Media must act responsibly when reporting on impact of pandemic on mental health
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Since the onset of the Covid-19 pandemic in early 2020, there has been concern and much debate about the impact of the pandemic on mental health and wellbeing of individuals.
We hear many discussions referring to the ‘real’ epidemic as the effects of Covid-19 and associated public health measures on self-harm and suicide. Media reports and headlines which suggest a ‘tsunami’ or ‘crisis’ in relation to suicide and self-harm can be damaging and may heighten anxiety among individuals experiencing mental health difficulties.
It is therefore crucial that accurate and responsible media reporting on these topics is adhered to.
When we look to previous pandemics for guidance on what to expect, studies on suicidal behaviour are limited and of low quality. However, the findings indicate a potential association between infectious disease-related public health emergencies and increased suicidal behaviour, particularly in the longer term.
In response to these concerns, a group of experts formed the International Covid-19 Suicide Prevention Research Collaboration (ICSPRC). A recent publication from this group, using data from 21 high- and upper middle-income countries, found no evidence of a significant increase in risk of suicide during the first wave of the pandemic, between March and August 2020.
Conversely, there was evidence of a decrease in suicide in 12 countries/areas including Australia, New Zealand, and Japan.
However, we must remain vigilant that this relatively reassuring pattern may change over time considering that real-time suicide data in Japan has demonstrated an increase in suicide during the second wave (July-October), particularly among women.
In Ireland, we see a similar picture in relation to available suicide data. While there is no system which records real-time surveillance data on suicide at a national level, complete data on suspected suicide cases has been made available by the Cork County Coroners as part of the Suicide and Self-Harm Observatory (SSHO).
Based on comparison of data between 2019 and 2020, no significant increase in suspected suicides has been detected in the Cork area.
We notice similar patterns when we examine hospital-presenting self-harm. Ireland is fortunate to have a national registry which monitors self-harm presentations to all hospitals. The National Self-Harm Registry Ireland is operated by the National Suicide Research Foundation with funding from the HSE's National Office for Suicide Prevention.
Thank you to colleagues at the Ottawa Hospital Research Institute for creating this helpful infographic related to our collaboration led by @zortea_tiago last year.
— National Suicide Research Foundation (@NSRFIreland) April 29, 2021
Full article here: https://t.co/zYap9LVJR3 pic.twitter.com/qmokFiFWOX
Provisional data for 2020 from 18 nationally representative hospitals found a 4% reduction in the rate of self-harm between January and October 2020 when compared with the same timeframe in previous years. The lowest number of presentations coincided with periods of high-level restrictions across the country.
These findings are similar to reports from England which show a significant decline in hospital presentations during the 12 weeks following the introduction of lockdown restrictions in March 2020. It’s possible that these findings arise from an avoidance of going to hospital under an assumption that services were not operating as normal or a fear of being exposed to Covid-19 in the hospital environment.
While important observations, we cannot infer there was a reduction in the overall incidence of self-harm so we also need to consider self-harm which may be occurring in the community.
While data on self-harm in community settings is limited, findings from the University College London (UCL) Covid-19 Social Study in the UK report that rates have remained fairly consistent since the lockdown.
However, a UK-wide survey led by researchers at University of Glasgow reported an increase in suicidal ideation, particularly among young adults, during the initial phase of the Covid-19 pandemic (March 31-May 11). Given the reported increase in suicidal ideation, these findings warrant further monitoring and investigation as further data become available.
While the data we have gathered to date is somewhat reassuring, these findings should be interpreted with caution. The Covid-19 pandemic is constantly evolving so it is possible that patterns may change over time.
We know that many of the risk factors associated with suicide and self-harm continue to be heightened by the pandemic, of which outcomes remain unclear. Risk factors include social isolation, loneliness, alcohol and drug misuse, domestic violence, sudden bereavement, job loss, and economic uncertainty.
The economic consequences are of particular concern given existing evidence for increases in suicidal behaviour during economic recessionary times. In 2015, Corcoran and colleagues found that five years of economic recession and austerity in Ireland between 2008 and 2012 had a significant negative impact on rates of suicide in men and on self-harm in both men and women.
While it is too soon to examine the effect of economic hardships on self-harm and suicide, this will become clearer in the longer-term. As put by leading expert Professor Louis Appleby “serious economic stresses as a consequence of Covid-19 may represent the greatest risk of a rise in the suicide rate”.
Steps will therefore need to be taken to ensure appropriate and sustained resources are in place for people facing job loss or financial hardship as a result of the pandemic.
In May of last year, mental health professionals in Ireland predicted an escalation in the mental health needs of individuals. International experts also highlighted the necessity for mental health service providers to prepare for an increased workload and the need to find new ways of working.
In terms of preparedness, it will be of fundamental importance to evaluate the effectiveness of modified mental health services especially for those with pre-existing mental health conditions who may experience negative long-term impacts of Covid-19.
Coinciding with the necessary modification of mental health services, the HSE launched a free 24/7 text-based service (50808) in June 2020 to provide immediate support for people experiencing a mental health or emotional crisis. Since its launch, the provider has reported a month-on-month increase in those using the service for reasons associated with self-harm.
While patient referrals to mental health services were reported to be lower than expected in a UK study during the first wave of Covid-19, data from the 50808 service may be indicative of individuals utilising alternative methods of support during pandemic times. An increase in the use of helplines and online services may not necessarily indicate an increase in suicide or self-harm, but in fact may represent an increase in help-seeking behaviours and potential mitigation of risk of suicide and self-harm.
As further data become available, it will be important to continue to monitor and evaluate the incidence of suicide and self-harm as the pandemic unfolds. Appropriate services should also be prioritised for known ‘at-risk’ groups and for those with known mental health difficulties. Considering the consistent findings indicating no significant increase in self-harm and suicide during the first wave of Covid-19, there is no basis for concerning and sensationalist media coverage.
While vigilance and ongoing monitoring of suicide and self-harm must be a key priority, we strongly encourage caution in the reporting of incorrect and speculative comments on these highly sensitive topics. Negative and unverified statements may impact negatively on people with severe mental health conditions.
We urge the media to be cautious and adhere to responsible reporting on suicide in relation to the Covid-19 pandemic.
- Dr Mary Joyce, Professor Ella Arensman and Dr Eve Griffin of the National Suicide Research Foundation, on behalf of the National Self-Harm Registry Ireland and Suicide and Self-Harm Observatory teams.