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Measures against Suicide: An Urgent Public Health Challenge for Japan

Kayako Sakisaka
Specially-Appointed Associate Professor, Faculty of Policy Studies, Chuo University
Areas of Specialization: Global Health, Social Epidemiology, Public Health

Japan fails to reduce nearly 90 suicides per day

This year, more Japanese people have died than in normal years, partly due to the Great East Japan Earthquake. As the distressing days continue, I would like to express my deepest sympathy to those who were affected by the disaster.

My fields of study include public health and social epidemiology, which treat health issues in developing and developed countries. We process global- or national-level large datasets, including data from remote areas in Africa where even adults do not wear shoes. Today, Japan is a blessed country in that people can expect the longest life when they are born, i.e., their life expectancy is the longest in the world.

Suicide in Japan is one of the research issues I have been engaged in for several years.

Japan is continuously suffering an exceptionally high suicide rate compared to other developed countries. The number has also been more than 30,000 annually since 1998 and shows no sign of decline. This means that nearly 90 Japanese people die by suicide every day. Japan is far behind in efforts for reducing suicides.

Males are a high-risk group

As shown in many other countries in the world, there are currently more male suicides than female ones in Japan. Males account for about 70 percent, while females account for 30 percent of total suicides. Given that, males, particularly the age group in their prime (45 - 59 years old), are a high-risk group. This group includes fewer people who have the experience of a suicide attempt and more people with economic problems. According to an interview with bereaved families in which I was involved, in the case of independent business owners, 50 percent died within one year, 70 percent within two years, and 100 percent within three years since family members or other acquaintances found a sign of suicide. The interviewees' responses imply that those suicides displayed a sign before their death and a significant proportion of people surrounding them were aware of it. This finding supports suggestions by experts that suicide is death resulting from being driven into it and that people who want to die also struggle to live until the last minute.

Research and education falling behind

The method of interview with bereaved families employed in the study mentioned above, which is called verbal autopsy, is very effective in Japan today for measures against suicide. This is because, in Japan, suicide is a form of death disgraceful to and painful for bereaved families. It is not considered acceptable to reveal to other people that a family member committed suicide. We can obtain information only after paying adequate attention to what each interviewee feels, committing to protecting private information, and spending substantial time in a face-to-face manner.

The Harvard School of Public Health I attended for study two years ago has a regular class called Suicide Control and Prevention, in which students can study the problem from various perspectives as an issue in the field of public health. It seems that Japan still falls far behind here.

Background of lagged efforts

There might be some reasons for the delayed efforts in reducing suicides in Japan. First, Japanese somewhat tolerate suicide. In Christian nations, people are taught from the time they are young that suicide is evil. Japanese, on the other hand, may accept some deaths as honor or atonement for sin. Second, incidents of suicide are primarily treated by the National Police Agency, instead of the Ministry of Health, Labor and Welfare responsible for issues in medical care and public health. It was only recently that data started to be published monthly, and the cooperation between those agencies is still insufficient.

As a matter of fact, it is estimated that there are ten times more attempted suicides than suicides. In many cases, even if survivors of a suicide attempt are taken to a hospital and receive life-saving care or treatment from a medical provider, for example, the treatment may be finished without adequate mental care. I believe that medical insurance should cover consultation on mental problems so that continuous counseling becomes more commonly available. Another more important problem is that only a smaller budget is assigned to measures against suicide, related to which more than 30,000 deaths are reported annually, than to initiatives against traffic accidents, where dead victims have decreased to approximately 5,000 a year. At the Tokyo Suicide Prevention Center providing telephone consultation service, in which I have only had limited involvement, volunteers are waiting for calls all through the night, and phones do not stop ringing. Then the volunteers return to their own work in the morning. Their dedication to the activity is definitely respectable. In fact, I could not continue working there long, because work through the night made me sleepy during work the next day. I am very sorry for that. While I feel their selfless efforts are admirable, I am certain that a more adequate budget would enable the center to employ more staff with the ability to save more lives.

Suicide can be prevented: Consider grief work as an option

According to the latest data as of May 2011 released by the government, suicides increased by 656 year on year, and increased especially among women aged 70 or over. This figure is exceptional for May data.

(See http://www8.cao.go.jp/jisatsutaisaku/toukei/pdf/tsukibetsu/h2305.pdfnew window)

Fukushima is one of the prefectures in which suicides increased by ten percent or more year on year.

A number of nations around the world succeeded in decreasing suicides. This fact shows that suicide can be prevented. According to experience in those countries, it is important that someone stands close to, simply listens to, and makes a potential suicide victim aware that she is loved. In areas affected by the earthquake disaster, lack of mental care would lead to more severe situations. The elderly is a group with a potentially high risk of suicide. The study mentioned above also showed a particularly significant correlation in this group between suicide and the experience of a relative's death within several years.

Shortly before, I joined training at The Dougy Center (Portland, Oregon. http://www.dougy.orgnew window), which provides mental care for children who lost precious family members in the United States. Their activities would be a good model for Japan today. After the great disaster, I believe that more attention should be paid also in Japan to the field of grief work - managing to cope with grief that would otherwise be impossible to cope with - for getting close to those who lost anyone significant, as well as measures against suicide.

Kayako Sakisaka
Specially-Appointed Associate Professor, Faculty of Policy Studies, Chuo University
Areas of Specialization: Global Health, Social Epidemiology, Public Health
Born in Tokyo. Graduated from the School of International Health, the Graduate School of Medicine, the University of Tokyo with Master of Public Health (MPH) and Doctor of Health Science degrees (PhD); and Takemi Program, Harvard School of Public Health (2009 - 2010). Also graduated from the Graduate School of International Politics, Economics and Communication, Aoyama Gakuin University with a Master of International Economics degree. Specializes in Global health, social epidemiology, statistics, and public health. Served as an Assistant Professor on the Faculty of Medicine and the Graduate School of Medicine, the University of Tokyo from 2004 to 2010 before assuming her current position in April 2011.