‘The dual pandemic’ of suicide and COVID-19: A biopsychosocial narrative of risks and prevention

• Coronavirus disease 2019 (COVID-19) has emerged as a global health threat. • Number of suicidal deaths during times of COVID-19 is rising though data is limited. • Pandemics lead to several risk factors for suicidality like isolation, loneliness, economic fallout, domestic abuse, stigma and fear. • Biological vulnerabilities (family history of suicide, substance use, etc.) and psychosocial risks (migration, old age, low socio-economic class, etc.) amplify the suicidal risks of pandemics. • Stress and immune reaction to infections like COVID-19 are hypothesized as possible linking pathways to suicidal risk. • Suicide-prevention is discussed as an integral part of public health response to pandemics. The Coronavirus disease 2019 (COVID-19) has emerged as a new global health threat. By increasing the risk of isolation, fear, stigma, abuse and economic fallout, COVID-19 has led to increase in risk of psychiatric disorders, chronic trauma and stress, which eventually increase suicidality and suicidal behavior. There is limited data on association of pandemics and suicides. Cases of suicides have been rising since COVID-19 first emerged in China. The association between suicides and pandemics can possibly be explained through various models like Durkheim's theory, Joiner's interpersonal theory, social stress theory, biological theories, etc. The frontline workers, elderly, migrants, homeless, socio-economically impoverished classes as well as those with pre-existing mental disorders, substance abuse and family history of suicides are at higher risk. Suicides are preventable and need early detection, awareness and socio-culturally tailored interventions. This narrative review draws global perspectives on the association of suicidality and pandemics, the theories and risk factors related to same based on the available evidence. It also hypothesizes neuroimmunity and immune based risk factors as possible links between the psychosocial vulnerabilities and suicide during outbreaks like COVID-19. Proposed strategies of suicide-prevention, as an integral part of public health response to the pandemic are subsequently discussed.