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Assessment of Suicide in Japan During the COVID-19 Pandemic vs Previous Years

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To identify the key insights or developments described in this article
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Key Points

Question  Have suicide rates in Japan increased during the coronavirus disease 2019 (COVID-19) pandemic?

Findings  In this cross-sectional study using national data on suicide mortality in Japan, including 90 048 individuals who died of suicide, suicide rates in 2020 compared with 2016 to 2019 were increased in October and November for men and in July through November for women, and the relative increases were particularly pronounced among men aged younger than 30 years and women aged younger than 30 years and 30 to 49 years.

Meaning  These findings suggest that the COVID-19 pandemic was associated with increases in suicide rates in Japan.

Abstract

Importance  There are concerns that suicide rates may have increased during the coronavirus disease 2019 (COVID-19) pandemic.

Objective  To assess whether suicide rates in Japan increased in April through November 2020 compared with previous years.

Design, Setting, and Participants  This cross-sectional study used national data obtained from the Ministry of Health, Labor and Welfare from 2016 to 2020 on the monthly number of individuals who died of suicide in Japan from January to November of 2016 to 2020.

Exposure  2020 vs previous years.

Main Outcomes and Measures  The main outcome was monthly suicide rates, calculated as the number of individuals who died of suicide divided by the total population. A difference-in-difference regression model was used to estimate the change in monthly suicide rates in April to November 2020 vs these months in 2016 to 2019.

Results  Analyses included 90 048 individuals (61 366 [68.1%] men) who died of suicide from 2016 to 2020. The difference-in-difference analysis of men showed that there was no increase in suicide rates from April through September 2020 compared with these months in 2016 to 2019, but that suicide rates were increased in October (difference-in-difference, 0.40 [95% CI, 0.14 to 0.67] suicide deaths per 100 000 population) and November (difference-in-difference, 0.34 [95% CI, 0.07 to 0.60] suicide deaths per 100 000 population). Among women, suicide rates in 2020 compared with 2016 to 2019 increased in July (difference-in-difference, 0.24 [95% CI, 0.09 to 0.38] suicide deaths per 100 000 population), August (difference-in-difference, 0.30 [95% CI, 0.16 to 0.45] suicide deaths per 100 000 population), September (difference-in-difference, 0.29 [95% CI, 0.15 to 0.44] suicide deaths per 100 000 population), October (difference-in-difference, 0.62 [95% CI, 0.48 to 0.77] suicide deaths per 100 000 population), and November (difference-in-difference, 0.29 [95% CI, 0.15 to 0.44] suicide deaths per 100 000 population). In secondary analyses in which the suicide rates of 2020 were compared with the expected rates based on trends from 2011 to 2019, the increases in suicide rates were most pronounced among men aged younger than 30 years (eg, November: observed vs expected rate ratio [RR], 1.48 [95% CI, 1.26-1.71]) and women aged younger than 30 years (eg, October: observed vs expected RR, 2.14 [95% CI, 1.76 to 2.52]) and 30 to 49 years (eg, October: observed vs expected RR, 2.30 [95% CI, 2.01 to 2.58]).

Conclusions and Relevance  These findings suggest that compared with previous years, suicide rates in Japan in 2020 increased in October and November for men and in July through November for women.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: December 27, 2020.

Published: February 2, 2021. doi:10.1001/jamanetworkopen.2020.37378

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Sakamoto H et al. JAMA Network Open.

Corresponding Author: Peter Ueda, MD, PhD, Department of Global Health Policy, University of Tokyo Graduate School of Medicine, 113-0033 Tokyo, Japan (peter.ueda@gmail.com).

Author Contributions: Dr Ueda had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Ghaznavi, Ueda.

Drafting of the manuscript: Ishikane, Ueda.

Critical revision of the manuscript for important intellectual content: Sakamoto, Ishikane, Ghaznavi.

Statistical analysis: Ghaznavi, Ueda.

Administrative, technical, or material support: Sakamoto, Ishikane.

Supervision: Sakamoto, Ishikane.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was funded by grant No. 16H02643 from Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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