Suicide in Akita Prefecture, Japan

Abstract

In recent years, the number of suicides in Japan has increased dramatically, particularly among middle-aged men. According to the Brief Report on Suicides in 2001 by the National Police Agency of Japan (NPA, 2002), the number of suicides in Japan was 31 042, and the national suicide rate was 24.4/100 000. Akita is an agricultural prefecture with a population of approximately 1 200 000. According to the Akita Prefectural Police (APP), the number of suicides in Akita Prefecture was 457 (299 males, 158 females) in 2001. Akita Prefecture currently has the highest rate of suicide in Japan. The identification of strategies for suicide prevention is therefore imperative.

Psychological autopsy is useful for obtaining background information regarding suicide victims (Conwell et al, 1996; Cheng et al, 2000). However, obtaining consent for such studies from the families of the deceased is difficult in Japan. As members of the Akita Prefectural Medical Association (APMA) are thought to have many opportunities to obtain background information on suicides, an investigation of suicides in which members of the APMA are consulted might prove advantageous for accumulating representative data from a large number of cases. The present report describes the results of a questionnaire about suicide that was distributed to members of the APMA in order to determine the factors underlying suicide in Akita Prefecture.

The survey

Members of the APMA who had attended a suicide case were asked to complete a questionnaire about it. The APMA conducted this investigation from 1 July 2001 to 30 June 2002. The total number of suicides during this period was 138 (102 males, 36 females). A major peak in the number of suicides was observed among individuals in their 50s and 60s, particularly for males. Conversely, female cases increased in number in elderly age-groups compared with male cases. The most common method of suicide was hanging, which was observed in 105 cases (78 males, 27 females). Most suicides (94 cases) were performed at home. The number of suicides according to time of day tended to increase from midnight to early morning and from daytime to evening, which would be when the rest of the family was asleep or absent. Regarding physical disorders, the majority involved chronic diseases (e.g. hypertension). Depressive disorder was the most common psychiatric disorder. Furthermore, character traits which are thought to be strongly associated with depression were common.

Typically, a suicidal individual recruits others on a message board. Subsequently, in a sealed car, they take sleeping pills and light charcoal stoves

The most frequently observed complaints were economic problems. In addition, different age-groups tended to present with different complaints. Specifically, for individuals under 40 years of age, most complaints involved private problems other than health-related ones. For those aged 40–59 years, most complaints involved economic problems. For older adults (those aged over 60 years), most complaints involved health-related problems.

Discussion

For individuals under 40 years of age, most complaints involved private problems other than health-related ones. For those aged 40–59 years, most complaints involved economic problems. For older adults (those aged over 60 years), most complaints involved health-related problems.

In 1998, the number of suicides in Japan increased sharply and the annual number of suicides exceeded 30 000, making suicide a significant national problem. Particularly notable was an increase in suicides among middle-aged males.

Recently, in addition to suicide among middle-aged males, suicide pacts among young people who meet via the internet (‘internet group suicide’ cases) have been reported frequently in Japan, though this was not part of the survey. Typically, a suicidal individual recruits others on a message board. Subsequently, in a sealed car, they take sleeping pills and light charcoal stoves (rentan). Death results from carbon monoxide poisoning. In some cases, group members send emails to inform their family or friends just before the final act, or even after, with the message relayed from an automatic mailing system. The common use of charcoal stoves suggests that groups are imitating earlier cases reported by the media.

Statistics from the NPA indicate that when all suicide victims who left a suicide note are classified according to motive, ‘health-related problems’ represent the leading cause of suicide, followed by ‘economic and life-related problems’. Since 1998, the number of cases falling into the latter category has increased substantially, to the extent that this motive is likely to surpass ‘health-related problems’ as the leading cause of suicide. The NPA reported that, among all suicides in 1998, 6058 were committed because of economic difficulties, which represents an increase of 70.4% from 1997. Furthermore, the 1999 NPA report showed that for 6758 individuals (20.4% of suicides) suicide was a result of economic difficulties, which was up 11.6% from 1998. In addition, the 2000 NPA report showed that concerns over economic difficulties accounted for 6838 suicides (21.4%). These findings clarify a potential relationship between suicide and economic strife (e.g. financial hardships, low income, or unemployment, as a result of the deep and prolonged recession of the Japanese economy). Indeed, the popular press has focused on the correlation between the current economic situation in Japan and suicide rates. According to the APP, the number of suicides in Akita Prefecture that are a result of economic and life-related problems has increased markedly. In 2002, this motive became the leading cause of suicide by surpassing health-related problems (the leading cause until 2001). Similarly, in the present study, economic problems were shown to be most common, followed by health-related problems.

Based on the results of the present study, suicides can be categorised into two groups: one considered to be relatively amenable to medical intervention; and the other considered to be relatively resistant to it. Included in the former group are suicides caused by several psychiatric disorders (depression in particular), while the latter group includes suicides influenced by social situations such as economic problems (e.g. Japan’s prolonged recession). As noted in previous studies, early detection and appropriate treatment for depression are obviously crucial for suicide prevention (Rutz et al, 1992). However, the majority of middle-aged male suicides are thought to be performed in order to settle economic problems, which reflects current social conditions. In such cases, medical approaches alone may be insufficient for suicide prevention.

The present results do not exclude the possibility that economic problems are a major factor in the recent increase in the number of suicides. However, strategies for managing depression are also considered important.