Suicide associated with COVID-19 infection: an immunological point of view

M.J. Choi, J.W. Yang, S. Lee, J.Y. Kim, J.W. Oh, J. Lee, B. Stubbs, K.H. Lee, A. Koyanagi, S.H. Hong, R.A. Ghayda, J. Hwang, E. Dragioti, L. Jacob, A.F. Carvalho, J. Radua, T. Thompson, L. Smith, M. Fornaro, A. Stickley, E.L. Bettac, Y.J. Han, A. Kronbichler, D.K. Yon, S.W. Lee, J.I. Shin, E. Lee, M. Solmi

Yonsei University College of Medicine, Seoul, Republic of Korea. shinji@yuhs.ac

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• Infectious Diseases
• Psychiatry

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is a pandemic and leading cause of death. Beyond the deaths directly caused by the virus and the suicides related to the psychological response to the dramatic changes as socioeconomic related to the pandemic, there might also be suicides related to the inflammatory responses of the infection. Infection induces inflammation as a cytokine storm, and there is an increasing number of studies that report a relationship between infection and suicide.

MATERIALS AND METHODS: We searched the World Health Organization status report and the PubMed database for keywords (COVID-19, suicide, infection, inflammation, cytokines), and reviewed five cytokine pathways between suicide and inflammation using two meta-analyses and two observational studies starting from November 31, 2020, focusing on the relationship between suicide and inflammation by infection. First, we discussed existing evidence explaining the relationship between suicidal behaviors and inflammation. Second, we summarized the inflammatory features found in COVID-19 patients. Finally, we highlight the potential for these factors to affect the risk of suicide in COVID-19 patients.

RESULTS: Patients infected with COVID-19 have high amounts of IL-1β, IFN-γ, IP10, and MCP1, which may lead to Th1 cell response activation. Also, Th2 cytokines (e.g., IL-4 and IL-10) were increased in COVID-19 infection. In COVID-19 patients, neurological conditions, like headache, dizziness, ataxia, seizures, and others have been observed.

CONCLUSIONS: COVID-19 pandemic can serve as a significant environmental factor contributing directly to increased suicide risk; the role of inflammation by an infection should not be overlooked.

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