Modeling Suicidality Risks and Understanding the Phenomenon of Suicidality Under the Loupe of Pandemic Context: National Findings of the COMET-G Study in the Russian Population

Abstract

BACKGROUND: Suicidality is a complex clinical phenomenon reflecting vulnerability to suicidal behavior which can be explained via the biopsychosocial paradigm and in relationship with a variety of country-specific factors. Data on suicides within the Russian population are inconsistent (from 11.7 up to 25.1 per 100.000), whereas the population’s suicidality risks have not been investigated in detail. Suicidality estimates during the multifactorial influence of the COVID-19 pandemic could serve as a basis to learn more about this mental health indicator.

METHODS: The current study is a part of the COMET-G international project (40 countries, n=55.589), which represents an analysis of data collected from Russia’s general population (n=7714, 33±12 y.o., 61% female) to estimate suicidality using the Risk Assessment Suicidality Scale (RASS) and its relationships with socio-demographic, clinical, and life-habit characteristics during the COVID-19 pandemic. The evaluation of the statistical data (descriptive statistics, ANOVA, LASSO linear regression, significant at α=0.05) was undertaken using TIBCO Statistica.

RESULTS: According to the RASS, at least 20.68%, and up to 29.15%, of the general population in Russia demonstrated increased risk of suicidality during the pandemic. Modelling these risks pointed to the key vulnerabilities related to mental and behavioral disorders, such as (i) current severe depression and a history of mental disorders, (ii) bipolar disorder, (iii) use of illicit drugs surprisingly outranking the alcohol misuse, and psychiatric compounds (hypnotics), highlighting sleep quality deterioration, (iv) a history of suicide attempts and self-harm — though not self-reported changes in depression — in response were predictors of the risk of suicidality, which can be explained by the phenomenon of “learned suicidality”, a habitual behavioral suicidality pattern completion accumulated over the background. Such (v) socio-demographic indicators as younger age (disregarding the gender factor), a marital status of single, having no children, living with fewer people in the household, a recent increase in family conflicts, increased need for emotional support, decreased need for communication, and not believing in precautionary measures against COVID-19, contributed to the increase of suicidality risk in the context of the pandemic.

CONCLUSIONS: The findings of this study revealed new suicide risk factors that should be taken into account in suicidality risk assessments for the Russian population and in the implementation of suicide prevention programs in the region.

Keywords

COVID-19 pandemic / depression / family conflicts / self-harm / sleep disturbances / social support / suicide prevention / suicidality / young age

References

[1] WHO [Internet]. Practice manual for establishing and maintaining surveillance systems for suicide attempts and self-harm: World Health Organization; 2016 [cited 2022 March 15]. Available from: https://apps.who.int/iris/handle/10665/208895

[2] WHO [Internet]. Preventing suicide: Russian Federation adapts WHO self-harm monitoring tool. 10-09-2020 2020 [cited 2022 March 14]. Available from: https://www.euro.who.int/en/countries/russian-federation/news/news/2020/9/preventing-suicide-russian-federation-adapts-who-self-harm-monitoring-tool

[3] Center for Behavioral Health Statistics and Quality, 2021 [Internet]. 2020 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration [cited 2022 March 14]. Available from: https://www.samhsa.gov/data/sites/default/files/reports/rpt35330/2020NSDUHMethodSummDefs092421/2020NSDUHMethodsSummDefs092421.htm

[4] Smirnova D, Syunyakov T, Bragin D, Fedotov I, Filatova V, Ignatenko Y, KuvshinovaN, Prokopenko E, Romanov D, Spikina A, Yashikhina A, Morozov P, Fountoulakis NK. Interactions between Anxiety Levels and Life Habits Changes in General Population during the Pandemic Lockdown: Decreased Physical Activity, Falling Asleep Late and Internet Browsing about COVID-19 Are Risk Factors for Anxiety, whereas Social Media Use Is not. Psychiatria Danubina. 2021(33(Suppl 9)):119–129.

[5] Vrublevska J, Sibalova A, Aleskere I, Rezgale B, Smirnova D, Fountoulakis KN, Rancans E. Factors related to depression, distress, and self-reported changes in anxiety, depression, and suicidal thoughts during the COVID-19 state of emergency in Latvia. Nord J Psychiatry. 2021 Nov;75(8):614–623. doi: 10.1080/08039488.2021.1919200.

[6] Deng J, Zhou F, Hou W, Silver Z, Wong CY, Chang O, Huang E, Zuo QK. The prevalence of depression, anxiety, and sleep disturbances in COVID-19 patients: a meta-analysis. Ann N Y Acad Sci. 2021 Feb;1486(1):90–111. doi: 10.1111/nyas.14506.

[7] Kulig B, Erdelyi-Hamza B, Elek LP, Kovacs I, Smirnova D, Fountoulakis K, Gonda X. [Effects of COVID-19 on psychological well-being, lifestyle and attitudes towards the origins of the pandemic in psychiatric patients and mentally healthy subjects: first Hungarian descriptive results from a large international online study]. Neuropsychopharmacol Hung. 2020 Dec;22(4):154–165. Hungarian.

[8] Fountoulakis KN, Karakatsoulis G, Abraham S, Adorjan K, Ahmed HU, Alarcon RD, Arai K, Auwal SS, Berk M, Bjedov S, et al. Results of the COVID-19 mental health international for the general population (COMET-G) study. Eur Neuropsychopharmacol. 2022 Jan;54:21–40. doi: 10.1016/j.euroneuro.2021.10.004.

[9] World Health Organisation [Internet]. 732 days of COVID-19 in the WHO European Region — in 15 figures [cited 2022 May 14]. Available from: https://www.euro.who.int/en/health-topics/health-emergencies/pages/news/news/2022/01/732-days-of-covid-19-in-the-who-european-region-in-15-figures

[10] John A, Eyles E, Webb RT, Okolie C, Schmidt L, Arensman E, Hawton K, O’Connor RC, Kapur N, Moran P, et al. The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: update of living systematic review. F1000Res. 2020;9:1097. doi: 10.12688/f1000research.25522.2.

[11] Dube JP, Smith MM, Sherry SB, Hewitt PL, Stewart SH. Suicide behaviors during the COVID-19 pandemic: A meta-analysis of 54 studies. Psychiatry Res. 2021 Jul;301:113998. doi: 10.1016/j.psychres.2021.113998.

[12] Liu RT, Bettis AH, Burke TA. Characterizing the phenomenology of passive suicidal ideation: a systematic review and meta-analysis of its prevalence, psychiatric comorbidity, correlates, and comparisons with active suicidal ideation. Psychol Med. 2020 Feb;50(3):367–383. doi: 10.1017/S003329171900391X.

[13] Kopishinskaia S, Cumming P, Karpukhina S, Velichko I, Raskulova G, Zheksembaeva N, Tlemisova D, Morozov P, Fountoulakis KN, Smirnova D. Association between COVID-19 and catatonia manifestation in two adolescents in Central Asia: Incidental findings or cause for alarm? Asian J Psychiatr. 2021 Sep;63:102761. doi: 10.1016/j.ajp.2021.102761.

[14] Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020 Mar 14;395(10227):912–920. doi: 10.1016/S0140-6736(20)30460-8.

[15] The L. COVID-19: fighting panic with information. Lancet. 2020 Feb 22;395(10224):537. doi: 10.1016/S0140-6736(20)30379-2.

[16] Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. Lancet Psychiatry. 2021 May;8(5):416–427. doi: 10.1016/S2215-0366(21)00084-5.

[17] Kumar S, Veldhuis A, Malhotra T. Neuropsychiatric and Cognitive Sequelae of COVID-19. Front Psychol. 2021;12:577529. doi: 10.3389/fpsyg.2021.577529.

[18] Zelikowsky M, Hui M, Karigo T, Choe A, Yang B, Blanco MR, Beadle K, Gradinaru V, Deverman BE, Anderson DJ. The Neuropeptide Tac2 Controls a Distributed Brain State Induced by Chronic Social Isolation Stress. Cell. 2018 May 17;173(5):1265–1279 e1219. doi: 10.1016/j.cell.2018.03.037.

[19] Calati R, Ferrari C, Brittner M, Oasi O, Olie E, Carvalho AF, Courtet P. Suicidal thoughts and behaviors and social isolation: A narrative review of the literature. J Affect Disord. 2019 Feb 15;245:653–667. doi: 10.1016/j.jad.2018.11.022.

[20] Bertin P, Nera K, Delouvee S. Conspiracy Beliefs, Rejection of Vaccination, and Support for hydroxychloroquine: A Conceptual Replication-Extension in the COVID-19 Pandemic Context. Front Psychol. 2020;11:565128. doi: 10.3389/fpsyg.2020.565128.

[21] Surina S, Martinsone K, Perepjolkina V, Kolesnikova J, Vainik U, Ruza A, Vrublevska J, Smirnova D, Fountoulakis KN, Rancans E. Factors Related to COVID-19 Preventive Behaviors: A Structural Equation Model. Front Psychol. 2021;12:676521. doi: 10.3389/fpsyg.2021.676521.

[22] Tangcharoensathien V, Calleja N, Nguyen T, Purnat T, D’Agostino M, Garcia-Saiso S, Landry M, Rashidian A, Hamilton C, AbdAllah A, et al. Framework for Managing the COVID-19 Infodemic: Methods and Results of an Online, Crowdsourced WHO Technical Consultation. J Med Internet Res. 2020 Jun 26;22(6):e19659. doi: 10.2196/19659.

[23] Wong FHC, Liu T, Leung DKY, Zhang AY, Au WSH, Kwok WW, Shum AKY, Wong GHY, Lum TY. Consuming Information Related to COVID-19 on Social Media Among Older Adults and Its Association With Anxiety, Social Trust in Information, and COVID-Safe Behaviors: Cross-sectional Telephone Survey. J Med Internet Res. 2021 Feb 11;23(2):e26570. doi: 10.2196/26570.

[24] Fountoulakis KN, Apostolidou MK, Atsiova MB, Filippidou AK, Florou AK, Gousiou DS, Katsara AR, Mantzari SN, Padouva-Markoulaki M, Papatriantafyllou EI, et al. Mental health and conspirasism in health care professionals during the spring 2020 COVID-19 lockdown in Greece. Acta Neuropsychiatr. 2021 Dec 10:1–16. doi: 10.1017/neu.2021.38.

[25] Wasserman IM. The impact of epidemic, war, prohibition and media on suicide: United States, 1910–1920. Suicide Life Threat Behav. 1992 Summer;22(2):240–254.

[26] Brooks JR, Hong JH, Cheref S, Walker RL. Capability for suicide: Discrimination as a painful and provocative event. Suicide Life Threat Behav. 2020 Dec;50(6):1173–1180. doi: 10.1111/sltb.12671.

[27] Gabhart M. Spinoza on self-preservation and self-destruction. J Hist Philos. 1999;37(4):613–629. doi: 10.1353/hph.2008.0814.

[28] Pierre JM. Culturally sanctioned suicide: Euthanasia, seppuku, and terrorist martyrdom. World J Psychiatry. 2015 Mar 22;5(1):4–14. doi: 10.5498/wjp.v5.i1.4.

[29] Stengel E. Self-destructiveness and self-preservation. Clin Med (Northfield). 1962 Oct;69:2275–2279.

[30] Banerjee D, Kosagisharaf JR, Sathyanarayana Rao TS. ‘The dual pandemic’ of suicide and COVID-19: A biopsychosocial narrative of risks and prevention. Psychiatry Res. 2021 Jan;295:113577. doi: 10.1016/j.psychres.2020.113577.

[31] Pirkis J, John A, Shin S, DelPozo-Banos M, Arya V, Analuisa-Aguilar P, Appleby L, Arensman E, Bantjes J, Baran A, et al. Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries. Lancet Psychiatry. 2021 Jul;8(7):579–588. doi: 10.1016/S2215-0366(21)00091-2.

[32] Titov N, Staples L, Kayrouz R, Cross S, Karin E, Ryan K, Dear B, Nielssen O. Rapid report: Early demand, profiles and concerns of mental health users during the coronavirus (COVID-19) pandemic. Internet Interv. 2020 Sep;21:100327. doi: 10.1016/j.invent.2020.100327.

[33] Bellman V, Namdev V. Suicidality Among Men in Russia: A Review of Recent Epidemiological Data. Cureus. 2022 Mar;14(3):e22990. doi: 10.7759/cureus.22990.

[34] Federal state statistics service (Rosstat). Russian statistical yearbook 2021: statistical handbook. Moscow: R76; 2021. 692 p. Russian.

[35] Semyonova V, Sabgayda T, Zubko A, Gavrilov L. Mortality among the Russian working-age population from suicide: official and actual rates. European Journal of Public Health. 2020;30(Supplement_5). doi: 10.1093/eurpub/ckaa166.1371.

[36] Jukkala T, Makinen IH, Stickley A. The historical development of suicide mortality in Russia, 1870–2007. Arch Suicide Res. 2015;19(1):117–130. doi: 10.1080/13811118.2014.915774.

[37] Pridemore WA, Chamlin MB, Andreev E. Reduction in male suicide mortality following the 2006 Russian alcohol policy: an interrupted time series analysis. Am J Public Health. 2013 Nov;103(11): 2021–2026. doi: 10.2105/AJPH.2013.301405.

[38] Lyubov E, Zotov P. Diagnosis of suicidal behavior and assessing the degree of suicidal risk. Message II. Suicidology. 2018;9(1): 23–35. Russian.

[39] Kolesnik D. Suicide Mortality in Russia: Do Urban Men React to Economic Fluctuations More than Women? SSRN Electronic Journal. 2017 doi: 10.2139/ssrn.3111345.

[40] Razvodovsky Y, Kandrychyn S. Population Drinking and Gender Gap in Suicide Mortality in Europe. ARC Journal of Addiction. 2018;3(2):60–61.

[41] Bogdanova UZ, Abrarova ZF, Kovrov VF, Hajrullina NG. Attitude of Russian Youth Towards Suicide. Utopía y Praxis Latinoamericana. 2020;25(5):126–34. doi: 10.5281/ZENODO.3984216.

[42] Shakhmalova I, Nekrasova M. Features of suicidal behavior of adolescents: motives, causes and factors. Modern Pedagogical Education. 2021;(6):44–46. Russian

[43] Bebtschuk M, Smirnova D, Khayretdinov O. Family and family therapy in Russia. Int Rev Psychiatry. 2012 Apr;24(2):121–127. doi: 10.3109/09540261.2012.656305.

[44] Mosolov SN. [Problems of mental health in the situation of COVID-19 pandemic]. Zh Nevrol Psikhiatr Im S S Korsakova. 2020;120(5):7–15. doi: 10.17116/jnevro20201200517. Russian.

[45] Mosolova E, Sosin D, Mosolov S. Stress, anxiety, depression and burnout in frontline healthcare workers during two peaks of COVID-19 pandemic in Russia. Psychiatry Res. 2021 Dec;306:114226. doi: 10.1016/j.psychres.2021.114226.

[46] Verzhitskaya E, Polilov S. Interrelation of suicidal proposition with coping strategies in youth. International Journal of Humanities and Natural Sciences. 2021;56(5-3):128–133. doi: 10.24412/2500-1000-2021-5-3-128-133.

[47] Sorokin MY, Kasyanov ED, Rukavishnikov GV, Makarevich OV, Neznanov NN, Lutova NB, Mazo GE. Behavioral and Emotional Reactions of the Russian Population to the Beginning of the COVID-19 Pandemic: An On-Line Survey Results. Psychiatr Danub. 2021 Fall;33(3):386–392. doi: 10.24869/psyd.2021.386.

[48] Sorokin MY, Kasyanov ED, Rukavishnikov GV, Makarevich OV, Neznanov NG, Morozov PV, Lutova NB, Mazo GE. Stress and Stigmatization in Health-Care Workers during the COVID-19 Pandemic. Indian J Psychiatry. 2020 Sep;62(Suppl 3):S445–S453. doi: 10.4103/psychiatry.IndianJPsychiatry_870_20.

[49] Karpenko OA, Syunyakov TS, Kulygina MA, Pavlichenko AV, Chetkina AS, Andrushchenko AV. Impact of COVID-19 pandemic on anxiety, depression and distress — online survey results amid the pandemic in Russia. Consortium Psychiatricum. 2020;1(1):8–20.

[50] Zhang SX, Miller SO, Xu W, Yin A, Chen BZ, Delios A, Dong RK, Chen RZ, McIntyre RS, Wan X, et al. Meta-analytic evidence of depression and anxiety in Eastern Europe during the COVID-19 pandemic. Eur J Psychotraumatol. 2022;13(1):2000132. doi: 10.1080/20008198.2021.2000132.

[51] Fountoulakis KN, Apostolidou MK, Atsiova MB, Filippidou AK, Florou AK, Gousiou DS, Katsara AR, Mantzari SN, Padouva-Markoulaki M, Papatriantafyllou EI, et al. Self-reported changes in anxiety, depression and suicidality during the COVID-19 lockdown in Greece. J Affect Disord. 2021 Jan 15;279:624–629. doi: 10.1016/j.jad.2020.10.061.

[52] Fountoulakis KN, Pantoula E, Siamouli M, Moutou K, Gonda X, Rihmer Z, Iacovides A, Akiskal H. Development of the Risk Assessment Suicidality Scale (RASS): a population-based study. J Affect Disord. 2012 May;138(3):449–457. doi: 10.1016/j.jad.2011.12.045.

[53] Spielberger CD, Gorsuch RL, Lushene R. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologist Press; 1970.

[54] Radloff LS. The CES-D Scale. Applied Psychological Measurement. 2016;1(3):385–401. doi: 10.1177/014662167700100306.

[55] Fountoulakis KN, Pantoula E, Siamouli M, Moutou K, Gonda X, Rihmer Z, Iacovides A, Akiskal H. Development of the Risk Assessment Suicidality Scale (RASS): a population-based study. J Affect Disord. 2012 May;138(3):449–457. doi: 10.1016/j.jad.2011.12.045.

[56] Knight RG, Waal-Manning HJ, Spears GF. Some norms and reliability data for the State-Trait Anxiety Inventory and the Zung Self-Rating Depression scale. Br J Clin Psychol. 1983 Nov;22 (Pt 4):245–249. doi: 10.1111/j.2044-8260.1983.tb00610.x.

[57] Federal State Statistics Service [Internet]. Population of the Russian Federation by gender and age as of January 1, 2021 [cited 2022 March 25]. Available from: https://rosstat.gov.ru/storage/mediabank/Bul_chislen_nasel-pv_01-01-2021.pdf Russian.

[58] World Health Organisation [Internet]. Suicide rate estimates, crude. Estimates by country [cited 2022 March 25]. Available from: https://apps.who.int/gho/data/view.main.MHSUICIDEv

[59] Zhang L, Zhang D, Fang J, Wan Y, Tao F, Sun Y. Assessment of Mental Health of Chinese Primary School Students Before and After School Closing and Opening During the COVID-19 Pandemic. JAMA Netw Open. 2020 Sep 1;3(9):e2021482. doi: 10.1001/jamanetworkopen.2020.21482.

[60] Wang R, Li J, Mei J. Research on the suicide risk, sleep, psychological status and influencing factors of coronavirus disease 2019 patients. J Third Mil Med Univ. 2020;14:1462–1468.

[61] Iob E, Frank P, Steptoe A, Fancourt D. Levels of severity of depressive symptoms among at-risk groups in the UK during the COVID-19 pandemic. JAMA network open. 2020;3(10):e2026064-e.

[62] Zalsman G, Stanley B, Szanto K, Clarke DE, Carli V, Mehlum L. Suicide in the Time of COVID-19: Review and Recommendations. Arch Suicide Res. 2020 Oct-Dec;24(4):477–482. doi: 10.1080/13811118.2020.1830242.

[63] Grimmond J, Kornhaber R, Visentin D, Cleary M. A qualitative systematic review of experiences and perceptions of youth suicide. PLoS One. 2019;14(6):e0217568. doi: 10.1371/journal.pone.0217568.

[64] Miller JN, Black DW. Bipolar Disorder and Suicide: a Review. Curr Psychiatry Rep. 2020 Jan 18;22(2):6. doi: 10.1007/s11920-020-1130-0.

[65] Yuodelis-Flores C, Ries RK. Addiction and suicide: A review. Am J Addict. 2015 Mar;24(2):98–104. doi: 10.1111/ajad.12185.

[66] Farooq S, Tunmore J, Wajid Ali M, Ayub M. Suicide, self-harm and suicidal ideation during COVID-19: A systematic review. Psychiatry Res. 2021 Dec;306:114228. doi: 10.1016/j.psychres.2021.114228.

[67] Kim H, Kim Y, Myung W, Fava M, Mischoulon D, Lee U, Lee H, Na EJ, Choi KW, Shin MH, et al. Risks of suicide attempts after prescription of zolpidem in people with depression: a nationwide population study in South Korea. Sleep. 2020 Mar 12;43(3). doi: 10.1093/sleep/zsz235.

[68] Li DJ, Ko NY, Chen YL, Wang PW, Chang YP, Yen CF, Lu WH. COVID-19-Related Factors Associated with Sleep Disturbance and Suicidal Thoughts among the Taiwanese Public: A Facebook Survey. Int J Environ Res Public Health. 2020 Jun 22;17(12). doi: 10.3390/ijerph17124479.

[69] Maier SF, Seligman ME. Learned helplessness: Theory and evidence. Journal of Experimental Psychology: General. 1976;105(1):3–46. doi: 10.1037/0096-3445.105.1.3.

[70] Gunnell D, Bennewith O, Peters TJ, House A, Hawton K. The epidemiology and management of self-harm amongst adults in England. J Public Health (Oxf). 2005 Mar;27(1):67–73. doi: 10.1093/pubmed/fdh192.

[71] McManus S, Gunnell D, Cooper C, Bebbington PE, Howard LM, Brugha T, Jenkins R, Hassiotis A, Weich S, Appleby L. Prevalence of non-suicidal self-harm and service contact in England, 2000–14: repeated cross-sectional surveys of the general population. Lancet Psychiatry. 2019;6(7):573–581. doi: 10.1016/s2215-0366(19)30188-9.

[72] Isumi A, Doi S, Yamaoka Y, Takahashi K, Fujiwara T. Do suicide rates in children and adolescents change during school closure in Japan? The acute effect of the first wave of COVID-19 pandemic on child and adolescent mental health. Child Abuse Negl. 2020 Dec;110(Pt 2):104680. doi: 10.1016/j.chiabu.2020.104680.

[73] Chen Q, Zhang-James Y, Barnett EJ, Lichtenstein P, Jokinen J, D’Onofrio BM, Faraone SV, Larsson H, Fazel S. Predicting suicide attempt or suicide death following a visit to psychiatric specialty care: A machine learning study using Swedish national registry data. PLoS Med. 2020 Nov;17(11):e1003416. doi: 10.1371/journal.pmed.1003416.

[74] Thibaut F, van Wijngaarden-Cremers PJM. Women’s Mental Health in the Time of Covid-19 Pandemic. Front Glob Womens Health. 2020;1:588372. doi: 10.3389/fgwh.2020.588372.

RIGHTS & PERMISSIONS

Syunyakov T.S., Pavlichenko A.V., Morozov P.V., Fedotov I.A., Filatova V.E., Gayduk A.J., Ignatenko Y.S., Spikina A.A., Yashikhina A.A., Patsali M.E., Fountoulakis K.N., Smirnova D.A.