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The sudden economic fallout at the start of the COVID-19 pandemic affected millions of people and contributed to a three-fold rise in persistent or elevated depression in the United States. But the extent of this toll on mental health is still coming to light.
Now, a new study led by Boston University School of Public Health (BUSPH) researchers reveals that suicidal thoughts increased substantially, as well, during the pandemic.
Published in the journal PLOS One, the study found that suicidal ideation was nearly five times higher at the start of the pandemic and disproportionately affected people living in low-income households. People who had difficulty paying rent or who felt lonely—two problems that intensified during COVID due to social distancing to reduce spread of COVID-19 and the unprecedented shock to the economy—also reported a substantial rise in suicidal thoughts.
The study provides valuable insight into the short- and long-term mental health effects of the pandemic. As people continue to experience multiple COVID-related stressors, the researchers emphasize the need for policies and programs that provide financial and social support, particularly to vulnerable populations.
“Everyone felt the toll of mental distress from the challenges of the pandemic and unemployment crisis, and people who are low-income and housing insecure were most impacted,” says study lead and corresponding author Dr. Julia Raifman, assistant professor of health law, policy & management at BUSPH. “Policies and programs that help people stay in their homes and avoid economic hardship may make a big difference for improving mental health. It is also key to ensure that there are mental health services and supports for low-income children and adults.”
For the study, Raifman and colleagues examined nationally representative survey data on demographics, suicidality, and a variety of pandemic-related stressors, including COVID-19 illness and bereavement, income, job loss, financial distress, loneliness, and more. The data included responses from more than 1,400 participants in the COVID-19 Life Stressors Impact on Mental Health and Well-Being (CLIMB) survey from March 31, 2020 to April 13, 2020, and more than 5,000 participants in the 2017-2018 National Health and Nutrition Examination Survey (NHANES).
The prevalence of suicidal thoughts increased from 3.4 percent in 2017-2018 pre-pandemic, to 16.3 percent after the start of the pandemic. The spike was greatest among participants who earned less than $20,000 each year, Hispanic participants, and participants ages 18 to 29. Suicidal ideation also burdened 31 percent of people who had trouble paying their rent, and 25 percent of people who struggled with loneliness.
“It was striking that around a quarter of low-income persons, Hispanic persons, and people ages 18-29 years reported suicidal ideation in 2020,” says study coauthor Dr. Catherine Ettman, postdoctoral fellow in the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health. “These findings add evidence to the growing body of work showing the mental health disparities experienced during the pandemic across asset and demographic groups. The early pandemic particularly affected the mental health of young people, persons with low assets, and groups that have been traditionally marginalized by society.”
Job loss was not associated with suicidal ideation in the CLIMB survey, but further research could provide insight into the potential effects of prolonged COVID-related unemployment, and whether suicidality risks differ by wealth. In previous work, the researchers found links between assets and mental health, suggesting that people with higher income and savings are less likely to experience depression, a risk factor for suicidality.
“We are now starting to see the long term consequences of the COVID-19 pandemic,” says study coauthor Dr. Salma Abdalla, research fellow at BUSPH. “The effects of the pandemic will be felt for a long time, particularly for young persons who will navigate the health and mental health consequences of this moment across the lifecourse.”
Policies that target populations experiencing financial distress and social isolation could serve as a valuable tool for suicide prevention, as well as policies that strengthen firearm restrictions—the primary means of suicide deaths—the researchers say.
“I hope we may see more research on how policies and programs that jointly maximize health and economic well-being,” Dr. Raifman says. “After the period when we conducted this study, Congress implemented stimulus checks, the expanded child tax credit, and unemployment insurance expansion that led to record reductions in poverty—benefiting health and reducing economic hardship for millions of Americans. This shows us the best of what is possible with policies, and I hope we will see more enduring federal and state investments in similar policies.”
The study's senior author was Dr. Sandro Galea, BUSPH dean and Robert A. Knox Professor. The study was also coauthored by Dr. Lorraine Dean, associate professor in the Departments of Epidemiology and Health Policy and Law at Bloomberg SPH and at Johns Hopkins University School of Medicine; Alexandra Skinner, a doctoral student at Brown University School of Public Health; and Colleen Barry, inaugural dean of the Cornell Jeb E. Brooks School of Public Policy.
About Boston University School of Public Health
Founded in 1976, Boston University School of Public Health is one of the top five ranked private schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.
Method of Research
Subject of Research
Economic precarity, loneliness, and suicidal ideation during the COVID-19 pandemic
Article Publication Date
SG reports serving as a consultant for Sharecare and Tivity Health.