key: cord-258126-8ityzjjh
authors: Mamun, Mohammed A.; Ullah, Irfan
title: COVID-19 suicides in Pakistan, dying off not COVID-19 fear but poverty? – The forthcoming economic challenges for a developing country
date: 2020-05-11
journal: Brain Behav Immun
DOI: 10.1016/j.bbi.2020.05.028
sha: 
doc_id: 258126
cord_uid: 8ityzjjh

• Suicide increment during and afterwards a pandemic is highly common. • This study reports COVID-19 suicide cases in Pakistan for the first time. • Most of the suicides occur due to lockdown-related economic recession. • Fear of infection is the second suicide contributing factor. • Lockdown-related unemployment aggravates the life-threatening situation.

The coronavirus disease (COVID-19) pandemic has created a major mental health challenge throughout the world . Like the previous pandemics, the unimaginable mental sufferings such as depression, panic, trauma, adjustment disorder, etc. are reported in general people as well as healthcare professionals (Ahorsu et al., 2020; Frank et al., 2020; Jahanshahi et al., 2020; Montemurro, 2020) . These psychiatric sufferings are also accounted for about 90% of the global suicide occurrences in the extreme cases . Thus, suicide rate increment during and afterwards a pandemic is not highly unexpected, but more common. For instance, the COVID-19 fear leads to suicide completion that is reported in Pakistan's neighborhood countries like Bangladesh, India (e.g., Goyal et al., 2020; . Besides, another non-representative study utilizing only 7-cases claims that the global COVID-19 suicide risk factors to be -(i) social isolation and distancing, (ii) economic recession, (iii) mental problems among healthcare professional, and (iv) social boycott and discrimination etc. (Thakur & Jain, 2020) . The study is not representative as of it does not consider the COVID-19 suicide cases based on either global or a representative country.

Hence, the conclusion of the global COVID-19 risk factors is arguably limited by selecting one suicide case for each causality, that also limits in overrating the prominent risk factors more generally in the crisis time. Besides, the decreasing of German Finance Minister is reported for economic recession suicide case rather than considering the general economic recession victims, that is totally unable to convey the evidence of lockdown-related economic recession suicides among the general people (Thakur & Jain, 2020) . These non-representative and selective findings lead us to investigate the actual COVID-19 suicide causalities by considering all the COVID-19 suicide cases from a developing country (e.g., Pakistan).

Like the previous retrospective suicide researches conducted in the Pakistan's neighborhood south Asian countries (e.g., India, Armstrong et al., 2019; Bangladesh, Mamun et al., 2020a, b) where the national suicide database is unavailable, the present study followed the methods of extracting suicide data from press reports. Since January 2020, a total 29 suicide cases were P a g e | 3

reported in Pakistani press media (i.e., news reports in both English and Urdu languages). Of these, 16 suicidality cases (i.e., 12 completions and four attempts) were directly related to COVID-19 issues and were included in this study. About 12 were males,13 victims had suffered from economic recession and only three were feared of COVID-19 infection (Table 1) .

Based on the aforementioned COVID-19 suicide cases, it is clear evident that most of the Pakistani cases occur due to the lockdown-related economic recession. Although previous case studies from the Pakistan neighborhood countries, such as in Bangladesh and in India, COVID-19 suicides are reported to be due to fear of infection and social boycott (Goyal et al., 2020; Mamun & Griffiths, 2020) . Besides, social isolation and distancing and economic recession are also reported for suicide causality in another non-representative study (Thakur & Jain, 2020) . However, the present study provides an actual COVID-19 suicides figure on economic recession in general people more rigorously that is not reported in the previous study by Thakur and Jain (2020) .

The economic recession is defined as the contractions within an economic cycle, which reduces the economic productivity that is usually measured by gross domestic product and unemployment rate (Oyesanya et al., 2015) . Any destructions in economic cycle leads to lower gross domestic product and higher unemployment rates in a country. The economic recessions are estimated to affect significantly on the people mental health and wellbeing by magnitude the relative and attributable risks. Research indicates a significant adverse effect of job loss and unemployment on mental health sufferings like depression, anxiety, stress etc. (Rafi et al., 2019) , which act as the mediators of suicide attempt and completion .

Based on a systematic review, 31 global studies exhibit a positive association between economic recession and increased suicide rates (Oyesanya et al., 2015) . However, the present findings also support the previous literatures of increasing suicide rates during the financial crisis and economic constraints in the lockdown.

The COVID-19 crisis threatens to excessively by hitting undeveloped and developing countries like Pakistan, not only as a public health crisis in the short term but as a devastating economic and social crisis over months and years to come. For instance, $220 billion income losses are expected in developing countries according to the United Nations Development Program (UNDP, 2020) . For the Pakistani economy, was projected by the Asian Development Bank to decrease by 3.3% in 2019 to 2.6 % by 2020, and this inflation likely to persist around 11.5% for insecurity and unceasing natural and manmade disasters etc. The country has a 24% of the total population living below the national poverty line and 38.8% are poor based on the Multidimensional Poverty Index (Humanitarian Response, 2019). This nastiest situation is also reflected in food security as a bleak picture. For instance, 20.5% of the total population is reported to be undernourished during the 2015-2017 time-period according to a recent report (Humanitarian Response, 2019) . Thus, the COVID-19 lockdown is a tough choice for a country like Pakistan as a large number of poor people will be starving to death.

The present suicide reports from Pakistan are not only tensing the country, but also rising concerns for other underdeveloped and developing countries around the world. Globally 55% of the people are estimated to have no proper social protection, these losses will reverberate through societies, will impact on education system, human rights as well as basic food security and nutrition in the most extreme cases (UNDP, 2020) . At the COVID-19 pandemic time, such statistics alarms for the uprising unemployment status, poverty and starvation in the months to come, which are the mental health sufferings (as well as suicide completion, in the extreme cases) driving factors. But, we have no estimations on -how many periods the COVID-19 pandemic will persist, how many people have to starve, how many lives to sacrifice, and what will be the end of this crisis . However, the national and international authorities should focus on and support the unprivileged people for voluntary basis.

Besides, no interest and optional moratorium on EMIs loans can be provided for reducing the financial recessions and burdens if the free succors are not possible with the worldwide limited resources. Lastly, the all types previous loans should permit to grant a moratorium up to the end of COVID-19 pandemic in combating the economic recession.

The study can be limited due to not documenting all the suicide cases in Pakistani press media, because of suicide being crime and related to social issues (i.e., fear of harassment, stigma and taboos, complicated legal proceedings etc.) in the country under the Penal Code -Article section 325. Despite the limitations, the present study by reporting all the available Pakistani COVID-19 suicide cases, provides a novel data on lockdown-related economic crisis and recession that has not studied elsewhere. And it is anticipated that the present findings will be helpful in safeguarding the unprivileged people by turning national and international authority's attentions. 

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