Was the COVID-19 pandemic associated with a change in the pace of self-inflicted injury deaths?: A time series analysis of suicide and accidental injury mortality data

The COVID-19 pandemic struck in the context of growing self-inflicted injury rates and appears to have increased nation-wide levels of distress. This study describes mortality trends in Maryland during the first six months of the pandemic and adds to the current literature by accounting for characteristics of pre-pandemic mortality trends and by distinguishing differences in mortality trends based on cause (e.g., overdose) and manner (e.g., suicidal) of death. We obtained data for all unnatural deaths in Maryland from January 2003 to August 2020 from the Maryland Office of the Chief Medical Examiner. We grouped decedents based on cause and manner of death (e.g., suicidal poisoning). We used ARIMA, exponential smoothing, and/or seasonal time series modeling to project the expected rate of self-inflicted mortality during March through August 2020. We compared expected mortality rates based on these self-inflicted injury models to the observed during the pandemic period mortality to investigate the hypothesis that self-inflicted injury deaths would increase at a more rapid pace than observed prior to the pandemic. The models forecasting accidental overdose deaths fit the data well (model R2 = .90, model BIC = 3.77). There were more deaths by accidental poisoning and fewer deaths by accidental falls in March and May 2020 than predicted by pre-COVID-19 models. Most self-inflicted suicidal and accidental injury deaths appear to continue to occur at the same rate during the early months of the pandemic. This research is limited by its use a limited dataset that captured mortality in one state for six months. This study may not capture longer-term effects of the COVID-19 pandemic or the association between the pandemic and rarer events (e.g., firearm deaths.) Additionally, this study does not account for the disproportionate impact of the COVID-19 pandemic on people of color who are dying by suicide at a faster rate than their White counterparts in Maryland during the pandemic.