# The effect of the quality of the national health security systems in 12 countries on the prevalence of suicide crisis syndrome during the COVID-19 pandemic

## TL;DR

This study examines how the quality of health systems in 12 countries affected suicide crisis syndrome during the pandemic, finding that better health systems reduced SCS in those with COVID-19 symptoms.

## Contribution

The study introduces a novel analysis linking national health system quality to suicide crisis syndrome during the pandemic.

## Key findings

- SCS was more prevalent in countries with high COVID-19 death rates and among those with symptoms.
- Better health systems were associated with fewer cases of SCS in individuals with COVID-19 symptoms.
- The interaction between health system quality and pandemic factors significantly influenced SCS.

## Abstract

Limited access to health services and overwhelmed healthcare systems created a challenging environment for those in need of mental health support during the COVID-19 pandemic, and the pandemic impacted suicide risk in several ways.

The present study aimed to analyse how the quality of the health security systems in 12 countries affected suicide crisis syndrome (SCS) during the pandemic. We hypothesised that countries with robust health systems were better able to respond to the increased demand for (mental) health support, resulting in fewer cases of SCS.

From June 2020 to September 2021, 11 848 participants from 12 different countries took part in an online survey. Besides asking about sociodemographic information, the survey assessed the severity of SCS with the Suicide Crisis Inventory (SCI). The Global Health Security Index and the Legatum Prosperity Health Index were used to operationalise the quality of the national health systems. Multilevel analyses were performed to evaluate the impact of health system quality and COVID-19-associated factors on SCI scores.

SCS was more prevalent among participants with COVID-19 symptoms and in countries with high rates of COVID-19-associated deaths. Multilevel analyses revealed a significant interaction effect of COVID-19 symptoms and national health indices. SCS occurred significantly less frequently in participants with COVID-19 symptoms living in countries with good health security systems.

The challenges posed by the pandemic highlight the necessity to promote accessible and affordable health services to mitigate the negative impact of the pandemic on suicidal ideation and behaviour.