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STRESS AND SUICIDE: Is there a link between the COVID-19 pandemic and suicide?

Adeola Adeyemi

Adeola Adeyemi

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Stressful life events are experiences that affect a person’s everyday life, day-to-day activities, resulting in a significant change that requires re-adjustment. The level of stress may or may not be significant but the psychological reactions to the stressful situation, be it significant or not, really matters. Also, reaction to stress is subjective. Two people might be exposed to the same level of stress and one may develop mental health problems, while the other is able to cope without breaking down mentally.

For the normal stresses of life, your level of flexibility and ability to cope is an indicator of your mental stability. These normal stresses, such as preparing for a presentation, meeting a deadline, driving in traffic, may not be substantial enough to necessitate a need for huge adjustment. However, stressful life events usually lead to substantial alteration and require adaptation. They are enormous and significant enough to trigger mental health disorders such as depression, generalized anxiety disorder, post-traumatic stress disorder, substance abuse, all of which have been linked to suicidal behavior.

According to Holmes and Rahe stress scale, the 10 top most stressful events that could occur in a person’s life and lead to mental health problems, include:
1. Death of a spouse
2. Divorce
3. Marriage Separation
4. Imprisonment
5. Death of a close relatives
6. Physical illness or injury
7. Marriage
8. Loss of Job
9. Marriage reconciliation
10. Retirement

COVID-19, first identified by the WHO in March 2020 as a pandemic, posed as an intense new stressor which removed many of the traditional resources people have used to cope with stressful events. The pandemic led to the enforcement of restrictive measures to protect physical health, but which had a toll on mental health. Millions of people lost their jobs due to downsizing; some lost their homes or businesses; the rate of partner violence increased; substance abuse, increase in suicide cases etc.

Research has shown that people who encounter major stressful life events are prone to suicide. Over 90% of cases of suicide has been linked to mental health problems and depression, a major risk factor for suicide, account for 60 percent of suicide rates. The risk factors for suicidal behavior within the pandemic are not far fetched as it has profound psychosocial effects on everyone which may result in mental health consequences that are linked to suicidality.

The pandemic has been linked to increased rate of :
1. Anxiety symptoms (Fear of contagion, fear of uncertainties)
2. Depressive illnesses (due to loss of job, loss of loved ones)
3. Substance abuse (unhealthy coping strategies)
4. Abuse/Domestic Violence (social isolation, lockdown/restrictions)
5. Exacerbation of pre-existing mental illnesses

All of the above have been associated with the risk of suicide.

In America, it was reported that the percentage of people who voiced out suicidal intent via the helplines in April increased by 900%, on account of the COVID-19 pandemic. Other cases of suicide reported include that of a 66-year-old man in New York with throat cancer, who hanged himself after testing positive to COVID-19; a man in Illinois, who killed himself and his girlfriend because of the fear of COVID-19; and a 49-year-old head of emergency department in New York, who died by suicide after telling his family members the stress he went through, taking care of people who had COVID-19. In India, 72 cases of Suicide from March-May 2020 have been reported and the reported suicide reasons include the fear of contracting COVID 19, financial crisis, loneliness from lockdown restrictions, inability to meet set goals.

While limited studies are available for Nigeria, anecdotal reports indicate increase in suicidal intents and attempts.
United Nations (2020) reports taken from 24 states showed a 56% increase in the rate of sexual violence between March and April. Sexual violence has been linked to increase in the rate of suicide.

What are the preventive measures?
1. Public Awareness:

Suicide is preventable and help is available. Therefore, more effort should be put into educating the public, using movies, radio programs, TV and social media, on how to identify the red flags and get help. Red flags of Suicide include previous attempt, disclosure of suicidal intents, marked feelings of hopelessness, excessive use of alcohol and other psychoactive substances, chronic painful / terminal illness (e.g Cancer), Social Isolation, Personality problems (Impulsive personality traits as in Borderline and Antisocial personalities).

In addition, healthy coping strategies and empathy skills should be taught;cyberbullying, bodyshaming and social media trolling should be discouraged. Persons with suicidal ideations should be encouraged to ask for help and join mental health support groups like the Talk Mental Health Tribe

2. Psychosocial Support

Helplines/hotlines manned by trained mental health professionals for support should be made available and publicised. Through this telemedicine platform, adequate assessments can be done and appropriate management can commence. Uplifting signposts should be erected in public areas to encourage people not to give up as well as publicise the helplines.

3. Mental Health Bill: This is a legal framework that protects the right of people with mental health disorders, ensures they have access to treatment and care, discourage stigma and discrimination; and also improve mental health care in Nigeria. One of the laws in this bill is that suicidal attempt will no longer be criminalized, rather it will be a ground for involuntary admission, i.e people who attempt suicide will be connected to source of help, rather than imprisoned. This bill has passed the 3rd hearing and if it is enacted, the rate of suicide will reduce because people with mental health problems will get access to treatment and the needed psychosocial support.

4. Family Support: Family members should be educated on the signs of suicide, and be encouraged to monitor their relatives closely, pay attention to these signs and not take any verbal intent with a pinch of salt.

5. Health insurance: Of all those with mental health problems, only 10 per cent have access to treatment in low and middle-income countries like Nigeria. The burden of care is humongous because of cost implications and this has worsened since the COVID-19 pandemic. If there are effective Health Insurance options available to access mental healthcare, the treatment gap would be bridged, access to treatment will increase and the rate of suicide will automatically reduce.

6. Responsible reportage by the media: The media should be trained on how to report suicide cases e.g. avoiding gory details and putting out sensitive contents. This is to prevent copy-cat suicide. Rather, they should respect the privacy of the deceased and their families and promote suicide preventive measures.

7. Adoption of the Gatekeeper model: This involves the training of non-specialized workers within the community to identify red flags of suicide and refer for appropriate treatment. Integrating mental health care services within the community will reduce the stigma, encourage help-seeking behaviour and bridge the treatment gaps.

Just as we looked out for each other during the peak of the pandemic, let us continue to watch out for each other’s mental well-being.

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