ABSTRACT
OBJECTIVES: There is concern that the COVID-19 pandemic will be associated with an increase in suicides, but evidence supporting a link between pandemics and suicide is limited. Using data from the three influenza pandemics of the 20th century, we aimed to investigate whether an association exists between influenza deaths and suicide deaths. DESIGN: Time series analysis. SETTING: Sweden. PARTICIPANTS: Deaths from influenza and suicides extracted from the Statistical Yearbook of Sweden for 1910-1978, covering three pandemics (the Spanish influenza, the Asian influenza and the Hong Kong influenza). MAIN OUTCOME MEASURES: Annual suicide rates in Sweden among the whole population, men and women. Non-linear autoregressive distributed lag models was implemented to explore if there is a short-term and/or long-term relationship of increases and decreases in influenza death rates with suicide rates during 1910-1978. RESULTS: Between 1910 and 1978, there was no evidence of either short-term or long-term significant associations between influenza death rates and changes in suicides (ß coefficients of 0.00002, p=0.931 and ß=0.00103, p=0.764 for short-term relationship of increases and decreases in influenza death rates, respectively, with suicide rates, and ß=-0.0002, p=0.998 and ß=0.00211, p=0.962 for long-term relationship of increases and decreases in influenza death rates, respectively, with suicide rates). The same pattern emerged in separate analyses for men and women. CONCLUSIONS: We found no evidence of short-term or long-term association between influenza death rates and suicide death rates across three 20th century pandemics.