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The Spanish Flu pandemic and stable New Zealand suicide rates: historical lessons for COVID-19.

There were initial concerns that the COVID-19 pandemic might significantly increase worldwide suicide rates, due to the combined effects of economic recession, rising unemployment, job insecurity, income shock, social isolation, possible barriers to receiving mental health treatment, increased alcohol use, strained relationships, increased levels of national anxiety and distress.1,2 Also, if the COVID-19 pandemic were to trigger another 1929–1930s “Great Depression” and raise unemployment by potentially 15–20%, suicide rates could increase by at least 15%, with working age men being the highest risk group.1 Stuckler et al3 reported that within European Union countries between 1970 and 2007, every 1% increase in unemployment rate was associated with a 0.79% increase in suicide rate for those aged under 65. Pirkis et al4 recently published the early impacts of the COVID-19 pandemic on suicide rates in mainly high-income and upper middle-income countries. They found that suicide rates were either stable or reduced compared with the pre-pandemic period. Pirkis et al also analysed New Zealand suicide rates during the COVID-19 pandemic and found that there was a statistically significant decrease in New Zealand suicide rates in both primary analysis between 1 April and 31 July 2020 (rate ratio: 0·79; 95% CI: 0·68−0·91) and sensitivity analysis between 1 April and 31 October 2020 (rate ratio: 0.81; 95% CI: 0.72–0.90), compared with the pre-pandemic period.4 In the context of the unexpected fall in New Zealand suicide rates during the COVID-19 pandemic, we have investigated whether the early phase of a previous pandemic—the “Spanish Flu” pandemic of 1918–1920—was associated with decreased New Zealand suicide rates. If so, we hypothesise that the longer-term effects of the Spanish Flu pandemic on New Zealand suicide rates might be indicative of the longer-term effects of the COVID-19 pandemic on future New Zealand suicide rates. The Spanish Flu (1918–1920) killed 40 million people worldwide (ie, 2.1% of the world population), equivalent to 150 million deaths at current world population levels.5 The significant estimated flu-generated worldwide gross domestic product (GDP) decline was c.6–8%.5 The Spanish Flu was also New Zealand’s most severe disaster event and is estimated to have killed 9,000 people.6