Economic precarity, social isolation, and suicidal ideation during the COVID-19 pandemic

ImportanceThe US population faces stressors associated with suicide brought on by the COVID-19 pandemic. Understanding the relationship between stressors and suicidal ideation may inform policies and programs to prevent suicide. ObjectiveTo evaluate the relationship between stressors and suicidal ideation during the COVID-19 pandemic. DesignWe compared suicidal ideation in 2017-2018 to suicidal ideation in 2020. We estimated the association between stressors and suicidal ideation in bivariable and multivariable Poisson regression models with robust variance. SettingUnited States ParticipantsParticipants were from two, nationally representative surveys of US adults: The 2017-2017 National Health and Nutrition Examination Survey and the 2020 COVID-19 and Life Stressors Impact on Mental Health and Well-being study (conducted March 31 to April 13), analyzed April 28 to September 30, 2020. ExposuresEconomic precarity as measured through job loss or difficulty paying rent and social isolation based on reporting "feeling alone." Main outcome measureSuicidal ideation based on reporting "Thoughts that you would be better off dead or of hurting yourself in some way" over the past two weeks. ResultsSuicidal ideation increased more than fourfold, from 3.4% in the 2017-2018 NHANES to 16.3% in the 2020 CLIMB survey, and from 5.8% to 26.4% among participants in low-income households. Suicidal ideation was more prevalent among people facing difficulty paying rent (31.5%), job loss (24.1%), and loneliness (25.1%), with each stressor associated with suicidal ideation in bivariable models. In the multivariable model, difficulty paying rent was associated with suicidal ideation (aPR: 1.5, 95% CI: 1.2 to 2.1), while losing a job was not (aPR: 0.9, 95% CI: 0.6 to 1.2). Feeling alone was associated with suicidal ideation (aPR: 1.9, 95% CI: 1.5 to 2.4). Conclusions and relevanceSuicidal ideation increased more than fourfold during the COVID-19 pandemic. Difficulty paying rent and loneliness were most associated with suicidal ideation. Policies and programs to support people experiencing economic precarity and loneliness may contribute to suicide prevention.