Panic disorder and suicide in Mie Prefecture, Japan


Ken Inoue, MD, Department of Psychiatry, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514–8507, Japan. Email:

The number of suicides in Japan has been increasing.1 It has increased from about 22 000 per year from 1988 to 1997 to over 30 000 per year since 1998, and the need to decrease suicidal numbers is one of the important problems in Japan. In Japan, 34 427 suicides in 2003 was the highest on record. In recent years, many researchers around the world have tried to elucidate almost every aspect of anxiety disorders. Among anxiety disorders, panic disorder is one of the psychiatric disorders that is most frequently diagnosed according to the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders.2 There have been many reports on panic disorder.3–5 However, there are few reports on completed suicide in panic disorder patients. The increase in suicide is one of the crucial problems in the world. In addition, many reports have concluded that psychiatric disorders are the main reason for the increase.6 Therefore, it is important to elucidate the relationship between panic disorder and suicide. In this report, the authors examine the presence of panic disorder in all suicidal cases reported at Mie Prefectural Police Headquarters during the 7-year period from 1996 to 2002. Psychiatric specialists confirmed the diagnoses of psychiatric disorders. Mie Prefecture is located in the center of Japan. The population is approximately 1 800 000, with a population density of approximately 320 per km2. All data were completely anonymous after encoding. During the test period, 1979 male and 969 female suicides were reported to Mie Prefectural Police Headquarters, giving a male/female ratio of approximately 2:1. Among all the victims of completed suicide, nine exhibited panic disorder diagnosed by psychiatric specialists, including three men and six women. The results of Fisher’s exact test among suicides in Mie Prefecture and for completed suicides among individuals with panic disorder of this Prefecture showed a statistically significant difference (P < 0.05). Therefore, medical staff members should especially pay attention to female patients with panic disorder, who have a high risk of completed suicides. Of the nine victims of completed suicide who exhibited panic disorder, six suffered from major depression and panic disorder. There was a high rate of comorbidity of major depression and panic disorder among panic disorder patients in the current results, which are similar to the results of other reports. In the current results, the authors discovered that the risk of completed suicide among individuals with panic disorder is higher in women than men.

The authors conclude that medical staff members must pay attention to suicide attempts and completed suicides in panic disorder patients who also exhibit other psychiatric disorders. Special attention should be paid to female patients with major depression and panic disorder. As they provide medical care to such patients, medical professionals should perform not only subjective evaluation but also objective evaluation of psychiatric symptoms as well as of suicidal risk.

The current study involves suicides that occurred over a short-term of 7 years, from 1996 to 2002. Therefore, the authors intend to continue this investigation in the future so as to verify their results.