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Keywords:

  • overdose;
  • psychiatric treatment;
  • psychological autopsy;
  • suicide;
  • young adults

Abstract

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

Aim:  The present study was conducted to examine differences in psychosocial and psychiatric characteristics between suicide completers with and without a history of psychiatric treatment within the year before death, using a psychological autopsy method.

Methods:  A semi-structured interview was administered by a psychiatrist and other mental health professionals for the closest bereaved of 76 suicide completers.

Results:  Suicide completers with a history of psychiatric treatment (n = 38) were significantly younger than those without (n = 38) (P < 0.01), and a significantly higher proportion of cases in the treatment group were estimated to be suffering from schizophrenia. Further, in 57.9% of the treatment group, the fatal suicidal behavior involved overdose with prescribed psychotropic drugs. In addition, female suicide completers in the treatment group were more likely to have a history of self-harm or non-fatal suicidal behavior.

Conclusion:  Many suicide completers who received psychiatric treatment were young adults. It was common for suicide completers to overdose on prescribed drugs as a supplementary means of suicide, and many experienced self-harming behavior before death. In addition, a higher proportion of the treatment cases suffered from schizophrenia.

IN JAPAN, THE number of suicides has rapidly increased over the last several decades, to over 30 000 in 1998, and remains high today. Although multiple factors are known to influence suicide, the presence of a mental disorder is one of the most important risk factors.1,2 Over the last 2 decades, the correlation between suicide and mental disorders has been the focus of several studies.3,4 Previous reports have indicated that, despite more than 90% of suicide completers exhibiting some kind of mental disorder immediately prior to suicide, most did not receive psychiatric treatment.5,6 These findings appear to support the appropriateness of Japanese countermeasures for suicide, which seek to increase high-risk individuals' access to psychiatric treatment.

However, some suicide completers do receive psychiatric treatment before death. Several studies have reported that suicide among psychiatric patients is particularly strongly associated with acute episodes of disease, recent hospital discharge, social factors, and some self-harming behaviors.7,8 These findings indicate that currently available psychiatric treatment may be insufficient to prevent suicide of patients susceptible to these risk factors, suggesting that the improvement of psychiatric services is required, as well as increasing patients' access to psychiatric treatment. However, no studies in Japan have examined the detailed profiles of suicide completers under psychiatric treatment, and accordingly, it is unclear how psychiatric services should be improved.

The present study sought to clarify the psychosocial characteristics of suicide completers that received psychiatric treatment, compared with suicide completers that did not have access to psychiatric treatment.

METHODS

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

Subjects

Subjects were suicide completers who died by suicide between January 2006 and December 2009, whose bereaved consulted prefectural Mental Health Welfare Centers (MHWC) to seek support, and consented to participation in our study. The study was not an exhaustive survey, and the investigator chose bereaved who replied, and could participate in an interview, in consideration of their psychological condition. As of December 2009, information regarding 76 Japanese suicide cases from 54 MHWC had been collected. According to the statistics of the National Police Agency,9 the total number of suicides occurring in Japan in the same 4-year period was 130 342. Thus, our subjects constituted 0.06% of all recorded suicides in Japan.

The subjects' addresses at the time of death were distributed around Japan, classified into five areas: Hokkaido and Tohoku area (13 cases; 17.1%), Kanto-Shinetsu area (24 cases; 31.6%), Tokai-Hokuriku and Kinki area (25 cases; 32.9%), Chugoku and Shikoku area (eight cases; 10.5%), and Kyushu and Okinawa area (six cases; 7.9%). This distribution was biased to the Kanto and Kinki regions including the populated area, the Tokyo and Osaka prefectures, compared with the suicide-death statistics released by the Japanese Ministry of Health, Labour, and Welfare.

Procedure

In the present study, information on suicide completers was collected from one member of each bereaved family, via a semi-structured interview. Informants were chosen according to the following criteria: the closest bereaved family member who had lived together with or had continued close contact with the subject before death. In cases where two or more of the closest bereaved met the criteria, informants were selected in the order of spouse, parent, and child.

Semi-structured interviews were carried out based on the Japanese version of the interview schedule for a psychological autopsy, developed by the Beijing Suicide Research and Prevention Center in China.10 The items of this instrument included questions about family environment, history of suicide attempts, life history, socioeconomic and physical health status, and psychiatric diagnosis according to the DSM-IV criteria11 at the time of death. Preceding the present study, we repeatedly revised our interview, and examined the validity of the Japanese version through a pilot study.

The interview was conducted by the local investigators, a pair of psychiatrists and several other mental health professionals, such as a public health nurse and psychiatric social worker, who completed 3 days of training for consistency of the judgment on our study, including clinical diagnosis. Furthermore, each pair of investigators discussed and got consensus about the details, after the interview. The local investigators in each area requested the participation of all bereaved who visited MHWC for support or attended ‘survivors’ meetings at MHWC. The interview data was anonymized and sent to the Center for Suicide Prevention, National Institute of Mental Health in Japan.

The protocol was approved by the Ethics Committee of the National Center of Neurology and Psychiatry. Written informed consent was obtained from all participants.

Assessment measures

The assessment items in the interview were based on assessment instruments used in a previous study.10 These items reflected various factors, including psychosocial and economic variables, as described below, which were assumed to influence the rapid increase in suicide in Japan after 1998.

1. Sociodemographic variables

Sociodemographic variables included questions concerning the subjects' sex, age, educational history, employment, and marital status.

2. Medical variables

Medical variables included questions concerning the subjects' lifetime and recent histories of physical diseases, mental health problems, medical and psychiatric treatments, and suicidal behavior. Additionally, we asked whether subjects were under the influence of any psychoactive substances at the time of death, such as alcohol or psychotropic drugs.

3. Psychosocial variables

Psychosocial variables examined the subjects' social environment and life events. Such items included the subjects' family size, marital status, experience of physical, sexual and psychological abuse, separation from parents in childhood, job history and unmanageable debt.

4. Psychiatric diagnosis

In the current study, the DSM-IV psychiatric diagnoses before death were clinically estimated by a psychiatrist who was one of the two local investigators, referring to the Japanese version of the structured interview schedule for psychological autopsy studies.

To develop a Japanese version of the structured interview assessment tool used in a previous Chinese psychological autopsy study, we translated the questions and adapted descriptions of the Structured Clinical Interview for DSM-IV Axis I Disorders and the World Health Organization Composite International Diagnostic Interview to generate diagnoses at the time of death. Furthermore, we applied a dual diagnosis when the diagnoses corresponded to the DSM-IV criteria; that is, a subject may have had more than one mental disorder.

5. Characteristics of psychiatric treatment

Informants were asked about the content of the subjects' psychiatric treatment (pharmacotherapy, hospitalization to a psychiatric ward, duration of psychiatric treatment, and the date of final consultation before the death) in cases where there was a history of psychiatric treatment within 1 year of death.

Statistical analysis

We examined differences in psychosocial and psychiatric characteristics between suicide completers with and without histories of psychiatric treatment within the year prior to death, thus our subjects were divided into two groups, the treatment group (n = 38) and the untreated group (n = 38).

Sociodemographic, psychosocial, medical, and psychiatric variables were compared between groups. For the classification of life-stage, the Cabinet Office of Japan classified ‘adults’ as being between 30 and 64 years.9 However, this range of adulthood is too wide for analysis of detailed suicidal factors. Therefore, in this study, we used three age groups (youth ≤39, middle-aged 40–59, elderly ≥60) for analysis.

Statistical analyses were performed using Predictive Analytic Software, Version 17.0 (spss Inc, Chicago, IL, USA). We compared differences between groups using Fisher's exact test for qualitative variables, and Student's t-tests for continuous variables.

RESULTS

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

1. Sociodemographic, medical, and psychosocial characteristics

Table 1 compares sociodemographic, medical, and psychosocial characteristics between suicide completers with and without a history of psychiatric treatment within the year prior to the death.

Table 1.  Sociodemographic, medical, and psychosocial characteristics of suicide completers with and without psychiatric treatment within a year prior to death n = 76 Thumbnail image of

Of the subjects, 50% (38 cases) had a history of psychiatric treatment within a year prior to death. On sociodemographic characteristics, a significantly higher proportion of women was found in the treatment group than the untreated group (P < 0.01). The treatment group (mean age 36.8 years [SD = 13.9]) was significantly younger compared with the untreated group (mean age 46.3 years [SD = 17.2]) (P < 0.01). The youth group, who were aged ≤39 years, accounted for the largest portion of the suicides under a psychiatric treatment before death (65.8%).

On medical characteristics, no significant differences were found in the history of physical disease or contact with medical professionals within a year prior to death between groups. In both groups, more than half (the treatment group, 57.9%; the untreated group, 55.3%) of subjects had been aware of a poor physical condition continuing for over a week 1 month prior to death. While over 90% of subjects in the treatment group had contact with medical professionals for consultation about physical sickness, less than 50% of cases in the untreated group had direct contact with medical professionals (P < 0.01).

A significant difference was found in the rate of overdose with psychotropic drugs at the time of death between the two groups (P < 0.001). The treatment group more frequently overdosed with prescribed psychotropic drugs as part of their treatment at the time of death, compared with the untreated group, although overdose was not necessarily the fatal method of suicide. We found a particularly strong tendency for prescription misuse in relatively young subjects in the treatment group (P < 0.05) (data not shown). The treatment group also exhibited significantly more experience of self-harming behavior and non-fatal suicide attempts before death (P < 0.01).

On psychosocial characteristics, significant differences were found between groups regarding marriage and financial difficulties in the year prior to death. A higher proportion of the untreated group experienced marriage (76.3% vs 44.7% in the untreated and treatment groups, respectively; P < 0.01). In addition, a higher proportion of the untreated group experienced financial difficulties during the year prior to death (34.2% vs 10.5% in the untreated and treatment groups, respectively; P < 0.05). In contrast, no significant differences between groups were found in family size, abuse history, separation from parents in childhood, or experiences of divorce or job change or suspension from work, in the year prior to death.

2. Association between DSM-IV mental disorders and suicide

Table 2 compares psychiatric diagnoses between the treatment and untreated groups. Two cases were excluded from this analysis due to insufficient information.

Table 2.  Association between DSM-IV mental disorders and suicide n = 74†,‡
 Treatment groupUntreated group
n = 37n = 37
  • *

    P < 0.05.

  • Because diagnoses of psychiatrists were not attached, the two cases were excluded from the analysis.

  • A subject may have more than one mental disorder.

  • §

    In Substance-Related Disorders, one subject had two diagnoses of Alcohol Dependence and Nicotine Dependence.

  • In Mood Disorders, nine subjects had two diagnoses of Major Depressive Disorder and Dysthymic Disorder.

  • ††

    In Anxiety Disorders, two subjects had two diagnoses of Generalized Anxiety Disorder and Panic Disorder.

Psychiatric diagnosis (DSM-IV classification)*36 (97.3%)30 (81.8%)
Disorders usually first diagnosed in infancy, childhood, or adolescence2 (5.4%)0
  Pervasive developmental disorders1 (2.7%)0
  Mental retardation1 (2.7%)0
Delirium, dementia, and amnestic and other cognitive disorders1 (2.7%)0
  Dementia1 (2.7%)0
Substance-related disorders§6 (16.2%)9 (24.3%)
 Alcohol-related disorders4 (10.8%)9 (24.3%)
  Alcohol dependence3 (8.1%)6 (16.2%)
  Alcohol abuse1 (2.7%)3 (8.1%)
 Drug-related disorders2 (5.4%)1 (2.7%)
  Drug dependence2 (5.4%)0
  Nicotine dependence01 (2.7%)
Psychotic disorders*7 (18.9%)0
  Schizophrenia*7 (18.9%)0
Mood disorders27 (73.0%)20 (54.1%)
  Major depressive disorder21 (56.8%)18 (48.6%)
  Dysthymic disorder8 (21.6%)5 (13.5%)
  Bipolar I disorder2 (5.4%)0
  Bipolar II disorder1 (2.7%)1 (2.7%)
Anxiety disorders††7 (18.9%)4 (10.8%)
  Generalized anxiety disorder5 (13.5%)3 (8.1%)
  Obsessive–compulsive disorder2 (5.4%)0
  Panic disorder1 (2.7%)2 (5.4%)
Somatization disorder01 (2.7%)
  Hypochondriasis01 (2.7%)
Dissociative amnesia1 (2.7%)0
Eating disorders1 (2.7%)2 (5.4%)
  Anorexia nervosa1 (2.7%)1 (2.7%)
  Bulimia nervosa01 (2.7%)
Impulse-control disorders not elsewhere classified03 (8.1%)
  Pathological gambling03 (8.1%)
Adjustment disorders*06 (16.2%)
Personality disorders4 (10.8%)3 (8.1%)

The results revealed that 66 cases (89.2%) of all subjects were estimated to fit a diagnosis of a mental disorder at the time of the death. The most frequently estimated diagnosis was mood disorder, accounting for 63.5% of all subjects. A significant difference was found in the proportion of the suicide completers diagnosed with schizophrenia and adjustment disorder between the treatment and untreated groups (P < 0.05). Schizophrenia was found to be more common in the treatment group, while adjustment disorder was more common in the untreated group.

3. Characteristics of psychiatric treatment

Table 3 shows the characteristics of the psychiatric treatment received by the 38 cases in the treatment group.

Table 3.  Characteristics of psychiatric treatment during the year prior to death n = 38
 WholeMenWomen
n = 38n = 22n = 16
Period from the final consultation to suicide   
 Within 5 days (hospitalized patients are included)17 (44.7%)11 (50.0%)6 (37.5%)
 Within 1 month18 (47.4%)8 (36.4%)10 (62.5%)
 Within 3 months2 (5.3%)2 (9.1%)0
 Unknown1 (2.6%)1 (4.5%)0
Mean day of the period from the final consultation to suicide (days)21.3 (SD = 53.7)30.1 (SD = 70.6)10.0 (SD = 10.5)
Duration of psychiatric treatment   
 Initial consultation only2 (5.3%)1 (4.5%)1 (6.3%)
 Less than 1 year5 (13.2%)3 (13.6%)2 (12.5%)
 1–5 years11 (28.9%)4 (18.2%)7 (43.8%)
 More than 5 years14 (36.8%)11 (50.0%)3 (18.8%)
 Unknown6 (15.8%)3 (13.6%)3 (18.8%)
Medication during the year prior to death30 (78.9%)18 (81.8%)12 (75.0%)
Treatment interruptions and/or drug discontinuation during the year prior to death8 (21.1%)5 (22.7%)3 (18.8%)
Therapeutic effect during the year prior to death   
 Improved10 (26.3%)6 (27.3%)4 (25.0%)
 Stable2 (5.3%)02 (12.5%)
 Unchanged7 (18.4%)5 (22.7%)2 (12.5%)
 Got worse17 (44.7%)10 (45.5%)7 (43.8%)
 Unknown2 (5.3%)1 (4.5%)1 (6.3%)
Hospitalization to a psychiatric ward during the year prior to death7 (18.4%)2 (9.1%)3 (18.8%)

Regarding the period between final consultation and suicide, 17 cases (44.7%) consulted a psychiatrist within 5 days (including during hospitalization) before suicide, and 18 cases (47.4%) sought a consultation within 1 month. The mean period from final consultation to suicide was 21.3 days (SD = 53.7). Regarding duration of psychiatric treatment, 25 cases (65.7%) received continuing psychiatric treatment for longer than 1 year. Thirty cases (78.9%) received continuing psychiatric treatment during the year prior to death, while eight cases (21.1%) received interrupted psychiatric treatment or discontinued psychiatric pharmacotherapy. Additionally, seven cases (18.4%) had an experience of hospitalization to a psychiatric ward within the year prior to death.

4. Analysis of sex differences in the treatment group

Table 4 presents a comparison of the data between both sexes in the treatment group.

Table 4.  Comparison between men and women in psychiatric treatment group n = 38 Thumbnail image of

Female suicide completers receiving psychiatric treatment were significantly younger than men in the same group (30.1 years [SD = 12.3] vs 41.7 years [SD = 13.1]). Approximately 90% of the female treatment group was classified into the youth age group (younger than 30 years of age), whereas the component ratio of the youth group in women was almost equal to that of the middle-aged group in men.

No significant differences were found in the rate of overdose involving psychotropic drugs at the time of death between sexes in the treatment group. However, a marked sex difference was found in the experience of self-harming behavior and non-fatal suicide attempts before death in the treatment group (P < 0.01): a history of self-destructive behavior was more common among female subjects.

DISCUSSION

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

1. Histories of psychiatric treatment and mental disorders in the suicides

Approximately 90% of our subjects were estimated to have suffered from a mental disorder immediately prior to suicide, and half of them had a history of psychiatric treatment within a year before death. Our findings regarding the prevalence of mental disorders in suicide completers are largely consistent with the results of previous studies conducted in Japan and elsewhere.5,12

On the other hand, the rate of psychiatric treatment history in suicide completers in our study is higher than that reported in previous studies in Western countries, none of which reported a rate exceeding 40%.13,14 This discrepancy may be related to the small sample size and biased sample representation of our study, as well as some institutional differences, including differences in the medical insurance and general practitioner systems between Japan and Western countries.

However, it cannot be disregarded that our findings are consistent with two previous studies conducted in Japan. One psychological autopsy study conducted in Tokyo reported that 46% of suicide completers had been receiving psychiatric treatment at the time of death.15 In another study, Tokyo Metropolitan Government reported that 54% of the suicide completers had consulted a psychiatrist within 2 weeks prior to death.16 It should be noted that both of these studies were conducted in Tokyo.

We speculate that the present findings may reflect the particular characteristics of suicide completers in the populated area in Japan, as both samples of our study and the two previous studies were biased to those in the populated area, including Tokyo. In Japan, the number of psychiatric clinics in big cities has increased in recent years, almost doubling in the metropolitan area in the past decade or so.17 Our findings may indicate that accessibility to psychiatric treatment has improved in the populated area in Japan.

Incidentally, the distribution of mental disorder diagnosis in our sample was at least partially consistent with reports from other countries. However, the proportion of mood disorders and schizophrenia in our study was slightly higher than those in several Western studies, while the proportions of substance-related disorders and personality disorders were relatively low compared with the other countries.5 On the basis of the current data, we cannot draw firm conclusions about whether the subtle differences in diagnostic distribution were caused by differences in national characteristics or psychiatrists' diagnostic abilities.

2. Characteristics of suicides within 1 year of contact with mental health professionals

The results of the present study revealed that age at the time of death was significantly lower in the treatment group than the untreated group. This may be largely explained by reduced hesitation among younger people to consult psychiatrists, related to the recent implementation of education directed towards reducing stigma.18

The estimation of psychiatric diagnoses of suicide completers revealed that individuals in the treatment group were more frequently diagnosed with schizophrenia compared to the untreated group. In addition to disorders related to depression and alcohol use, schizophrenia is reported to be closely related to suicide,19,20 raising the suicide risk more than eight times.21

Nevertheless, predicting suicide among schizophrenic patients remains extremely difficult. Previous studies reported that approximately 90% of suicide completers with schizophrenia were receiving psychiatric treatment at the time of death.22 This suggests that routinely assessing suicide risk among schizophrenic patients may be required for suicide prevention, even if the psychiatric symptoms appear stable and under control.

On the other hand, the present results revealed that untreated suicide completers were more frequently diagnosed with adjustment disorder than those that were treated. Suicide completers in the untreated group were found to more frequently suffer from social problems, such as unemployment or economic distress, compared to those in the treatment group, indicating that the mental health problems resulting in suicide in these cases might have been connected with social difficulties. Consequently, the mental health status of untreated suicide completers before suicide may be more frequently diagnosed as an adjustment disorder.

In the present study, over half of the suicide completers in the treatment group overdosed on psychotropic drugs that were prescribed by a psychiatrist as part of their treatment at the time of death. Overdosing on psychotropic drugs is a less-lethal method of self-injury relative to hanging or jumping from a height.23 However, the pharmacological effects of overdose with psychotropic drugs may cause disinhibition and an increase in impulsive behavior, promoting other fatal suicidal behavior.24 Our findings suggest that psychiatrists should prescribe psychotropic drugs more carefully to young patients.

Additionally, a disproportionate number of women in the treatment group had histories of self-harm and attempted suicide. These self-destructive behaviors are well known as important risk factors for suicide. Establishing an assessment of suicide risk in young female patients engaging in non-lethal self-harming behavior, and developing treatment systems for young women may be important in psychiatric practice, although such patients are likely to elicit negative reactions from mental health professionals.25,26

In our study, approximately 90% of suicide completers who received psychiatric treatment had consulted a psychiatrist in the month before suicide, and many cases in the treatment group were receiving regular psychiatric pharmacotherapy. These results suggest that an additional psychosocial intervention or support may be required as well as pharmacotherapy, to control the abuse of prescribed-psychotropic drugs and prevent such patients from committing suicide.

3. Problems and suggestions for suicide prevention

The most important finding of the present study was that suicide completers receiving psychiatric treatment were typically aged in their 20s and 30s. In Japan, recent countermeasures for suicide prevention have included education focusing on reducing the stigma associated with mental health disorders, leading to an increase in the rate of psychiatric consultation. However, our findings suggest that necessary strategies are countermeasures for prescribed drug misuse on young adult patients as well as promotion of psychiatric consultation.

Suicide prevention among young adults with psychiatric treatment provides a future target of suicide countermeasures in Japan, as the number of suicides among people in their 20s and 30s has markedly increased within the current decade, whereas rates of suicide among middle- and older age groups have decreased since 2005.9 Based on the current findings, we propose three strategies to prevent young adults from committing suicide, as follows.

First, a strategy focusing on schizophrenia as well as depression is required. This proposal has already been specified in the partial revision of the ‘Comprehensive Suicide Prevention Initiative’ (October, 2008), stating a goal of ‘promoting countermeasures for the high-risk person of suicide with mental disorders other than depression, including schizophrenia,’ although concrete strategies have not been proposed.

Second, a strategy for preventing the abuse of prescribed psychotropic drugs is required. According to several recent studies, the number of patients transported to emergency medical units after attempting suicide by overdosing on psychotropic drugs has increased steadily in the last several years.27 The long-term prescription of some psychotropic drugs was permitted by revisions to government policies in 2008 in Japan. We suspect that this change may have influenced the increase in rates of abuse and overdose involving psychotropic drugs, as well as forged prescriptions and illegal acquisition of drugs via the Internet. The UK government has regulated access to some over-the-counter drugs (e.g. acetaminophen), resulting in a decrease in the rate of youth suicides.28 This suggests that controlling access to drugs that have the potential to be abused with suicidal intent may be an effective countermeasure.

Finally, the development of appropriate treatment for self-harming behavior frequently exhibited by young female patients is required. According to the suicide statistics of the National Police Agency, the history of attempted suicide before death is most common in cases aged in their 20s, and the rate of suicide attempts in girls and women is high in all age groups. Some medical professionals may be inclined to negatively interpret ‘low-lethality’ self-harm behaviors, such as overdosing and self-cutting, as manipulative behaviors. Such attitudes among medical professionals may result in the underestimation of the suicide risk associated with these behaviors. Education focused on overcoming negative attitudes among medical professionals toward self-harming patients is required.

4. Limitations

Our study involved four main limitations. First, the sample size was relatively small. Although cooperating local government agencies publicized our study in the catchment community, it was difficult to recruit the bereaved participating in this study. One possible reason is that social prejudice against suicide may have reduced their motivation to participate. Second, the sample representation may have been biased, as subjects were limited to suicide completers whose bereaved consented to participate in our study, among those who accessed the survivor support provided by MHWC. We speculate that bereaved who disapproved of or distrusted psychiatric care for suicides may have been more likely to participate in our study. Thus, we cannot deny the possibility the sample constituted a high encounter rate group. Moreover, suicide completers who had lived alone were excluded from our sample, and the information source was limited to only one family member of the suicide completers. Third, an effect of recall bias among the bereaved informers cannot be entirely excluded because of the retrospective data collection method.

Finally, our study lacked a control group. However, the psychosocial characteristics of suicide completers with access to psychiatric treatment examined in the present study, who tended to be younger adults, women, and patients suffering from schizophrenia, are in accord with the characteristics of the individuals reported to be most inclined to undertake help-seeking behavior.29 Accordingly, a comparative study using a control group consisting of alive individuals receiving psychiatric treatment is required.

Despite these limitations, the current study is valuable in providing the first research in Japan to use a psychological autopsy method to clarify the clinical characteristics of suicide completers receiving psychiatric treatment before death compared with those who received no psychiatric treatment. Our findings may thus be useful for developing suicide prevention strategies for psychiatric patients. In future, a comparative study using a control group matched for age, sex, and area of residence will be required to identify risk factors for suicide among individuals receiving psychiatric treatment.

Conclusion

The present study examined suicide completers receiving psychiatric treatment within the year prior to death using a psychological autopsy method. We found that a relatively high number of young adults were receiving psychiatric treatment before suicide. Our results revealed that many of the suicides among the treatment group involved overdose with psychotropic drugs at the time of death, and prior experience of self-harm. Additionally, treated cases were more frequently diagnosed with schizophrenia than untreated cases. Our findings thus indicate the necessity of revised strategies for suicide prevention in the future. Detailed investigation of actual suicide situations involving individuals with schizophrenia, controlling inappropriate access to prescribed drugs, and education for medical professionals regarding self-harming behavior may be valuable strategies for suicide prevention for individuals receiving psychiatric treatment.

ACKNOWLEDGMENTS

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

We wish to thank the bereaved families for participating in our study, and investigators from local government agencies for their cooperation and valuable data collection.

This study has been supported by the Health Labour Sciences Research Grant by the Ministry of Health and Welfare, Comprehensive Research on Disability Health and Welfare, ‘A study on the causes and processes of suicide using a data base collected by a psychological autopsy method’ (Principal investigator, Kaga M). We declare no conflicts of interest that may be inherent in this study.

REFERENCES

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