Suicide risk up in lockdown

I get this frantic SMS on sunny Sunday in July and jumped into action: I phone the jumper’s number, no reply. Ten minutes later and still no peep I, out of desperation, SMS the SA Depression and Anxiety Group (Sadag) helpline numbers. Hours later still no response – and I still don’t know if she jumped…

Even though I professionally have to cope with suicides and threats of suicide on a daily basis, I’m just human… Thoughts raced through my mind: I hoped she was fine and managed to get help. And I hoped she’s not one of those that fell through the cracks.

If you can believe Health Minister Zweli Mkhize, the country had 1,781 suicide-related deaths during the first four months of lockdown, between 27 March and 27 July. This equates to one suicide at least every two hours, he told parliament last month. But where does this figure come from?

It is known quoted figures to be an underestimation of the true situation. SA suicide statistics remain variable. Last year, the SA Society of Psychiatrists (Sasop) reported the estimated SA suicide rate to be 13.4 people per 100,000 – four times the global rate of 3.6 per 100,000.

The World Health Organisation (WHO) last year quoted estimates that one person in the world dies by suicide every 40 seconds. This tragic statistic led the WHO to their campaign of “40 seconds of action” with an emphasis on suicide prevention. The Covid-19 pandemic hit the world with a vengeance this year.

Although the initial emphasis was on the physical management of the infection, the long-term mental health consequences has now been widely acknowledged.

A recent article in the Journal of the American Medical Association (Psychiatry) titled “Suicide Mortality and Coronavirus Disease 2019: A Perfect Storm?” outlines many of the economic, financial, job loss, social distancing and lockdown risk factors – and predicts far more suicides in the years to come.

Psychology Today published “Are We Facing a Post-Covid-19 Suicide Epidemic?’ The author says the world is “besieged by news stories about the loss of life, the dangers faced by the most vulnerable, healthcare professionals and other essential personnel and the natural exhaustion we all feel while wondering when it will end”.

It concludes that the damage caused to our mental health may be more far-reaching than anyone realises, especially in terms of suicide risk.

The Lancet Psychiatry (April 2020) echoes these sentiments: the mental health effects of the Covid-19 pandemic might be profound and there are suggestions that the suicide rates will rise. More pressing issue Suicide risks might also increase because of stigma towards individuals with Covid-19 and their families.

As the pandemic spreads and has longer-term effects on the population, the economy and vulnerable groups, suicide will become a more pressing concern. Suicide prevention needs urgent consideration. Here are some more frightening stats:

• From 24 to 30 June, the Centres for Disease Control and Prevention in the US conducted a web-based survey which included 5 412 adults over the age of 18. Overall, just under half (40.9%) of respondents reported having at least one adverse mental or behavioural health condition which was almost three times higher than general epidemiological surveys in previous years. A total of 10.7% of respondents seriously considered suicide and it was significantly higher among younger respondents (aged 18 to 24, 25.5%), Hispanic persons (18.6%), black persons (15.1%), unpaid caregivers for adults (3.7%), and essential workers (21.7%).
• Mental Health America (MHA) has been running voluntary online screening for mental health problems since 2014. In its most recent report, published last month, it reports that since the start of the Covid-19 pandemic, there has been a dramatic increase in depression, anxiety, psychosis and suicidality. “The problem is bigger than anyone imagined, making it clear how the pandemic is affecting people now and will continue to affect people who mourn loved ones and whose serious mental conditions are left untreated,” its CEO said.
• MHA says the most profound health problems were found among adults younger than 25. About 90% of the younger adults screened positive for moderate to severe depression, and 80% screened positive for moderate to severe anxiety.
• In June, 25 498 participants who screened positive for depression reported thinking of suicide or self-harm on “more than half of days to nearly every day”. A total of 14 607 participants said they had these thoughts every day, the survey claimed.
• And back home? Sadag runs the only and by far the largest helpline centres in SA. Sadag reports that its call volumes have more than doubled since the Covid-19 lockdown. From an average of 600 calls a day, the numbers have climbed to an average of more than 1,400 calls per day.

Here are some monthly figures to tell you of the dire mental state of South Africans: March – 19 507 calls, April – 40,347 calls, May – 44,948 calls, June – 47,322 calls. As the long-term consequences of Covid-19 impact South Africans, Sadag anticipate the call volumes to increase even further.

As I search for the latest South African Covid-19 statistics, my eye catches a headline: Man hangs himself after Covid test comes back positive. And I wonder again about the jumper… I tell myself that suicide is and should be preventable. This can only happen if gaps in South Africa’s public and private healthcare system are closed. And it needs to be addressed: I have seen the impact suicide has on loved one…

Today is World Suicide Prevention Day. Contact Sadag on Suicide Helpline 0800-567-567 or SMS 31393 or visit www.sadag.org

Dr Frans A Korb

Dr Frans A Korb is a psychiatrist

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