Is the COVID-19 pandemic associated with changes in the reasons for suicide in Japan?
In this cross-sectional study of 21 027 reason-identified suicides, all categories of reasons for suicide had monthly excess suicide rates during the COVID-19 pandemic, except for school in men. There were gender differences in subcategories.
The findings of this study could help to develop gender-specific suicide prevention interventions and programs.
Although the suicide rate in Japan increased during the COVID-19 pandemic, the reasons for suicide have yet to be comprehensively investigated.
To assess which reasons for suicide had rates that exceeded the expected number of suicide deaths for that reason during the COVID-19 pandemic.
Design, Setting, and Participants
This national, population-based cross-sectional study of data on suicides gathered by the Ministry of Health, Labor, and Welfare from January 2020 to May 2021 used a times-series analysis on the numbers of reason-identified suicides. Data of decedents were recorded by the National Police Agency and compiled by the Ministry of Health, Labor, and Welfare.
For category analysis, we compared data from January 2020 to May 2021 with data from December 2014 to June 2020. For subcategory analysis, data from January 2020 to May 2021 were compared with data from January 2019 to June 2020.
Main Outcomes and Measures
The main outcome was the monthly excess suicide rate, ie, the difference between the observed number of monthly suicide deaths and the upper bound of the 1-sided 95% CI for the expected number of suicide deaths in that month. Reasons for suicide were categorized into family, health, economy, work, relationships, school, and others, which were further divided into 52 subcategories. A quasi-Poisson regression model was used to estimate the expected number of monthly suicides. Individual regression models were used for each of the 7 categories, 52 subcategories, men, women, and both genders.
From the 29 938 suicides (9984 [33.3%] women; 1093 [3.7%] aged <20 years; 3147 [10.5%] aged >80 years), there were 21 027 reason-identified suicides (7415 [35.3%] women). For both genders, all categories indicated monthly excess suicide rates, except for school in men. October 2020 had the highest excess suicide rates for all cases (observed, 1577; upper bound of 95% CI for expected number of suicides, 1254; 25.8% greater). In men, the highest monthly excess suicide rate was 24.3% for the other category in August 2020 (observed, 87; upper bound of 95% CI for expected number, 70); in women, it was 85.7% for school in August 2020 (observed, 26; upper bound of 95% CI for expected number, 14).
Conclusions and Relevance
In this study, observed suicides corresponding to all 7 categories of reasons exceeded the monthly estimates (based on data from before or during the COVID-19 pandemic), except for school-related reasons in men. This study can be used as a basis for developing intervention programs for suicide prevention.
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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.
Accepted for Publication: December 6, 2021.
Published: January 31, 2022. doi:10.1001/jamanetworkopen.2021.45870
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Koda M et al. JAMA Network Open.
Correction: This article was corrected on February 22, 2022, to fix an error in the Results section.
Corresponding Author: Masahide Koda, PhD, Department of Psychiatry, Faculty of Medicine, University of Miyazaki, 5200 Kiyotake machi-Kihara, Miyazaki 889-1692, Japan (firstname.lastname@example.org).
Author Contributions: Dr Koda 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. Drs Koda and Harada shared first authorship.
Concept and design: Koda, Harada.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Koda, Harada.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Koda, Harada, Eguchi.
Obtained funding: Koda, Nomura.
Administrative, technical, or material support: Koda, Ishida.
Supervision: Harada, Ishida.
Conflict of Interest Disclosures: Dr Ishida reported receiving grants from the Japan Society for the Promotion of Science. No other disclosures were reported.
Funding/Support: This study was funded by the Japan Society for the Promotion of Science, grants 19K19462 and 21H03203.
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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