Psychological Trauma:

Theory, Research, Practice, and Policy

© 2020 American Psychological Association 2020, Vol. 12, No. S1, S118 –S119
ISSN: 1942-9681 http://dx.doi.org/10.1037/tra0000741

What Lies Ahead: Elevated Concerns for the Ongoing Suicide Pandemic
Jack C. Lennon
Adler University and Rush University Medical Center

The genesis and global spread of coronavirus disease 2019 (COVID-19) has resulted in significant health
concerns amid societies that were ill-equipped for such a formidable opponent. The COVID-19 pandemic
has illuminated systemic health disparities and weaknesses within our health care and political systems.
With aggressive but necessary interventions to thwart the instantaneous reproduction number, we have
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

simultaneously introduced risk factors for new and exacerbated mental health concerns. Suicide, an
This document is copyrighted by the American Psychological Association or one of its allied publishers.

ongoing pandemic whose rates are higher than they have been in the past 50 years, is one of these
concerns as we navigate COVID-19 deaths and fears surrounding its spread. This article aims to briefly
describe in retrospect some of the historical pandemics and their downstream consequences as well as
present what may lie ahead in terms of anxiety, depression, and suicidal behaviors. This applies not only
to frontline health care workers but also the public at large, who may very well experience long-term
stressor- and trauma-related consequences through ongoing exposure to a virus that is not only potentially
fatal but may have taken the lives of loved ones.

Keywords: coronavirus disease 2019, suicide, anxiety disorders, trauma

It is difficult to find distractions from the ongoing coronavirus
disease 2019 (COVID-19) pandemic—a serious and devastating
situation for which we were simply unprepared politically, eco-
nomically, and medically (Murthy, Gomersall, & Fowler, 2020). It
is difficult to understand how there are still people who choose to
engage with others in restaurants, bars, and other social events,
ultimately placing themselves and everyone else at risk of con-
tracting a dangerous virus. In such a scientifically advanced soci-
ety, we would like to expect better. As we engage in social
distancing, close down restaurants, cancel large events, and at-
tempt to obtain sufficient ventilators and tests, we must not forget
that our lack of preparedness is going to be directly related to
substantial cleanup. Some of the residual impact may very well
contribute to another ongoing pandemic of a different variety—
suicide. This is a U.S. epidemic that has been discussed for
decades, but this is an egregious understatement because it is a
global phenomenon that is emergent, currently unpredictable in the
short term, and rising annually.
The 1918 influenza pandemic took the lives of approximately 50
million individuals globally. Cross-city variations in mortality
were noted, with three population-level factors accounting for 50%
of this variability: (a) incidence of poverty indicators; (b) prior
health status; and (c) air pollution (Clay, Lewis, & Severnini,
Editor’s Note. This commentary received rapid review due to the time-
sensitive nature of the content. It was reviewed by the Journal Editor.—KKT
This article was published Online First June 1, 2020.
X Jack C. Lennon, Department of Psychology, Adler University, and
Department of Neurological Sciences, Rush University Medical Center.
Correspondence concerning this article should be addressed to Jack C.
Lennon, Department of Psychology, Adler University, 17 North Dearborn
Street, Chicago, IL 60602. E-mail: jlennon@adler.edu
2019). The AIDS epidemic, which began in 1981, has taken the
lives of more than 700,000 people, whereas 1.1 million are living
with HIV (Centers for Disease Control and Prevention, 2018). The
2003 severe acute respiratory syndrome (SARS) epidemic in Hong
Kong resulted in social isolation and downstream social ramifica-
tions, resulting in increased risk of suicide deaths in older adult
females, to an extent greater than previous years and the general
population (Chan, Chiu, Lam, Leung, & Conwell, 2006). SARS-
related suicides were found to be related to fears surrounding
perceived burdensomeness, including subjecting others to the ill-
ness (Yip, Cheung, Chau, & Law, 2010). The experiences of
quarantining, witnessing traumatic events, and fear of risk were
associated with elevated depressive symptoms over the course of
the subsequent 3 years (Liu et al., 2012). The 2011 earthquake and
nuclear disaster in Fukushima, Japan, was met with an increase in
suicides compared with overall rates in Japan, with many of these
individuals beginning psychiatric treatment prior to their suicides
(Takebayashi, Hoshino, Kunii, Niwa, & Maeda, 2020).
From 2012 through 2016, the United States observed an average
annual increase of 1,090.5 suicide deaths (Drapeau & McIntosh,
2015a, 2015b, 2015c, 2016). If this average change in crude
suicide deaths carried over time, at that time, we would have
expected there to be 49,324 suicide deaths in 2020. However,
according to the American Association of Suicidology (Drapeau &
McIntosh, 2018, 2020), both 2017 and 2018 have already exceeded
these annual increase estimates by 1,120.5 and 1,201, respectively.
Essentially, increases in suicide deaths in the most recent years
have more than doubled the average increase from 2012 through
2016. From 2016 through 2018, the average rate change was 1,691
and suggests that suicide deaths in 2020, if this trend remains
relatively consistent, will equate to 51,726 —a 27.4% increase
since 2012. These rates, however, are seemingly unpredictable at
present and may continue to rise beyond our expectations.

S118
 WHAT LIES AHEAD
Currently we have individuals who are social distancing within
homes of domestic violence, risking the safety and overall well-
being of victims (Pico-Alfonso et al., 2006). Individuals who
already experience substantial trait anxiety are disadvantaged be-
cause even an ongoing state of anxiety in the context of financial
uncertainty can create tremendous issues in the long term. Poten-
tiation of the systems that keep fear and anxiety levels high occurs
when certainty is lacking and individuals are unable to cope with
that uncertainty. It is important now, more than ever, that we
prepare for not only what may lie ahead but also what is currently
noticeable. Socioeconomic effects and other inequities on suicide
risk are well documented—We now know that many individuals
cannot work remotely and may not be getting paid; we know that
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
those who can work are in fear of losing that ability. Those who are
This document is copyrighted by the American Psychological Association or one of its allied publishers.
working their same jobs at grocery stores are in fear of a serious,
life-threatening condition but need to earn money to support them-
selves and their families. This is a breeding ground for suicide
risk—viral shedding of COVID-19 in survivors has been observed
at approximately 22 days (Zhou et al., 2020), but we simply cannot
shed or forget about the long-term psychological consequences
that reside within the brain.
With the introduction of COVID-19 across the globe, people are
experiencing increased anxiety and mood disturbances and greater
difficulty in receiving care in the wake of a different, infectious
disease pandemic. Socioeconomic status and social isolation are
strong predictors of suicidality and could certainly result in spikes
at this time (Kim, Kim, Choi, Lee, & Park, 2016; Näher, Rummel-
Kluge, & Hegerl, 2020). Whereas suicide has remained the tenth-
leading cause of death in the United States, it may very well soon
rank above deaths caused by kidney disease and possibly other
conditions (Drapeau & McIntosh, 2020). It would behoove the
science community to consider the significant ramifications of
such a problematic state of affairs and its psychological and
behavioral manifestations. Given what we already know, we
should prepare for high demand for mental health treatment as well
as preemptive screening. We can no longer rely on ineffective
primary prevention strategies—Secondary and tertiary prevention
methods will be critical to getting people into treatment. As a
public health crisis, it is our moral responsibility to not only make
this pandemic known to the public but also seek to help those who
may need it. Without these efforts, our field will be as unprepared
for the consequences as the world was for COVID-19.
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Received April 28, 2020
Accepted April 29, 2020 䡲