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What happens when a global pandemic coincides with a national suicide crisis?

Secondary outcomes of the COVID-19 coronavirus such as economic stress and decreased access to mental health treatment risk colliding with a rising suicide rate to further accelerate the epidemic, wrote Mark A. Reger, PhD, of the University of Washington in Seattle, and colleagues, in a viewpoint published in

Measures taken to reduce the spread of the virus, like "social distancing," can exacerbate preexisting mental and physical health problems, they cautioned. Suicidal thoughts have been .

"Concerns about negative secondary outcomes of COVID-19 prevention efforts should not be taken to imply that these public health actions should not be taken," they wrote. "However, implementation should include a comprehensive approach that considers multiple U.S. public health priorities, including suicide prevention."

Suicide rates increased 35% between 1999 and 2018, These rates were compared to other professions before the outbreak began.

It appears likely that the COVID-19 pandemic will lead to increased rates of mental health problems, and "we must recognize the pandemic that will quickly follow it -- that of mental and behavioral illness," wrote Sandro Galea, MD, of the Boston University School of Public Health, and colleagues in a separate viewpoint published in

After experiencing trauma or other stressors on the frontline of the pandemic, healthcare providers will be particularly vulnerable to the mental health impact of the crisis, the authors noted.

In where the pandemic began, about half of healthcare workers reported experiencing increased depression and/or anxiety symptoms. In an earlier study published in 2007, and psychological distress following the severe acute respiratory syndrome (SARS) epidemic.

Mental health outcomes and the potential for psychological crisis should be considered in screening and prevention procedures related to COVID-19, Reger's group suggested.

Notably, patients who seek emergency treatment for suicidal thoughts or attempts may experience delayed treatment as a result of overwhelmed emergency rooms. They may also refrain from seeking treatment in the first place due to reports of smaller practices shutting down to preserve resources, Reger and co-authors noted.

Telehealth is a viable option for patients with mental health conditions and the Centers for Medicare & Medicaid Services (CMS) recently retroactively starting March 6.

Still, not all patients with mental health needs have access to phones or computers with video capabilities, and the use of "tele-mental health" for individuals with suicidal ideation has generally "lagged far behind," in part because providers are paralyzed by "fear of adverse events and lawsuits," the authors noted.

Yet some remote suicide prevention techniques do exist. and interventions involving have been shown to be particularly effective in reducing suicide rates, the authors reported.

Overall, the authors of the viewpoint advocated for individuals to stay connected as much as possible through telephone or video conferencing, emphasizing that "social distancing" refers to "physical distance between people, not social distance."

Interestingly, suicide rates have previously been shown to decline after certain national disasters, like the Sept. 11, 2001, terrorist attacks, perhaps from a "pulling-together effect," the authors noted.

"Individuals undergoing shared experience might support one another, thus strengthening social connectedness," they wrote. "Epidemics and pandemics may also alter one's views on health and mortality, making life more precious, death more fearsome, and suicide less likely."

If you or someone you know is considering suicide, call the National Suicide Prevention Hotline at 1-800-273-8255.

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