DEATHS caused by suicide, assault and self-inflicted harm were up by at least a fifth during the first six months of the pandemic in Scotland, but the true toll is likely to be even higher.

The data also shows that nearly 16,000 people have died in their own homes since the pandemic took off in Scotland, up by over 4,600 compared to previous years.

It comes amid Scotland's second de facto lockdown, after the entire mainland was plunged into Level Four restrictions for a period of at least three weeks on Boxing Day. 

Figures compiled by the National Records of Scotland show that there were 481 deaths by "intentional self-harm, assault and undetermined intent" between April and the end of September this year, 19 per cent higher than the five-year average of 405.

There were also 32 poisonings and 597 accidental deaths over the same six month period, although NRS cautions that true number of deaths for all three categories will end up "much larger" once 1,121 deaths currently included under the "ill-defined and unknown causes" category are classified and added.

The NRS data also shows that deaths by self-harm and assault have increased steadily during 2020, compared to previous years.

In the first quarter of 2020, from January to March, there were 201 deaths in this category - up 4% on the five-year average.

However, this increased to 14% more than average with 226 deaths between April and June, and 23% above average with 255 deaths between July and September.

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No specific suicide figures are available yet for 2020, but MSPs were told in September that NHS 24 call handlers in Scotland were encountering "much higher levels of anxiety within the population" and "a higher level than usual of people with suicidal thoughts".

Chief executive Angiolina Foster described it as a "very discernible and alarming trend".

There is also some evidence of increased deaths due to diabetes, which were up 15% between April and September this year with 515 deaths compared to the five-year average of 446.

Earlier this year, charity Diabetes UK warned that there was a risk that patients were dying due to delays in care or not seeking medical attention during lockdown.

There was also a 7% increase in deaths from "parasitic and infectious diseases" - excluding coronavirus - with 345 recorded between April and September this year, 23 more than average.

Deaths from diseases of the digestive system - which include ailments such as acute pancreatitis - were up 7%, from an average of 1,496 to 1,606 in the six months from April.

Acute pancreatitis is characterised by sudden abdominal pain, fever, nausea and diarrhoea.

It can be caused by consuming too much alcohol and in some cases can lead to fatal complications if untreated.

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These deaths are among those which are included in the NRS' weekly excess death count, under the umbrella of 'other' causes.

The latest excess death figures also show that deaths at home have increased more than those in hospitals, care homes, or other settings, such as prisons, during the pandemic.

Between March 16 and December 13, there were 15,830 deaths in home and 'non-institution' settings, which includes any public spaces such as parks or shopping centres.

This is up 41% on average, while deaths in hospital have declined by 3% - largely due to a reduction in admissions for some complex elective surgeries.

Deaths in care homes meanwhile have been 24% higher than average this year, but this has been driven almost entirely by Covid-19 infections.

In comparison, coronavirus accounted for only 305 of the 4,641 excess deaths at home this year.

There were 1,138 deaths (25%) included under the NRS' umbrella term of 'other' causes - which can include everything from suicide to pancreatitis - but the majority (37%) of at-home excess deaths during the pandemic were caused by cancer, with 1,735 cases recorded by NRS.

Although many terminally people prefer to die at home than in hospital, Richard Meade, the head of policy for Marie Curie in Scotland, said a shortage of support for people caring for a dying loved one risked leaving a legacy of "grief, guilt and anger".

He said: “The care providers that are still seeing people in the community are stretched, some patients are going weeks without support in the home.

"At Marie Curie, we’ve ramped up the support we provide for people dying in their own homes in communities across Scotland and we are seeing more and more people, but we can’t do it alone.

"There needs to be greater investment in community based services to support terminally ill people who need care and support, including palliative care services.”

A spokeswoman for Macmillan Cancer Support in Scotland said she had spoken to one man who looked after his dying father in his final weeks, when hospital visiting was limited. 

"He didn't want to lose lots of time with him," she said. 

"He said the nurses did what they could, but he wasn't equipped to look after his Dad alone for long periods, and is now reeling from how difficult it was."

The number of people dying at home with dementia or Alzheimer's disease has also nearly doubled, from an average of 369 to 668 during the pandemic.

Jim Pearson, director of policy and research at Alzheimer Scotland said it was "extremely concerned" by the trend.

He said: "This further reinforces the urgency of understanding the factors which may have contributed to this alarming increase so that we can act to prevent any avoidable harm or further loss.

"We have consistently raised this matter with Scottish Government who have committed to a study to specifically understand the reasons for this increased loss of life."

Deaths at home from strokes and heart disease - which includes heart attacks - are also up 31% since mid-March, from an average of 3,360 to 4,418.

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Covid infection is known to cause blood to become sticky and clot, possibly explaining some of the increase.

However, Jane-Claire Judson, chief executive at Chest Heart & Stroke Scotland, said it was also vital that people seek medical attention for symptoms quickly.

She said: “During the first lockdown many people felt they should avoid hospital, and so people having a heart attack or stroke didn’t always get the emergency treatment they needed to give them the best chance of recovery.

"We’re also worried that many patients have not been seeking help when they experience symptoms of a TIA [mini stroke], which can lead to a serious stroke.

“The result of this complex picture has been over 1,000 more deaths at home from heart disease or stroke than normal.

"The evidence shows that emergency hospital admissions have been consistently low since March, and equally worrying is data which shows that a third of people would avoid contacting their GP even now."

When life is difficult, Samaritans are here – day or night, 365 days a year. You can call them for free on 116 123, email them at jo@samaritans.org, or visit samaritans.org to find your nearest branch.