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The Role of Pandemic-Related Social Distancing in Suicide Risk Receives National Media Attention

February 1, 2021

Takeaway: An article in JAMA Psychiatry by Mark Reger, PhD, and colleagues discusses social connections and suicide risk, and the critical public health strategy of social distancing. Concerns about negative secondary outcomes of COVID-19 prevention efforts should not imply that these public health actions should not be taken. However, implementation should include a comprehensive approach that also considers the public health priority of suicide prevention.

Leading theories of suicide emphasize the key role of social connections in suicide prevention, so the critical public health strategy of social distancing is concerning. In addition, financial problems have been associated with suicide. Further, attendance at religious services has been associated with lower suicide rates, so the effects of closing churches and community centers may further contribute to social isolation. Moreover, the real or perceived barriers to mental health access may negatively impact patients with suicidal ideation. Despite these challenges, there are opportunities to improve suicide prevention efforts during this time:

  • Social distancing requires physical space between people, but efforts can be made to stay connected by telephone or video, especially for individuals with substantial suicide risk factors. Of note, suicide rates have declined after past national disasters (e.g. 9/11 attacks), perhaps due to the “pulling together effect,” where a shared experience strengthens social connectedness.
  • Increase access to suicide prevention interventions that were designed to be delivered remotely, such as telephone-based outreach and the Caring Letters intervention, in which letters are sent through the mail.
  • Follow up with individuals who are positive for COVID-19 and have suicide risk factors.


The Altmetric (calculated from the readership, social media attention, news coverage) is in the 99th percentile of all research papers ever tracked (out of over 16 million). It is the #8 paper among all JAMA Psychiatry manuscripts tracked (out of more than 2,000 papers). The article has been viewed by over 230,000 readers and has generated media interview requests from the Today Show, CBS News, CNBC, and many others. It has already been cited 62 times.

Dr. Reger also leads QUERI’s Randomized Evaluation of a Caring Letters Suicide Prevention Campaign that works to test the effects of a Caring Letters Campaign on Veteran Crisis Line (VCL) callers. Caring Letters QUERI has partnered with the VCL and VA’s Office of Mental Health and Suicide Prevention to conduct the first-ever test of Crisis Callers – and will be the largest evaluation of a Caring Letters intervention ever conducted. Results of this evaluation are expected to help identify an effective and sustainable evidence-based practice to help prevent suicide on a public health scale.

Reger M, Stanley I, Joiner T. Suicide mortality and coronavirus disease 2019 – A perfect storm? Viewpoint. JAMA Psychiatry. April 10, 2020; Epub ahead of print.

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