Economic precarity, social isolation, and suicidal ideation during the COVID-19 pandemic

  1. Julia Raifman
  2. Catherine K. Ettman
  3. Lorraine Dean
  4. Colleen Barry
  5. Sandro Galea

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Abstract

Importance

The US population faces stressors associated with suicide brought on by the COVID-19 pandemic. Understanding the relationship between stressors and suicidal ideation may inform policies and programs to prevent suicide.

Objective

To evaluate the relationship between stressors and suicidal ideation during the COVID-19 pandemic.

Design

We compared suicidal ideation in 2017-2018 to suicidal ideation in 2020. We estimated the association between stressors and suicidal ideation in bivariable and multivariable Poisson regression models with robust variance.

Setting

United States

Participants

Participants were from two, nationally representative surveys of US adults: The 2017-2017 National Health and Nutrition Examination Survey and the 2020 COVID-19 and Life Stressors Impact on Mental Health and Well-being study (conducted March 31 to April 13), analyzed April 28 to September 30, 2020.

Exposures

Economic precarity as measured through job loss or difficulty paying rent and social isolation based on reporting “feeling alone.”

Main outcome measure

Suicidal ideation based on reporting “Thoughts that you would be better off dead or of hurting yourself in some way” over the past two weeks.

Results

Suicidal ideation increased more than fourfold, from 3.4% in the 2017-2018 NHANES to 16.3% in the 2020 CLIMB survey, and from 5.8% to 26.4% among participants in low-income households. Suicidal ideation was more prevalent among people facing difficulty paying rent (31.5%), job loss (24.1%), and loneliness (25.1%), with each stressor associated with suicidal ideation in bivariable models. In the multivariable model, difficulty paying rent was associated with suicidal ideation (aPR: 1.5, 95% CI: 1.2 to 2.1), while losing a job was not (aPR: 0.9, 95% CI: 0.6 to 1.2). Feeling alone was associated with suicidal ideation (aPR: 1.9, 95% CI: 1.5 to 2.4).

Conclusions and relevance

Suicidal ideation increased more than fourfold during the COVID-19 pandemic. Difficulty paying rent and loneliness were most associated with suicidal ideation. Policies and programs to support people experiencing economic precarity and loneliness may contribute to suicide prevention.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.10.05.20205955: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We excluded participants who did not respond to questions about suicidal ideation in NHANES and participants who did not respond to any variables included in analyses in CLIMB data.
    NHANES
    suggested: (NHANES, RRID:SCR_013201)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations include that suicidal ideation was based on self-report and that the characteristics of participants in CLIMB and NHANES differed. Those who responded to surveys may have differed from those who did not, particularly if stressors affected survey participation. The CLIMB study was conducted early in the pandemic period, and the relationship between stressors and suicidal ideation may have changed as the pandemic and associated stressors continue to affect the US population.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.10.05.20205955 on medRxiv