JMIR Publications

ABSTRACT

Background:

The coronavirus disease (COVID-19) pandemic, and countries’ response measures, have had a globally significant mental health impact. This mental health burden has also been fuelled by an infodemic; an information overload, which includes misinformation and disinformation. Suicide, the worst mental health outcome, is a serious public health problem which can be prevented with timely, evidence-based, and often low-cost interventions. Suicide ideation, one important risk factor for suicide, is thus important to measure and monitor, as are the factors which may impact on it.

Objective:

This investigation has two primary aims: (1) to estimate and compare country specific prevalence of suicide ideation at two different time points, overall and by gender and age groups; and, (2) to investigate the influence of sociodemographic and infodemic variables on suicide ideation.

Methods:

A repeated online eight country (Canada, United States of America, England, Switzerland, Belgium, Hong Kong, Philippines and New Zealand) cross-sectional study was undertaken of adults aged ≥18 years; with measurement wave 1 conducted from 29th May 29 to 12th June 2020, and measurement wave 2 conducted from 6-18th November 2021. Self-reported suicide ideation was derived from item 9 of the Patient Health Questionnaire-9 (PHQ-9). Age standardized suicide ideation rates were reported, a binomial regression model was used to estimate suicide ideation indication rates for each country and measurement wave, and logistic regression models were then employed to relate sociodemographic, pandemic, and infodemic variables to suicide ideation.

Results:

The final sample totalled 17,833 adults; 8,806 (49.4%) from measurement wave 1 and 9,027 (50.6%) from wave 2 – with over 1,000 from each country at each time-point. Overall, 24.2% and 27.5% of participants reported suicide ideation at measurement waves 1 and 2, respectively, a difference that was significant (P<.001). Considerable variability was observed in suicide ideation age standardized rates between countries, ranging from 15.6% in Belgium (wave 1) to 42.9% in Hong Kong (wave 2). Frequent social media usage was associated with increased suicide ideation at wave 2 (adjusted odds ratio [AOR]=1.47, P<.001) but not wave 1 (AOR=1.11, P=.16). However, having a weaker sense of coherence (SOC) (AOR=3.80 at wave 1 and AOR=4.37 at wave 2; both P<.001) had the largest overall effect size.

Conclusions:

Suicide ideation is prevalent and significantly increasing over time in this COVID-19 pandemic era, with considerable variability between countries. Younger adults and those residing in Hong Kong carried disproportionately higher rates. Social media appears to have an increasingly detrimental association with suicide ideation, although having a stronger SOC had a larger protective effect. Policies and promotion of SOC, together with disseminating health information that explicitly tackles the infodemic’s misinformation and disinformation, may importantly reduce the rising mental health morbidity and mortality triggered by this pandemic. Clinical Trial: N/A