More than 30 000 Japanese people take their own lives each year, a statistic that has remained fairly constant since the Asian financial crisis of 1997. A Comment with The Lancet Japan Series looks at these alarming figures and what is being done to address them. The Comment is by Professor Yutaka Motohashi, Department of Public Health, Akita University Graduate School of Medicine, Japan.
Professor Motohashi says: "Tellingly, the changes in the unemployment and suicide rates have been similar… It seems likely that this negative socioeconomic background is associated with the suicide trend in Japan."
The Japanese government has introduced special initiatives, in addition to efforts to control access to dangerous places and drugs. For example, model projects for suicide prevention in six towns in Akita prefecture showed that comprehensive suicide-prevention efforts that combine primary, secondary, and tertiary prevention methods resulted in a steady reduction in the number of suicides in the community. Such actions raised awareness and prevented isolation, and saw the suicide rate in the intervention towns fall from 70•8 per 100 000 per year before the intervention (1999) to 34•1 per 100 000 per year after the intervention (2004) compared with little change in suicide rates in the control towns.
New national laws in 2006 and 2007 drafted principles for dealing with suicide, and nationwide television advertising campaigns over recent years have seen suicide rates fall during the months the campaigns are active, with higher rates of success in rural areas, a finding which Professor Motohashi says should be investigated further. The 2008 Plan to Accelerate Suicide Prevention Measures specifically address those with mental illness and addiction problems at high risk of suicide, stating that early and proper coordination is needed between psychiatrists and physicians.
Professor Motohashi concludes: "Better efforts to increase public knowledge about depression and progress towards elimination of prejudice would probably help to raise the consultation rate for depression, thereby leading to appropriate psychiatric treatment. Schemes are also needed for family doctors to refer their patients with depression to specialists. The key to successfully reduce the rate of suicides in Japan is thus the use of multidisciplinary and interprofessional approaches to develop comprehensive suicide prevention measures and implement them on a broader scale."
Professor Yutaka Motohashi, Department of Public Health, Akita University Graduate School of Medicine, Japan. E) motohasi@med.akita-u.ac.jp
Journal
The Lancet