Original Research Focus on Suicide April 17, 2023

Pandemics and Suicide Rates in Spain: From the Spanish Flu to COVID-19

Sergio Sanz-Gómez, MSc; Adrián Alacreu-Crespo, Prof; Ana Fructuoso, PhD; María Isabel Perea-González, MSc; Julio Antonio Guija, MD; Lucas Giner, Prof, MD

J Clin Psychiatry 2023;84(3):22m14601

ABSTRACT

Objective: The aim of this study was to examine suicide rates in Spain during the COVID-19 pandemic and the influenza pandemic of 1918–1920.

Methods: Data on deaths by cause for the periods 1910–1925 and 2016–2020 were obtained from the National Statistics Institute of Spain.

Results: During the Spanish influenza pandemic, a peak of deaths in 1918 due to influenza, acute bronchitis, pneumonia, and other respiratory diseases coincided with an increase in suicides (from 5.9 in 1917 to 6.6 per 100,000 population in 1918). The pattern was repeated in the COVID-19 pandemic during 2020, with an increase in suicides from 7.8 in 2019 to 8.3 per 100,000 population in 2020. In both cases, the male:female suicide ratio was reduced in similar proportion, with a higher net increase in the number of suicides among males but a higher percentage increase among females.

Conclusions: Albeit limited, there is evidence that the pandemics may have affected suicide rates. However, the effect was most likely due to precipitation of different diathesis-stressor factors in each setting, given the different historical contexts.

Continue Reading...

Did you know members enjoy unlimited free PDF downloads as part of their subscription? Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.

Subscribe Now

Already a member? Login

Purchase PDF for $40

Members enjoy free PDF downloads on all articles. Join today

  1. Sher L. The impact of the COVID-19 pandemic on suicide rates. QJM. 2020;113(10):707–712. PubMed CrossRef
  2. Gunnell D, Appleby L, Arensman E, et al; COVID-19 Suicide Prevention Research Collaboration. Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatry. 2020;7(6):468–471. PubMed CrossRef
  3. Cénat JM, Blais-Rochette C, Kokou-Kpolou CK, et al. Prevalence of symptoms of depression, anxiety, insomnia, posttraumatic stress disorder, and psychological distress among populations affected by the COVID-19 pandemic: a systematic review and meta-analysis. Psychiatry Res. 2021;295:113599. PubMed CrossRef
  4. Zortea TC, Brenna CTA, Joyce M, et al. The impact of infectious disease-related public health emergencies on suicide, suicidal behavior, and suicidal thoughts. Crisis. 2021;42(6):474–487. PubMed CrossRef
  5. Leaune E, Samuel M, Oh H, et al. Suicidal behaviors and ideation during emerging viral disease outbreaks before the COVID-19 pandemic: a systematic rapid review. Prev Med. 2020;141:106264. PubMed CrossRef
  6. Wasserman D, Iosue M, Wuestefeld A, et al. Adaptation of evidence-based suicide prevention strategies during and after the COVID-19 pandemic. World Psychiatry. 2020;19(3):294–306. PubMed CrossRef
  7. Lopez-Morinigo J-D, Blasco-Fontecilla H, Courtet P, et al. Investigating the relationship between cross-national suicide rates and COVID-19 first and second waves spread across the world: an exploratory study [published online ahead of print February 28, 2022]. Rev Psiquiatr Salud Ment. 2022. PubMed CrossRef
  8. Instituto Nacional de Estadística (INE). Estadística de Defunciones según la causa de muerte. Metodología. Notas prensa INE. 2015:1–9. https://ine.es/daco/daco42/sanitarias/metodologia_00.pdf
  9. De Motes JM. El crecimiento moderno de la población de España de 1850 a 2001: una serie homogénea anual. Investig Hist Económica. 2008;4(10):129–162. CrossRef
  10. Martini M, Gazzaniga V, Bragazzi NL, et al. The Spanish Influenza Pandemic: a lesson from history 100 years after 1918. J Prev Med Hyg. 2019;60(1):E64–E67. PubMed. 10.15167/2421-4248/jpmh2019.60.1.1205
  11. Bastiampillai T, Allison S, Smith D, et al. The Spanish Flu pandemic and stable New Zealand suicide rates: historical lessons for COVID-19. N Z Med J. 2021;134(1541):134–137. PubMed
  12. Bastiampillai T, Allison S, Looi JCL. Spanish Flu (1918–1920) Impact on US suicide rates by race: potential future effects of the COVID-19 pandemic. Prim Care Companion CNS Disord. 2021;23(6):21com03088. PubMed CrossRef
  13. Prados de la Escosura L. Spanish Economic Growth, 1850–2015. 2017.
  14. Stuckler D, Meissner C, Fishback P, et al. Banking crises and mortality during the Great Depression: evidence from US urban populations, 1929–937. J Epidemiol Community Health. 2012;66(5):410–419. PubMed CrossRef
  15. Alvarez-Galvez J, Salinas-Perez JA, Rodero-Cosano ML, et al. Methodological barriers to studying the association between the economic crisis and suicide in Spain. BMC Public Health. 2017;17(1):694. PubMed CrossRef
  16. Marazziti D, Avella MT, Mucci N, et al. Impact of economic crisis on mental health: a 10-year challenge. CNS Spectr. 2021;26(1):7–13. PubMed CrossRef
  17. Ornell F, Benzano D, Borelli WV, et al. Differential impact on suicide mortality during the COVID-19 pandemic in Brazil. Br J Psychiatry. 2022;44(6):628–634. PubMed CrossRef
  18. Almudéver Campo L, Camaño Puig RE. Medidas de salud pública durante la pandemia de gripe en el periodo 1918–1920 en España. Rev Esp Salud Publica. 2020;94(2):1–17. www.mscbs.es/respCorrespondencia
  19. Courtet P, Olié E, Debien C, et al. Keep socially (but not physically) connected and carry on: preventing suicide in the age of COVID-19. J Clin Psychiatry. 2020;81(3):20com13370. PubMed CrossRef
  20. Pompili M. Can we expect a rise in suicide rates after the Covid-19 pandemic outbreak? Eur Neuropsychopharmacol. 2021;52:1–2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254017/pdf/main.pdf PubMed CrossRef
  21. Elbogen EB, Lanier M, Blakey SM, et al. Suicidal ideation and thoughts of self-harm during the COVID-19 pandemic: the role of COVID-19-related stress, social isolation, and financial strain. Depress Anxiety. 2021;38(7):739–748. PubMed CrossRef
  22. Stack S, Rockett IRH. Social distancing predicts suicide rates: analysis of the 1918 flu pandemic in 43 large cities, research note. Suicide Life Threat Behav. 2021;51(5):833–835. PubMed CrossRef
  23. Nakanishi M, Yamasaki S, Endo K, et al. Suicide rates during the COVID-19 pandemic in Japan from April 2020 to December 2021. Psychiatry Res. 2022;316(August):114774. PubMed CrossRef
  24. Pirkis J, John A, Shin S, et al. Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries. Lancet Psychiatry. 2021;8(7):579–588. PubMed CrossRef
  25. Pirkis J, Gunnell D, Shin S, et al. Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: an interrupted time series analysis in 33 countries. EClinicalMedicine. 2022;51:101573. PubMed CrossRef
  26. Knipe D, John A, Padmanathan P, et al. Suicide and self-harm in low- and middle- income countries during the COVID-19 pandemic: a systematic review. PLOS Glob Public Heal. 2022;2(6):e0000282. CrossRef
  27. Kahil K, Cheaito MA, El Hayek R, et al. Suicide during COVID-19 and other major international respiratory outbreaks: a systematic review. Asian J Psychiatr. 2021;56:102509. PubMed CrossRef