The Impact of the COVID-19 Pandemic on Suicide Attempts in Kerman Province: An Interrupted Time Series Analysis
Abstract
Background: The COVID-19 pandemic has had a significant impact on global suicide attempt rates. This study evaluated the effect of the COVID-19 pandemic on suicide attempts in the Kerman Province, eastern Iran.
Methods: This is a cross-sectional study. Data on suicide attempt cases in Kerman Province was obtained from the database of Mental, Social, and Addiction Health Office of the Deputy for Health of Medical Sciences Universities from 2018 to 2021. An interrupted time-series model was used to assess the changes in suicide attempts before and after the pandemic.
Results: Suicide attempts exhibited a decreasing trend before the pandemic, with a monthly decrease of 0.9% (P<0.001). The immediate effect of the pandemic indicated that, at the beginning of the pandemic, there was a 4.5% increase in suicide attempts (P=0.134). The sustained effect of the pandemic showed that in the months following the onset of the pandemic, the rate of suicide attempts increased by 1.8% compared to before the pandemic (P<0.001). By the end of 2021, the number of suicide attempts per month exceeded the predicted amount based on pre-pandemic data. Factors such as marital status, education, occupation, place of residence, and previous suicide attempts were found to influence suicide attempts during the pandemic.
Conclusion: Given the significant increase in suicide attempts following the onset of the pandemic, it is crucial to prioritize the implementation of prevention and intervention programs during this crisis.
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6. Turecki G, Brent DA, Gunnell D, et al (2019). Suicide and suicide risk. Nat Rev Dis Primers, 5(1): 74.
7. Kitamura N, Abbas K, Nathwani D (2022). Public health and social measures to mitigate the health and economic impact of the COVID-19 pandemic in Turkey, Egypt, Ukraine, Kazakhstan, and Poland during 2020–2021: situational analysis. BMC Public Health, 22(1): 991.
8. Moreno C, Wykes T, Galderisi S, et al (2020). How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry, 7(9): 813-24.
9. Xiong J, Lipsitz O, Nasri F, et al (2020). Impact of COVID-19 pandemic on mental health in the general population: A systematic review. J Affect Disord, 277: 55-64.
10. Hossain MM, Tasnim S, Sultana A, et al (2020). Epidemiology of mental health problems in COVID-19: a review. F1000Res, 9:636.
11. Wasserman D, Iosue M, Wuestefeld A, et al (2020). Adaptation of evidence‐based suicide prevention strategies during and after the COVID‐19 pandemic. World Psychiatry, 19(3): 294-306.
12. Killgore WD, Cloonan SA, Taylor EC, et al (2020). Suicidal ideation during the COVID-19 pandemic: The role of insomnia. Psychiatry Res, 290: 113134.
13. Kastner UW, Javaheripour N, Arand J, et al (2022). Effects of the COVID-19 pandemic on suicide attempts in a rural region in Germany, a 5-year observational study. J Affect Disord, 318: 393-9.
14. Dubé JP, Smith MM, Sherry SB, et al (2021). Suicide behaviors during the COVID-19 pandemic: A meta-analysis of 54 studies. Psychiatry Res, 301: 113998
15. Kasal A, Kuklová M, Kågström A, et al (2023). Suicide risk in individuals with and without mental disorders before and during the CoViD-19 pandemic: an analysis of three nationwide cross-sectional surveys in Czechia. Arch Suicide Res, 27(2): 671-85.
16. Acharya B, Subedi K, Acharya P, et al (2022). Association between COVID-19 pandemic and the suicide rates in Nepal. PLoS One, 17(1): e0262958.
17. Raifman J, Ettman CK, Dean L, et al (2022). Economic precarity, social isolation, and suicidal ideation during the COVID-19 pandemic. PLoS One, 17(11):e0275973.
18. Pirkis J, Gunnell D, Shin S, et al (2022). Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries. EClinicalMedicine, 51: 101573.
19. Osaki Y, Otsuki H, Imamoto A, et al (2021). Suicide rates during social crises: Changes in the suicide rate in Japan after the Great East Japan earthquake and during the COVID-19 pandemic. J Psychiatr Res, 140: 39-44.
20. Yan Y, Hou J, Li Q, Yu NX (2023). Suicide before and during the COVID-19 pandemic: a systematic review with meta-analysis. Int J Environ Res Public Health, 20(4): 3346.
21. Carlin GL, Baumgartner JS, Moftakhar T, et al.(2021). Impact of COVID-19 lockdown on suicide attempts: A retrospective analysis of the springtime admissions to the trauma resuscitation room at the Medical University of Vienna from 2015–2020. Wien Klin Wochenschr, 133: 915-22.
22. Kang J-H, Lee S-W, Ji J-G, et al (2021). Changes in the pattern of suicide attempters visiting the emergency room after COVID-19 pandemic: an observational cross sectional study. BMC Psychiatry, 21(1): 571.
23. Yard E, Radhakrishnan L, Ballesteros MF, et al (2021). Emergency department visits for suspected suicide attempts among persons aged 12–25 years before and during the COVID-19 pandemic—United States, January 2019–May 2021. MMWR Morb Mortal Wkly Rep, 70(24): 888–94.
24. Reif-Leonhard C, Lemke D, Holz F, et al (2022). Changes in the pattern of suicides and suicide attempt admissions in relation to the COVID-19 pandemic. Eur Arch Psychiatry Clin Neurosci, 273(2): 357-65.
25. Kim SY, Kim H-R, Park B, et al (2021). Comparison of stress and suicide-related behaviors among Korean youths before and during the COVID-19 pandemic. JAMA Netw Open, 4(12): e2136137.
26. Olié E, Nogue E, Picot M, et al (2021). Hospitalizations for suicide attempt during the first COVID‐19 lockdown in France. Acta Psychiatr Scand, 143(6): 535–6.
27. Danielsen S, Joensen A, Andersen PK, et al (2022). Self-injury, suicidal ideation and-attempt and eating disorders in young people following the initial and second COVID-19 lockdown. medRxiv, 2-22, preprint.
28. Pouradeli S, Rezaeian M, Rahmanian V (2022). Epidemiology of occupational injuries in Kerman province during 2012-2016. J Inj Violence Res, 14(1): 65-73.
29. Farvahari A, Amirzadeh Googhari S, Borhaninejad V, et al.(2022). Assessing the Mental Health Status of the General Population of Kerman and the Factors Affecting it During the Covid-19 Pandemic. Journal of Health Research in Community, 8(1): 69-80.
30. Pouradeli S, Ahmadinia H, Vazirinezhad R, et al (2023). An analysis of suicide rates in Kerman province, the largest province in Iran, before and after COVID-19:(2017-2020). Asian J Psychiatr, 85: 103614.
31. WHO. Preventing suicide: a resource for media professionals: update 2017 Switzerland: World Health Organization. Regional Office for Europe; 2021
32. Borhani F, Shafiepour Motlagh M, et al (2021). Changes in short-lived climate pollutants during the COVID-19 pandemic in Tehran, Iran. Environ Monit Assess, 193(6): 133.
33. Wikipedia. Solar Hijri calendar 2022 [updated 20 October 2022. Available from: https://en.wikipedia.org/wiki/Solar_Hijri_calendar
34. Leske S, Kõlves K, Crompton D, et al (2021). Real-time suicide mortality data from police reports in Queensland, Australia, during the COVID-19 pandemic: an interrupted time-series analysis. Lancet Psychiatry, 8(1): 58-63.
35. Turner SL, Karahalios A, Forbes AB, et al (2021). Comparison of six statistical methods for interrupted time series studies: empirical evaluation of 190 published series. BMC Med Res Methodol, 21(1): 134.
36. Khan AR, Shimul SAK, Arendse N (2021). Suicidal behaviour and the coronavirus (COVID‐19) pandemic: Insights from Durkheim's sociology of suicide. Int Soc Sci J, 71(Suppl 1):7-21.
37. Paykel E, Myers J, Lindenthal J, et al (1974). Suicidal feelings in the general population: a prevalence study. Br J Psychiatry, 124(0): 460-9.
38. Ryan EP, Oquendo MA (2020). Suicide risk assessment and prevention: challenges and opportunities. Focus (Am Psychiatr Publ), 18(2):88-99.
39. Reifels L, Krysinska K, Andriessen K (2024). Suicide prevention during disasters and public health emergencies: a systematic review. Front Public Health, 12: 1338099.
40. Mazza JJ, Catalano RF, Abbott RD, et al (2011). An examination of the validity of retrospective measures of suicide attempts in youth. J Adolesc Health, 49(5): 532-7.
41. Efstathiou V, Stefanou M-I, Siafakas N, et al (2022). Suicidality and COVID‑19: Suicidal ideation, suicidal behaviors and completed suicides amidst the COVID‑19 pandemic. Exp Ther Med, 23(1): 107.
42. Cénat JM, Blais-Rochette C, Kokou-Kpolou CK, et al (2021). Prevalence of symptoms of depression, anxiety, insomnia, posttraumatic stress disorder, and psychological distress among populations affected by the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry Res, 295: 113599.
43. Behera A, Singla N, Sharma N, et al.(2022). Paradigm shift in pattern and prevalence of poisoning during COVID-19 pandemic. J Family Med Prim Care, 11(1): 208-14.
44. McGillivray L, Rheinberger D, Wang J, et al (2022). Non-disclosing youth: a cross sectional study to understand why young people do not disclose suicidal thoughts to their mental health professional. BMC Psychiatry, 22(1): 3.
45. Blomqvist S, Virtanen M, LaMontagne AD, et al (2022). Perceived job insecurity and risk of suicide and suicide attempts: a study of men and women in the Swedish working population. Scand J Work Environ Health, 48(4): 293-301.
46. Mathieu S, Treloar A, Hawgood J, et al (2022). The role of unemployment, financial hardship, and economic recession on suicidal behaviors and interventions to mitigate their impact: a review. Front Public Health, 10: 907052
47. Khan A, Ratele K, Arendse N (2020). Men, suicide, and Covid-19: Critical masculinity analyses and interventions. Postdigit Sci Educ, 2(3): 651-6.
48. Roberts A, Rogers J, Mason R, et al (2021). Alcohol and other substance use during the COVID-19 pandemic: A systematic review. Drug Alcohol Depend, 229(Pt A):109150.
49. Walther A, Grub J, Tsar S, et al (2023). Status loss due to COVID-19, traditional masculinity, and their association with recent suicide attempts and suicidal ideation. Psychol Men Masc, 24(1): 47-62.
50. Allan NP, Volarov M, Koscinski B, et al (2021). Lonely, anxious, and uncertain: Critical risk factors for suicidal desire during the COVID-19 pandemic. Psychiatry Res, 304: 114144.
51. Mamun MA, Griffiths MD (2020). First COVID-19 suicide case in Bangladesh due to fear of COVID-19 and xenophobia: Possible suicide prevention strategies. Asian J Psychiatr, 51: 102073.
52. Rothman S, Sher L (2021). Suicide prevention in the covid-19 era. Prev Med, 152(Pt 1):106547.
53. Kim M-J, Paek S-H, Kwon J-H, et al (2022). Changes in suicide rate and characteristics according to age of suicide attempters before and after COVID-19. Children (Basel), 9(2): 151.
54. Koppen A, Thoonen IM, Hunault CC, et al (2023). Significant increase in deliberate self-poisonings among adolescents during the second year of the COVID-19 pandemic. J Adolesc Health, 73(2): 319-24.
55. Suokas J, Suominen K, Isometsä E, et al (2001). Long‐term risk factors for suicide mortality after attempted suicide‐Findings of a 14‐year follow‐up study. Acta Psychiatr Scand, 104(2): 117-21.
2. Mamun MA (2021). Suicide and suicidal behaviors in the context of COVID-19 pandemic in Bangladesh: a systematic review. Psychol Res Behav Manag, 14: 695-704.
3. WHO. Suicide worldwide in 2019: global health estimates: World Health Organization; 2021
4. Ivbijaro G, Kolkiewicz L, Goldberg D, et al (2021). Suicide prevention and COVID‐19. Asia Pac Psychiatry, 13(3): e12482
5. Bidgoli HH, Bogg L, Hasselberg M (2011). Pre-hospital trauma care resources for road traffic injuries in a middle-income country—A province based study on need and access in Iran. Injury, 42(9): 879-84.
6. Turecki G, Brent DA, Gunnell D, et al (2019). Suicide and suicide risk. Nat Rev Dis Primers, 5(1): 74.
7. Kitamura N, Abbas K, Nathwani D (2022). Public health and social measures to mitigate the health and economic impact of the COVID-19 pandemic in Turkey, Egypt, Ukraine, Kazakhstan, and Poland during 2020–2021: situational analysis. BMC Public Health, 22(1): 991.
8. Moreno C, Wykes T, Galderisi S, et al (2020). How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry, 7(9): 813-24.
9. Xiong J, Lipsitz O, Nasri F, et al (2020). Impact of COVID-19 pandemic on mental health in the general population: A systematic review. J Affect Disord, 277: 55-64.
10. Hossain MM, Tasnim S, Sultana A, et al (2020). Epidemiology of mental health problems in COVID-19: a review. F1000Res, 9:636.
11. Wasserman D, Iosue M, Wuestefeld A, et al (2020). Adaptation of evidence‐based suicide prevention strategies during and after the COVID‐19 pandemic. World Psychiatry, 19(3): 294-306.
12. Killgore WD, Cloonan SA, Taylor EC, et al (2020). Suicidal ideation during the COVID-19 pandemic: The role of insomnia. Psychiatry Res, 290: 113134.
13. Kastner UW, Javaheripour N, Arand J, et al (2022). Effects of the COVID-19 pandemic on suicide attempts in a rural region in Germany, a 5-year observational study. J Affect Disord, 318: 393-9.
14. Dubé JP, Smith MM, Sherry SB, et al (2021). Suicide behaviors during the COVID-19 pandemic: A meta-analysis of 54 studies. Psychiatry Res, 301: 113998
15. Kasal A, Kuklová M, Kågström A, et al (2023). Suicide risk in individuals with and without mental disorders before and during the CoViD-19 pandemic: an analysis of three nationwide cross-sectional surveys in Czechia. Arch Suicide Res, 27(2): 671-85.
16. Acharya B, Subedi K, Acharya P, et al (2022). Association between COVID-19 pandemic and the suicide rates in Nepal. PLoS One, 17(1): e0262958.
17. Raifman J, Ettman CK, Dean L, et al (2022). Economic precarity, social isolation, and suicidal ideation during the COVID-19 pandemic. PLoS One, 17(11):e0275973.
18. Pirkis J, Gunnell D, Shin S, et al (2022). Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries. EClinicalMedicine, 51: 101573.
19. Osaki Y, Otsuki H, Imamoto A, et al (2021). Suicide rates during social crises: Changes in the suicide rate in Japan after the Great East Japan earthquake and during the COVID-19 pandemic. J Psychiatr Res, 140: 39-44.
20. Yan Y, Hou J, Li Q, Yu NX (2023). Suicide before and during the COVID-19 pandemic: a systematic review with meta-analysis. Int J Environ Res Public Health, 20(4): 3346.
21. Carlin GL, Baumgartner JS, Moftakhar T, et al.(2021). Impact of COVID-19 lockdown on suicide attempts: A retrospective analysis of the springtime admissions to the trauma resuscitation room at the Medical University of Vienna from 2015–2020. Wien Klin Wochenschr, 133: 915-22.
22. Kang J-H, Lee S-W, Ji J-G, et al (2021). Changes in the pattern of suicide attempters visiting the emergency room after COVID-19 pandemic: an observational cross sectional study. BMC Psychiatry, 21(1): 571.
23. Yard E, Radhakrishnan L, Ballesteros MF, et al (2021). Emergency department visits for suspected suicide attempts among persons aged 12–25 years before and during the COVID-19 pandemic—United States, January 2019–May 2021. MMWR Morb Mortal Wkly Rep, 70(24): 888–94.
24. Reif-Leonhard C, Lemke D, Holz F, et al (2022). Changes in the pattern of suicides and suicide attempt admissions in relation to the COVID-19 pandemic. Eur Arch Psychiatry Clin Neurosci, 273(2): 357-65.
25. Kim SY, Kim H-R, Park B, et al (2021). Comparison of stress and suicide-related behaviors among Korean youths before and during the COVID-19 pandemic. JAMA Netw Open, 4(12): e2136137.
26. Olié E, Nogue E, Picot M, et al (2021). Hospitalizations for suicide attempt during the first COVID‐19 lockdown in France. Acta Psychiatr Scand, 143(6): 535–6.
27. Danielsen S, Joensen A, Andersen PK, et al (2022). Self-injury, suicidal ideation and-attempt and eating disorders in young people following the initial and second COVID-19 lockdown. medRxiv, 2-22, preprint.
28. Pouradeli S, Rezaeian M, Rahmanian V (2022). Epidemiology of occupational injuries in Kerman province during 2012-2016. J Inj Violence Res, 14(1): 65-73.
29. Farvahari A, Amirzadeh Googhari S, Borhaninejad V, et al.(2022). Assessing the Mental Health Status of the General Population of Kerman and the Factors Affecting it During the Covid-19 Pandemic. Journal of Health Research in Community, 8(1): 69-80.
30. Pouradeli S, Ahmadinia H, Vazirinezhad R, et al (2023). An analysis of suicide rates in Kerman province, the largest province in Iran, before and after COVID-19:(2017-2020). Asian J Psychiatr, 85: 103614.
31. WHO. Preventing suicide: a resource for media professionals: update 2017 Switzerland: World Health Organization. Regional Office for Europe; 2021
32. Borhani F, Shafiepour Motlagh M, et al (2021). Changes in short-lived climate pollutants during the COVID-19 pandemic in Tehran, Iran. Environ Monit Assess, 193(6): 133.
33. Wikipedia. Solar Hijri calendar 2022 [updated 20 October 2022. Available from: https://en.wikipedia.org/wiki/Solar_Hijri_calendar
34. Leske S, Kõlves K, Crompton D, et al (2021). Real-time suicide mortality data from police reports in Queensland, Australia, during the COVID-19 pandemic: an interrupted time-series analysis. Lancet Psychiatry, 8(1): 58-63.
35. Turner SL, Karahalios A, Forbes AB, et al (2021). Comparison of six statistical methods for interrupted time series studies: empirical evaluation of 190 published series. BMC Med Res Methodol, 21(1): 134.
36. Khan AR, Shimul SAK, Arendse N (2021). Suicidal behaviour and the coronavirus (COVID‐19) pandemic: Insights from Durkheim's sociology of suicide. Int Soc Sci J, 71(Suppl 1):7-21.
37. Paykel E, Myers J, Lindenthal J, et al (1974). Suicidal feelings in the general population: a prevalence study. Br J Psychiatry, 124(0): 460-9.
38. Ryan EP, Oquendo MA (2020). Suicide risk assessment and prevention: challenges and opportunities. Focus (Am Psychiatr Publ), 18(2):88-99.
39. Reifels L, Krysinska K, Andriessen K (2024). Suicide prevention during disasters and public health emergencies: a systematic review. Front Public Health, 12: 1338099.
40. Mazza JJ, Catalano RF, Abbott RD, et al (2011). An examination of the validity of retrospective measures of suicide attempts in youth. J Adolesc Health, 49(5): 532-7.
41. Efstathiou V, Stefanou M-I, Siafakas N, et al (2022). Suicidality and COVID‑19: Suicidal ideation, suicidal behaviors and completed suicides amidst the COVID‑19 pandemic. Exp Ther Med, 23(1): 107.
42. Cénat JM, Blais-Rochette C, Kokou-Kpolou CK, et al (2021). Prevalence of symptoms of depression, anxiety, insomnia, posttraumatic stress disorder, and psychological distress among populations affected by the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry Res, 295: 113599.
43. Behera A, Singla N, Sharma N, et al.(2022). Paradigm shift in pattern and prevalence of poisoning during COVID-19 pandemic. J Family Med Prim Care, 11(1): 208-14.
44. McGillivray L, Rheinberger D, Wang J, et al (2022). Non-disclosing youth: a cross sectional study to understand why young people do not disclose suicidal thoughts to their mental health professional. BMC Psychiatry, 22(1): 3.
45. Blomqvist S, Virtanen M, LaMontagne AD, et al (2022). Perceived job insecurity and risk of suicide and suicide attempts: a study of men and women in the Swedish working population. Scand J Work Environ Health, 48(4): 293-301.
46. Mathieu S, Treloar A, Hawgood J, et al (2022). The role of unemployment, financial hardship, and economic recession on suicidal behaviors and interventions to mitigate their impact: a review. Front Public Health, 10: 907052
47. Khan A, Ratele K, Arendse N (2020). Men, suicide, and Covid-19: Critical masculinity analyses and interventions. Postdigit Sci Educ, 2(3): 651-6.
48. Roberts A, Rogers J, Mason R, et al (2021). Alcohol and other substance use during the COVID-19 pandemic: A systematic review. Drug Alcohol Depend, 229(Pt A):109150.
49. Walther A, Grub J, Tsar S, et al (2023). Status loss due to COVID-19, traditional masculinity, and their association with recent suicide attempts and suicidal ideation. Psychol Men Masc, 24(1): 47-62.
50. Allan NP, Volarov M, Koscinski B, et al (2021). Lonely, anxious, and uncertain: Critical risk factors for suicidal desire during the COVID-19 pandemic. Psychiatry Res, 304: 114144.
51. Mamun MA, Griffiths MD (2020). First COVID-19 suicide case in Bangladesh due to fear of COVID-19 and xenophobia: Possible suicide prevention strategies. Asian J Psychiatr, 51: 102073.
52. Rothman S, Sher L (2021). Suicide prevention in the covid-19 era. Prev Med, 152(Pt 1):106547.
53. Kim M-J, Paek S-H, Kwon J-H, et al (2022). Changes in suicide rate and characteristics according to age of suicide attempters before and after COVID-19. Children (Basel), 9(2): 151.
54. Koppen A, Thoonen IM, Hunault CC, et al (2023). Significant increase in deliberate self-poisonings among adolescents during the second year of the COVID-19 pandemic. J Adolesc Health, 73(2): 319-24.
55. Suokas J, Suominen K, Isometsä E, et al (2001). Long‐term risk factors for suicide mortality after attempted suicide‐Findings of a 14‐year follow‐up study. Acta Psychiatr Scand, 104(2): 117-21.
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| Issue | Vol 54 No 1 (2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Suicide attempt COVID-19 Pandemics Interrupted time series analysis Iran | ||
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How to Cite
1.
Pouradeli S, Ahmadinia H, Bahramnejad A, Rezaeian M. The Impact of the COVID-19 Pandemic on Suicide Attempts in Kerman Province: An Interrupted Time Series Analysis. Iran J Public Health. 2025;54(1):195-204.
