Aims: To investigate the prevalence of suicidal thoughts and behaviors (STB;i e , suicidal ideation, plans or attempts) in the Spanish adult general population during the first wave of the Spain COVID-19 pandemic (March-July, 2020), and to investigate the individual- and population-level impact of relevant distal and proximal STB risk factor domains Methods: Cross-sectional study design using data from the baseline assessment of an observational cohort study (MIND/COVID project) A nationally representative sample of 3,500 non-institutionalized Spanish adults (51 5% female;mean age=49 6 [SD = 17 0]) was taken using dual-frame random digit dialing, stratified for age, sex, and geographical area Professional interviewers carried out computer-assisted telephone interviews (June 1-30, 2020) Thirty-day STB was assessed using modified items from the Columbia Suicide Severity Rating Scale Distal (i e , pre-pandemic) risk factors included sociodemographic variables, number of physical health conditions, and pre-pandemic lifetime mental disorders;proximal (i e , pandemic) risk factors included current mental disorders and a range of adverse events-experiences related to the pandemic Logistic regression was used to investigate individual-level associations (odds ratios [OR]) and population-level associations (population attributable risk proportions [PARP]) between risk factors and thirty-day STB All data were weighted using post-stratification survey weights Results: Estimated prevalence of thirty-day STB was 4 5% (1 8% active suicidal ideation;n=5 [0 1%] suicide attempts) STB was 9 7% among the 34 3% of respondents with pre-pandemic lifetime mental disorders, and 1 8% among the 65 7% without any pre-pandemic lifetime mental disorder Factors significantly associated with STB were pre-pandemic lifetime mental disorders (total PARP=49 1%) and current mental disorders (total PARP=58 4%), i e , Major Depressive Disorder (OR=6 0;PARP=39 2%), Generalized Anxiety Disorder (OR=5 6;PARP=36 3%), Post-Traumatic Stress Disorder (OR=4 6;PARP=26 6%), Panic Attacks (OR=6 7;PARP=36 6%), and Alcohol/Substance Use Disorder (OR=3 3;PARP=5 9%) Pandemic-related adverse events-experiences associated with STB were lack of social support, interpersonal stress, stress about personal health and about the health of loved ones (PARPs 32 7-42 6%%), and having loved ones infected with COVID-19 (OR=1 7;PARP=18 8%) Up to 74 1% of STB is potentially attributable to the joint effects of mental disorders and adverse events-experiences related to the pandemic Conclusions: STB at the end of the first wave of the Spain COVID-19 pandemic was high, and large proportions of STB are potentially attributable to mental disorders and adverse events-experiences related to the pandemic, including health-related stress, lack of social support and interpersonal stress There is an urgent need to allocate resources to increase access to adequate mental healthcare, even in times of healthcare system overload © 2021 CSIRO All rights reserved
Thirty-day suicidal thoughts and behaviors in the spanish adult general population during the first wave of the Spain COVID-19 pandemic