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Keywords:

  • economic difficulties;
  • Japan;
  • prevent;
  • psychiatric disorders;
  • suicide

Abstract

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGMENTS
  8. REFERENCES

Abstract  The number of suicides in Japan has increased from approximately 22 000 per year from 1988 to 1997 to >30 000 per year since 1998. Likewise, the number of suicides has been increasing in Mie Prefecture. The purpose of the present study was to examine the incidence of and circumstances surrounding all suicide cases during 1996–2002 in Mie Prefecture and to compare the data with those from 1989 to 1995. In Mie Prefecture, the age-specific suicide rate during the second 7-year period included marked increases among men aged 50–59 and 60–69 years. Among women, the age-specific suicide rate increased with age during both 7-year periods. During the second period, psychiatric disorders as causative factors increased in all generations. They were especially important for women of the younger generation, whereas economic problems were the most common causative factor among men aged 40–64. Physical illness as a causative factor in suicide was high among the elderly, but among the other age groups this factor trailed behind economic difficulties for men and psychiatric disorders for women. To prevent suicide, social cooperation as well as a plenitude of visiting nurses and psychiatric care is required, and early detection and treatment are also important.


INTRODUCTION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGMENTS
  8. REFERENCES

Mie Prefecture is located in the center of Japan. Its population is approximately 1 800 000, at a density of approximately 320 per km2.

In Japan, a large-scale study of suicide was undertaken by Yoshioka, which covered the 7 years from 1989 to 1995.1 In that report the following was found.

  • 1
    The number and rate of suicides were highest in the spring and early summer months.
  • 2
    The suicide rate was very high among the elderly in both sexes, and it was high among middle-aged men.
  • 3
    Hanging was the most common method of suicide in both sexes.
  • 4
    The most frequent causative factor among younger individuals of both sexes was ‘psychiatric disorders’, and among the elderly of both sexes it was ‘suffering from physical illness’. ‘Suffering from physical illness’ was the most frequent causative factor among middle-aged men, and ‘suffering from physical illness’ and ‘psychiatric disorders’ were the most frequent causative factors among middle-aged women. Across all generations, ‘suffering from physical illness’ was a frequent causative factor.
  • 5
    Regarding family constitution, most suicide completers of either sex were living with their intact family at the time of death.
  • 6
    Among suicide completers, women were more likely than men to have had a history of suicide attempts.

Abe et al. presented a statistical analysis of the suicides in Mie Prefecture during the 7 years from 1989 to 1995.2 This prefecture showed intermediate levels of suicide relative to Japan as a whole.

Beginning in 1998, the number of suicides has increased rapidly in Mie Prefecture, as well as in Japan generally. We were able to obtain and analyze detailed Mie Prefectural data on suicides to investigate the causes, which we presumed would reflect national trends in Japan. Therefore, we thought that because the rate of suicide in Mie Prefecture is similar to that for all of Japan, we considered our findings on suicidal behavior in this prefecture to be applicable to Japan as a whole. In the present study we examined the incidence of and the circumstances surrounding all suicide completers during the 7-year period 1996–2002 in Mie Prefecture, and compared the data with those from the previous 7-year period, 1989–1995, in the same prefecture.

METHODS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGMENTS
  8. REFERENCES

We investigated all inquest records in Mie Prefecture during the 7-year period 1996–2002, in cooperation with the First Department of Criminal Investigation of the Mie Prefectural Police Headquarters. In all cases classified as suicides, we extracted data on age, sex, time of occurrence, means of suicide, backgrounds, family constitution, and history of suicide attempts. We used the same investigative methods as those of Yoshioka.1 The repetition methods and causes of suicide counted were many for the present study.1 We stored all these data in our database.

The age-adjusted suicide rates were calculated per 100 000 inhabitants per year and were classified by sex and age. Three age groups were established: younger (under 39), middle aged (40–64), and elderly (65 or over).

The means of suicide were divided into eight groups: hanging, drowning, poisoning, gases, impact with vehicles, jumping, burning, and others.

Among each group and each sex, we found a significant difference between hanging and not hanging. We compared cases of jumping and drowning from 1996 to 2002 with all suicide cases in Mie Prefecture during the previous 7-year period, 1989–1995, between male and female suicide completers.

The records concerning suicide are carefully evaluated by inquest doctors, and they become a police record. In addition, medical doctors from our group reconfirmed these records during the investigation. We judged completed suicides in our investigation from the cases regarded as suicide by inquest doctors. The case backgrounds (causative factors and medical histories, as diagnosed by medical professionals) were classified into six groups: suffering from physical illness (malignant neoplasm, diseases of the central nervous system, cardiovascular disease, digestive organ disease, diabetes mellitus, orthopedic disorder, urinary organ/generative organ disease, and others), pessimism, economic difficulties, personal relationships, psychiatric disorders (depression, schizophrenia, and other psychiatric disorders), as well as others and unknown.

Family constitution and history of suicide attempts were analyzed based on the results of police investigations.

Among the suicide cases discovered in later periods, a specialist in forensic medicine estimated the date and time of death, and they were entered in the inquest records in Mie Prefecture at the First Department of Criminal Investigation of the Mie Prefectural Police Headquarters. In these cases we went by the estimated date and time of death.

We compared these 1996–2002 cases with all suicide cases in Mie Prefecture during the previous 7-year period, 1989–1995.2 Annual suicide rates were obtained from the adjusted mortality rate in Japan.

Statistical analysis was performed using the u-test and Fisher’s exact test. All data were completely anonymous after encoding.

RESULTS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGMENTS
  8. REFERENCES

Gender

During the second 7-year period, suicides involving 1979 male and 969 female suicide completers were reported to Mie Prefectural Police Headquarters (Fig. 1), giving a male/female ratio of approximately 2:1. The average number of suicides per year was 421.1.

image

Figure 1. No. suicides for the years 1989–2002. (□) Male; (▪) female.

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During the first 7-year period, suicides involving 1297 male and 803 female suicide completers were reported to Mie Prefectural Police Headquarters (Fig. 1), giving a male/female ratio of 1.7:1. The average number of suicides per year was 300.

The suicide rates by sex were 30.6 male and 14.0 female suicide completers per 100 000 during the second 7-year period, and 20.3 male and 11.6 female suicide completers per 100 000 during the first 7-year period (Table 1). There was a statistical difference between men and women for the second 7-year period (< 0.01).

Table 1.  Average rate of suicides per year (per 100 000)
 1989–19951996–2002
  • *

     P < 0.01.

Total15.822.1
Male20.330.6*
Female11.614.0*

Monthly and seasonal distribution

During the second 7-year period, the months with the highest numbers of suicides were March–July (Fig. 2). The most frequent day for suicides was Monday, while the least frequent was Sunday (Fig. 3).

image

Figure 2. No. suicides per month. (□) 1989–1995; (bsl00023) 1996–2002; (▪) 1989–2002.

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image

Figure 3. No. suicides per day of the week. (□) 1989–1995; (bsl00023) 1996–2002; (▪) 1989–2002.

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During the first 7-year period, March was the month with the greatest number of suicides, and it continued with April and December (Fig. 2). The most frequent day was Friday, while the least was Saturday (Fig. 3).

However, we found no statistically significant differences between the first and second 7-year periods with regard to the month and day (P > 0.1). Therefore, during the 14-year period 1989–2002, the number of suicides was highest in the spring and early summer months (Fig. 2). The day with the most suicides was Monday, while the day with the least was Saturday (Fig. 3).

Age distributions for men and women

Different age distributions in the suicide rate were found for men and women.

During the second 7-year period, the age-specific number of suicides, for both sexes combined, was highest in the 50–59 age group (n = 654) followed by the 60–69 and 40–49 age groups. Among men, those aged 50–59 had the highest number of suicides (n = 493) followed by the 60–69 and 40–49 age groups (Fig. 4a). The pattern among women was less consistent across the years but generally peaked later than the male pattern; that is, women aged 70–79 had the highest number of cases (n = 204), followed by those aged 50–59 and those aged 60–69 (Fig. 4b).

image

Figure 4. Age-specific suicide numbers for (a) men and (b) women. (□) 1989–1995; (bsl00023) 1996–2002; (▪) 1989–2002.

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During the first 7-year period, the age-specific distribution of suicides, for both sexes combined, showed that the 50–59 age group was highest (n = 405), followed by the 40–49 and 60–69 age groups. Among men, those aged 40–49 and 50–59 groups had the equally highest number of suicides (n = 287), and then the 60–69 age group (Fig. 4a). Among women, the 70–79 age group had the highest number of suicides (n = 168), followed by the 60–69 group and then the over-80 group (Fig. 4b).

Therefore, the age-specific suicide numbers in male suicide completers peaked in the middle-aged group, while in female suicide completers it increased progressively with age.

In male suicide completers, the age-specific suicide rate during the second 7-year period peaked in the 50–59 age group, followed by the 60–69 and over-80 groups, whereas in the first 7-year period it increased progressively (50–59 age group, P < 0.05; 60–69 age group, P < 0.05; Fig. 5a). In female suicide completers, the age-specific suicide rate increased progressively during both 7-year periods (Fig. 5b).

image

Figure 5. Age-specific suicide rate in (a) men (P < 0.05 for 50–59 years, 60–69 years) and (b) women. (▪) 1989–1995; (◆) 1996–2002.

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Methods of suicide

During the second 7-year period, hanging was the most common method of suicide (61.6%) in both sexes (Figs 6,7). Hanging was the most common means in all three age categories: in younger people (under 39), in the middle-aged (40–64), and in the elderly (65 or over); but it increased as a function of age in both male and female suicide completers (male: middle-aged and elderly, P < 0.01; female: elderly, P < 0.05). Among female suicide completers, suicide by jumping was more common in younger people than in the other age categories (< 0.05).

image

Figure 6. Suicide methods in men. (a) All age groups: (left) 1989–1995 (%), (right) 1996–2002 (%); (b) ≤39 years: (left) 1989–1995 (%), (right) 1996–2002 (%); (c) 40–64 years: (left) 1989–1995 (%), (right) 1996–2002 (%); (d) ≥65 years: (left) 1989–1995 (%), (right) 1996–2002 (%).

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image

Figure 7. Suicide methods in women. (a) All age groups: (left) 1989–1995 (%), (right) 1996–2002 (%); (b) ≤39 years: (left) 1989–1995 (%), (right) 1996–2002 (%); (c) 40–64 years: (left) 1989–1995 (%), (right) 1996–2002 (%); (d) ≥65 years: (left) 1989–1995 (%), (right) 1996–2002 (%). Poisoning, ≤39 years: P < 0.05 for 1989–1995 and 1996–2002.

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During the first 7-year period, as during the second, hanging was the most common method of suicide (56.4%) for the two sexes combined (male: middle-aged and elderly, P < 0.01; female: elderly, P < 0.05).

In both 7-year periods, suicide by drowning was more common among middle-aged women and elderly women (second 7-year period: middle-aged and elderly, P < 0.05; first 7-year period: middle-aged, P < 0.01; elderly, P < 0.05).

Causative factors

During the second 7-year period, ‘psychiatric disorders’ was the most serious issue for the overall age groups, accounting for 23.8% of all cases, followed by ‘suffering from physical illness’ and then ‘economic difficulties’(Figs 8–10). The most frequent causative factor was ‘psychiatric disorders’ (30.2%) in the younger age group, ‘economic difficulties’ (25.7%) in the middle-aged group, and ‘suffering from physical illness’ (39.4%) in the elderly group. The second most frequent factor in the middle-aged and elderly groups was ‘psychiatric disorders’ (22.6% and 21.8%, respectively). Among men overall, the most common causative factor was ‘economic difficulties’ (23.1%), followed by ‘suffering from physical illness’ (18.8%). The most frequent factor among younger male suicide completers was ‘psychiatric disorders’ (24.6%), while that for middle-aged men was ‘economic difficulties’ (30.9%) and that for elderly men was ‘suffering from physical illness’ (41.6%). In contrast, in women overall, the most frequent causative factor was ‘psychiatric disorders’ (36.0%), followed by ‘suffering from physical illness’ (25.0%). The most common factor in both the younger and middle-aged female suicide completers was ‘psychiatric disorders’ (45.0% and 40.7%, respectively), whereas it was ‘suffering from physical illness’ (37.4%) in elderly women. The second most frequent factor was ‘personal relationships’ (23.1%) among the younger-aged women, ‘suffering from physical illness’ (19.4%) among the middle-aged women, and ‘psychiatric disorders’ (28.8%) in elderly women.

image

Figure 8. Causative factors in men. (a) All age groups: (left) 1989–1995 (%), (right) 1996–2002 (%); (b) ≤39 years: (left) 1989–1995 (%), (right) 1996–2002 (%); (c) 40–64 years: (left) 1989–1995 (%), (right) 1996–2002 (%); (d) ≥65 years: (left) 1989–1995 (%), (right) 1996–2002 (%). Suffering from physical illness: P < 0.05 for all age groups, ≤39 years, 40–64 years, for 1989–1995 and 1996–2002.

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image

Figure 9. Causative factors in women. (a) All age groups: (left) 1989–1995 (%), (right) 1996–2002 (%); (b) ≤39 years: (left) 1989–1995 (%), (right) 1996–2002 (%); (c) 40–64 years: (left) 1989–1995 (%), (right) 1996–2002 (%); (d) ≥65 years: (left) 1989–1995 (%), (right) 1996–2002 (%). Suffering from physical illness: P < 0.05 for all age groups, ≤39 years, 40–64 years, ≥65 years, for 1989–1995 and 1996–2002.

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image

Figure 10. Distribution of psychiatric disorders. (a) total: (left) 1989–1995 (%), (right) 1996–2002 (%); (b) men: (left) 1989–1995 (%), (right) 1996–2002 (%); (c) women: (left) 1989–1995 (%), (right) 1996–2002 (%).

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During the first 7-year period,2‘suffering from physical illness’ was the most serious issue overall for men and women combined, accounting for 35.8% of all cases, followed by ‘psychiatric disorders’ (22.9%). The most frequent causative factor was ‘psychiatric disorders’ (32.5%) in the younger age group, and ‘suffering from physical illness’ in both the middle-aged and elderly groups (31.3% and 56.2%, respectively). The second most frequent factor in the middle-aged and elderly groups was ‘psychiatric disorders’ (23.5% and 15.7%). In men overall, the most common causative factor was ‘suffering from physical illness’ (31.9%), followed by ‘psychiatric disorders’ (19.6%). The most frequent factor among younger male suicide completers was ‘psychiatric disorders’ (28.4%), while ‘suffering from physical illness’ was the most common among middle-aged and elderly men (29.5% and 56.8%). In contrast, in women overall, the most frequent causative factor was ‘suffering from physical illness’ (42.1%), followed by ‘psychiatric disorders’ (28.3%). The most frequent factor among younger women was ‘psychiatric disorders’ (42.4%), while ‘suffering from physical illness’ was the most frequent among middle-aged and elderly women (35.7% and 55.8%). The second most frequent factor in middle-aged and elderly women was ‘psychiatric disorders’ (35.4% and 18.5%).

With regard to the factor ‘suffering from physical illness’, we found significant decreases between the genders and between age groups from 1989–1995 to 1996–2002 (all , younger, and middle age groups of total, men, and women, P < 0.05; and elderly group in female suicide completers, P < 0.05). However, the rate of ‘suffering from physical illness’ did not decrease significantly between the two periods (1996–2002 [all : younger : middle : elderly]: male, 485:31:239:214; female, 317:13:90:214; 1989–1995: male, 487:49:249:189; female, 397:22:124:250). During both periods, the rate of ‘economic difficulties’ increased among male suicide completers overall and among middle-aged and elderly men specifically (men overall, middle-aged and elderly, P < 0.1). Among female suicide completers, the rate of ‘psychiatric disorders’ tended to increase among the elderly in both periods (elderly women, P < 0.1). Details regarding the psychiatric disorders are provided in Fig. 10.

Histories of suicide attempts

During the second 7-year period, there were histories of suicide attempts in 13.4% of all cases; 10.7% for men and 18.9% for women (Table 2).

Table 2.  History of suicide attempts
Age (years)1989–1995 (%)1996–2002 (%)
MaleFemaleTotalMaleFemaleTotal
−190.01.9 0.9 3.3 3.8 3.6
20–2914.311.513.015.612.014.0
30–3918.812.515.714.714.214.5
40–4925.021.223.122.319.120.8
50–5910.717.313.919.415.317.5
60–6917.914.416.216.614.815.7
70–797.112.5 9.7 5.213.7 9.1
80–6.38.7 7.4 2.8 7.1 4.8
All8.613.010.310.718.913.4

In the first 7-year period, there were histories of past suicide attempts in 10.3% of all cases; 8.6% for men and 13.0% for women.

We did not find significant differences between the first and second 7-year periods statistically, but the rate during the second 7-year period was higher than that in the first.

Family constitution

Regarding family constitution, during the second 7-year period, 16.5% of all suicide completers lived alone at the time of death; 19.1% of men and 11.4% of women. In contrast, those who lived in a family constituted 73.5% of all cases; 70.3% of male and 79.9% of female suicide completers. The status was Unknown 10.0% of all cases; 10.6% of male and 8.7% of female suicide completers.

During the first 7-year period, 14.5% of all suicide completers lived alone; 16.0% of men and 12.3% of women. In contrast, those who were living with their family at the time of death constituted 85.5% of all cases; 84.0% of male and 87.7% of female suicide completers.

We found significant gender differences between those who lived alone and those who lived with their family in each 7-year period (both sexes, men, and women, P < 0.01).

DISCUSSION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGMENTS
  8. REFERENCES

The number of suicides in Mie Prefecture increased markedly in the 7-year period 1996–2002, to 1.5-fold that of the previous 7 years (Fig. 1).2 This tendency closely mirrors the increase in Japan overall.3 The ratio of male to female suicide completers was higher in the second 7-year period than in the first (Table 1).2 It was equal to the tendency throughout Japan for the suicide rate to increase significantly in male subjects.4 The most common methods of suicide (Figs 6,7) were almost the same between the two periods, the number of suicides committed by middle-aged men increased remarkably (Fig. 4).2 The months for suicide had some differences between the two periods (Fig. 2). Spring and early summer months were common in the two periods, December in the first 7-year period.2 Among the seasonal variations in suicide in Japan, Nakamura et al. and Araki et al. have reported that there are more suicides in spring to early summer and autumn.5,6 Yoshioka has also reported that there are many suicides from spring to early summer.7 The day of the week on which suicides most commonly occurred in Ishikawa Prefecture was Monday, while the least common days were Saturday and Sunday.8 According to Jessen and Jensen suicides most commonly occur the day after a holiday, while they least commonly occur on a holiday.9 Our results are similar to these preliminary findings (Fig. 3).

Regarding the various methods of suicide, Yamauchi has reported hanging to be the most common method in both male and female suicide completers; suicide by jumping is more common in younger women, and suicide by drowning is more common among women in Niigata Prefecture.10 Our results are similar to these reported by Yamauchi.

Among causative factors, ‘psychiatric disorders’, ‘economic difficulties’, and ‘suffering from physical illness’ were the most common during both 7-year periods and across all generations (Figs 8,9).2 Among ‘psychiatric disorders’ in Japan, Funahashi reported that the medical examination rate increases in the second period.11 Therefore, we thought that this factor increased from the first to the second period.2

Implementing measures to address psychiatric disorders is one means of reducing the suicide rate. In Japan, clear methods for preventing suicide due to psychiatric disorders have not yet been implemented. In the USA, Britain, Sweden, and Finland, the suicide rate has decreased as a result of efforts to lecture on and disseminate information about psychiatric disorders, particularly depression, to the general public and general practitioners.12–15 The steps taken to prevent suicide in those countries are as follows. The general public and general practitioners understand psychiatric disorders, conduct early detection and diagnosis measures relative to them, and carry out appropriate efforts to address the problem. Because this has led to decreased rates of suicide, it follows that such measures should be implemented urgently at a national level in Japan.

In the second 7-year period, economic difficulties as a causative factor increased rapidly in Mie Prefecture among both middle-aged individuals and among all generations overall (Fig. 8). In particular, an increase in the unemployment rate beginning in 1998 correlated with the increase in the number of male suicides. One factor for the increased number of suicides was ‘loss of jobs’, which refers to a lack of opportunity in the local or national economy rather than to a specific job that was lost.16 Therefore, the rapid increase in suicides since 1998 has likely been caused primarily by the economic depression in Japan and the progressively increasing rate of unemployment it produced. Measures to improve an individual’s ability to recover from unemployment with economic recovery should be investigated at the national level in Japan. Moreover, rapidly responsive psychological health care focused on issues related to job loss, is required.

As a causative factor, the rate of ‘suffering from physical illness’ significantly decreased from the first to the second 7-year periods for the overall age group and specifically among the younger and middle-aged groups. However, it was the most common causative factor among the elderly of both sexes and in both periods.2 In Japan, the decrease in this factor for the overall age group was lately due to the increase in house calls and in-home services by general practitioners and home health nurses. However, because this factor remained the most common among the elderly, it will be important to provide even more home health nursing, as well as to implement a system of health care in which general practitioners are closely partnered with the populace.17–20

In both 7-year periods, the rate of histories of suicide attempts exceeded 10% for both sexes overall, and among female subjects was highest in the under-40 and 40–49 age groups (Table 2).2 Orihara et al. reported that the rate of histories of suicide attempts exceeds 10% for both sexes overall, and our result are similar.21 Therefore, medical staff should carry out thorough preventative measures, such as psychological care for persons who have attempted suicide in the past.

Regarding ‘family constitution’ as a causative factor, in both periods the suicide rate for people who were living with their family at time of death was higher than that for people living alone. This was attributed to the accumulation of stress that persons feel due to sensing that their illness has diminished their value within the family and that they are a nuisance to family members, rather than directly to the suffering caused by their physical illness or psychiatric disorder. Therefore, communication and interaction between couples and family members are important for preventing suicide.

Although many papers regarding suicide have been published, few have provided detailed analyses of causative factors and preventative measures.22–34 The present paper therefore focused on these subjects to clarify the causes of the rapid increase in suicide in Japan, and examined measures to address those factors.

Our research resembles that of Yoshioka (in Yoshioka’s thesis pages 5 and 6). In the Yoshioka report in pages 5 and 6, points (1), (2), (3), (5), (6) (as can be seen in ‘Introduction’ in the present paper) were similar to ours, while (4) differs from our results. According to our research, ‘economic difficulties’ are the most frequent causative factor among all generations and middle-aged men, and ‘psychiatric disorders’ are the most frequent causative factor among all generations of female suicide completers.

These factors mirror the present Japanese characteristics. Therefore, the characteristics of suicide in Mie Prefecture very much resemble those of Japanese as a whole.

In conclusion, social cooperation as well as physical and psychiatric care are required in order to prevent suicide. Further understanding of psychiatric disorders, along with their early detection and treatment by the general public and general practitioners, are important. Measures need to implemented urgently in Japan to identify and treat psychiatric disorders in people of all generations and both sexes, especially elderly women.

In recent years, the number of suicides among middle-aged men has radically increased (Fig. 5). This result corresponds to that of Yamasaki et al.35 Given the current sluggish economy, which is failing to improve, social solutions on the national level must be generated. In addition, the relationship between family and their community, as well as psychological care for persons with histories of attempted suicide, are important.

ACKNOWLEDGMENTS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGMENTS
  8. REFERENCES

We thank the staff of the Department of Forensic Medicine and Sciences and the Department of Psychiatry, Mie University Graduate School of Medicine; and the First Department of Criminal Investigation of Mie Prefectural Police Headquarters, for their enthusiastic cooperation.

REFERENCES

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGMENTS
  8. REFERENCES
  • 1
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  • 2
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  • 3
    Ishihara A. Suicide in Japan: the analysis of vital statistics. J. Mental Health 2003; 49 (Suppl.): 1326 (in Japanese).
  • 4
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  • 5
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  • 8
    Sato Y, Konodo N, Oshima T. Examination of statistics of suicide in Ishikawa prefecture. Ishikawa Med. J. 1996; 1126: 3439 (in Japanese).
  • 9
    Jessen G, Jensen BF. Postponed suicide death? Suicides around birthdays and major public holidays. Suicide Life Threat. Behav. 1999; 29: 272283.
  • 10
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    Greenfield SF, Reizes JM, Magruder KM, Muenz LR, Kopans B, Jacobs DG. Effectiveness of community-based screening for depression. Am. J. Psychiatry 1997; 154: 13911397.
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    Paykel ES, Hart D, Priest RG. Changes in public attitudes to depression during the Defeat Depression Campaign. Br. J. Psychiatry 1998; 173: 519522.
  • 16
    Lindeman SM, Hirvonen JI, Hakko HH, Lonnqvist JK. Use of the national register of medico-legal autopsies in epidemiological suicide research. Int. J. Legal Med. 1995; 107: 306309.
  • 17
    Lodhi LM, Shah A. Factors associated with the recent decline in suicide rates in the elderly in England and Wales, 1985–1998. Med. Sci. Law 2005; 45: 3138.
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    Salib E, Rahim S, El-Nimr G, Habeeb B. Elderly suicide: an analysis of coroner’s inquests into two hundred cases in Cheshire 1989–2001. Med. Sci. Law 2005; 45: 7180.
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