School problems and suicide in Japanese young people

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SUICIDE AMONG YOUNG people has become a serious public health problem worldwide.1 As well as psychiatric disorders, school problems (such as bullying or absence from school) have also been associated with suicidal behaviors in adolescents and young adults.2–4 This issue has never been examined in a young Japanese population. From November 2006, we conducted a study on suicide-completers nationwide in Japan using a psychological autopsy method and a semi-structured interview of the closest bereaved in cooperation with 54 prefectural Mental Health Welfare Centers (MHWC). Our subjects were suicide-completers whose bereaved consulted the prefectural MHWC and consented to participate in our study. As of June 2009, we collected the psychosocial information of 15 Japanese suicide-completers under the age of 30 from 10 prefectural MHWC (eight male and seven female subjects; mean age 23.7 ± 4.42). Of the 15 cases, the average period between the death and the time of the survey was 16.2 ± 23.6 months. Of the 15 young suicide-completers, 12 cases (80%) had psychiatric disorders meeting DSM-IV criteria5 at the time of death, including the primary diagnoses of schizophrenia (two cases; 13.3%), mood disorder (six cases; 40%), substance use disorder (two cases; 13.3%), adjustment disorder (one case; 6.7%), and avoidant personality disorder (one case; 6.7%). Additionally, 11 cases (73.3%: five male and six female subjects) had histories of school-related problems, including three cases (20.0%: one male and two female subjects) with histories of school refusal (absence from school for over a month without any somatic disorder), three cases (20.0%: three male subjects) who had suffered bullying during their school lives, and five cases (33.3%: one male and four female subjects) with both problems.

The present study was preliminary owing to the small sample size, biased sample representation and lack of controls. In addition, we were not able to clarify the association between school-related problems and the onset of psychiatric disorders in this study. However, the prevalence of these school-related problems appears to be rather high. Our findings lead us to the following speculation: school-related problems such as school refusal and bullying, as well as psychiatric disorders, may be closely associated with suicide in Japanese adolescents and young adults. This indicates that a suicide prevention strategy in school may be required. To clarify whether these school-related problems are risk factors for completed suicide in Japanese young people, we are now planning a case–control study.

ACKNOWLEDGMENTS

The present study was supported by the Japanese Ministry of Health, Labor and Welfare.

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