Shifting vulnerabilities in suicide mortality from the COVID-19 crisis to the socioeconomic aftermath in Spain...

The transition from the acute Coronavirus Disease 2019 (COVID-19) crisis to the subsequent socioeconomic aftermath introduced complex stressors. We aimed to determine the differential impacts of pandemic onset (March 2020) and the socioeconomic aftermath (July 2021) on suicide mortality in Spain, examining heterogeneous effects by sex and age.

We analysed 108 months (2016-2024) of national registry data. Using a Bayesian Interrupted Time-Series (ITS) design with a Triple Interaction framework (Sex×Age×Event), we isolated immediate (level) and long-term (trend) risk trajectories, adjusting for Gross Domestic Product (GDP), Public Health Expenditure (PHE), and (COVID-19) mortality. Leave-One-Out Cross-Validation (LOO-CV) was used to validate the complex specification against simpler models.

Impacts differed fundamentally across demographics. Pandemic onset was associated with an immediate increase in men aged 80+ (Rate Ratio [RR] = 1.46; 95% BCI 1.13-1.90), while other male groups remained stable. Conversely, the socioeconomic aftermath triggered a delayed acute shock in women, specifically aged 15-29 (RR = 1.66; 95% BCI 1.05-2.68). Bayesian comparison confirmed simpler models failing to account for triple interactions obscured these effects.

The ecological design precludes causal inference at the individual level.

Suicide risk pathways were highly heterogeneous: male vulnerability was concentrated in the elderly during the initial viral threat, whereas female vulnerability emerged later as a delayed response to the socioeconomic aftermath. Prevention requires adapting strategies to the distinct nature of immediate isolation in older men versus delayed socioeconomic strain in women.