Why have suicide rates not increased during the pandemic? An interrupted time series of suicides in Ontario to examine changes in demographics and methods during the pandemic; an interrupted time series analysis and descriptive study of suicides looking at the effects of states of emergencies on suicides; and a mixed methods study of people who survive opioid overdoses to examine whether suicide deaths have been displaced into opioid overdose deaths.

Contrary to predictions at the start of the COVID-19 pandemic suicide rates have not increased and may have declined during the pandemic. However, some sub-populations may have had an increase in rates which is hidden in the general population figures. Possible explanations for the absence of an increase in suicides include a paradoxical increase in social support "everyone pulling together" and a shift from suicide deaths to deaths by opioid overdoses. We propose two research streams to examine these hypotheses. The first research stream will focus on suicides in the general population which addresses the extent and impact of COVID-19 and the resilience of people of Canada. We plan to do an analysis of suicide deaths from Ontario coroners' records of suicides from 2015 to February 2020 compared to suicides after March 2020 to detect any changes in demographics and suicide methods. Second, we will compare the number and circumstances of suicides during Ontario's states of emergency during the pandemic to times during the pandemic when these states were not in place. These two studies should answer questions about the effect of the pandemic on suicides in different sub-populations and the influence of social isolation. This will identify the effects of policy decisions around lockdown interventions in future health emergencies and pandemics. The second research stream will address whether some suicides have been shifted into the opioid using population. This will generate evidence related to the marginalised population of drug users and the effect of the pandemic on exacerbated substance use. We will do a qualitative study of drug users who have survived an opioid overdose to assess whether the overdose was a result of suicidal thoughts and to ask what could have made their drug use safer. Second, we will identify people who have survived opioid overdoses before and during the pandemic to examine differences in mental health morbidity and mortality.