{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T04:56:42Z","timestamp":1776574602095,"version":"3.51.2"},"reference-count":120,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2021,4,27]],"date-time":"2021-04-27T00:00:00Z","timestamp":1619481600000},"content-version":"unspecified","delay-in-days":116,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiol Psychiatr Sci"],"published-print":{"date-parts":[[2021]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S2045796021000214_sec_a1\"><jats:title>Aims<\/jats:title><jats:p>Suicide accounts for 2.2% of all years of life lost worldwide. We aimed to establish whether infectious epidemics are associated with any changes in the incidence of suicide or the period prevalence of self-harm, or thoughts of suicide or self-harm, with a secondary objective of establishing the frequency of these outcomes.<\/jats:p><\/jats:sec><jats:sec id=\"S2045796021000214_sec_a2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO and AMED were searched from inception to 9 September 2020. Studies of infectious epidemics reporting outcomes of (a) death by suicide, (b) self-harm or (c) thoughts of suicide or self-harm were identified. A random-effects model meta-analysis for the period prevalence of thoughts of suicide or self-harm was conducted.<\/jats:p><\/jats:sec><jats:sec id=\"S2045796021000214_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>In total, 1354 studies were screened with 57 meeting eligibility criteria, of which 7 described death by suicide, 9 by self-harm, and 45 thoughts of suicide or self-harm. The observation period ranged from 1910 to 2020 and included epidemics of Spanish Flu, severe acute respiratory syndrome, human monkeypox, Ebola virus disease and coronavirus disease 2019 (COVID-19). Regarding death by suicide, data with a clear longitudinal comparison group were available for only two epidemics: SARS in Hong Kong, finding an increase in suicides among the elderly, and COVID-19 in Japan, finding no change in suicides among children and adolescents. In terms of self-harm, five studies examined emergency department attendances in epidemic and non-epidemic periods, of which four found no difference and one showed a reduction during the epidemic. In studies of thoughts of suicide or self-harm, one large survey showed a substantial increase in period prevalence compared to non-epidemic periods, but smaller studies showed no difference. As a secondary objective, a meta-analysis of thoughts of suicide and self-harm found that the pooled prevalence was 8.0% overall (95% confidence interval (CI) 5.2\u201312.0%; 14\u00a0820 of 99\u00a0238 cases in 24 studies) over a time period of between seven days and six months. The quality assessment found 42 studies were of low quality, nine of moderate quality and six of high quality.<\/jats:p><\/jats:sec><jats:sec id=\"S2045796021000214_sec_a4\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>There is little robust evidence on the association of infectious epidemics with suicide, self-harm and thoughts of suicide or self-harm. There was an increase in suicides among the elderly in Hong Kong during SARS and no change in suicides among young people in Japan during COVID-19, but it is unclear how far these findings may be generalised. The development of up-to-date self-harm and suicide statistics to monitor the effect of the current pandemic is an urgent priority.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s2045796021000214","type":"journal-article","created":{"date-parts":[[2021,4,27]],"date-time":"2021-04-27T07:07:45Z","timestamp":1619507265000},"source":"Crossref","is-referenced-by-count":47,"title":["Suicide, self-harm and thoughts of suicide or self-harm in infectious disease epidemics: a systematic review and meta-analysis"],"prefix":"10.1017","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4671-5410","authenticated-orcid":false,"given":"J. 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