Suicide deaths in Ireland before and during the first year of COVID-19: What changed?

Suicide deaths in Ireland before and during the first year of COVID-19: What changed?

Public health emergencies such as the COVID-19 pandemic have raised concerns regarding their impact on suicide risk, through increased social isolation, healthcare disruption, and economic stress. International evidence on suicide trends during the first year of the pandemic is mixed; there is limited peer-reviewed research examining suicide deaths in Ireland during this period. The study aimed to compare sociodemographic, mental health, and physical health characteristics of individuals who died by suicide in Ireland before and after the onset of the COVID-19 pandemic, and to identify the distinguishing characteristics of individuals whose deaths involved documented COVID-19-related risk factors. Data were drawn from the Irish Probable Suicide Deaths Study (IPSDS), comprising coronial records of all probable suicides in Irelands from 2015 to the end of 2020 (N = 3620). Descriptive statistics and chi-square tests compared characteristics of suicide deaths before (n = 3156) versus after (n = 464) the COVID-19 lockdown. A binary logistic regression compared the differences in characteristics of individuals with documented COVID-19-related risk factors to those without such factors. Compared with the pre-pandemic cohort, individuals who died by suicide during the lockdown period in 2020 were more likely to be female, have a documented physical health concern, and were more likely to exhibit behavioural changes prior to death. Individuals with mental and physical health concerns were more likely to have COVID noted as a significant factor in their deaths. The COVID-19 pandemic was associated with modest but important shifts in the characteristics of suicide deaths in Ireland, particularly among individuals with physical health conditions.

Highlights

•Suicide deaths during the first COVID lockdown were more likely to involve females and those with physical health concerns.

•Study and work-related stressors were less prominent following lockdown.

•Mental and physical health concerns were more common in COVID-related suicide deaths.

1Introduction

Public health emergencies can impact population mental health and suicide risk and accentuate key risk factors such as social isolation, reduced access to mental health services, financial insecurity, and heightened fear and uncertainty [1], [2]. Learnings from previous public health emergencies, such as the COVID-19 pandemic, can be invaluable in informing planned responses to potential future public health emergencies. While the specific drivers of suicide may change depending on the nature of the crisis, the patterns of how risk shifts across demographic groups offer critical insights into the resilience of social safety nets and mental health systems. Understanding these shifts is essential not only for pandemic preparedness but for developing adaptive suicide prevention strategies that can be deployed during any period of acute societal instability.

COVID-19 was declared a public health emergency of international concern by the World Health Organisation in January 2020 and designated a pandemic in March 2020 [3]. In response, countries adopted varying approaches to contain the virus [4]. Concerns about a potential increase in suicide deaths during the COVID‑19 pandemic were raised early, given the widespread presence and amplification of known suicide risk factors [5], [6]. In addition to reduced social support and enforced social isolation, the pandemic was associated with significant economic disruption, job loss, housing precarity, and increased exposure to psychosocial stressors [6], [7]. Disruptions to routine healthcare and community‑based services further heightened concerns about reduced access to mental health assessment and ongoing care, particularly for individuals with pre‑existing mental health conditions [5].

International evidence on suicide trends during the first year of the COVID‑19 pandemic has been mixed. Several countries reported no increase, or even temporary decreases, in suicide deaths during 2020 [8], [9]. Conversely, emerging evidence suggests increases among specific population groups, such as children and adolescents [10], and older adults [11]. These divergent findings highlight the importance of examining differential impacts across sociodemographic groups.

Ireland provides a relevant context for investigating suicide during the COVID‑19 pandemic. Ireland implemented some of the longest and most restrictive public health measures in Europe during 2020 [12]. While these measures contributed to Ireland recording one of the lowest excess death rates [13], they also entailed prolonged restrictions on social contact, mobility, education, and employment. Simultaneously, the Irish government introduced a range of economic and social protection measures aimed at mitigating financial stressors. Understanding how these concurrent risk and protective factors influenced suicide mortality is essential for informing future public health emergency planning. While Irish data show suicide rates remained relatively unchanged before and during the first year of the pandemic, [14], limited research examines whether this varied by characteristic, and key risk factors that shaped outcomes.

1.1Aims

•To compare the sociodemographic, mental health, and physical health characteristics of individuals who died by suicide before and after the onset of the COVID-19 pandemic (2015–2020)

•To describe the characteristics of individuals whose coronial files included documented COVID-19-related risk factors for suicide, and to compare these individuals to those without documented COVID-19-related risk factors.

2Methods

2.1Data

The Irish Probable Suicide Deaths Study (IPSDS) records detailed characteristics of all individuals who died by suicide in Ireland between 01/01/2015 and 31/12/2020 (N = 3630) [15]. Suicide deaths were defined where there was either a verdict of suicide or where the death was in line with the Rosenberg [16] criteria of suicide. Data were collected across all coroners' districts nationally. Coronial files were examined by nurse researchers, who extracted relevant information compiled as part of the death-investigation process.

2.2Sample and data cleaning

The IPSDS contains sociodemographic variables (e.g., age, sex, living situation, employment status), health-related indicators (e.g., mental health, physical health, substance misuse, prior self-harm), and documented risk factors (e.g., behavioural changes, study/work stress, COVID-19-related factors). Risk factors were researcher determined based on information supplied during the inquest. For example, behavioural changes were defined as any reports of significant changes in an individual’s behaviour during the period leading up to their death. As coroners did not follow a structured data extraction methodology, there was a range of missingness, (0% for sex, age, and method of suicide; 3.0% for relationship status; 9.3% for living situation; 15.7% for employment status; 43.8% for socioeconomic status). Risk-factor variables, such as prior self-harm, drug and/or alcohol misuse, study/work stress, and COVID-19-related factors, were coded as binary (1 = documented presence, 0 =no documented presence). Low frequency categories were collapsed to facilitate statistical comparison. Age was grouped categorically.

The study included all individuals who died by suicide in Ireland before (n = 3156) and after (n = 464) the onset of the COVID-19 pandemic, defined as the 12th March 2020, for the study period of 2015–2020. This date corresponds to the official announcement by the Irish Taoiseach (Prime Minister) introducing national public health measures and formally acknowledging the pandemic.

2.3Analysis methods

Descriptive statistics summarised the sociodemographic, mental, and physical health characteristics of study individuals who died by suicide before versus after the onset of the pandemic. Group comparisons were conducted using chi-square tests.

Descriptive statistics compared individuals with versus without documented COVID-19-related risk factors. Initial chi-square comparisons, frequencies, and percentages were calculated. Open-text descriptions of COVID-19-related risk factors were grouped into thematic categories and are described below.

A binary logistic regression assessed differences between those with and without COVID-19-related risk factors, with sex, age category, mental health status, and physical health status included as independent variables, and COVID risk factor status as the dependent variable. These variables were selected due to both theoretical relevance and significance in the initial chi-square exploratory analyses. Adjusted odds ratios with 95% confidence intervals were reported.

Analyses were performed in RStudio v4.4.0.

3Results

3.1Characteristics of the suicide cohort before and after the onset of the COVID-19 pandemic (2015–2020)

Descriptive findings (Table 1) indicated that, compared to the cohort who died by suicide before the beginning of the COVID-19 lockdown period, individuals who died by suicide in post-lockdown 2020 were more likely to be female (p = .004). However, there were no significant differences in age group or other sociodemographic characteristics between the cohorts.Table 1Characteristics of the national suicide cohort before and during the COVID-19 lockdown period (2015–2020).

Pre-COVID-19 lockdown (2015 – March 2020) Post-COVID-19 lockdown (March – December 2020)

n % n % χ2 df p Effect size (Cramer’s V)

Gender Female 2376 75% 320 69% 8.17 1 .004** 0.05

Male 780 25% 144 31%

Age category 10–24 400 13% 59 13% 0.27 3 .965 0.01

25–44 1235 39% 178 38%

45–64 1171 37% 172 37%

65 + 350 11% 55 12%

Had a physical health condition Yes 578 18% 118 25% 12.74 1 < .001*** 0.06

No 2578 82% 346 75%

Had a mental health condition Yes 2092 66% 287 62% 3.33 1 .068 0.03

No 1064 34% 177 38%

Prescription for mental health medication Yes 1212 38% 161 35% 2.20 1 .138 0.03

No 2415 77% 350 75%

Prior self-harm Yes 741 23% 114 25% 0.21 1 .647 0.01

No 2415 77% 350 75%

Method of suicide Drowning 367 12% 29 6% 14.64 3 .002** 0.06

Hanging 1978 63% 324 70%

Other 420 13% 60 13%

Poisoning 391 12% 51 11%

Drug/alcohol Yes 838 27% 123 27% 0.00 1 .999 0.00

No 2318 73% 341 73%

Employment status Employed 1088 34% 177 38% 4.70 3 .195 0.04

Student 232 7% 37 8%

Unemployed 786 25% 100 22%

Retired/unable to work/Not working 558 18% 72 16%

Socioeconomic status Higher 306 10% 47 10% 2.78 2 .250 0.04

Middle 751 24% 123 27%

Lower 716 23% 92 20%

Relationship status Co-habiting 183 6% 15 3% 6.05 3 .109 0.04

Married/Civil partnership 943 30% 135 29%

Separated/divorced/widowed 346 11% 48 10%

Single 1592 50% 250 54%

Living situation Alone 774 25% 112 24% 0.09 3 .993 0.01

Family 913 29% 136 29%

Other shared (e.g., with friends) 120 4% 17 4%

Partner/children/both 923 29% 138 30%

Have children Yes 528 17% 80 17% 0.02 1 .894 0.00

No 1994 63% 294 63%

Changes in behaviour Yes 468 15% 192 41% 189.50 1 < .001*** 0.23

No 2688 85% 272 59%

Study/work stress Yes 275 9% 26 6% 4.73 1 .030* 0.04

No 2881 91% 438 94%

Note: ***p < .001, **p < .01, *p < .05; Cramer’s V 0.10 = small, 0.30 = medium, 0.50 = large.

The post-lockdown 2020 cohort were significantly more likely to have a documented physical health concern (p < .001), but not more likely to have a mental health concern or a documented history of self-harm or drug/alcohol dependency.

There was a significant difference in suicide method following the onset of the pandemic (p = .002), with a lower proportion of deaths by drowning in the post-lockdown period. Individuals in the post-pandemic cohort were significantly more likely to have documented changes in behaviour prior to death (p < .001), and significantly less likely to have documented education-related or work-related stressors (p = .030).

3.2Characteristics of individuals with documented COVID-19-related risk factors

Of the 464 individuals who died by suicide in post-lockdown 2020, 64 (13.8%) had COVID-19-related factors noted as a probable contributor to their death. The most frequent factor was COVID-19 restrictions and lockdown (67%, n = 43; e.g., “Effect of isolation due to Covid 19 restrictions on mental health”), followed by general/non-specific COVID-19-related factors (16%; n = 10), financial/employment impacts (9%; e.g., “loss of business due to Covid restrictions”), healthcare-related factors (6%; e.g., “Unable to get a GP appointment due to Covid”), and high-risk or positive COVID-status (6%; e.g., “High risk for COVID”).

Descriptive findings (Table 2) indicated that individuals with COVID-19-related risk factors were significantly more likely to be aged over 65 years, female, have documented physical and mental health concerns, have received a prescription for mental health medication, and have documented behavioural changes prior to their deaths.Table 2Cohort of individuals who exhibited COVID-related determinants of suicide vs those without, 2015–2020.

With COVID-19-related risk factors Without COVID-19-related risk factors

n % n % χ2 df p Effect size (Cramer’s V)

Sex Female 25 39% 900 25% 5.57 1 .018* 0.04

Male 39 61% 2657 75%

Age category 10–24 n < 10 8% 454 13% 13.74 3 .003** 0.06

25–44 25 39% 1388 39%

45–64 18 28% 1325 37%

65 + 16 25% 389 11%

Physical health condition Had a documented physical health concern 24 38% 672 19% 12.87 1 < .001*** 0.06

Did not have a documented physical health concern 40 63% 2887 81%

Mental health Had a documented mental health concern 54 84% 2325 65% 9.24 1 .002** 0.05

Did not have a documented mental health concern 10 16% 1231 35%

Prescription for mental health medication Yes 37 58% 1336 38% 9.44 1 .002** 0.07

No 27 42% 389 62%

Prior self-harm Yes 18 28% 837 24% 0.51 1 .477 0.01

No 46 &2% 2722 76%

Method suicide Drowning n < 10 8% 391 11% 1.77 3 .621 0.02

Hanging 44 69% 2261 64%

Other n < 10 9% 474 13%

Poisoning n < 10 14% 433 12%

Drug/alcohol dependency Yes 14 22% 462 15% 0.51 1 .477 0.01

No 50 78% 2609 85%

Employment status Employed 27 48% 1238 43% 1.50 3 .682 0.02

Student n < 10 9% 264 9%

Unemployed 13 23% 873 31%

Retired/unable to work 11 20% 486 17%

Socioeconomic status Higher n < 10 23% 345 17% 5.15 2 .076 0.05

Middle 14 40% 860 43%

Lower 13 37% 795 40%

Relationship status Co-habiting n < 10 6% 194 6% 1.83 3 .609 0.02

Married/Civil partnership 22 35% 1057 31%

Separated/divorced/widowed n < 10 6% 390 11%

Single 32 52% 1812 52%

Living situation Alone 19 31% 867 28% 2.60 3 .458 0.03

Family 15 25% 1034 34%

Other shared (e.g., with friends) n < 10 7% 133 4%

Partner/children/both 23 38% 1039 34%

Have children Yes 14 25% 595 21% 0.33 1 .565 0.01

No 42 75% 2248 79%

Changes in behaviour Yes 36 56% 624 18% 60.68 1 < .001*** 0.13

No 28 44% 2935 82%

Study/work stress Yes 10 16% 291 8% 3.65 1 .056 0.03

No 54 84% 3268 92%

Note: ***p < .001, **p < .01, *p < .05; Cramer’s V 0.10 = small, 0.30 = medium, 0.50 = large.

3.2.1Logistic regression model

Binary logistic regression indicated that individuals with a mental health concern were 2.6 times more likely to have a documented COVID-19-related risk factor than those without (OR=2.60, 95%CI[1.36, 5.48], p = .007). Those with physical-health concerns were 2.2 times more likely to have a documented COVID-19-related risk factor (OR=2.17, 95%CI[1.25, 3.67], p = .005).

Sex and age category did not retain significance in the model (female vs. male: p = .057; age 65 + vs. 10–24: p = .064), suggesting that the observed raw differences in COVID status by age and sex (Table 1) were not retained while controlling for mental and physical health status. Instead, the differences in age and gender may be driven by the higher co-occurrence of mental and physical health conditions within those sociodemographic groups.

4Discussion

This study examined the characteristics of individuals who died by suicide in Ireland before and during the first year of the COVID-19 pandemic. Characteristics remained relatively stable across the pre- and post-pandemic periods, potentially due to buffering effects of social protection measures early in the pandemic. Notably, study and work-related stressors were less prominent following lockdown, potentially reflecting the efficacy of such measures. However, several important changes in characteristics were identified: the post-lockdown cohort were significantly more likely to be female, have a physical health concern, and have documented behaviour changes, suggesting impacts were not uniform but concentrated among specific subgroups. The increased representation of women may reflect gendered experiences of pandemic-related stressors. During the early pandemic, women reported greater COVID anxiety and faced disproportionate socioeconomic pressures, including increased caregiving responsibilities, higher rates of precarious employment, and greater exposure to domestic stressors [17], [18], [19]. Similarly, the increased prevalence of physical health conditions in the post-lockdown cohort may be explained by associated stressors, such as heightened perceived health risk, social isolation, and healthcare disruption [20].

The study also specifically examined a sub-group for whom COVID was a significant factor in their death, who significantly more likely to be female and over 65 years. However, the combined model suggested the COVID sub-group was more likely to have a history of mental and physical illness, whereas there were no sex and age differences. Individuals with pre-existing mental and physical health concerns may have been disproportionally impacted by the pandemic. However, no overall difference in mental health concerns were observed between the pre- and post-pandemic cohorts. It is possible that mental health functioned as a mediating factor for unmeasured factors.

A key strength of this study is the use of complete national population-level coronial data, offering detailed information beyond routine mortality statistics. Limitations include reliance on information recorded during the death investigation process, potentially under-reporting risk factors. The study period was confined to the first year of the pandemic, and suicide patterns may have evolved differently as restrictions changed, vaccination programmes were introduced, and cumulative socioeconomic consequences emerged. Lastly, the study was conducted specifically within an Irish cohort, which may limit the generalisability of the findings to populations outside of Ireland.

The first year of the COVID-19 pandemic in Ireland was associated with modest shifts, rather than broad changes in the characteristics of suicide deaths. Females and individuals with pre-existing physical health conditions were over-represented, while individuals with mental and physical health concerns were more likely to have COVID noted as a significant factor in their deaths.

CRediT authorship contribution statement

Leigh Huggard: Conceptualisation, Formal analysis, Writing – original draft. Isabela Troya: Conceptualisation, Writing – original draft. Gemma Cox: resources, writing – original draft. Katerina Kavalidou: Resources, Writing – review & editing. Paul Corcoran: Writing – review & editing. Elaine McMahon: Conceptualisation, Writing – original draft.

Ethics approval

This retrospective database study was conducted in accordance with the ethical standards of the relevant institutional and national research committees and with the 1964 Helsinki Declaration and its later amendments. Ethical approval for the original IPSDS study was obtained from the Ethics Committee of the Irish College of General Practitioners (ICGP) in 2016. Ethical approval for the current study was obtained from the Clinical Research Ethics Committee of the Cork Teaching Hospitals. Data were analysed in de-identified form and all applicable confidentiality and data protection requirements were observed.

Funding

This work was supported by the Health Research Board, grant number HRB-EIA-2024-011.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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