Coronavirus disease 2019 (COVID-19) has attained a pandemic status and is associated with a high morbidity and mortality. Social isolation, fear of ostracization, and illness itself and limited access to care can lead to worsening of mental illnesses. We report a case from the United States describing a young male with a suicidal attempt who was subsequently found to have COVID-19 infection. Further research is needed to evaluate potential factors for this unique association.
The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2), that was first reported in China has quickly spread globally achieving a pandemic status, accounting for more than 1.5 million cases and close to 100,000 deaths worldwide [
A 38-year-old American man with past medical history significant for hypertension, diabetes mellitus, obesity, and cervical spine disk bulge and a past psychiatric history significant for anxiety and depression self-presented to our hospital’s emergency department (ED) after a suicide attempt. He ingested 10-15 tablets of baclofen 10 mg each prior to arrival. The patient reported suicidal ideation with intent after suicidal behavior with possible injuries. He recently moved to Iowa from Minnesota, started a new job and found a new apartment over the past two weeks. Apart from worsening depression and active suicidal ideation with intent, he complained of recent worsening of headaches, neck pain, “feeling warm,” and mild nausea. Patient denied prior history of any suicide attempts, homicidal ideation, psychosis, or manic symptoms. The patient had seen a psychiatrist two months prior and denied depressive symptoms at that time. He reported three prior psychiatric hospitalizations for worsening mood symptoms, once requiring electroconvulsive therapy (ECT). The patient reported medication adherence that providers confirmed with pharmacy. The patient recently moved in with his cousin in Iowa and was single. He reported good family support and financial resources. Liabilities included recent move, physical illness complaints, living situation, and chronic mental illness. Of note, the patient reported two paternal family members who completed suicide as well as maternal and paternal family history of depression.
In the emergency department, the patient’s vitals were temperature 99.5°F (37.5°C), blood pressure 107/60, respiratory rate 18 breaths/min, and oxygen saturation 97%. He was tachycardic with HR 123 beats per minute. The patient’s physical exam was normal both in the emergency department and during the initial history and physical except tachycardia. Significant laboratory data in the ED showed thrombocytopenia with platelets
A few hours after admission, the patient was noted to be febrile with temperature measured 101.3°F (38.5°C). On repeat questioning, he admitted to a mild dry cough over the last 12 hours. He denied any recent travel history or exposure to sick contacts. Medicine service was consulted, and the patient was transferred to the general medical floor. Given his symptoms, a nasopharyngeal swab was sent as part of COVID-19 surveillance, which came back positive for SARS-CoV-2 on polymerase chain reaction (PCR) assay. The patient was put in an isolation room, and proper precautions were taken to prevent spread to healthcare workers. However, the situation was challenging due to inability to perform comforting measures like hand holding and engage in conversations from close distance. The patient was discharged on day 5 for self-quarantine at home.
This case describes a patient with known anxiety and depression who was admitted for a suicide attempt and was diagnosed with COVID-19 infection during the same hospitalization. The patient had no prior history of suicide attempt prior to this encounter. To the best of our knowledge, this is among the first reports of suicidal ideation in a patient with COVID-19 infection from the United States.
COVID-19 has been demonstrated to be associated with high morbidity and mortality. The three most common symptoms reported by patients infected with COVID-19 are fever, cough, and dyspnea. Less common symptoms are myalgia, anorexia, malaise, sore throat, nasal congestion, and headache. Symptoms may appear in as few as two days or can take as long as 14 days after exposure. Anecdotally, mental disorders have been linked to infection with common respiratory viruses [
Coronaviruses are negatively stranded RNA viruses, with the capacity of rapid mutation and recombination. Generally, two proposed pathophysiologic mechanisms explain the bidirectional relationship between viral illness and psychiatric illness. First, the virus can be directly toxic to the brain. They are capable of replication within the nervous system; the presence of viral RNA has been previously demonstrated in the brain tissue of patients with multiple sclerosis [
Secondly, the immune response generated by the host in response to viral illness can also affect mood disorders through indirect neurological effects [
Symptoms such fatigue, lack of appetite, decrease of social interaction, and loss of interest can be seen in both scenarios [
Recent Chinese publications have expressed concerns regarding clusters of COVID-19 breakouts among those with mental illness [
With the ongoing COVID-19 pandemic, health care providers must recognize the relationship between mental illness and viral illness to better treat patients. Although this case cannot support causation, it does stress the bidirectional effects that physical and mental illness share. Certainly, this patient had social stressors prior to his suicide attempt; however, coexisting COVID-19 infection could have exacerbated the effects of these social stressors on his mental health and vice versa. Health care professionals and society should take note of these associations with the current pandemic and its ramifications.
We present a case of 38-year-old male who presented with his first suicidal attempt and was subsequently diagnosed to have COVID-19 infection. Factors underlying this association need to be further evaluated.
Not applicable.
The patient has given consent for publication of his case details.
There are no competing interests or disclosures.
All authors contributed to the manuscript and approve of submission.