Suicide and self-harm in low- and middle- income countries during the COVID-19 pandemic: A systematic review

  1. Duleeka Knipe
  2. Ann John
  3. Prianka Padmanathan
  4. Emily Eyles
  5. Dana Dekel
  6. Julian P. T. Higgins
  7. Jason Bantjes
  8. Rakhi Dandona
  9. Catherine Macleod-Hall
  10. Luke A. McGuinness
  11. Lena Schmidt
  12. Roger T. Webb
  13. David Gunnell

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Abstract

There is widespread concern over the potential impact of the COVID-19 pandemic on suicide and self-harm globally, particularly in low- and middle-income countries (LMIC) where the burden of these behaviours is greatest. We synthesised the evidence from the published literature on the impact of the pandemic on suicide and self-harm in LMIC. This review is nested within a living systematic review (PROSPERO ID CRD42020183326 ) that continuously identifies published evidence (all languages) through a comprehensive automated search of multiple databases (PubMed; Scopus; medRxiv, PsyArXiv; SocArXiv; bioRxiv; the WHO COVID-19 database; and the COVID-19 Open Research Dataset by Semantic Scholar (up to 11/2020), including data from Microsoft Academic, Elsevier, arXiv and PubMed Central.) All articles identified by the 4th August 2021 were screened. Papers reporting on data from a LMIC and presenting evidence on the impact of the pandemic on suicide or self-harm were included. Methodological quality was assessed using an appropriate tool, and a narrative synthesis presented. A total of 22 studies from LMIC were identified representing data from 12 countries. There was an absence of data from Africa, the Pacific, and the Caribbean. The reviewed studies mostly report on the early months of COVID-19 and were generally methodologically poor. Few studies directly assessed the impact of the pandemic. The most robust evidence, from time-series studies, indicate either a reduction or no change in suicide and self-harm behaviour. As LMIC continue to experience repeated waves of the virus and increased associated mortality, against a backdrop of vaccine inaccessibility and limited welfare support, continued efforts are needed to track the indirect impact of the pandemic on suicide and self-harm in these countries.

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  1. Version published to 10.1371/journal.pgph.0000282
  2. ScreenIT

    SciScore for 10.1101/2021.09.03.21263083: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    RandomizationOne hundred randomly sampled outputs were subsequently rescreened (blind) by DG – there was complete agreement for all excluded studies.
    BlindingOne hundred randomly sampled outputs were subsequently rescreened (blind) by DG – there was complete agreement for all excluded studies.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Information sources: We searched PubMed, Scopus, medRxiv, bioRxiv, the COVID-19 Open Research Dataset by Sematic Scholar, and the Allen Institute for AI, which includes relevant records from Microsoft Academic, Elsevier, arXiv and PubMed Central (up to 11/2020); and the WHO COVID-19 database.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    bioRxiv
    suggested: (bioRxiv, RRID:SCR_003933)
    Sematic Scholar
    suggested: None
    arXiv
    suggested: (arXiv, RRID:SCR_006500)
    For time-series studies we used the risk of bias criteria suggested by the Cochrane Effective Practice and Organisation of Care (14).
    Cochrane Effective
    suggested: None
    For studies that reported estimates for a pre-pandemic period as well as the COVID-19 period, we have calculated a rate ratio with associated confidence intervals, using the csi command in STATA.
    STATA
    suggested: (Stata, RRID:SCR_012763)

    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:
    Whilst we searched multiple databases, a limitation is that these tended to index primarily English language journals and therefore we may have missed important publications from regions in which English is not the first language. Furthermore, any literature review such as this is prone to publication bias if the studies that reach publication are not representative of those that have been conducted. In the absence of reliable epidemiological data on suicide and self-harm in LMIC, it is impossible to assess the impact of the COVID-19 pandemic on these behaviours and to plan evidence-based prevention approaches. The lack of infrastructure and data on these behaviours has been longstanding, but the pandemic has brought this underinvestment into sharp focus. International organisations (e.g. World Health Organisations) need to support and invest in data collection in these countries. Whilst there is a need for more research and evidence to help track suicide and self-harm and support prevention, governments and policy makers also need to be proactive in their prevention efforts acting on the existing evidence base (47). Government and health systems should focus on: i) provision of economic supports and active labour market schemes, which may require foreign assistance; ii) working with the media to report responsibly; iii) ensuring protection measures are in place for victims of domestic violence; and iv) improving accesses to services and support charities for individuals who ...

    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.

    Results from scite Reference Check: We found no unreliable references.

    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.

  3. Version published to 10.1101/2021.09.03.21263083v1 on medRxiv