Prevalence of Suicide and Self-harm During the Coronavirus 2019 Pandemic: A Systematic Review Study

Document Type : Review Article


1 Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran

2 Department of Clinical Psychology, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

3 Department of Clinical Psychology, Islamic Azad University of Ardabil Branch, Ardabil, Iran

4 Department of Clinical Psychology, Islamic Azad University of Najaf Abad Branch, Isfahan, Iran

5 Department of General Psychology, Allameh Tabatabaei University Campus, Tehran, Iran


Introduction: During the COVID-19 epidemic, many people around the world committed suicide and self-harm due to psychological disorders. For this purpose, studies on the prevalence of self-harm and suicide attempt during COVID-19 have been reviewed in the present study.
Method: In this review study the following specialized keywords were searched between 2020 (May) and 2022 (January) in English databases such as Google Scholar, ISI, Scopus, Science Direct, and PubMed:  suicide, suicidal thoughts, suicide attempts, self-harm, self-injury, self-harm deliberate, COVID-19.
Results: The results showed that the prevalence of suicide (2%-71.9%) and self-harm (2%-47.6%) during COVID-19 has increased significantly compared to the past. Economic problems, young age, being a woman, unemployment, family problems, loneliness, and psychological distress were among the factors that aggravated self-harm and suicide attempt during COVID-19. In contrast, social support, resilience, psychological resilience, and spiritual health reduced suicidal thoughts and behaviors.
Conclusion: According to the obtained results, lack of access to a psychologist was one of the important reasons for thoughts and behaviors related to self-harm and suicide during COVID-19 epidemic. For this reason, it is necessary for psychological centers, hospitals, and related organizations to take measures in order to increase tele-mental health services.


  1. Xu B, Gutierrez B, Mekaru S, Sewalk K, Goodwin L, Loskill A, et al. Epidemiological data from the COVID-19 outbreak, real-time case information. Scientific data. 2020;7(1):1-6. DOI:10.6084/m9.figshare.11974344
  2. Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al. Psychological impact and coping strategies of frontline medical staff in Hunan between January and March 2020 during the outbreak of coronavirus disease 2019 (COVID-19) in Hubei, China. Medical science monitor: international medical journal of experimental and clinical research. 2020;26:e924171-1. DOI: 10.12659/MSM.924171
  3. Bagheri Sheykhangafshe F, Fathi-Ashtiani A. The Role of Marital Satisfaction and Sexual Satisfaction during the Coronavirus 2019 Pandemic on the Mental Health of Families. Journal of Family Research. 2021;17(1):45-62. DOI: 10.52547/JFR.17.1.45
  4. Zanardo V, Manghina V, Giliberti L, Vettore M, Severino L, Straface G. Psychological impact of COVID‐19 quarantine measures in northeastern Italy on mothers in the immediate postpartum period. International Journal of Gynecology & Obstetrics. 2020;150(2):184-8. DOI: 10.1002/ijgo.13249
  5. Tasnim R IM, Sujan MS, Sikder MT, Potenza MN. Suicidal ideation among Bangladeshi university students early during the COVID-19 pandemic: Prevalence estimates and correlates. Children and youth services review. 2020(119):105703. DOI: 10.1016/j.childyouth.2020.105703
  6. Bagheri Sheykhangafshe F, Hajialiani V, Hasani J. The role of resilience and emotion regulation in psychological distress of hospital staff during the COVID-19 pandemic: a systematic review study. Journal of research and health. 2021;11(6):365-74. DOI: 10.32598/JRH.11.6.1922.1
  7. Iob E, Steptoe A, Fancourt D. Abuse, self-harm and suicidal ideation in the UK during the COVID-19 pandemic. The British Journal of Psychiatry. 2020;217(4):543-6. DOI: 10.1192/bjp.2020.130
  8. John A, Lee SC, Solomon S, Crepaz-Keay D, McDaid S, Morton A, et al. Loneliness, coping, suicidal thoughts and self-harm during the COVID-19 pandemic: a repeat cross-sectional UK population survey. BMJ open. 2021;11(12):e048123. DOI: 10.1136/bmjopen-2020-048123
  9. Halford EA, Lake AM, Gould MS. Google searches for suicide and suicide risk factors in the early stages of the COVID-19 pandemic. PloS one. 2020;15(7):e0236777. DOI: 10.1371/journal.pone.0236777
  10. Xu Y, Su S, Jiang Z, Guo S, Lu Q, Liu L, et al. Prevalence and risk factors of mental health symptoms and suicidal behavior among university students in Wuhan, China during the COVID-19 pandemic. Frontiers in psychiatry. 2021;12. DOI: 10.3389/fpsyt.2021.695017
  11. Radeloff D, Papsdorf R, Uhlig K, Vasilache A, Putnam K, Von Klitzing K. Trends in suicide rates during the COVID-19 pandemic restrictions in a major German city. Epidemiology and psychiatric sciences. 2021;30. DOI: 10.1017/s2045796021000019
  12. Elbogen EB, Lanier M, Blakey SM, Wagner HR, Tsai J. Suicidal ideation and thoughts of self‐harm during the COVID‐19 pandemic: The role of COVID‐19‐related stress, social isolation, and financial strain. Depression and anxiety. 2021;38(7):739-48. DOI: 10.1002/da.23162
  13. Paul E, Fancourt D. Factors influencing self-harm thoughts and behaviours over the first year of the COVID-19 pandemic in the UK: longitudinal analysis of 49 324 adults. The British Journal of Psychiatry. 2022;220(1):31-7. DOI: 10.1192/bjp.2021.130
  14. Czeisler MÉ, Lane RI, Petrosky E, Wiley JF, Christensen A, Njai R, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic—United States, June 24–30, 2020. Morbidity and Mortality Weekly Report. 2020;69(32):1049. DOI: 10.15585/mmwr.mm6932a1
  15. Pramukti I, Strong C, Sitthimongkol Y, Setiawan A, Pandin MGR, Yen C-F, et al. Anxiety and suicidal thoughts during the COVID-19 pandemic: cross-country comparative study among Indonesian, Taiwanese, and Thai University students. Journal of medical Internet research. 2020;22(12):e24487. DOI: 10.2196/24487
  16. Sapara A, Shalaby R, Osiogo F, Hrabok M, Gusnowski A, Vuong W, et al. COVID-19 pandemic: demographic and clinical correlates of passive death wish and thoughts of self-harm among Canadians. Journal of Mental Health. 2021;30(2):170-8. DOI: 10.1080/09638237.2021.1875417
  17. Hawton K, Casey D, Bale E, Brand F, Ness J, Waters K, et al. Self-harm during the early period of the COVID-19 pandemic in England: comparative trend analysis of hospital presentations. Journal of affective disorders. 2021;282:991-5. DOI: 10.1016/j.jad.2021.01.015
  18. Shields C, Bernard J, Mirza OI, Reeves D, Wells A, Heagerty A. Covid-19, Lockdown and self-isolation: evaluation of deliberate self-harm admissions. Frontiers in psychiatry. 2021:706. DOI: 10.3389/fpsyt.2021.662885
  19. Wang X, Hegde S, Son C, Keller B, Smith A, Sasangohar F. Investigating mental health of US college students during the COVID-19 pandemic: cross-sectional survey study. Journal of medical Internet research. 2020;22(9):e22817. DOI: 10.2196/22817
  20. Fortgang RG, Wang SB, Millner AJ, Reid-Russell A, Beukenhorst AL, Kleiman EM, et al. Increase in suicidal thinking during COVID-19. Clinical Psychological Science. 2021;9(3):482-8. DOI: 10.1177/2167702621993857
  21. Berardelli I, Sarubbi S, Rogante E, Cifrodelli M, Erbuto D, Innamorati M, et al. The impact of the COVID-19 pandemic on suicide ideation and suicide attempts in a sample of psychiatric inpatients. Psychiatry research. 2021;303:114072. DOI: 10.1016/j.psychres.2021.114072
  22. Höller I, Forkmann T. Ambivalent heroism?–Psychological burden and suicidal ideation among nurses during the Covid‐19 pandemic. Nursing open. 2022;9(1):785-800. DOI: 10.1002/nop2.1130
  23. Rahman QM, Khan AH, Al Zubayer A, Ahmed M, Hasan MT, Rahaman A, et al. Factors associated with suicidal behavior among university students in Bangladesh after one year of COVID-19 pandemic. Heliyon. 2022;8(1):e08782. DOI: 10.1016/j.heliyon.2022.e08782
  24. Turner BJ, Robillard CL, Ames ME, Craig SG. Prevalence and correlates of suicidal ideation and deliberate self-harm in Canadian adolescents during the coronavirus disease 2019 pandemic. The Canadian Journal of Psychiatry. 2022;67(5):403-6. DOI: 10.1177/07067437211036612
  25. John SM, John A, Hazra D, Murugan S, Abhilash KPP. Prevalence, spectrum, and outcome of deliberate self-harm presenting to emergency department during CoViD-19 pandemic of 2020. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2021;25(12):1387. DOI: 10.5005/jp-journals-10071-24050
  26. Xu X, Wang W, Chen J, Ai M, Shi L, Wang L, et al. Suicidal and self-harm ideation among Chinese hospital staff during the COVID-19 pandemic: Prevalence and correlates. Psychiatry research. 2021;296:113654. DOI: 10.1016/j.psychres.2020.113654
  27. Maatouk I, Assi M, Jaspal R. Predicting sexual risk and sexual health screening in a sample of university students in Lebanon: a cross-sectional study. Journal of American College Health. 2021:1-7. DOI: 10.1080/07448481.2021.1899188
  28. Steeg S, Bojanić L, Tilston G, Williams R, Jenkins DA, Carr MJ, et al. Temporal trends in primary care-recorded self-harm during and beyond the first year of the COVID-19 pandemic: Time series analysis of electronic healthcare records for 2.8 million patients in the Greater Manchester Care Record. EClinicalMedicine. 2021;41:101175. DOI: 10.1016/j.eclinm.2021.101175
  29. Bagheri Sheykhangafshe F, Fathi Ashtiani A. The Role of Religion and Spirituality in the Life of the Elderly in the Period of Coronavirus Disease 2019 (COVID-19) Pandemic: A Systematic Review. Studies in Islam and Psychology. 2021;15(28):273-92. DOI: 10.30471/PSY.2021.7527.1834
  30. McIntyre A, Tong K, McMahon E, Doherty A. COVID-19 and its effect on emergency presentations to a tertiary hospital with self-harm in Ireland. Irish journal of psychological medicine. 2021;38(2):116-22. DOI: 10.1017/ipm.2020.116
  31. Walsh B. Clinical assessment of self‐injury: A practical guide. Journal of clinical psychology. 2007;63(11):1057-68. DOI: 10.1002/jclp.20413
  32. Tanaka T, Okamoto S. Increase in suicide following an initial decline during the COVID-19 pandemic in Japan. Nature human behaviour. 2021;5(2):229-38. DOI: 10.1038/s41562-020-01042-z
  33. Wiebenga JX, Dickhoff J, Mérelle SY, Eikelenboom M, Heering HD, Gilissen R, et al. Prevalence, course, and determinants of suicide ideation and attempts in patients with a depressive and/or anxiety disorder: A review of NESDA findings. Journal of affective disorders. 2021;283:267-77. DOI: 10.1016/j.jad.2021.01.053
  34. Shrestha R, Siwakoti S, Singh S, Shrestha AP. Impact of the COVID-19 pandemic on suicide and self-harm among patients presenting to the emergency department of a teaching hospital in Nepal. PLoS one. 2021;16(4):e0250706. DOI: 10.1371/journal.pone.0250706
  35. Henry N, Parthiban S, Farroha A. The effect of COVID-19 lockdown on the incidence of deliberate self-harm injuries presenting to the emergency room. The International Journal of Psychiatry in Medicine. 2021;56(4):266-77. DOI: 10.1177/0091217420982100
  36. Rethlefsen ML, Kirtley S, Waffenschmidt S, Ayala AP, Moher D, Page MJ, et al. PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews. Systematic reviews. 2021;10(1):1-19. DOI: 10.1186/s13643-020-01542-z
  37. Gifford W, Davies B, Edwards N, Griffin P, Lybanon V. Managerial leadership for nurses' use of research evidence: an integrative review of the literature. Worldviews on Evidence‐Based Nursing. 2007;4(3):126-45. DOI: 10.1111/j.1741-6787.2007.00095.x
  38. Rahman ME, Al Zubayer A, Bhuiyan MRAM, Jobe MC, Khan MKA. Suicidal behaviors and suicide risk among Bangladeshi people during the COVID-19 pandemic: an online cross-sectional survey. Heliyon. 2021;7(2):e05937. DOI: 10.1016/j.heliyon.2021.e05937
  39. McIntyre RS, Lui LM, Rosenblat JD, Ho R, Gill H, Mansur RB, et al. Suicide reduction in Canada during the COVID-19 pandemic: lessons informing national prevention strategies for suicide reduction. Journal of the Royal Society of Medicine. 2021;114(10):473-9. DOI: 10.1177/01410768211043186
  40. Crasta D, Daks JS, Rogge RD. Modeling suicide risk among parents during the COVID-19 pandemic: Psychological inflexibility exacerbates the impact of COVID-19 stressors on interpersonal risk factors for suicide. Journal of contextual behavioral science. 2020;18:117-27. DOI: 10.1016/j.jcbs.2020.09.003