A proposed approach to suicide prevention in Japan: the use of self-perceived symptoms as indicators of depression and suicidal ideation

Abstract

The incidence of suicide in Japan has increased markedly in recent years, making suicide a major social problem. Between 1997 and 2006, the annual number of suicides increased from 24,000 to 32,000; the most dramatic increase occurred in middle-aged men, the group showing the greatest increase in depression. Recent studies have shown that prevention campaigns are effective in reducing the total number of suicides in various areas of Japan, such as Akita Prefecture. Such interventions have been targeted at relatively urban populations, and national data from public health and clinical studies are still needed. The Japanese government has established the goal of reducing the annual number of suicides to 22,000 by 2010; toward this end, several programs have been proposed, including the Mental Barrier-Free Declaration, and the Guidelines for the Management of Depression by Health Care Professionals and Public Servants. However, the number of suicides has not declined over the past 10 years. Achieving the national goal during the remaining years will require extensive and consistent campaigns dealing with the issues and problems underlying suicide, as well as simple screening methods for detecting depression. These campaigns must reach those individuals whose high-risk status goes unrecognized. In this review paper, we propose a strategy for the early detection of suicide risk by screening for depression according to self-perceived symptoms. This approach was based on the symposium Approach to the Prevention of Suicide in Clinical and Occupational Medicine held at the 78th Conference of the Japanese Society of Hygiene, 2008.

Sleep, Serotonin, and Suicide in Japan

“…Since many risk factors have been implicated in suicide (Nakao et al, 2008), it is difficult to establish direct links between suicide and specific neurotransmitters. Indeed, norepinephrine, serotonin, dopamine (Gunnell et al, 2009), CRF/cortisol, and retinoic acid (Bremner and McCaffery, 2008) are reported to be involved in affective disorders including depression, which is highly prevalent among people who die as a result of suicide (Conwell et al, 1996).…”

“…It is well established that insufficient sleep has a negative effect on daytime functioning (Wolfson and Carskadon, 1998;Randazzo et al, 1998;Teixeira et al, 2007), general well-being (Ohayon and Vecchierini, 2005), metabolic and endocrine function (Spiegel et al, 1999;Spiegel et al, 2005), body weight (Taheri et al, 2004), and psychomotor skills and mood (Dinges et al, 1997), in addition to the increased risk of suicide attempts mentioned above (Liu, 2004). Although difficulty in maintaining sleep has been recognized as a risk factor for suicide in Japan (Fujino et al, 2005), a recent review on suicide in Japan did not discuss this issue (Nakao et al, 2008). To the author's knowledge, the current review and the recent brief report mentioned above (Kohyama, 2010) are the first reports suggesting an association between sleep and suicide in Japan.…”

“…Depression is highly prevalent among people who commit suicide (Conwell et al, 1996), but many other risk factors have also been implicated, including other health conditions (e.g., alcohol dependency, cancer), sociodemographic features (e.g., higher rates in males, the unmarried, and unemployed individuals), socioeconomic factors, and climatic factors (e.g., cold weather, insufficient sunshine, and snowfall; Nakao et al, 2008). In Japan, the number of cases of suicide increased significantly in 1998, and the suicide rate has remained high to date.…”

Perspectives of “PUFA-GPR40 Signaling” Crucial for Adult Hippocampal Neurogenesis

“…However, in the past 50 years, the consumption of n-3 fatty acids has decreased remarkably even in Japan, which, the author speculates, might be one of the causative factors of major depression (approximately 700,000/year) and suicide (approximately 30,000/year) recently increasing in this country. For instance, patients with depression that plays an important role in the epidemiology of suicide, were reported to have increased from 100,000 (83.1 per 100,000 population) to 430,000 (340.0 per 100,000) between 1984 and 1998 in Japan (Nakao et al 2008). Mammalian brain tissues are predominantly composed of lipids including saturated, monounsaturated, and PUFA.…”

Effects of Universal Screening for Depression Among Middle-Aged Adults in a Community With a High Suicide Rate

“…The strong association of depression with suicide often indicates the necessity for a high-risk approach for suicide prevention. In Japan, there has been an increased risk for suicide since the prolonged economic downturn that began in the 1990s; rates are particularly high among people aged 40 to 64 years, unemployed, and late-treated adults with depression (Japan Cabinet Office, 2007;Nakao et al, 2008). More than half of the individuals who died because of suicide have also been identified as having had depressive symptoms (Nakao et al, 2008).…”