10043 84. 14. Dubé JP, Smith MM, Sherry SB, Hewitt PL, Stewart SH. Suicide behaviors Funding during the COVID-19 pandemic: a meta-analysis of 54 studies. Psychiatry None. Res. 2021;301:113998. https:// doi. org/ 10. 1016/j. psych res. 2021. 113998. 15. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, Moher D, Availability of data and materials Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, All data generated or analyzed during this study are included in this published Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey article [and its additional information files]. CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tunçalp Ö, Straus SE. PRISMA extension for scoping reviews (PRISMA-ScR): Declarations checklist and explanation. Ann Intern Med. 2018;169(7):467–73. https:// doi. org/ 10. 7326/ M18- 0850. Ethics approval and consent to participate 16. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Not applicable. Systematic review or scoping review? Guidance for authors when choos- ing between a systematic or scoping review approach. BMC Med Res Consent for publication Methodol. 2018;18(1):143. https:// doi. org/ 10. 1186/ s12874- 018- 0611-x. Not applicable. PMID. 17. WHO Director-General’s opening remarks at the media briefing on Competing interests COVID19 -March 2020. The authors declare that they have no competing interests. 18. Arksey H, O’Malley L. Scoping studies: towards a methodological frame- work. Int J Soc Res Methodol. 2005;8(1):4–18. 19. Khosravani V, Samimi Ardestani SM, Sharifi Bastan F, McKay D, Asmundson Received: 20 January 2023 Accepted: 3 March 2023 GJG. The associations of obsessive-compulsive symptom dimensions and general severity with suicidal ideation in patients with obsessive- compulsive disorder: the role of specific stress responses to COVID-19. Clin Psychol Psychother. 2021;28(6):1391–402. https:// doi. org/ 10. 1002/ cpp. 2602. References 20. Alonso P, Bertolín S, Segalàs J, Tubío-Fungueiriño M, Real E, Mar-Barrutia 1. Worldometers. https:// www. world omete rs. info/ coron avirus/ Accessed 19 L, Fernández-Prieto M, Carvalho S, Carracedo A, Menchón JM. How is April 2022. COVID-19 affecting patients with obsessive-compulsive disorder? A lon- 2. Bachmann S. Epidemiology of suicide and the psychiatric perspective. Int gitudinal study on the initial phase of the pandemic in a Spanish cohort. J Environ Res Public Health. 2018;15:1425. Eur Psychiatry. 2021;64(1):e45. https:// doi. org/ 10. 1192/j. eurpsy. 2021. 2214. 3. Wasserman IM. The impact of epidemic, war, prohibition and media 21. Na PJ, Tsai J, Hill ML, Nichter B, Norman SB, Southwick SM, Pietrzak RH. on suicide: United States, 1910–1920. Suicide Life Threat Behav. Prevalence, risk and protective factors associated with suicidal ideation 1992;22(2):240–54. during the COVID-19 pandemic in U.S. military veterans with pre-existing 4. Cheung Y T, Chau PH, Yip PS. A revisit on older adults suicides and severe psychiatric conditions. J Psychiatr Res. 2021;137:351–9. https:// doi. org/ 10. acute respiratory syndrome (SARS) epidemic in Hong Kong. Int J Geriatr 1016/j. jpsyc hires. 2021. 03. 021. Psychiatry. 2008;23(12):1231–8. https:// doi. org/ 10. 1002/ gps. 2056. (PMID: 22. Rømer TB, Christensen RHB, Blomberg SN, Folke F, Christensen HC, Benros 18500689). ME. Psychiatric admissions, referrals, and suicidal behavior before and 5. Serafini G, Parmigiani B, Amerio A, Aguglia A, Sher L, Amore M. The during the COVID-19 pandemic in Denmark: a time-trend study. Acta psychological impact of COVID-19 on the mental health in the general Psychiatr Scand. 2021;144(6):553–62. https:// doi. org/ 10. 1111/ acps. 13369. population. QJM. 2020;113(8):531–7. https:// doi. org/ 10. 1093/ qjmed/ 23. Fountoulakis KN, Apostolidou MK, Atsiova MB, Filippidou AK, Florou AK, hcaa2 01. Gousiou DS, Katsara AR, Mantzari SN, Padouva-Markoulaki M, Papatri- 6. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, antafyllou EI, Sacharidi PI, Tonia AI, Tsagalidou EG, Zymara VP, Prezerakos Rubin GJ. The psychological impact of quarantine and how to reduce it: PE, Koupidis SA, Fountoulakis NK, Chrousos GP. Self-reported changes rapid review of the evidence. Lancet. 2020;395(10227):912–20. https:// in anxiety, depression and suicidality during the COVID-19 lockdown in doi. org/ 10. 1016/ S0140- 6736(20) 30460-8. Greece. J Aec ff t Disord. 2021;15(279):624–9. https:// doi. org/ 10. 1016/j. jad. 7. Nordt C, Warnke I, Seifritz E, Kawohl W. Modelling suicide and unemploy-2020. 10. 061. ment: a longitudinal analysis covering 63 countries, 2000–11. Lancet 24. Nichter B, Hill ML, Na PJ, Kline AC, Norman SB, Krystal JH, Southwick Psychiatry. 2015;2(3):239–45. https:// doi. org/ 10. 1016/ S2215- 0366(14) SM, Pietrzak RH. Prevalence and trends in suicidal behavior among 00118-7. US military veterans during the COVID-19 pandemic. JAMA Psychiat. 8. Almaghrebi AH. Risk factors for attempting suicide during the COVID-19 2021;78(11):1218–27. https:// doi. org/ 10. 1001/ jamap sychi atry. 2021. 2332. lockdown: identification of the high-risk groups. J Taibah Univ Med Sci. PMID: 34431 973; PMCID: PMC83 87942. 2021;16(4):605–11. https:// doi. org/ 10. 1016/j. jtumed. 2021. 04. 010. 25. Na P, Tsai J, Harpaz-Rotem I, Pietrzak R. Mental health and suicidal idea- 9. Dsouza DD, Quadros S, Hyderabadwala ZJ, Mamun MA. Aggregated tion in US military veterans with histories of COVID-19 infection. BMJ Mil COVID-19 suicide incidences in India: fear of COVID-19 infection is the Health. 2022 Feb;168(1):15–19. doi: https:// doi. org/ 10. 1136/ bmjmi litary- prominent causative factor. Psychiatry Res. 2020;290:113145. https:// doi. 2021- 001846. Epub 2021 May 25. PMID: 34035155; PMCID: PMC8154290. org/ 10. 1016/j. psych res. 2020. 113145. Bar lattani et al. Annals of General Psychiatry (2023) 22:10 Page 47 of 48 26. Batterham PJ, Calear AL, Shou Y, Farrer LM, Gulliver A, McCallum SM, in an emergency department during COVID-19. J Psychosom Res. Dawel A. Eec ff ts of the COVID-19 pandemic on suicidal ideation in a 2021;150:110619. https:// doi. org/ 10. 1016/j. jpsyc hores. 2021. 110619. representative Australian population sample-Longitudinal cohort study. 36. Ridout KK, Alavi M, Ridout SJ, Koshy MT, Awsare S, Harris B, Vinson DR, J Aec ff t Disord. 2022;1(300):385–91. https:// doi. org/ 10. 1016/j. jad. 2022. 01. Weisner CM, Sterling S, Iturralde E. Emergency department encounters 022. among youth with suicidal thoughts or behaviors during the COVID-19 27. Fountoulakis KN, Karakatsoulis G, Abraham S, Adorjan K, Ahmed HU, pandemic. JAMA Psychiat. 2021;78(12):1319–28. https:// doi. org/ 10. 1001/ Alarcón RD, Arai K, Auwal SS, Berk M, Bjedov S, Bobes J, Bobes-Bascaran jamap sychi atry. 2021. 2457. PMID: 34468 724; PMCID: PMC84 11357. T, Bourgin-Duchesnay J, Bredicean CA, Bukelskis L, Burkadze A, Abud IIC, 37. Jefsen OH, Rohde C, Nørremark B, Østergaard SD. COVID-19-related Castilla-Puentes R, Cetkovich M, Colon-Rivera H, Corral R, Cortez-Vergara self-harm and suicidality among individuals with mental disorders. Acta C, Crepin P, De Berardis D, Zamora Delgado S, De Lucena D, De Sousa A, Psychiatr Scand. 2020;142(2):152–3. https:// doi. org/ 10. 1111/ acps. 13214. Stefano RD, Dodd S, Elek LP, Elissa A, Erdelyi-Hamza B, Erzin G, Etchevers 38. Menculini G, Moretti P, Pandolfi LM, Bianchi S, Valentini E, Gatto M, MJ, Falkai P, Farcas A, Fedotov I, Filatova V, Fountoulakis NK, Frankova I, Amantini K, Tortorella A. Suicidality and COVID-19: data from an emer- Franza F, Frias P, Galako T, Garay CJ, Garcia-Álvarez L, García-Portilla MP, gency setting in Italy. Psychiatr Danub. 2021;33(Suppl 9):158–63 (PMID: Gonda X, Gondek TM, González DM, Gould H, Grandinetti P, Grau A, 34559796). Groudeva V, Hagin M, Harada T, Hasan MT, Hashim NA, Hilbig J, Hossain 39. Mortier P, Vilagut G, Ferrer M, Serra C, Molina JD, López-Fresneña N, S, Iakimova R, Ibrahim M, Iftene F, Ignatenko Y, Irarrazaval M, Ismail Z, Puig T, Pelayo-Terán JM, Pijoan JI, Emparanza JI, Espuga M, Plana N, Ismayilova J, Jacobs A, Jakovljević M, Jakšić N, Javed A, Kafali HY, Karia S, González-Pinto A, Ortí-Lucas RM, de Salázar AM, Rius C, Aragonès E, Del Kazakova O, Khalifa D, Khaustova O, Koh S, Kopishinskaia S, Kosenko K, Cura-González I, Aragón-Peña A, Campos M, Parellada M, Pérez-Zapata Koupidis SA, Kovacs I, Kulig B, Lalljee A, Liewig J, Majid A, Malashonkova A, Forjaz MJ, Sanz F, Haro JM, Vieta E, Pérez-Solà V, Kessler RC, Bruffaerts R, E, Malik K, Malik NI, Mammadzada G, Mandalia B, Marazziti D, Marčinko D, Alonso J, MINDCOVID Working group. Thirty-day suicidal thoughts and Martinez S, Matiekus E, Mejia G, Memon RS, Martínez XEM, Mickevičiūtė behaviors among hospital workers during the first wave of the Spain D, Milev R, Mohammed M, Molina-López A, Morozov P, Muhammad NS, COVID-19 outbreak. Depress Anxiety. 2021;38(5):528–44. https:// doi. org/ Mustač F, Naor MS, Nassieb A, Navickas A, Okasha T, Pandova M, Panfil AL, 10. 1002/ da. 23129. Panteleeva L, Papava I, Patsali ME, Pavlichenko A, Pejuskovic B, Pinto Da 40. Al-Humadi S, Bronson B, Muhlrad S, Paulus M, Hong H, Cáceda R. Costa M, Popkov M, Popovic D, Raduan NJN, Ramírez FV, Rancans E, Razali Depression, Suicidal Thoughts, and Burnout Among Physicians During S, Rebok F, Rewekant A, Flores ENR, Rivera-Encinas MT, Saiz P, de Carmona the COVID-19 Pandemic: a Survey-Based Cross-Sectional Study. Acad MS, Martínez DS, Saw JA, Saygili G, Schneidereit P, Shah B, Shirasaka T, Psychiatry. 2021;45(5):557–65. Silagadze K, Sitanggang S, Skugarevsky O, Spikina A, Mahalingappa SS, 41. Bruffaerts R, Voorspoels W, Jansen L, Kessler RC, Mortier P, Vilagut G, De Stoyanova M, Szczegielniak A, Tamasan SC, Tavormina G, Tavormina MGM, Vocht J, Alonso J. Suicidality among healthcare professionals during the Theodorakis PN, Tohen M, Tsapakis EM, Tukhvatullina D, Ullah I, Vaidya first COVID19 wave. J Aec ff t Disord. 2021;15(283):66–70. https:// doi. org/ R, Vega-Dienstmaier JM, Vrublevska J, Vukovic O, Vysotska O, Widiasih N, 10. 1016/j. jad. 2021. 01. 013. Yashikhina A, Prezerakos PE, Smirnova D. Results of the COVID-19 mental 42. Mamun MA, Syed NK, Griffiths MD. Indian celebrity suicides before health international for the general population (COMET-G) study. Eur and during the COVID-19 pandemic and their associated risk factors: Neuropsychopharmacol. 2022;54:21–40. https:// doi. org/ 10. 1016/j. euron evidence from media reports. J Psychiatr Res. 2020;131:177–9. https:// doi. euro. 2021. 10. 004.org/ 10. 1016/j. jpsyc hires. 2020. 09. 002. 28. Liu R, Xu X, Zou S, Li Y, Wang H, Yan X, Du X, Zhang L, Zhang Q, Li W, 43. Panigrahi M, Pattnaik JI, Padhy SK, Menon V, Patra S, Rina K, Padhy SS, Cheung T, Ungvari GS, Ng CH, Xiang Y T. Prevalence of suicidality and Patro B. COVID-19 and suicides in India: a pilot study of reports in the its association with quality of life in older patients with clinically stable media and scientific literature. Asian J Psychiatr. 2021;57:102560. https:// psychiatric disorders in China during the COVID-19 pandemic. J Geriatr doi. org/ 10. 1016/j. ajp. 2021. 102560. Psychiatry Neurol. 2022;35(2):237–44. https:// doi. org/ 10. 1177/ 08919 44. Olié E, Dubois J, Benramdane M, Guillaume S, Courtet P. Psychological 88722 10785 57. PMID: 35246 000; PMCID: PMC88 99831. state of a sample of patients with mood disorders during the first French 29. Montalbani B, Bargagna P, Mastrangelo M, Sarubbi S, Imbastaro B, De COVID-19 lockdown. Sci Rep. 2021;11(1):23711. https:// doi. org/ 10. 1038/ Luca GP, Anibaldi G, Erbuto D, Pompili M, Comparelli A. The COVID-19 s41598- 021- 03037-w. PMID: 34887 481; PMCID: PMC86 60817. outbreak and subjects with mental disorders who presented to an Italian 45. Behera C, Gupta SK, Singh S, Balhara YPS. Trends in deaths attributable to psychiatric emergency department. J Nerv Ment Dis. 2021;209(4):246–50. suicide during COVID-19 pandemic and its association with alcohol use https:// doi. org/ 10. 1097/ NMD. 00000 00000 001289. and mental disorders: Findings from autopsies conducted in two districts 30. Berardelli I, Sarubbi S, Rogante E, Cifrodelli M, Erbuto D, Innamorati M, of India. Asian J Psychiatr. 2021;58:102597. https:// doi. org/ 10. 1016/j. ajp. Lester D, Pompili M. The impact of the COVID-19 pandemic on suicide 2021. 102597. ideation and suicide attempts in a sample of psychiatric inpatients. 46. Mortier P, Vilagut G, Ferrer M, Alayo I, Bruffaerts R, Cristóbal-Narváez P, Del Psychiatry Res. 2021;303:114072. https:// doi. org/ 10. 1016/j. psych res. 2021. Cura-González I, Domènech-Abella J, Felez-Nobrega M, Olaya B, Pijoan 114072. JI, Vieta E, Pérez-Solà V, Kessler RC, Haro JM, Alonso J, MINDCOVID Work- 31. Kang JH, Lee SW, Ji JG, Yu JK, Jang YD, Kim SJ, Kim YW. Changes in the ing group. Thirty-day suicidal thoughts and behaviours in the Spanish pattern of suicide attempters visiting the emergency room after COVID- adult general population during the first wave of the Spain COVID-19 19 pandemic: an observational cross-sectional study. BMC Psychiatry. pandemic. Epidemiol Psychiatr Sci. 2021;30:e19. https:// doi. org/ 10. 1017/ 2021;21(1):571. https:// doi. org/ 10. 1186/ s12888- 021- 03570-y. PMID: 34781 S2045 79602 10000 93. 918; PMCID: PMC85 91586. 47. Sáiz PA, de la Fuente-Tomas L, García-Alvarez L, Bobes-Bascarán MT, 32. Lee J, Kim D, Lee WJ, Woo SH, Jeong S, Kim SH. Association of the COVID- Moya-Lacasa C, García-Portilla MP, Bobes J. Prevalence of Passive Suicidal 19 pandemic and low-rescue suicide attempts in patients visiting the Ideation in the Early Stage of the Coronavirus Disease 2019 (COVID-19) emergency department after attempting suicide. J Korean Med Sci. Pandemic and Lockdown in a Large Spanish Sample. J Clin Psychiatry. 2021;36(34):e243. https:// doi. org/ 10. 3346/ jkms. 2021. 36. e243. 2020. 33. Mutlu E, Anıl Yağcıoğlu AE. Relapse in patients with serious mental dis- 48. Sáiz PA, Dal Santo F, García-Alvarez L, Bobes-Bascarán MT, Jiménez-Treviño orders during the COVID-19 outbreak: a retrospective chart review from L, Seijo-Zazo E, Rodríguez-Revuelta J, González-Blanco L, García-Portilla a community mental health center. Eur Arch Psychiatry Clin Neurosci. MP, Bobes J. Suicidal ideation trends and associated factors in different 2021;271(2):381–3. https:// doi. org/ 10. 1007/ s00406- 020- 01203-1. large Spanish samples during the first year of the COVID-19 pandemic. J 34. Seifert J, Meissner C, Birkenstock A, Bleich S, Toto S, Ihlefeld C, Zindler Clin Psychiatry. 2022;83(2):21br14061. https:// doi. org/ 10. 4088/ JCP. 21br1 T. Peripandemic psychiatric emergencies: impact of the COVID-19 4061. pandemic on patients according to diagnostic subgroup. Eur Arch 49. Wathelet M, Duhem S, Vaiva G, et al. Factors associated with mental Psychiatry Clin Neurosci. 2021;271(2):259–70. https:// doi. org/ 10. 1007/ health disorders among university students in France confined during s00406- 020- 01228-6. the COVID-19 pandemic. JAMA Netw Open. 2020;3(10):e2025591. https:// 35. Grossman MN, Fry CE, Sorg E, MacLean RL, Nisavic M, McDowell doi. org/ 10. 1001/ jaman etwor kopen. 2020. 25591. MJ, Masaki C, Bird S, Smith F, Beach SR. Trends in suicidal ideation Barlattani et al. Annals of General Psychiatry (2023) 22:10 Page 48 of 48 50. López Steinmetz LC, Dutto Florio MA, Leyes CA, Fong SB, Rigalli A, Godoy 65. Hyland P, Rochford S, Munnelly A, Dodd P, Fox R, Vallières F, McBride O, JC. Levels and predictors of depression, anxiety, and suicidal risk during Shevlin M, Bentall RP, Butter S, Karatzias T, Murphy J. Predicting risk along COVID-19 pandemic in Argentina: the impacts of quarantine extensions the suicidality continuum: A longitudinal, nationally representative study on mental health state. Psychol Health Med. 2022;27(1):13–29. https:// of the Irish population during the COVID-19 pandemic. Suicide Life doi. org/ 10. 1080/ 13548 506. 2020. Threat Behav. 2022;52(1):83–98. https:// doi. org/ 10. 1111/ sltb. 12783. 51. Vrublevska J, Sibalova A, Aleskere I, Rezgale B, Smirnova D, Fountoulakis 66. McDowell MJ, Fry CE, Nisavic M, Grossman M, Masaki C, Sorg E, Bird S, KN, Rancans E. Factors related to depression, distress, and self-reported Smith F, Beach SR. Evaluating the association between COVID-19 and changes in anxiety, depression, and suicidal thoughts during the COVID- psychiatric presentations, suicidal ideation in an emergency department. 19 state of emergency in Latvia. Nord J Psychiatry. 2021;75(8):614–23. PLoS ONE. 2021;16(6):e0253805. https:// doi. org/ 10. 1371/ journ al. pone. https:// doi. org/ 10. 1080/ 08039 488. 2021.02538 05. 52. Papadopoulou A, Efstathiou V, Yotsidi V, Pomini V, Michopoulos I, Marko- 67. Hamm ME, Brown PJ, Karp JF, Lenard E, Cameron F, Dawdani A, Lavretsky poulou E, Papadopoulou M, Tsigkaropoulou E, Kalemi G, Tournikioti K, H, Miller JP, Mulsant BH, Pham VT, Reynolds CF, Roose SP, Lenze EJ. Experi- Douzenis A, Gournellis R. Suicidal ideation during COVID-19 lockdown in ences of American older adults with pre-existing depression during the Greece: prevalence in the community, risk and protective factors. Psychia- beginnings of the COVID-19 pandemic: a multicity mixed-methods study. try Res. 2021;297:113713. https:// doi. org/ 10. 1016/j. psych res. 2021. 113713. Am J Geriatr Psychiatr. 2020;28(9):924–32. https:// doi. org/ 10. 1016/j. jagp. 53. Shi L, Que JY, Lu ZA, Gong YM, Liu L, Wang YH, Ran MS, Ravindran N, 2020. 06. 013. Ravindran AV, Fazel S, Bao YP, Shi J, Lu L. Prevalence and correlates of 68. Knipe D, Silva T, Aroos A, Senarathna L, Hettiarachchi NM, Galappaththi suicidal ideation among the general population in China during the SR, Spittal MJ, Gunnell D, Metcalfe C, Rajapakse T. Hospital presentations COVID-19 pandemic. Eur Psychiatry. 2021;64(1):e18. https:// doi. org/ 10. for self-poisoning during COVID-19 in Sri Lanka: an interrupted time- 1192/j. eurpsy. 2021.5. series analysis. Lancet Psychiatry. 2021;8(10):892–900. https:// doi. org/ 10. 54. Iob E, Steptoe A, Fancourt D. Abuse, self-harm and suicidal ideation in the 1016/ S2215- 0366(21) 00242-X. UK during the COVID-19 pandemic. Br J Psychiatry. 2020;217(4):543–6. 69. Czeisler MÉ, Wiley JF, Facer-Childs ER, Robbins R, Weaver MD, Barger LK, https:// doi. org/ 10. 1192/ bjp. 2020. 130. PMID: 32654 678; PMCID: PMC73 Czeisler CA, Howard ME, Rajaratnam SMW. Mental health, substance use, 60935. and suicidal ideation during a prolonged COVID-19-related lockdown in a 55. Kasal A, Kuklová M, Kågström A, Winkler P, Formánek T. Suicide risk in region with low SARS-CoV-2 prevalence. J Psychiatr Res. 2021;140:533–44. individuals with and without mental disorders before and during the https:// doi. org/ 10. 1016/j. jpsyc hires. 2021. 05. 080. COVID-19 pandemic: an analysis of three nationwide cross-sectional 70. Bertolote JM, Fleischmann A. Suicide and psychiatric diagnosis: a world- surveys in Czechia. Arch Suicide Res. 2022;24:1–15. https:// doi. org/ 10. wide perspective. World Psychiatr. 2002;1:181–5. 1080/ 13811 118. 2022. 20516 53. 71. Na PJ, Yaramala SR, Kim JA, Kim H, Goes FS, Zandi PP, Vande Voort JL, Sutor 56. Sasaki N, Tabuchi T, Okubo R, Ishimaru T, Kataoka M, Nishi D. Temporary B, Croarkin P, Bobo WV. The PHQ-9 Item 9 based screening for suicide employment and suicidal ideation in COVID-19 pandemic in Japan: a risk: a validation study of the patient health questionnaire (PHQ)-9 Item 9 cross-sectional nationwide survey. J Occup Health. 2022;64(1):e12319. with the Columbia suicide severity rating scale (C-SSRS). J Aec ff t Disord. https:// doi. org/ 10. 1002/ 1348- 9585. 12319. 2018;232:34–40. https:// doi. org/ 10. 1016/j. jad. 2018. 02. 045. 57. Every-Palmer S, Jenkins M, Gendall P, et al. Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand Publisher’s Note during the COVID-19 lockdown: A cross-sectional study. PLoS ONE. Springer Nature remains neutral with regard to jurisdictional claims in pub- 2020;15(11):e0241658. https:// doi. org/ 10. 1371/ journ al. pone. 02416 58. lished maps and institutional affiliations. 58. Daly Z, Slemon A, Richardson CG, Salway T, McAuliffe C, Gadermann AM, Thomson KC, Hirani S, Jenkins EK. Associations between periods of COVID-19 quarantine and mental health in Canada. Psychiatry Res. 2021;295:113631. https:// doi. org/ 10. 1016/j. psych res. 2020. 113631. 59. Veldhuis CB, Nesoff ED, McKowen ALW, Rice DR, Ghoneima H, Wootton AR, Papautsky EL, Arigo D, Goldberg S, Anderson JC. Addressing the critical need for long-term mental health data during the COVID-19 pandemic: changes in mental health from april to september 2020. Prev Med. 2021;146:106465. https:// doi. org/ 10. 1016/j. ypmed. 2021. 106465. 60. Hao F, Tan W, Jiang L, Zhang L, Zhao X, Zou Y, Hu Y, Luo X, Jiang X, McIn- tyre RS, Tran B, Sun J, Zhang Z, Ho R, Ho C, Tam W. Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry. Brain Behav Immun. 2020;87:100–6. https:// doi. org/ 10. 1016/j. bbi. 2020. 04. 069. 61. Louie LLC, Chan WC, Cheng CPW. Suicidal risk in older patients with depression during COVID-19 pandemic: a case-control study. East Asian Arch Psychiatry. 2021;31(1):3–8. https:// doi. org/ 10. 12809/ eaap2 055. 62. Carlin GL, Baumgartner JS, Moftakhar T, König D, Negrin LL. Impact of COVID-19 lockdown on suicide attempts : a retrospective analysis of Re Read ady y to to submit y submit your our re researc search h ? Choose BMC and benefit fr ? Choose BMC and benefit from om: : the springtime admissions to the trauma resuscitation room at the medical university of Vienna from 2015–2020. 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Journal

Annals of General PsychiatrySpringer Journals

Published: Mar 17, 2023

Keywords: Suicide; Covid-19; Mental disorder; Pandemic

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