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Relationship Between Substance Use and Suicide Behavior During the COVID-19 Pandemic: A Systematic Review and
Estefano D Cadena Barberis1, Ha Ram Oh2, Luis David Vélez Ordóñez1
1NeurALL Research Group, Quito 170157, Ecuador.
Journal of Clinical Medicine
|February 27, 2026
Summary
The COVID-19 pandemic saw frequent co-occurrence of substance use and suicidal behavior, especially suicidal ideation and alcohol use. Integrated interventions are crucial for mental health and substance use during public health crises.
Area of Science:
- Public Health
- Epidemiology
- Mental Health Research
Background:
- The COVID-19 pandemic significantly impacted social structures, healthcare, and mental well-being.
- This disruption potentially exacerbated substance use and suicidal behaviors.
- Previous research focused on these issues independently, lacking synthesis on their co-occurrence during the pandemic.
Purpose of the Study:
- To systematically review and meta-analyze the prevalence and patterns of suicidal behavior in individuals with substance use during the COVID-19 pandemic.
- To quantify the co-occurrence of substance use and suicidal behaviors.
- To identify specific substances associated with increased suicidal behavior.
Main Methods:
- Systematic search of major databases (PubMed, Scopus, Web of Science, EBSCO Host) from March 2020 to October 2022.
- Inclusion of observational studies on adults reporting substance use and suicidal behavior during the pandemic.
- Random-effects proportions meta-analysis with heterogeneity assessment (I² statistic).
Main Results:
- Twenty studies (70,684 individuals) were analyzed.
- Pooled prevalence of suicidal behavior among substance users was 33.8%.
- Suicidal ideation (36.8%) and alcohol use (36.2%) were most frequent; increased association between substance use and suicidal behavior noted compared to pre-pandemic.
Conclusions:
- Substance use and suicidal behavior frequently co-occurred during the COVID-19 pandemic.
- Suicidal ideation and alcohol use were particularly prevalent among substance users.
- Integrated mental health and substance use interventions are essential during public health crises.
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