An emergency response of the WPA member societies to the COVID-19 pandemic
The COVID-19 pandemic is a life-changing crisis that has shaken the globe. Overnight, people have been put in isolation and in quarantine; many have had to face the grim reality of unemployment, financial distress, as well as an uncertain future for themselves and their families. The absence of protective factors such as connectedness and easy access to somatic and mental health care poses a significant threat to mental health. Increase of suicide rates can be anticipated. (1)
We have an opportunity to make a change when testing tools to combat mental health problems in this pandemic - learning from the diversity and similarities between countries and from their responses to the pandemic.
Clinical action
The COVID-19 Brief Educational Motivational Awareness Increasing Intervention and long-term follow-up program (COVID-19 BIC) to prevent suicide, is a method that has been developed at Karolinska Institute in collaboration with the World Health Organization (WHO) in a SUPRE-MISS project (https://www.who.int/mental_health/prevention/suicide/supremiss/en/).
The effectiveness of BIC was demonstrated in significantly reducing suicide mortality in attempters (2) and will now be evaluated in a Randomized Controlled Trial (RCT) together with the WHO.
Suicide attempters who receive Treatment As Usual (TAU) per the standard guidelines at the respective site will be compared with suicide attempters who receive in-person motivational and awareness increasing conversations conducted by trained health care professionals (a doctor, a nurse, a psychiatrist, a psychologist) before discharge from health care facilities and will be followed-up (1,2,4, 8, 12 weeks and at 4,6,12,18 months) by trained volunteers.
The COVID-19 BIC study will be carried out in the following WHO regions and countries:
More countries can be included in the study (contact Danuta.wasserman@ki.se).
Community survey
Clinical study will be complemented with a survey of a random sample of participants selected from the same catchment area as the suicide attempters to the clinical RCT (3). The survey includes sociodemographic questionnaires, history of suicidal behaviours and family data, physical health, mental health, contact with health services in relation to COVID-19 and also measures community stress and problems.
Country level epidemiological study
On an aggregate level, data for each participating country's situation during COVID-19 will be analysed in relation to the number of affected and dead individuals in COVID-19, the number of deaths due to suicide, economic investments for the pandemic, lock down policies etc.
Significance
This action contributes to a global awareness of mental health promotion and suicide prevention and treatment in countries with different cultural, social and economic conditions. It will also build intercontinental and highly competitive Public Mental Health networks of clinicians and researchers which is an important goal for all member societies of the WPA. (ki.se/nasp).
Author: Danuta Wasserman, Karolinska Institute
References
1. Wasserman D, Iosue M, Wuestefeld A, Carli V. Adaptation of evidence-based suicide prevention strategies during and after COVID-19 pandemic. World Psychiatry 2020;19(3).
2. Fleischmann A, Bertolote JM, Wasserman D, De Leo D, Bolhari J, Botega NJ, et al. Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. Bulletin of the World Health Organization. 2008;86:703-9. https://pubmed.ncbi.nlm.nih.gov/18797646/
3. Bertolote, J., Fleischmann, A., De Leo, D., Bolhari, J., Botega, N., De Silva, D., . . . Wasserman, D. (2005). Suicide attempts, plans, and ideation in culturally diverse sites: The WHO SUPRE-MISS community survey. Psychological Medicine, 35(10), 1457-1465. https://pubmed.ncbi.nlm.nih.gov/16164769/