Predicting the pandemic’s psychological toll: why suicide modelling is so difficult


Jayashri Kulkarni, Monash University

We’ve recently heard experts raise concerns about a looming mental health crisis, warning COVID-19’s psychological toll on Australians could be like a second wave of the pandemic.

Suicide modelling from the University of Sydney’s Brain and Mind Centre has predicted a potential 25-50% increase in the number of people taking their lives in Australia over the next five years. The researchers expect this projected increase to disproportionately affect younger people.

Any suicide is a tragedy and prevention must be a priority.

But the grim predictions from suicide modelling warrant analysis and exploration. They have significant implications for public health policy and funding decisions, as well as community concern.

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The challenges of modelling in health

Models in health have to begin with questions about the basic assumptions underpinning them. They need to be built on reliable data, be clear on how they’ve dealt with uncertainty, and describe whether they are generalisable or not.

The best models for diseases are mechanistic models, not purely statistical ones. Mechanistic models are based on understanding how a system’s components interact with each other.

For example, the preferred mechanistic model for COVID-19 includes measures of actual viral infections and underlying transmission processes, plus testing how the pandemic may change under various conditions.

The complexities of mental illness mean suicide doesn’t fit neatly into a mathematical model.

Trying to emulate this in suicide modelling has many problems, starting with the basic assumptions. Mental illness and suicide are multifaceted, complex and fluctuating entities.

There is a spectrum from fleeting thoughts of suicide, through to planning or attempting suicide, to the final tragedy of completing suicide. These subtle but important phases are crucial to identify, intervene in and factor into a model.

But to date, existing suicide prediction tools have not been able to account for these factors, and have largely failed to generate accurate predictions.

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The recent modelling takes into account social factors such as homelessness, unemployment, domestic violence and substance use as causal factors for suicide. Importantly, psychological distress, a critical causal factor, can change rapidly and is very difficult to measure.

The lack of clear, objective tests for mental illness together with the many rapidly changing social and personal factors makes it very difficult to develop a reliable mechanistic model for suicide.

Add COVID-19, and it becomes even harder

Mental health during the coronavirus pandemic is impacted by many unique and variable factors which are difficult to model with reliability.

Suddenly Australians have had to be isolated from extended family and friends, contend with disrupted work and home routines, and manage the fear of becoming ill with a virus that has claimed more than 350,000 lives around the world to date.

These factors can create temporary psychological distress of varying severity, which changes with time and is difficult to measure.

All of this is quite different to mechanistic viral disease models, which include actual, stable measures of infection with nonlinear spread. This means one infected person can spread the virus to others who subsequently spread it – an exponential rise.

While viral disease models are not perfect either, we can’t track suicide in the same way.

Some people are at higher risk

International surveys show women of all ages are experiencing significantly higher rates of anxiety and depression than men during the pandemic.

Older citizens, (with a female majority due to their greater longevity), understandably have increased fears about their health and safety if infected, as well as their financial security. So they’re at greater risk of mental ill health too.

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People with pre-existing mental health conditions or physical illness are also likely to be struggling more with COVID-19-related mental health problems.

These disparities create further complexities that are difficult to model.

Some people will be at higher risk of mental ill health during COVID-19.

We need to act

For many of us, the fear and anxiety we felt during the early stages of COVID-19 will have improved as it’s become apparent Australia has been able to avoid the enormous toll seen elsewhere.

Nonetheless, past experience of financial crises and increased unemployment, such as during the great depression, show us the suicide rate does increase at such times.

Stressors such as rising household debt, increased social isolation and loneliness are key risk factors for suicide.

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COVID lockdowns have human costs as well as benefits. It’s time to consider both

While we may not be able to predict accurately how significantly deaths from suicide will rise, we do need to take action to prevent or minimise any increase in suicides in the months and years following the pandemic.

Close monitoring of the nation’s mental health through repeated targeted and well-constructed surveys will be vital to inform how we go about this.

We need all sectors of our nation to unite to face this challenge. Governments must invest wisely and in a timely manner to enhance mental health care for the whole community, paying particular attention to groups at higher risk.

Tackling this while avoiding a national panic about suicide is imperative. Raising well-meaning concerns is of course important, but placing the country on “suicide watch” is alarmist and could potentially cause more anxiety.The Conversation

Jayashri Kulkarni, Professor of Psychiatry, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

COVID lockdowns have human costs as well as benefits. It’s time to consider both

Gigi Foster, UNSW and Martha Hickey, University of Melbourne

Australia has been lucky. We’ve had time to consider our response to COVID-19, based on what was happening in other countries, before it hit us.

We implemented restrictions that are likely to have saved many from dying of COVID-19. Fewer than 100 have died so far, a fraction of the number initially projected.

At this pivotal moment, we need to think carefully about how best to protect ourselves going forward.

We need to consider whether the costs of continued restrictions to prevent transmission of COVID-19 – costs that can be quantified in terms of human lives harmed and human lives lost – are worth the benefits.

It is unpopular to question the value of protecting Australians against COVID-19 when the world is in the middle of the pandemic.

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Yet continuing the restrictions we have put in place will increase deaths from other causes, and decrease the quality of many lives.

Moving forward, we will need to make decisions that maximise the health and well-being of all Australians, including the most vulnerable. We will need to consider not only the deaths and suffering the restrictions prevent (the benefits), but also the deaths and suffering they bring about (the costs).

Benefit: lives saved

By Tuesday April 28, COVID-19 had killed 84 Australian residents, only a fraction of the 134,000 initially expected.

This striking outcome reflects both government restrictions and rapid responses by individuals, with the actual contribution of each uncertain.

Australia’s geography, environment, culture and demographic makeup are different from other countries which have had many more deaths, and this too might have contributed.

But the restrictions will have saved many lives that otherwise would have been taken by COVID-19.

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In Sweden, which had no forced lockdown and only voluntary social distancing, around 2500 deaths have been attributed to COVID-19.

Adjusted for Australia’s higher population, that per-capita death rate would have produced about 6,000 COVID-19 Australian deaths by now, instead of 84.

The restrictions might have also saved lives by reducing things such as traffic and workplace accidents. Around 100 Australians die each month in road accidents and 14 in accidents at work.

Cost: lives lost to domestic violence

Concerns are emerging internationally about increased deaths due to COVID-19 restrictions. Despite reporting lags and uncertainty about the specific causes, the signs are worrying.

Australia’s record in domestic violence was shameful before the pandemic.

On average, one woman every week is killed by her current or ex-partner in Australia. One in every four Australian women has experienced emotional abuse from a current or former partner.

In the UK, deaths from domestic violence have more than doubled during COVID-19 restrictions. Calls to helplines for women have surged seven-fold.

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In Australia, Google searches related to domestic violence almost doubled, with increasing calls from potential perpetrators of domestic violence.

Government restrictions have left many potential victims vulnerable inside their homes. Whilst the Australian government has pledged A$150 million to support those experiencing domestic violence during COVID-19, like Jobkeeper, the extra services may not be enough to fully fix the problems exacerbated by the shutdown.

Domestic violence not only leads to deaths, but also to increased suffering of victims, which can be quantified in units such as wellbeing-adjusted life years (known as WELLBYs).

These human costs are highly likely to be paid by young women and by mothers, creating inter-generational trauma, particularly within vulnerable populations.

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By contrast, the median age of Australians who have died due to COVID-19 is 79.

Many had pre-existing heart and lung conditions and might not have benefited from costly and invasive interventions such as mechanical ventilation.

Cost: lives lost to suicide

Each year over 65,000 Australians attempt suicide. 3000 die by suicide. Suicide is the leading cause of death for Australians between the ages 15 and 44.

A recent study described coronavirus interventions as the “perfect storm” for increased suicide risk.

Although the COVID-19 crisis is still evolving, deaths by suicide climbed in the United States during the 1918–19 influenza pandemic, and among older people in Hong Kong during the 2003 SARS epidemic.

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Another study concludes that suicide rates in Europe and the United States climb by about 1% for every one percentage point increase in unemployment. During the 2008 financial crisis Europe and the US recorded an extra 10,000 extra deaths by suicide. The authors expect twice as many extra deaths due to suicide over the next 24 months.

To the extent that this kind of increased human suffering is a result of COVID-19 restrictions, it should be counted in any assessment of whether to ease them.

Cost: lives lost to health care crowd-out

Arguably the biggest short-run health cost of our COVID-19 arrangements has flowed from the government’s preparation for a much greater burden on the health system than eventuated.

Private hospitals were brought under state control and non-urgent surgeries postponed. In the past week some have been restarted.

And there is growing evidence that people are avoiding seeking other forms of medical help because they are afraid of contracting COVID-19 or don’t want to burden health care providers.

In Britain, the number of people presenting at Accident and Emergency has fallen by one quarter. There is concern in the Britain and in Australia about excess deaths as a consequence.

In the UK there were 7,996 more registered deaths in the week ending April 10 than the five-year average for that period. COVID-19 accounted for 6213 of them, leaving an extra 1810 unexplained.

Are we prepared to do the maths?

There are undoubted health benefits from COVID-19 restrictions, including deaths averted and quality-adjusted life years saved. But there are also costs, which can be measured using the same metrics.

They include the consequences of lost education quality for the coronavirus cohort, and the long-run impact of a prolonged economic downturn.

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Making decisions based on lives saved and lost is challenging, but not new.

Our government makes such decisions every day when it considers such things as how much to spend on cancer research or whether to fund a new drug through the pharmaceutical benefits scheme.

These decisions are typically made using quality-adjusted life years or numbers of deaths averted, allowing governments to directly compare lives with lives, and deaths with deaths.

Now that the first wave of the pandemic has peaked, it is time for governments to consider carefully their next moves.

Sharing the full equation they are using – including the real costs as well as the real benefits of interventions – would enable the public to evaluate whether those decisions are being made with Australia’s best interests in mind.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.The Conversation

Gigi Foster, Professor, School of Economics, UNSW and Martha Hickey, Professor of Obstetrics and Gynaecology, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Are you worried someone you care about is thinking of suicide? Here’s how you can support them from afar


Milena Heinsch, University of Newcastle; Dara Sampson, University of Newcastle, and Frances Kay-Lambkin, University of Newcastle

We’ve now been social distancing for several weeks. While these measures have allowed us to slow the spread of COVID-19, they’ve also upended our day-to-day lives.

If you’ve found yourself experiencing feelings of fear, anxiety, depression, boredom, anger, frustration or irritability, you’re not alone.

Older adults, health-care workers, people with pre-existing mental health conditions and people experiencing financial pressure could be particularly vulnerable to psychological distress at this time.

When feelings of psychological distress increase, suicidal thoughts and behaviours may also increase.

So how do we know when to be worried about someone we love, and how can we support them from afar?

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Recognising the signs

During COVID-19, we may all be feeling more stressed than usual. That’s why we need to stay connected with each other online, on the phone and via text messages.

But it’s important we’re attuned to whether this extra stress and uncertainty is developing into something more for any of the people we care about.

Some warning signs for suicide might be easier to recognise when you can see a person’s facial expressions and gestures. But there are cues you can pick up on during text, phone or online communication.

Social withdrawal can indicate a person is at greater risk. Perhaps a friend or relative is increasingly difficult to contact via phone or text, disappears from social media or starts saying they just want to be alone.

A persistent drop in mood might be revealed on the phone by a flat tone of voice, talking less than usual or more slowly, and by shorter text messages or none at all.

You may be able to tell if a friend is becoming socially withdrawn by the tone of their messages.

Some people might say things like “you’d be better off without me” or “there’s nothing to live for”, which suggest they can’t see a way out of their situation and may be thinking about suicide.

If you’re worried someone you know might be suicidal, reaching out and having a conversation could save their life.

Talking on the phone or online

Choose a time and place where you can talk openly and without getting interrupted. This might be challenging when whole families are at home together for extended periods. But these can be sensitive and confronting conversations and it’s important to protect the person, as well as people in your family or household.

You could start the conversation by asking your friend or loved one how they are. You might also let them know you’ve noticed a change in them: “you don’t seem yourself”.

Starting the conversation may look different if you’re online. Perhaps someone has posted a comment or image on social media that seems unusual for them, or which makes it seem like they’re thinking about suicide. If so, contact them directly by sending a private message. It’s OK to talk online, just not in a public forum.

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Once you’ve started the conversation, ask directly about suicidal thoughts and intentions (for example, “are you thinking about suicide?”).

And be prepared they may answer “yes”. Then you just have to listen with supportive statements. Say things like “that sounds really tough” rather than “don’t be silly”.

Some people considering suicide might actually find it easier to talk online.
Jonas Leupe/Unsplash

Being at a distance can be an advantage

You might feel worried about having a difficult conversation on the phone or online, but this style of communication actually has some benefits.

People may feel more comfortable revealing suicidal thoughts, without fear of stigma, when communication isn’t face-to-face. And sometimes people find it easier to communicate via emoji, GIFs or images rather than having to find the words to express how they’re feeling.

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Further, listening on the phone or via messaging gives us time to think about how to best respond, and to let our initial reactions pass.

This is important because negative reactions, like criticising or dismissing someone’s feelings, may make the person less likely to seek help and increase their thoughts of suicide.

Encourage them to get help

If you’re worried about someone and you think they’re at risk of suicide, offering help is important. Our research with people who had previously attempted suicide found although participants wouldn’t necessarily seek help, many said they would accept it if it were offered.

While talking with the person you’re worried about is an important first step, you may be able to guide them towards professional help. For example, they may want help to make an appointment with a GP or counsellor, or to call a crisis line.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

Lauren Rogers, a research assistant at the University of Newcastle, contributed to this article.The Conversation

Milena Heinsch, Senior Research Fellow, Centre for Brain and Mental Health, University of Newcastle; Dara Sampson, Academic Research Manager, University of Newcastle, and Frances Kay-Lambkin, Professor, University of Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Nigeria: Latest Persecution News

The link below is to an article reporting on the latest persecution news from Nigeria, where over 40 people have been killed in a suicide attack.

For more visit:

India: Gang Rape Accused Commits Suicide

The link below is to an article concerning the apparent suicide of one of the gang rapists in India. It is difficult to feel sympathy I’m afraid.

For more visit:

Latest Persecution News – 15 June 2012

Suicide Bombing Hits Another Church in Jos, Nigeria

The following article reports on the latest news of persecution in Nigeria, where Boko Haram has continued its attacks against Christian churches.


The articles linked to above are by Compass Direct News and  relate to persecution of Christians around the world. Please keep in mind that the definition of ‘Christian’ used by Compass Direct News is inclusive of some that would not be included in a definition of Christian that I would use or would be used by other Reformed Christians. The articles do however present an indication of persecution being faced by Christians around the world.