Geography of suicide in Japan: spatial patterning and rural–urban differences

Yoshioka, Eiji; Hanley, Sharon J.B.; Sato, Yukihiro; Saijo, Yasuaki

doi:10.1007/s00127-020-01978-7

Cited by 18 publications

(16 citation statements)

References 35 publications

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“…Factors at both the compositional (e.g., age and gender) and the contextual level—including biological, genetic, psychological, social, and environmental determinants—are thought to be involved [ 4 , 5 , 6 ]. The literature on mental health points to notable geographic variations in suicide mortality [ 7 ] that differ not only between but also within countries, with differences between urban and rural areas standing out [ 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Inequalities of Suicide Mortality across Urban and Rural Areas: A Literature Review

Casant

Helbich

2022

IJERPH

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Suicide mortality is a major contributor to premature death, with geographic variation in suicide rates. Why suicide rates differ across urban and rural areas has not yet been fully established. We conducted a literature review describing the urban–rural disparities in suicide mortality. Articles were searched in five databases (EMBASE, PubMed, PsychINFO, Scopus, and Web of Science) from inception till 26 May 2021. Eligible studies were narratively analyzed in terms of the urban–rural disparities in suicides, different suicide methods, and suicide trends over time. In total, 24 articles were included in our review. Most studies were ecological and cross-sectional evidence tentatively suggests higher suicide rates in rural than in urban areas. Men were more at risk by rurality than women, but suicide is in general more prevalent among men. No obvious urban–rural pattern emerged regarding suicide means or urban–rural changes over time. Potential suicidogenic explanations include social isolation, easier access to lethal means, stigmatization toward people with mental health problems, and reduced supply of mental health services. For research progress, we urge, first, individual-level cohort and case-control studies in different sociocultural settings. Second, both rurality and urbanicity are multifaceted concepts that are inadequately captured by oversimplified typologies and require detailed assessments of the sociophysical residential environment.

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Section: Introductionmentioning

confidence: 99%

Inequalities of Suicide Mortality across Urban and Rural Areas: A Literature Review

Casant

Helbich

2022

IJERPH

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“…Three hundred thirty-five areas have been set up to provide efficient medical services as of January 2021 [5]. Studies on suicide have been conducted at each of the following regional levels: prefectures [6][7][8][9][10][11][12], secondary health care areas [13,14], municipal towns and villages [15][16][17][18][19][20], and cities and villages in specific prefectures [21,22]. It is critical to comprehensively assess the efficiency of suicide prevention measures in each administrative unit, such as prefectures, secondary health care areas, and municipalities, to assure the success of suicide prevention measures throughout Japan.…”

Section: Introductionmentioning

confidence: 99%

“…Except for a few studies [7,15,17,20] that noted that suicide neighborhoods clustered in spatial contiguity, most studies did not investigate the impact of spatial proximity on neighborhood suicide. This is problematic because suicide is influenced not only by the individual but also by the surrounding context [24].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies using spatial regression models suggested a regional continuum of suicide in Japan, related to access to psychiatric care population density and cultural values. Still, no further information is available [7,17,20]. In addition, it is not clear whether it is better to use the policy unit of the prefecture, secondary medical area, or municipality when considering spatial continuity.…”

Section: Introductionmentioning

confidence: 99%

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Spatial statistical analysis of regional disparities in suicide among policy units in Japan: Using the Bayesian hierarchical model

Koda

Kondo

Takahashi

et al. 2022

PLOS Glob Public Health

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Suicide prevention is a crucial policy issue in Japan to be addressed nationally. Nevertheless, if there are regional differences in suicide, even in adjacent sub-regions, measures may need to be taken at the sub-regional level. Previous studies have not compared regional differences in suicide based on the size of policy units, such as prefectures, secondary medical areas, and municipalities. This study used the number of suicides from open data for 10 years from 2009 to 2018 to obtain shrinkage estimates of the standardized mortality ratio (SMR) using the Bayesian hierarchical model. We visualized and compared the regional disparities in suicide for each policy unit. For each gender and policy unit, adjacent regions had similar clusters of SMRs and positive spatial autocorrelation of global Moran’s I (p < 0.001 for each). Comparisons between each policy unit showed that even if the SMR was low for the prefectural units, there were regions with high SMRs in municipalities and secondary medical areas, and vice versa. It was found that assessing suicide solely on a prefecture-by-prefecture basis may overlook regional disparities in suicide. This research emphasizes the need to establish suicide indicators at the secondary medical or municipal level and execute individual suicide prevention interventions in neighboring communities. Prefectures can also play a role in developing collaborative cooperation between neighboring regions by acting as actors.

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“…Investigation of the rural/urban gap on depression prevalence in Japan has been limited to those conducted in a single prefecture [ 23 , 24 ]. Studies that have evaluated the differences in suicide rates in Japan among rural and urban settings have had an ecological design at the prefectural or municipal level [ 25 – 29 ]. Because of the limitations of such a study design, it was not possible to analyze individual and regional effects separately or discuss them separately at the municipality level and link small regional-level factors to mental health-related outcomes.…”

Section: Introductionmentioning

confidence: 99%

Differences in depressive symptoms by rurality in Japan: a cross-sectional multilevel study using different aggregation units of municipalities and neighborhoods (JAGES)

et al. 2021

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Background Rurality can reflect many aspects of the community, including community characteristics that may be associated with mental health. In this study, we focused on geographical units to address multiple layers of a rural environment. By evaluating rurality at both the municipality and neighborhood (i.e., a smaller unit within a municipality) levels in Japan, we aimed to elucidate the relationship between depression and rurality. To explore the mechanisms linking rurality and depression, we examined how the association between rurality and depression can be explained by community social capital according to geographical units. Methods We used cross-sectional data from the 2016 wave of the Japan Gerontological Evaluation Study involving 144,822 respondents aged 65 years or older residing in 937 neighborhoods across 39 municipalities. The population density quintile for municipality-level rurality and the quintile for the time required to reach densely inhabited districts for neighborhood-level rurality were used. We calculated the prevalence ratios of depressive symptoms by gender using a three-level (individual, neighborhood, and municipality) Poisson regression. Community social capital was assessed using three components: civic participation, social cohesion, and reciprocity. Results The prevalence of depressive symptoms was higher in municipalities with lower population density than those with the highest population density; the ratios were 1.22 (95% confidence intervals: 1.15, 1.30) for men and 1.22 (1.13, 1.31) for women. In contrast, when evaluating rurality at the neighborhood level, the prevalence of depressive symptoms was 0.9 times lower for men in rural areas; no such association was observed for women. In rural municipalities, community civic participation was associated with an increased risk of depressive symptoms. In rural neighborhoods, community social cohesion and reciprocity were linked to a lower risk of depressive symptoms. Conclusions The association between rurality and depression varied according to geographical unit. In rural municipalities, the risk of depression may be higher for both men and women, and the presence of an environment conducive to civic participation may contribute to a higher risk of depression, as observed in this study. The risk of depression in men may be lower in rural neighborhoods in Japan, which may be related to high social cohesion and reciprocity.

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Geography of suicide in Japan: spatial patterning and rural–urban differences

Cited by 18 publications

References 35 publications

Inequalities of Suicide Mortality across Urban and Rural Areas: A Literature Review

Inequalities of Suicide Mortality across Urban and Rural Areas: A Literature Review

Spatial statistical analysis of regional disparities in suicide among policy units in Japan: Using the Bayesian hierarchical model

Differences in depressive symptoms by rurality in Japan: a cross-sectional multilevel study using different aggregation units of municipalities and neighborhoods (JAGES)

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