What Happens When Two Public Health Crises Collide? Suicide and COVID-19: What do we know?

The COVID-19 pandemic brought to the forefront the many health disparities experienced by American Indians and Alaska Natives (AI/AN). Tribal communities have been disproportionately impacted by the pandemic, which has made apparent the inequities facing AI/AN people and Indian health care providers. It has not only created new burdens in Tribal communities but has exacerbated existing health concerns–particularly those regarding behavioral and mental health.[1]

Over the course of the pandemic, many have faced and are currently facing feelings of stress, worry, fear, anger, and frustration. Public health measures such as physical (social) distancing have increased these feelings as well as contributed to making people feel isolated or alone. These emotions can be overwhelming for adults and children. While physical distance is necessary to reduce the spread of COVID-19, it may also impact suicide risk, which is concerning for Tribal communities that may already experience high suicide rates. Suicide is the tenth leading cause of death in the United States; however, among racial/ethnic groups AI/AN people have the highest suicide rates[2] and this rate has been consistently high over the years.[3] Among AI/AN youth, suicide is the second leading cause of death. Factors that protect AI/AN youth and young adults against suicidal ideations and behaviors–such as a sense of belonging to one’s culture, a strong Tribal/spiritual bond, and feeling connected to family and community– have become difficult to maintain during the pandemic[4] leading to some professionals’ increased concerns that suicides may increase.

There is limited data on the link between the COVID-19 pandemic and an increase in suicides. Data from previous studies suggest that emergencies such as epidemics are associated with a rise in suicides.[5]  A recently published study found an increase in suicidal ideation among youth during certain months throughout the current pandemic.[6]  Research has also shown that young adults, racial/ethnic minorities, essential workers, and unpaid caregivers have disproportionately suffered adverse mental health outcomes, increased substance use, and increased suicide ideation during late June 2020.[7]  This data, despite its limitations, highlights the need to continue to take steps to help mitigate mental and behavioral health consequences associated with COVID-19 and to help people cope with the complex emotions felt over the past year which they may continue to feel. These mitigation efforts can range from maintaining connections virtually to seeking professional assistance using telebehavioral health services. Many Tribes and Tribal organizations have hosted virtual gatherings and encouraged their communities to stay connected via phone or video.

COVID-19 vaccines may provide “a light at the end of the tunnel,” but it is important to continue offering services and tips to help Tribal communities cope with stressors from the COVID-19 pandemic. If you or someone you know is experiencing emotional stress, there are places that can help.

  • Texting services are available through the Crisis Text Line by texting NATIVE to 741741 to be connected to a trained Crisis Counselor.
  • The National Disaster Distress Helpline is available to anyone experiencing emotional distress related to COVID-19. Call 1-800-985-5990 or text TalkWithUs to 66746 to speak to a caring counselor.
  • The National Suicide Prevention Lifeline at 1-800-273-8255 or your local crisis line.
  • For coping tools and resources, visit the Lifeline website at suicidepreventionlifeline.org or Vibrant Emotional Health’s Safe Space at vibrant.org/safespace.

[1] Centers for Disease Control and Prevention. COVID-19 Data Visualization. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html

[2] Stone DM, Jones CM, Mack KA. Changes in Suicide Rates — United States, 2018–2019. MMWR Morbidity & Mortal Weekly Report 2021;70:261–268. DOI: http://dx.doi.org/10.15585/mmwr.mm7008a1external icon

[3] Leavitt RA, Ertl A, Sheats K, Petrosky E, Ivey-Stephenson A, Fowler KA. Suicides Among American Indian/Alaska Natives — National Violent Death Reporting System, 18 States, 2003–2014. MMWR Morbidity & Mortal Weekly Rep 2018;67:237–242. DOI: http://dx.doi.org/10.15585/mmwr.mm6708a1external icon

[4] Indian Health Service. Suicide Prevention and Care Program. https://www.ihs.gov/suicideprevention/

[5] John A, Pirkis J, Gunnell D, Appleby L, Morrissey J. Trends in suicide during the covid-19 pandemic BMJ 2020; 371 :m4352 DOI: http://doi:10.1136/bmj.m4352

[6] Hill, R. M., Rufino, K., Kurian, S., Saxena, J., Saxena, K., & Williams, L. (2021, March). Suicide Ideation and Attempts in a Pediatric Emergency Department Before and During COVID-19. Pediatrics, 147(3). DOI: https://doi.org/10.1542/peds.2020-029280

[7] Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1