After years of a steady climb in suicide deaths, prevention advocates worry there could be a mental health fallout from the coronavirus pandemic for years to come.

Consequences of the COVID-19 pandemic also are risk factors for suicide, experts say, including prolonged isolation, a down economy with massive job losses and an uptick in domestic violence.

That could lead to more suicides in the coming months or even years, said Jonathan Singer, associate professor of social work at Loyola University Chicago and president of the Washington, D.C.-based American Association of Suicidology.

“We’ve never been through this before, so we don’t actually know, but there are things that concern me,” he said, adding that studies show much of what the public is experiencing correlates with higher suicide death rates.

Studies also show that when a parent dies by suicide, children’s risk also increases, Singer added. “So, this could last years.”

The U.S. is already experiencing a tragic trend when it comes to suicide. From 1999 through 2018, the most recent year available, suicide rates increased by 35%, according to the Centers for Disease Control and Prevention, making it the 10th leading cause of death in the U.S.

Yet mental health supports and funding for research continue to lag, Singer said.

In an article published this month in JAMA, “Suicide Mortality and Coronavirus Disease 2019 – A Perfect Storm?” researchers call for prevention interventions for suicide to coincide with the unprecedented public health actions like stay-home orders put in place to fight the virus.

Along with social isolation and financial woes, the paper points to the lack of access to religious and community supports and overall barriers to mental health treatment in a time when in-person visits are prohibited and hospitals have restrictions.

Adding to those risk factors are reports that Americans have been buying up guns and ammunition as the pandemic heightened, according to the paper. (Firearms are the most common method of suicide.) In Illinois, state police received a record number of background check requests to buy firearms in March – most occurring during the second half of the month as concerns about the virus grew and quarantine measures intensified.

Medical professionals also are at risk, the JAMA report states. Physicians already are at a higher risk for suicide, and during the pandemic, they’re in even more stressful situations as they treat patients and worry about infecting themselves and their families.

Prevention efforts could include a ramp-up of teletherapy, as well as community support that can be done in a safe, remote way.

Singer noted sessions with a counselor over the phone or by video chat or even text offer the same level of support as face-to-face visits. But even though most therapists are offering phone or video sessions, barriers remain, he said. Not everyone has access to technology, and many insurance companies don’t cover phone sessions as they do in-person visits, Singer said, even if some have temporarily lifted such restrictions during the pandemic.

Singer said he hopes the pandemic will highlight barriers to care, like issues with telehealth, as well as broader problems when it comes to prioritizing mental health.

Recognizing the possible increased threat posed by the pandemic, the National Suicide Prevention Lifeline has reframed its #Bethe1To campaign to include suggestions for people who want to help a loved one they believe is at risk for suicide during the pandemic. Suggestions include ways to talk to someone about the risk even if they can’t physically be with their loved one, and ways to find help and follow up, said Christian Burgess, director of the Disaster Distress Helpline, an offshoot of the lifeline. Both are federally funded and overseen by New York-based Vibrant Emotional Health.

“Even if you’re not with family members or loved ones physically, you can still do these things,” Burgess said.

While the National Suicide Prevention Lifeline, which includes a series of crisis hotlines and text lines across the country, has not seen an increase in calls of late, Burgess said it’s not unusual in a disaster situation for such fallout to come later.

“When you start to get into long-term recovery, several weeks or even months (after a disaster), that’s when you start to see risk of suicidality increase,” he said.

The Disaster Distress Helpline, which offers a variety of mental health supports to those suffering due to a specific disaster, saw a 338% increase in calls last month compared with the previous month, Burgess said, and a 900% increase over March 2019.

But Burgess also noted the coronavirus pandemic is the first-of-its kind disaster since the helpline was created in 2012. And its calls cover more than suicide concerns. The helpline is meant to help those experiencing mental health symptoms stemming from natural or human disasters, like hurricanes or mass shootings. Typically, Burgess said, those are more localized, affecting a certain group of people.

The current pandemic, however, has national and worldwide reach, he said.

A recent national survey of crisis lines and other supports for suicide prevention showed the pandemic is having an impact on how crisis responders do their jobs.

The report, released by Michigan-based TBD Solutions LLC in conjunction with mental health organizations like the American Association of Suicidology, was compiled after surveying more than 350 crisis providers, including mobile crisis teams, residential programs and call centers.

Travis Atkinson, crisis systems consultant at TBD Solutions, said these supports are essential in reaching those at risk for suicide and other serious mental health problems before they need hospitalization – an especially important goal during a national pandemic.

“You don’t want a psych crisis in the ER right now,” he said.