Changes in suicide rates in Malaysia during the COVID-19 pandemic: An interrupted time series analysis

Limited research examined changes in suicide trends during COVID-19 outbreaks and related factors in lower-middle-income countries. We investigated the impact of the COVID-19 pandemic on suicide across different outbreak periods by sex, age, region, ethnicity, and method of suicide, and assessed potential factors associated with suicide rates in Malaysia. Suicide data for Malaysia (January 2016–December 2022) were extracted from the Integrated Police Reporting System. Changes in monthly suicide rates across different COVID-19 outbreak periods and subgroups were examined using interrupted time series (ITS) analyses. We also examined the associations of suicide rates with indicators of economic performance (unemployment rate), outbreak control (Google mobility and Stringency Index of outbreak control measures), and outbreak severity (COVID-19 incidence and mortality). A marked increase in suicides above the expected number, based on past trends, was observed during the 3rd (October 2020–May 2021) and 4th (June 2021–December 2021) outbreaks, as well as the post-outbreak period (January–December 2022). These increases were found across nearly all sex, age, ethnicity, region, and suicide method groups. By contrast, no changes or lower-than-expected suicide rates were found in the early pandemic periods (January–September 2020). Higher suicide rates were associated with higher unemployment rates, higher stringency levels of outbreak control measures, and increased outbreak severity during the pandemic period. Malaysian suicide rates increased above expectations in the later and post-outbreak periods and were associated with unemployment, outbreak control measures, and outbreak severity during the COVID-19 pandemic. These increases underscore the importance of continuous monitoring and prompt responses. • During COVID-19, Malaysian suicide rates varied across different outbreak periods. • Suicide rates were higher than expected in the later and post-outbreak periods. • The increases were found across nearly all sexes, ages, ethnicities, regions, and methods. • Unemployment, and outbreak control measures and severity, were linked with suicide rates. • Particularly, the association was greater among males and older adults.