Background : In Switzerland, since the 2000s, the unassisted suicide rates have been steadily falling, while the assisted suicide rates have been rising. However, suicides are distributed differently according to sex and age, with a predominance of men concerning unassisted suicides and elderly women concerning assisted suicides. The COVID-19 pandemic has had far-reaching effects at many levels (economic, social, health), and its impact on factors influencing mental health has been studied in depth in many countries, including Switzerland. Overall, studies have shown a decrease or no change in unassisted suicide rates in many countries. With regard to assisted suicides, right to die association (EXIT Suisse romande) has had to slow down its activities from March to May 2020, with an increase in assisted suicides in 2020 and 2021. However, there is little research on the impact of COVID-19 on assisted suicides. In this context, we sought to estimate the impact of COVID-19 on suicide rates by examining the monthly evolution of women and men deaths by assisted and unassisted suicide in the French-speaking cantons of Switzerland from 2017 to 2021 and relating them to the COVID Stringency Index.
Methods : This study was carried out with the collaboration of the “Centre universitaire romand de médecine légale” (CURML). Regarding assisted suicides, we used data for the cantons of Vaud, Geneva and Fribourg (n=1280) between January 01, 2017 and December 31, 2021. Regarding unassisted suicides, we were only able to use data from the canton of Vaud between January 01, 2017 and August 31, 2021 (n=535). We also used the Stringency index which measures the level of lockdown policies in time between each canton. The values range from 0 (=no measures) to 100 (=full lockdown). First, we performed a descriptive analysis. Then, autoregressive integrated moving average (ARIMA) time series analyses were performed on the monthly suicide rate separately for both type of suicides for each sex. Three separate models were fitted for assisted suicides and unassisted suicides and for men and women.
Results : Regarding assisted suicides, among women, we found a significant negative association between the stringency index and assisted suicide rates meaning that when the stringency index increased there was a decrease in assisted suicide rates. Among men, the "ramp" effect of COVID-19 was positive and significant, indicating a gradual monthly increase in assisted suicide rates starting from the onset of COVID-19. Regarding unassisted suicides, no significant associations were found among women. Among men, the “step” effect of COVID-19 was negative and significant indicating that there was a decrease in unassisted suicide rates between the pre-COVID-19 period and the post-COVID-19 period. The “ramp” effect of COVID-19 was negative and significative as well, indicating a gradual monthly decrease in unassisted suicide rates.
Discussion : The drop in unassisted suicides levels in men is in line with previous studies. In contrast, we were surprised not to find the same effect in women. This could be due either to our low statistical power or the fact that unassisted suicide rates among women have fallen less than among men, could suggest that women are more socially and economically impacted by the pandemic. As for assisted suicides, they have increased among men but not among women, and this raises questions. One explanation could be the marked vulnerability of older men during the pandemic. The drop in assisted suicides among women during the period of severe restrictions may be explained by the slowdown in EXIT Suisse romande's activities. What is less understandable is the difference in these results by gender. The pandemic may have accentuated inequalities in access to care, but also to right to die associations .