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Death by suicide is estimated to occur every 11 minutes in the U.S, yet a new form of might be emerging; seeking to catch on purpose, in order to secure death through this potentially suicidal act.

This is the startling conclusion of a new study, yet to be published, entitled ‘Preliminary Investigation of the Association Between COVID-19 and Suicidal Thoughts and Behaviors in the U.S.’ This survey found that a portion of individuals in the U.S. may be intentionally exposing themselves to the virus, with intent to kill themselves.

The authors of the study, Brooke Ammerman, Ross Jacobucci, and Kenneth McClure from the University of Notre Dame, and Taylor Burke of Brown University, point out in their paper that before the pandemic, it was recognised that suicidal people may attempt to contract diseases, for example HIV, as a method of dying.

The authors claim that theirs is the first study to examine the link between COVID-19 and suicidal thoughts and behaviors, as well as to explore intentional COVID-19 exposure. Their study found that 83 U.S. adults (9.2% of their sample) reported intentionally exposing themselves to COVID-19. Given how contagious the virus is, the authors contend this has enormous public health implications.

The reasons these people gave for seeking to intentionally expose themselves to the virus included 'wanted a break from life'; ‘Wanted to punish self’; ‘Wanted to hurt yourself (without wanting to die)’; ‘Didn’t want to be alive anymore’; and ‘Wanted to kill yourself.' Of note, approximately 50% who intentionally exposed themselves indicated their reason for doing so was ‘strongly-to-extremely’ due to wanting to kill themselves.

As the epidemic continues to spread, those suffering severe psychological distress will gain increased access to a potentially lethal means of suicide. The authors of this study conclude there is an urgent need to investigate to what extent intentional self-exposure to COVID-19, possibly because of suicidal intent, might be spreading across the U.S.

This study found that upwards of 45% of community members endorsing past-month suicidal thinking reported that their thoughts were explicitly linked to COVID-19 at least half of the time, and approximately 65% reported this to be the case at least some of the time.

The results suggest that the virus is having a direct negative effect on the mental health of the population and may be directly contributing to suicidal thinking.

But could the cure, in the form of ‘lockdown’ and all its restrictions, still be worse than the disease? Separate to the direct effect of the infection, what about the repercussions of the pandemic in terms of the economic and social consequences? Could the lockdown be making people suicidal more than the virus itself?

Following the last great recession of 2008, there was a dramatic increase in suicides in North America and Europe, to the extent that an extra 10,000 people in those regions killed themselves, between 2008 and 2010.

These shocking results came from a study published in the British Journal of which demonstrated that, using statistical and comparison techniques, it was possible to confirm that the economic downturn had contributed to a raised suicide rate. The study entitled ‘Economic suicides in the Great Recession in Europe and North America', also figured out what number of the additional suicides were linked to the recession.

But the current pandemic is predicted to produce a global economic meltdown of much greater breadth and depth than the recession of 2008. So how many more people might kill themselves as a direct result?

Professor Carl Weems, Bethany McCurdy and Mikaela Scozzafava, from Iowa State University and Professor Victor Carrion from Stanford University have conducted a study which suggests that fifty thousand extra suicides worldwide is currently the best estimate of the result of the current pandemic.

The authors of this latest study point out that the forecast could be much higher pending levels of unemployment and its duration and the duration of isolation, even potentially reaching 100,000 extra suicides worldwide. However, the authors are also keen to emphasise that their numbers are just a forecast, but should be used with a view to acting now to vigorously prevent the statistics ever reaching that scale.

Their current forecast is for the raised suicide rate to endure for up to two years from now.

Their study, entitled, ‘Increased Risk of Suicide Due to Economic and Social Impacts of Social Distancing Measures to Address the Covid-19 Pandemic: A Forecast’, developed a statistical forecast using previous estimates of the impact of unemployment and on suicide rates, from past published research.

They then factored into their model the current predicted unemployment and social isolation data for the present pandemic.

The researchers included in their modelling the known impacts of quarantine conditions, including post- stress symptoms, confusion, , infection fears, frustration, boredom, inadequate supplies and information, financial loss, and stigma contributing to psychological stress. Feelings of may be also be common, associated with not performing normal work or duties.

Previous research has established that loneliness was reported in 38·5% and social isolation in 60·6% of those quarantined during the 2003 severe acute respiratory syndrome (SARS) outbreak in Canada.

These researchers cite other studies that find that those who have felt very lonely and isolated from other people, just in the past two weeks, were then three times more likely to then feel very suicidal. Other research has found that merely living alone doubles the risk of suicide for women, it also raises it in men, but not to the extent that it does for women.

This unprecedented lockdown has also removed in a much more profound manner than any previous epidemic, possible compensatory supporting relationships from friends, family, neighborhood, church, school, and work.

As a result, the researchers predict more than 35,000 additional suicides worldwide just due to loneliness/isolation produced by the pandemic.

But on top of these difficulties is layered the strain of unemployment. According to International Labour Organization estimates, the pandemic could result in 24·7 million jobs lost worldwide, maybe even more.

According to the US National Longitudinal Mortality Study, unemployed men were twice as likely to commit suicide as those employed, with unemployed women 3.8 times more likely to kill themselves as their employed counterparts.

The researchers just focused on social isolation, mental health consequences, and unemployment, as these are well known to be major predictors for suicide, but given there are also other implicated factors they did not include, this means their estimates err on the conservative side.

Their conclusion is that the USA may experience over 3,800 additional suicides and that the world may see more than 5,100 additional due to unemployment. Also, the USA may endure over 5,600 additional suicides and that the world more than 35,000 additional suicides due to loneliness/isolation.

So, in total, roughly 50,000 extra suicides worldwide is currently the best estimate resulting from the current pandemic, according to these authors, but they also caution that modelling is an imperfect science, and that is their best estimate for the final figure given current parameters.

As these parameters change, say the unemployment rates turn out to be higher, or lockdown goes on for longer than anticipated, then the eventual numbers could be much worse.

For example, a variable which may not have been fully accounted for in latest modeling, because of its unprecedented nature, is that sales of firearms (one of the most common and also most deadly of suicide methods) have been reaching record levels in the U.S., since the pandemic started.

Brooke Ammerman, Ross Jacobucci, Kenneth McClure, and Taylor Burke argue that it is therefore urgent for public mental health campaigns reflect the increased suicide risk, now the community has more access to guns.

All causes of death are devastating in terms of impact, but it could be argued that suicide holds a special place in terms of human cost, because it is often otherwise physically healthy people, with many more years of active life ahead of themselves, who kill themselves. Dying through a mental impulse, when no physical disorder will have taken you instead, could be conceived as a much more unnecessary death.

Victims of suicide may have therefore had many more quality years of life left to be lived. Yet people who die from physical conditions, such as a viral illness which preferentially strikes the elderly, or those with prior conditions, are those, it could be argued, generally with fewer quality years of life left.

This may seem like a somewhat cold-blooded calculation, but it is, in a sense, the kind of balancing act our leaders, and we as a society, are making right now. The suicidal, given the stigma surrounding mental illness and , tend not to stand up for themselves, and fight their corner as robustly as others affected by governments' new restrictions.

They tend not to be on the streets demonstrating for the need to end the lockdown. Instead, suicidal leads to retreat, avoidance, and inhibition.

In which case publicising horrifying research results like these becomes one way to help fight their corner for them.

Dr. Peter Bruggen passed away in 2018. While this article was written by Dr. Raj Persaud, Dr. Bruggen's name is retained biographically as a tribute to his contributions overall.