Lifetime risk of suicide among survivors of the atomic bombings of Japan

Abstract

Aims The long-term physical health effects of the atomic bombings of Hiroshima and Nagasaki are well characterised, but the psychological effects remain unclear. Therefore, we sought to determine whether measures of exposure severity, as indirect measures of psychological trauma arising from exposure to the atomic bombings, are associated with suicide mortality among atomic bomb survivors. Methods The Life Span Study is a prospective cohort study of 93 741 Japanese atomic bomb survivors who were located within 10 km of the hypocentre in Hiroshima or Nagasaki at the time of the bombings in 1945, and 26 579 residents of Hiroshima and Nagasaki who were not in either city at the time of the bombings, matched to survivors on city, sex and age. Measures of exposure severity included: proximity to the hypocentre, type of shielding between the survivor and the blast and self-reported occurrence of acute radiation and thermal injuries. Date of death was obtained from the Japanese National Family Registry system. Cause of death was obtained from death certificates. Adjusted hazard ratios (HRs) were estimated from Cox regression models overall and stratified by sex and age. Results During the 60-year follow-up period (1950–2009), 1150 suicide deaths were recorded among 120 231 participants (23.6 per 100 000 person-years): 510 among 70 092 women (17.2 per 100 000 person-years) and 640 among 50 139 men (33.6 per 100 000 person-years). Overall, there was no association of proximity, type of shielding or the occurrence of acute injuries with suicide mortality. Among those <25 years of age at the time of the bombings, increased suicide risk was observed for survivors outside v. shielded inside any structure (HR: 1.24; 95% confidence interval (CI): 1.03, 1.48; interaction p = 0.054) and for those who reported flash burns (HR: 1.32; 95% CI: 1.00, 1.73; interaction p = 0.025). Sex-stratified analyses indicated that these associations were limited to men. Among women, closer proximity to the hypocentre was associated with a non-significant increase in suicide risk, with a positive association between proximity and suicide risk observed among women <15 years of age (HR: 1.09 per km; 95% CI: 1.00, 1.18; interaction p = 0.067). Conclusions Proximity to the hypocentre, shielding and acute injury presence do not generally appear to influence suicide mortality among atomic bomb survivors. However, heterogeneity may exist by age and sex, with younger survivors potentially more sensitive to psychological trauma. Coupled with other studies, our results suggest the importance of long-term monitoring of mental health among young populations exposed to catastrophic events or mass trauma.

Mental Health of Adolescents Exposed to the War in Ukraine

“…In comparison with previous reports, our findings suggest a much greater burden: exposure to war was associated with an estimated 39% greater prevalence in depression, 41% greater prevalence in clinically relevant psychological trauma, 62% greater prevalence in anxiety, and 21% greater prevalence in eating disorders, and the estimated prevalence of adolescents in Ukraine screening positive was 32.0% for depression, 17.9% for anxiety, and 35.0% for clinically relevant psychological trauma. Our findings support previous reports that suggest youth may be particularly vulnerable to psychological trauma, as evidenced by a study on younger survivors of the atomic bomb in Japan …”

“…Our findings support previous reports that suggest youth may be particularly vulnerable to psychological trauma, as evidenced by a study on younger survivors of the atomic bomb in Japan. 40 We provide the most up-to-date information on the mental health burden of the ongoing invasion on Ukrainian adolescents in, to our knowledge, the largest study on population mental health during the invasion to date. In addition, our study is among the largest on the mental health of the civilian population in war settings.…”

‘Measuring’ Collective Trauma: a Quantum Social Science Approach

“…Survivors experienced extreme physical and emotional distress (Lifton, 2012 ; Oughterson & Warren, 1956 ). A longitudinal study (Amano et al, 2021 ) reports that over the next 60 years (1950–2009), 1150 suicide deaths were recorded among 120,231 participants (23.6 per 100,000 person-years). Among those < 25 years of age at the time of the bombings, he noted an increased suicide risk.…”