Open Access

Jane Pirkis, David Gunnell, Sangsoo Shin, Marcos Del Pozo-Banos, Vikas Arya, Pablo Analuisa Aguilar, Louis Appleby, S. M. Yasir Arafat, Ella Arensman, Jose Luis Ayuso-Mateos, Yatan Pal Singh Balhara, Jason Bantjes, Anna Baran, Chittaranjan Behera, Jose Bertolote, Guilherme Borges, Michael Bray, Petrana Brečić, Eric Caine, Raffaella Calati, Vladimir Carli, Giulio Castelpietra, Lai Fong Chan, Shu-Sen Chang, David Colchester, Maria Coss-Guzmán, David Crompton, Marko Ćurković, Rakhi Dandona, Eva De Jaegere, Diego De Leo, Eberhard A. Deisenhammer, Jeremy Dwyer, Annette Erlangsen, Jeremy S. Faust, Michele Fornaro, Sarah Fortune, Andrew Garrett, Guendalina Gentile, Rebekka Gerstner, Renske Gilissen, Madelyn Gould, Sudhir Kumar Gupta, Keith Hawton, Franziska Holz, Iurii Kamenshchikov, Navneet Kapur, Alexandr Kasal, Murad Khan, Olivia J. Kirtley, Duleeka Knipe, Kairi Kõlves, Sarah C. Kölzer, Hryhorii Krivda, Stuart Leske, Fabio Madeddu, Andrew Marshall, Anjum Memon, Ellenor Mittendorfer-Rutz, Paul Nestadt, Nikolay Neznanov, Thomas Niederkrotenthaler, Emma Nielsen, Merete Nordentoft, Herwig Oberlerchner, Rory C. O’Connor, Rainer Papsdorf, Timo Partonen, Michael R. Phillips, Steve Platt, Gwendolyn Portzky, Georg Psota, Ping Qin, Daniel Radeloff, Andreas Reif, Christine Reif-Leonhard, Mohsen Rezaeian, Nayda Román-Vázquez, Saska Roskar, Vsevolod Rozanov, Grant Sara, Karen Scavacini, Barbara Schneider, Natalia Semenova, Mark Sinyor, Stefano Tambuzzi, Ellen Townsend, Michiko Ueda, Danuta Wasserman, Roger T. Webb, Petr Winkler, Paul S. F. Yip, Gil Zalsman, Riccardo Zoja, Ann John, Matthew J. Spittal

• Background: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries’ COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries’ income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue.