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Impact of COVID-19 Pandemic Related Lockdown on Suicide: Analysis of Newspaper Reports During Pre-Lockdown and Lockdown Period in Bangladesh and India

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Impact of COVID-19 Pandemic Related Lockdown on Suicide: Analysis of Newspaper Reports During Pre-Lockdown and Lockdown Period in Bangladesh and India Asian Journal of Psychiatry 60 (2021) 102649 Contents lists available at ScienceDirect Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp Impact of COVID-19 pandemic related lockdown on Suicide: Analysis of newspaper reports during pre-lockdown and lockdown period in Bangladesh and India Sujita Kumar Kar a,*, Vikas Menon b, S.M. Yasir Arafat c, Sagar Rai d, Charanya Kaliamoorthy b, Hasina Akter e, Shreya Shukla a, Nivedita Sharma d, Deblina Roy a, Vivekanandan Kavanoor Sridhar b a Department of Psychiatry, King George’s Medical University, Lucknow, 226003, Uttar Pradesh, India b Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India c Department of Psychiatry, Enam Medical College and Hospital, Dhaka, 1340, Bangladesh d King George’s Medical University, Lucknow, 226003, Uttar Pradesh, India e Department of Graduate Nursing, Bangabandhu Sheikh Mujib Medical University, Dhaka, 1000, Bangladesh ARTICLE INFO ABSTRACT Keywords: The economic and social devastation wrought by the COVID-19 crisiscoupled with the unavailability of tradi­ Suicide tional coping resources is a “perfect storm” for suicide. Evidence suggests that its impact may be dispropor­ COVID-19 tionately high in low-and-middle-income countries. The study aimed to assess and compare nature and correlates Pandemic of suicidesfrom news reportsduring the immediate pre-lockdown and lockdown phase of COVID-19 in Newspaper report Bangladesh and India. We performed analysis of suicide reports from purposively selected online vernacular and Bangladesh India English newspapers of Bangladesh and two states/union territory in India, between January to June 2020. We divided the time period of observation into two phases: pre-lockdown and lockdown phase. Country wise findings between the two phases were compared in terms of demographic and characteristics of the reported suicide. A total of 769 news reports wereanalysed; 141 from Bangladesh and 628 from India. When compared to the pre-lockdown period, the odds of suicide by hanging was significantlyhigher during lockdownin India (adjusted Odds Ratios [aOR] = 3.8, p = 0.018) and Bangladesh (aOR = 3.1, p = 0.048). Suicide demographics in India were different from Bangladesh during lockdown; more males died by suicide in India (aOR = 2.7, p = 0.023) and more people died by hanging (aOR = 2.6, p = 0.029). The pandemic restrictions impacted suicide de­ mographics in the studied regions of India and Bangladesh. Further research using population-based time-series data are warranted to investigate the issue. 1. Introduction psychiatric morbidity, and racial and ethnic factors (Iob et al., 2020). Further, changes like social isolation, lockdown resulting in scarcity of Vulnerability to suicidal behaviour in the wake of the COVID-19 resources, stigma, discrimination, and stress related to COVID-19 have crisis has been shown to vary across nations and settings. A study on also been implicated (Thakur and Jain, 2020). Suicide rates are known Google search trends datain the early part of the COVID-19 pandemic to increase during pandemics which are periods of social and economic noted an increase in several suicide risk factors that could potentially crisis (Cheung et al., 2008; Wasserman, 1992). Additionally, there is exacerbate long term suicide risk (Halford et al., 2020). Some of the mass unemployment, exhaustion of resources, financial crisis, health­ population level risk factors identified for suicideduring thepandemic care challenges, academic loss, and so on; all of which may negatively include female gender, COVID-19 positive status, hailing from a low impact population mental health. socio-economic status, unemployment, disability, history of medical or Experts have opined that the impact may be worse in low resource * Corresponding author. E-mail address: [email protected] (S.K. Kar). https://doi.org/10.1016/j.ajp.2021.102649 Received 8 November 2020; Received in revised form 18 February 2021; Accepted 5 April 2021 Available online 15 April 2021 1876-2018/© 2021 Elsevier B.V. All rights reserved. S.K. Kar et al. Asian Journal of Psychiatry 60 (2021) 102649 settings where the social and economic challenges owing to the 2.2. Data extraction pandemic are compounded by the lack of social safety and welfare nets (Gunnell et al., 2020). The impact is also worse in certain population Following reviewing the content of the included news reports, data sub-groups such as those with mental illnesses; such individuals are were extracted in a structured format under the following headings: unable to access treatment adequately (Muruganandam et al., 2020; country, region, date of publication of news report, name of the news­ Sher, 2020) and this may worsen suicide risk. This effect may also be paper, the language of the news report, particulars of the deceased (age, pronounced in low- and middle-income countries like India and gender, marital status, education, occupation), risk factors, life events, Bangladesh, two densely populated nations with inadequate, inequi­ mode of suicide, suicide note, presence of mental illness/substance use, table health care systems and a high treatment gap for mental health type of suicide (complete, incomplete, extended), suicide-pact, and ho­ disorders (Gautham et al., 2020; Hossain et al., 2014; Momotaz et al., micidal act associated with suicide. Quality checking of data was done 2019; Murthy, 2017). Further, these countries are located in South-East by two investigators (firstand second author) and duplicate entries were Asia, a suicide dense region that contributes to nearly 40 % of global removed.During data cleaning, duplicate suicide reports were removed suicides (Vijayakumar, 2017). by matching date & place of suicide, names (if available), age and These considerations add context to the present study whereinour gender. A total of 137 duplicate reports were removed. All the in­ primary objective was to systematically compare patterns and trends in vestigators (medical graduates, post-graduate trainees in psychiatry) suicidal behavior between pre-COVID lockdown and lockdown periodin involved in data collection underwent an initial online training session India and Bangladesh separately, by performing a content analysis of explaining the questionnaire responses and data coding. This session online published news reports of suicide.Additionally, we also aimed to was led by a psychiatrist (first author) with prior experience in con­ perform a cross-country comparison of nature and correlates suicide in ducting similar studies (Menon et al., 2020). Data collection was done the pre-lockdown and lockdown periods. No such research has been using google forms. To check the understanding of the investigators, carried out in these nations so far to the best of our knowledge; never­ they were allowed to cross-check certain random entries of other in­ theless, it has the potential to inform suicide prevention programs in vestigators. Final cleaning of the data was done by the first author. these countries and may also have relevance for similarly resource constrained settings. 2.3. Statistical analysis 2. Material & methods Data were analysed using Stata version 14.0 (Statacorp., Texas, United States). Categorical variables were summarized as frequency and 2.1. Study setting & data collection percentages. Patterns of suicide as reported by media during the pre- lockdown and during lockdown were compared between countries as Relevant suicide reports were collected from online news portals of well as for each country separately. The association of various inde­ English and vernacular newspapers by a team of bilingual investigators pendent variables with patterns of suicide was assessed using Chi-square from India and Bangladesh. In India, data were collected from two test and unadjusted odds ratios with 95 % CI were calculated. Multi­ specified geographical regions: Uttar Pradesh and Puducherry, both of variable logistic regression analysis was performed by including the which have certain unique characteristics. Uttar Pradesh is the most variables that had a p-value of less than 0.2 in unadjusted analysis and populous state in India with a relatively low suicide rate whereas adjusted odds ratios(aOR) with 95 % CI were calculated. For risk factors, Puducherry is a small union territory of India with the dubious however, ORs were not calculated as one report could contribute several distinction of the country’s one of the high suicide rate (National Crime reasons for observed suicide. A p-value of less than 0.05 was considered Records Bureau, 2020) and an annual suicide rate of nearly three times statistically significant. the national average in 2018 (National Crime Records Bureau, 2020). The newspapers of Bangladesh cover the whole country. There are lots of 2.4. Ethical approval socio-cultural similarities between Bangladesh and India. Similarly, there are no major differences in terms of economics between the two As we have only used information available in the public domain, no countries. Both countries are placed under lower-middle income coun­ formal ethical approval was sought. tries group in World bank report (World Bank, 2020). Because national lockdown was implemented in both Bangladesh 3. Results and India on the same time (25th March 2020 for India and 26th March 2020 for Bangladesh), we divided the time period of news publication 3.1. Sample description into two phases: pre-lockdown period from January
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