@article{ref1,
title="Pandemics and social cohesion: 1918-1920 influenza pandemic and the reduction in US suicide rates",
journal="Primary care companion to CNS disorders",
year="2021",
author="Bastiampillai, Tarun and Allison, Stephen and Brailey, Jonathan and Ma, Mandy and Wa, Sherry Kit and Looi, Jeffrey C. L.",
volume="23",
number="3",
pages="-",
abstract="The coronavirus disease 2019 (COVID-19) pandemic may increase US suicide rates due to the combined impact of high COVID-19-related mortality, acute recession, income shock, bankruptcy, decline in asset values, loss of savings, rising unemployment, job stress and insecurity, social isolation, barriers to accessing treatment, increased population distress and anxiety, and increased alcohol misuse.1,2 There is some suggestion that previous epidemics may have increased suicide rates in Hong Kong (severe acute respiratory syndrome epidemic) and in the United States (influenza pandemic: 1918-1920).3,4  However, increased social cohesion through shared experience in disasters (ie, a &quot;pulling-together effect&quot;) may mitigate the negative impact of COVID-19 on suicide rates.2 Durkheim5 hypothesized that greater social integration protects against suicide, and these protective effects may become evident during the community-wide responses to COVID-19. <br><br>FINDINGS from the last influenza pandemic between 1918 and 1920 suggest that Durkheim's hypothesis could be correct for pandemics: US suicide rates fell during this influenza pandemic, only increasing during a subsequent economic downturn.   The 1918-1920 influenza pandemic killed 1%-2.7% of the world's population, reducing US life expectancy by 13%, with 0.51% of the US population dying due to the Spanish flu.6,7 Analysis of the health and economic effects of the 1918-1920 influenza pandemic and impact on US suicide rates may help predict these corresponding effects of COVID-19.   US age-standardized suicide rates (Figure 1) during the pandemic (1918-1920) averaged 14.7 per 100,000, which were 24% lower than suicide rates between 1909 and 1917 (19.3 per 100,000).8,9 Male and female suicide rates declined by 26% and 12%, respectively, during this period.8,9 Following the pandemic (1921-1929), suicide rates increased by 12%, with male suicide rates increasing by 16% and female suicide rates declining slightly by 3%.8,9 Our results differ from those of Wasserman,3 which suggested an increase in US suicide rates during the first influenza wave (1918) followed by a decrease in suicide rates during the second influenza wave (1919-1920). However our data obtained from the US Centers for Disease Control and Prevention (CDC) showed a reduction of US suicide rates throughout each year of the pandemic compared to the baseline period...<p /> <p>Language: en</p>",
language="en",
issn="2155-7772",
doi="10.4088/PCC.20com02882",
url="http://dx.doi.org/10.4088/PCC.20com02882"
}