COVID-19 outbreak and suicides in Nepal: Urgency of immediate action

Abstract

Globally, COVID-19 pandemic has severely affected the socio-economic and mental health status of people. The most common mental disorders are low mood, irritability, stress, insomnia, emotional exhaustion, anger, depression and posttraumatic stress symptoms. While the COVID-19 outbreak likely to bring both short-term & long-term mental health problems, the currently existing research works findings only focusing on immediate mental health issues urges more in-depth studies on COVID-19 and mental health (Marahatta et al., 2020; World Health Organization [WHO], 2020).

The first COVID-19 case in Nepal was on January 30, 2020 (Bastola et al., 2020; Ministry of Health and Population [MoHP], 2020). The latest statistics on COVID-19 in Nepal shows a total of 48,138 cases as of September 09, 2020, with 306 deaths. To control and prevent the further spread, a nationwide full lockdown in Nepal came into effect on March 24 and extended until September 2020 (MoHP, 2020). According to World Health Organ-ization (WHO), there will be high possibilities of an increase in stress, anxiety, behavioral changes, loneliness, depression and suicidal activities due to the COVID-19 pandemic (WHO, 2020). Statistics from Nepal Central Police Bureau, it has been reported that nationwide 1,647 individuals (almost 25% rise as compared to suicides rate on the same period in the previous year) have committed suicide during lockdown with an average of 18 suicide cases per day (My Republica, 2020; Rising Nepal Daily, 2020; The New Indian Press, 2020).

COVID-19 outbreak and nationwide lockdown striking directly on the mental health of people and arising new issues while magnifying the pre-existing problems. Nationwide 1,233 suicides were reported from April 2020 to mid of July 2020 in the police stations of the country against 414 suicide cases during February and March 2020. Statistics showed that on average 414 people committed suicide before the COVID-19 outbreak but the number of suicide cases reached 559 per month after the COVID-19 outbreak & lockdown. Out of the suicide cases, 1,282 individuals died by hanging themselves and 365 individuals committed suicide by consuming poison. In the capital city, Kathmandu 89 people committed suicide. Based on the report, the major ways of committing suicides were found to be stabbing, burning, jumping from the heights, drowning during the lockdown period due to the COVID-19 pandemic (Kantipur News Daily, 2020; MoHP, 2020; My Republica, 2020; Rising Nepal Daily, 2020).

The suicide case from the village where a 36-years-old man hanged himself because of village people and he thought that he has been infected with COVID-19 based on the symptoms but later the corona test showed that the victim was found to be negative. A similar case was reported where the victim, returning from India also committed suicide by hanging himself to avoid the spread of the Coronavirus to other people of the village. A 38-years-old woman whose husband lost the job because of the nationwide lockdown was also found with the suicidal case due to the high stress and depression (MoHP, 2020; My Republica, 2020).

During the first 74 days of the lockdown in Nepal, people committing suicide across the nation compared with all of last year is relatively high. Based on the doctors of the health facilities of Nepal, no of psychologically disorders cases and mental health issues such as schizophrenia, depression, anxiety, insomnia, Post Traumatic Stress Disorder and self-harm tends to increase with the significant rate of 3%–5% (MoHP, 2020; Rising Nepal Daily, 2020).

The unexpected outbreak of the COVID-19 pandemic calls for the immediate and urgent actions by increasing the potential investment in mental healthcare services to tackle with the risk of a massive upsurge in mental health conditions of each people across the whole country shortly (Marahatta et al., 2020; Shah et al., 2020). Stress, Depression, Fear, misconceptions, unemployment, lack of support from the community people regarding COVID-19 among poorly educated people contributing to increased suicide rates in Nepal. This situation is worse in the remote part of Nepal where still lacks adequate information about the COVID-19. Therefore, it is highly important and crucial to strengthen and consider the psychological and mental health measures during the lockdown period with public awareness about COVID-19 facts for the effective control and avoidance of psychological disorders leading towards suicide (Lee, 2020; MoHP, 2020; Rising Nepal Daily, 2020).

People across the whole nation have been facing severe financial problems because of job loss and continuous long-term lockdown for the almost 4-months period (Kar et al., 2020; Lee, 2020). The fear and anxiety of getting infected with COVID-19 are one of the key reasons for worries and anxiousness among the people about the global pandemic (Lee, 2020). This will lead to more anxiety and depression in the public which may trigger the more suicidal events in the coming days. In Nepal, mental health problems and psychosocial disorders have always been considered as a social stigma. It is unacceptable to the society and even within the family if any of the individuals having a difficult period, depressed, shares about suicidal feelings & quitting his life. People with the low economic condition are more vulnerable to mental health disorders in Nepal (Kar et al., 2020; Lee, 2020; MoHP, 2020).

Government officials of Nepal stated that they are known about the risks to the mental health of the people and initiating the countermeasures for reducing the suicide cases efficiently. Helpline services from the government & non-government agencies to provide sufficient mental healthcare counseling has been recently initiated to overcome this situation (MoHP, 2020). The situation where all of the healthcare facilities and government officials within the country are being entirely focused on COVID-19 pandemic control through various preventive programs and strategies, very low attention and priority have given to the mental health status of people who are extremely worried and panicked of COVID-19 infection. Research studies indicate that mental health conditions of those with pre-existing mental health illnesses can be more worsen due to this sudden outbreak. Irregular social, recreational activities, and staying home for a long period have significantly impacted the emotional and mental wellbeing of the people (Ho et al., 2020).

The Ministry of Health and Population of Nepal implemented various public health measures (social distancing, hand washing and sanitizers, proper use of masks, mass awareness) and promotion through media, audiovisual advertisements, radio programs, Information Education and Communication (IEC) materials distribution, and strict domestic travel with full precautions policies. The government also initiated the COVID-19 health insurance policy via various government and private health insurance companies (Insurance signup with per individual 10$ and per family member 6$ with benefits of 1,000$ to infected person for the treatment) for all people for better treatment and to reduce the anxiety among the people due to the financial burden for hospital expenses. A mobile health application (Hamro Swasthya), web portal (covid19.mohp.gov.np) and hotline numbers for COVID-19 were launched from the Department of Health and Population, Government of Nepal. Furthermore, various IEC materials information was disseminated to provide a proper understanding of the COVID-19 transmission among the citizens (Government of Nepal HEOC, 2020).

The Government of Nepal has introduced the 6T approach: Strict traveling, treatment, testing, tracing and togetherness for controlling the COVID-19. The MoHP also introduced the COVID-19 funds to help and support to the families having difficulty to access daily food and basic health needs. There have been altogether 40 laboratories in seven provinces for the early and rapid diagnosis of the COVID-19 (Government of Nepal HEOC, 2020). The government lacking in dealing with the psychological impact due to COVID-19, the situation can be worst in the future. Studies have shown that more than 90% of the research participants perceived the anxiety and stress level moderate to severe high duet to the pandemic (Shah et al., 2020). This can probably lead to more suicide cases in the country in the coming days if not proper interventions were implemented immediately.

Conclusion & future aspects

Public movement restriction due to the nationwide lockdown in Nepal has significantly contributed on provoking the mental health, whereas individuals with pre-existing mental health disorders were unable to receive proper counseling services, as all of the mental health doctors have requested and informed to the patients not to visit any healthcare facilities unless if an emergency case. Suicide is a major public health concern in Nepal. Besides the lack of proper national data on suicide in Nepal, the available information & evidence shows that suicide rates are relatively higher as compare to the past years.

Due to the limited and in-depth research focusing on the mental health problems during the period of the COVID-19 pandemic in the developing countries, each day suicide cases extend to the peak point. Proper understanding of the mental state along with COVID-19 perspectives and relevant measures for coping with this pandemic through effective management is an urgent need. Prolonged isolation, strict lockdown lack of available recreational opportunities for citizens and growing economic burden will accelerate mental health issues like suicide, depression and prolonged psychological disorders. There is the necessity of a greater level understanding of mental healthcare with COVID-19, the public people, health professionals and mass media dealing with COVID-19.

Social distancing has been the most effective way for infection control. The government should do adequate preparation and plan for the effective implementation of public measures focusing on mental health, social inequality, poverty due to continuous lockdown in this emergency situation. The central government should coordinate with all of the grassroots levels of the health system, local government and media for the promotion of the mental health status of the people.

Evidence-based research works during the COVID-19 pandemic should be conducted & considered through various efficient and feasible online psychological and therapeutic interventional programs globally focusing in the low-middle developing and income countries to reduce the cases of suicide.

Limitation & implication of the study

This paper is a commentary article urging the call for action towards the upsurge of suicide cases during the COVID-19 outbreak period in Nepal. All the data and information collected about the suicide cases were from the secondary data sources. The current situation shows the challenges for the availability of medical supplies and testing kits for COVID-19. Though the government has been implemented the health workforce mainly focusing on the control of the infection, the other aspects (i.e. mental health impacts) have not been still considered properly. The government and respective authorities have been only focusing on the treatment of cases, other public health issues have been neglected and being ignored. Our paper aims to provide the current situation of suicide statistics during the COVID-19 pandemic period, so that respective authorities will implement the proper measures to reduce the suicides throughout the country. Thus, a more in-depth research is highly recommended in mental health impact due to the COVID-19 outbreak.

Footnotes

Authors contributions

Shiva Raj Acharya has designed the study, information collection, editing & paper writing. Deog Hwan Moon and Yong Chul Shin has performed review and supervision.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Shiva Raj Acharya

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