Police-reported suicides during the first 16 months of the COVID-19 pandemic in Ecuador: A time-series analysis of trends and risk factors until June 2021.

Background: There are widespread concerns that the COVID-19 pandemic may increase suicides. Few studies have analysed effects beyond the pandemic's early months or examined changes in known suicide risk factors. Methods: Using time series models fit with Poisson regression, we analysed monthly police-reported suicides in Ecuador from January 2015 to June 2021. Treating March 2020 as the start of the pandemic, we calculated rate ratios (RRs) comparing the observed to the expected number of suicides for the total population and by age and sex groups. We investigated changes in risk factors, precipitants, geographic distribution, and suicide methods. Findings: There was no evidence that suicide rates were higher than expected during the pandemic (RR 0·97 [95% CI 0·92-1·02]). There was some evidence of fewer than expected male suicides (RR 0·95 [95% CI 0·90-1·00]). The proportion of suicides occurring in urban and coastal areas increased but decreased amongst indigenous and other minorities. The proportions of suicides with evidence of alcohol consumption, disability, and amongst married and cohabiting individuals decreased, whereas suicides where mental health problems were considered contributory increased. There were relative increases in the proportion of suicides by hanging but decreases in self-poisoning and other suicide methods. Interpretation: The pandemic did not appear to adversely impact overall suicide numbers nationwide during the first 16 months of the pandemic. Reduced alcohol consumption may have contributed to the decline in male suicides. Funding: None.

Sociodemographic Analysis of Suicide Rates Among Older Adults Living in Ecuador: 1997-2019.

Background: Despite most suicides occurring in low-and-middle-income countries (LAMICs), limited reports on suicide rates in older adults among LAMICs are available. In Ecuador, high suicide rates have been reported among adolescents. Little is known about the epidemiology of suicides among older adults in Ecuador. Aim: To examine the sociodemographic characteristics of suicides among older adults living in Ecuador from 1997 to 2019. Methods: An observational study was conducted using Ecuador's National Institute of Census and Statistics database from 1997 to 2019 in Ecuadorians aged 60 and older. International Classification of Diseases 10th Revision (ICD-10) (X60-X84)-reported suicide deaths were included in addition to deaths of events of undetermined intent (Y21-Y33). Sex, age, ethnicity, educational level, and method of suicide were analyzed. Annual suicide rates were calculated per 100,000 by age, sex, and method. To examine the trends in rates of suicide, Joinpoint analysis using Poisson log-linear regression was used. Results: Suicide rates of female older adults remained relatively stable between 1997 and 2019 with an average annual percentage increase of 2.4%, while the male rates increased between 2002 and 2009, 2014 and 2016, and maintained relatively stable within the past 3 years (2017-2019). The annual age-adjusted male suicide rate was 29.8 per 100,000, while the female suicide rate was 5.26 per 100,000 during the study period. When adding deaths of undetermined intent, the annual male rate was 60.5 per 100,000, while the same rate was 14.3 for women. The most common suicide method was hanging (55.7%) followed by self-poisoning (26.0%). The highest suicide numbers were reported in urban districts, men, and those with lower education status. Conclusion: This study contributes to building the baseline for further studies on suicide rates of older adults in Ecuador. Results highlight priority areas of suicide prevention. By examining suicide trends over 23 years, findings can help inform policy and future interventions targeting suicide prevention.

Behavioral and sociodemographic predictors of anxiety and depression in patients under epidemiological surveillance for COVID-19 in Ecuador.

Ecuador has been one of the most affected countries by the Corona Virus Disease 19 (COVID-19) pandemic, by April 2020 this country presented the highest rates of mortality in Latin America. The purpose of the present study was to identify behaviors during confinement and sociodemographic variables associated with the mental health status of confirmed or suspected COVID-19 patients who were part of the epidemiological surveillance program in Ecuador that included mandatory confinement and self-isolation. A cross-sectional study was performed from March 22th to April 18th, 2020 using an online survey. The survey collected socio-demographic information and severity of depressive symptoms using the Patient Health Questionnaire-9 and anxiety symptoms through the Generalized Anxiety Disorder-7. A total of 759 patients completed the questionnaire, 20.3% presented moderate to severe symptoms of depression and 22.5% moderate to severe symptoms of anxiety. Being a woman and from the Coastal region were risk factors. Exercising, maintaining daily routines, and keeping informed about the COVID-19 but limiting to an hour was associated with better mental health. Regression analysis indicated that the mentioned behaviors explained approximately 17% of the variance for depression sum scores and 11.8% of the variance for anxiety sum scores while controlling for gender and region. Understanding the association between sociodemographic variables and psychological states in patients with COVID-19 is relevant to tackle future public mental health problems and to implement health policies that are intended to palliate further psychiatric complications. Promotion of modifiable behaviors such as exercising, maintaining daily routines, and keeping informed about the COVID-19 but limiting to less than an hour is recommended.

Earthquake-related stressors associated with suicidality, depression, anxiety and post-traumatic stress in adolescents from Muisne after the earthquake 2016 in Ecuador.

BACKGROUND: The Ecuadorian earthquake in April 16th was the second strongest and deadliest in 2016 worldwide, with approximately one million people affected. In this paper, we analyzed the psychological impact and the relationship between mental health events and various earthquake-related stressors related to the earthquake, 9 months after the event. METHODS: We conducted an analytical cross-sectional study, applying an anonymous survey to 316 adolescents (13-19 years old) from Muisne, Ecuador. Suicidal tendency, depression, anxiety and post-traumatic stress (PTSD) were evaluated via the Child PTSD Symptom Scale (CPSS), Spence Children's Anxiety Scale, Okasha Suicidality Scale, and the Center for Epidemiologic Studies Depression Scale (CES-D) and the adapted seven-questions earthquake-related stressors survey. RESULTS: We found a high prevalence of suicidal ideations and behavior, posttraumatic stress, depression and anxiety compared to international studies. Even though adolescents currently living in shelters had higher levels of anxiety, their suicidal tendency was significantly lower than those living in their own or their relatives' home. Finally, the earthquake-related stressors were not associated with suicidality and mental health events, with the exception of economic damage suffered by the family. CONCLUSIONS: High levels of depression, post-traumatic stress and anxiety among high-school students were found, especially among those who have suffered serious economic damage. The economic impact in their families and high unemployment rates among their parents seems to be related to lack of hope and favorable perspectives for their future, situation that might lead to lead to emotional disturbances and psychological disorders. Although prolonged homelessness experience in shelters may be a stressful occurrence, might also be related with spiritual growth among adolescents, and may work as a protective factor against suicidal ideations and attempts.

Análisis de tendencias temporales del suicidio en niños, adolescentes y adultos jóvenes en Ecuador entre 1990 y 2017 / Trend analysis of suicide among children, adolescent and young adults in Ecuador between 1990 and 2017

Fundamento. Analizar las tendencias temporales de las tasas de suicidio en niños, adolescentes y adultos jóvenes ecuatorianos, según sexo, y describir la evolución de las razones hombre/mujer entre 1990 y 2017. Método. Se emplearon los datos de población y defunciones generales del Instituto Nacional de Estadísticas y Censos de Ecuador para calcular las tasas de suicidio para cada grupo de edad (10-14, 15-19, 20-24 años) y sexo por año. Para estimar las tendencias temporales y los cambios porcentuales anuales (CPA) por edad y sexo se utilizó el Joinpoint Regression Program 4.6.0.2. Resultados. En Ecuador hubo un promedio de 313 suicidios anuales entre 1990 y 2017, con un incremento del 480% en niños, del 322% en niñas, del 111% en adolescentes varones y del 57% en adultos jóvenes, mientras que en las mujeres adolescentes y adultas jóvenes se redujo un 19 y un 37%. Las tasas de suicidio aumentaron anualmente en niños (CPA=5,10%), niñas (2,57%), adolescentes (3,07%) y adultos jóvenes (10,42%) mientras que, trasun máximo alrededor de 2006, disminuyeron para las adolescentes (0,81%, no significativo) y mujeres jóvenes (1,16%). Aunque hasta comienzos de siglo las mujeres adolescentes y jóvenes tuvieron mayores tasas de suicidio, actualmente son más altas para los hombres en todos los grupos de edad (entre 1,5:1 y 4,3:1 en 2017). Conclusiones. El suicidio en población menor de 25 años en Ecuador es un problema destacado de salud pública, y se ha incrementado entre 1990 y 2017, especialmente, entre niños, niñas, y adolescentes y jóvenes de sexo masculino. La estrategia intersectorial propuesta en 2018 para reducir el suicido queda pendiente de evaluación e inferencia

Background. Analyze the long-term sex specific trends in suicide rates for Ecuadorian children, adolescents and young people, as well as to describe the evolution of the male/female ratio between 1990 and 2017. Method. Population and mortality data were obtained from the National Institute of Statistics and Censuses of Ecuador. Suicide rates were calculated for each year, age group (10-14, 15-19, 20-24 years) and sex. We used the Joinpoint Regression Program 4.6.0.2 to analyze temporal trends and report annual percent change (APC) by each age group and sex. Results. An average of 313 suicides per year happened in Ecuador between 1990 and 2017, with increases of 480% in young boys and 322 % in girls aged between 10-14, 111% in male adolescents and 57% in young adults, while there was a decrease in adolescent girls (19%) and young adults (37%). The suicide rate increased annually among boys (APC = 5.10%) and girls (2.57%), as well as for male adolescents (3.07%) and young adults (10.42%), while for female adolescents (0.81%, not significant) and young women (1.16%) the trend decreased after reaching a peak around 2006. While up until the beginning of the XXI century young females aged between 10 and 19 years had higher suicide rates, during the last decade men had higher rates across all age groups (between 1.5:1 and 4.3:1 in 2017). Conclusions. Suicide in the population under 25 years in Ecuador is a major public health issue and increased between 1990 and 2017, particularly among children, and males between 15-24 years. The intersectorial strategy proposed in 2018 in order to reduce suicide is pending further evaluation and interpretation