COVID-19, anxiety, sleep disturbances and suicide.

Suicide is an important public health problem. During the epidemic of a highly contagious coronavirus 2019 disease (COVID-19) that was identified in China at the end of 2019, the risk of suicide may be exacerbated. COVID-19 has spread to other Asian countries, Europe, Australia, North and South America, and Africa. The COVID-19 epidemic is associated with anxiety, depression, distress, sleep disturbances, and suicidality [[1], [2], [3], [4], [5], [6], [7]].

Researchers in China examined psychological responses during the initial stage of the COVID-19 epidemic in the general population [3]. They found that 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe, 16.5% reported moderate to severe depressive symptoms, and 28.8% reported moderate to severe anxiety symptoms. Another nationwide survey of more than 50,000 people in China during the COVID-19 epidemic showed that about 35% of the respondents experienced psychological distress [4]. Another research group in China sampled and analyzed the online posts from about 18,000 Chinese social media users before and after the declaration of COVID-19 in China on January 20, 2020 [5]. Researchers found that negative emotions such as anxiety, depression, and anger increased, while positive emotions and life satisfaction decreased.

A research group investigated a relation between social capital as measured by the Personal Social Capital Scale 16 (PSCI-16) and sleep quality in individuals who were self-isolated during the COVID-19 outbreak [6]. The authors found that anxiety was associated with stress and reduced sleep quality, and the combination of anxiety and stress reduced the positive effects of social capital on sleep quality. The authors noted that “anxiety and stress of isolated individuals were at high levels, while the sleep quality was low.” Researchers in China also examined a state of mental health of about 1250 health care professionals who treated coronavirus patients [7]. 50.4% of study participants reported depression, 44.6% anxiety, 34.0% insomnia, and 71.5% distress.

Sleep disturbances are associated with anxiety, depression, and suicidal behavior. Sleep abnormalities are a stand-alone risk factor for suicidal ideation, suicide attempts, and suicide death. Appropriate treatment of sleep disturbances is always vital and reduces symptoms of psychiatric disorders and suicidality. However, recognizing and treating insomnia are especially important during stressful times such as the COVID-19 epidemic because it may significantly reduce suicides. It is important to identify and treat sleep disorders not only among psychiatric patient but also among individuals who are not in psychiatric treatment. People with sleep disturbances need to be evaluated for suicidal ideation and suicide intent. Clinicians need to be educated on how to assess individuals with sleep disorders for suicidality.