SARS-CoV-2 Infection and the Risk of Suicidal and Self-Harm Thoughts and Behaviour: A Systematic Review

Abstract

Objective: The COVID-19 pandemic has had a complex impact on risksof suicide and non-fatal self-harm worldwide with some evidence ofincreased risk in specific populations including women, young people,and people from ethnic minority backgrounds. This review aims tosystematically address whether SARS-CoV-2 infection and/or COVID-19disease confer elevated risk directly.Method: As part of a larger Living Systematic Review examining selfharmand suicide during the pandemic, automated daily searches using abroad list of keywords were performed on a comprehensive set ofdatabases with data from relevant articles published between January 1,2020 and July 18, 2021. Eligibility criteria for our present reviewincluded studies investigating suicide and/or self-harm in people infectedwith SARS-CoV-2 with or without manifestations of COVID-19 diseasewith a comparator group who did not have infection or disease. Suicidaland self-harm thoughts and behaviour (STBs) were outcomes of interest.Studies were excluded if they reported data for people who only hadpotential infection/disease without a confirmed exposure,clinical/molecular diagnosis or self-report of a positive SARS-CoV-2 testresult. Studies of news reports, treatment studies, and ecological studiesexamining rates of both SARS-CoV-2 infections and suicide/self-harmrates across a region were also excluded.Results: We identified 12 studies examining STBs in nine distinctsamples of people with SARS-CoV-2. These studies, which investigatedSTBs in the general population and in subpopulations, includinghealthcare workers, generally found positive associations between SARSCoV-2 infection and/or COVID-19 disease and subsequent suicidal/selfharmthoughts and suicidal/self-harm behaviour.Conclusions: This review identified some evidence that infection withSARS-CoV-2 and/or COVID-19 disease may be associated with increasedrisks for suicidal and self-harm thoughts and behaviors but a causal linkcannot be inferred. Further research with longer follow-up periods isrequired to confirm these findings and to establish whether theseassociations are causal