Police-Reported Suicides During the First 16 Months of the COVID-19 Pandemic in Ecuador: An Interrupted 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 interrupted time series models in Poisson regressions, we analysed monthly police-reported suicides in Ecuador from January 2015 to June 2021 to compare observed vs. expected suicides by age- and sex using rate ratios (RR), after the pandemic’s onset in March 2020. We investigated changes in risk factors, precipitants, geographic distribution, and suicide methods.Findings: There was no evidence of higher than expected suicides 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]), and greater than expected suicides in children aged 5–14 years (RR 1·82 [95% CI 1·51–2·20]. The proportion of suicides increased in urban and coastal areas and decreased in Indigenous and other minorities. Proportions of suicides with evidence of alcohol consumption, disability, and amongst married and cohabiting individuals decreased. Proportions of suicides increased where mental health problems were considered contributory. Proportions of hanging suicides increased whereas self-poisoning and other suicide methods decreased.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. Higher than predicted child suicide numbers may have occurred because pre-pandemic falls in their numbers were not sustained during the pandemic. Funding: None.Declaration of Interest: We declare no competing interests.Ethical Approval: Ethical approval was not required given that we used an anonymous deidentified database.