An infectious disease epidemic and resilience to suicide

To the Editor

An epidemic of coronavirus disease 2019 (COVID-19) began in China in December 2019 and has spread to South Korea, Australia, European countries, the United States and other regions of the world. Emerging infectious disease outbreaks, such as COVID-19, lead to fear, distress, insomnia and uncertainty. This may be related to multiple factors including our innate fear of something that is unknown and fear of contagion.

The COVID-19 epidemic is a stressful situation and, in fact, a test of resilience. Low-resilient individuals including some medical professionals may develop stress-related psychiatric disorders associated with suicidal ideation and behavior (Sher, 2019). For individuals who have pre-existing stress related or other psychiatric disorders, an unusual, highly stressful situation that lasts for months may be a trigger for suicide attempt (Sher, 2019). An infectious disease outbreak may increase suicides. For example, it has been reported that there was an increase in suicides among elderly people in Hong Kong during the 2003 severe acute respiratory syndrome (SARS) epidemic (Chan et al., 2006).

Epidemics show how important is to build individual and community resilience. Societies need highly resilient people, especially at the time of a crisis. High resilience is associated with good physical fitness. Physical exercise has positive effects on well-being, mood and self-esteem in both healthy and sick individuals and enhances resilience. This is especially important at the time of an epidemic of an infectious disease: physically strong individuals are both more psychologically resilient and have better immunity, that is, they are less likely to contract an infectious illness. Multiple lines of evidence indicate that high resilience is a protective factor against suicide risk (Sher, 2019). Possibly, resilience aspects are more significant predictor of the development of suicidal ideation and behavior than the degree of exposure to stressful life events such as the COVID-19 epidemic.

The English-language mass media publish a lot of anxiety-provoking articles which increase distress among the general public. Several guidelines on media reporting on suicide have been published (Gordon, 2019). Likewise, it is necessary to develop guidelines on media reporting on infectious outbreaks. Clinicians should advise individuals with psychiatric disorders to limit their media exposure.

Psychiatrists should help their patients, medical professionals and the general public to understand the potential psychological impact of the COVID-19 epidemic and help patients, medical professionals and communities to deal with this stressful situation and to improve resilience. Suicide prevention measures including identifying and supporting individuals at elevated suicide risk are especially important during stressful times.