Is an increase in Japan's suicides caused by COVID-19 alone?

Similar to other countries, the Japanese government quickly undertook preventative measures against increasing suicides during the pandemic, but could not suppress the increase. Suicide mortality among both sexes under 20 and females aged 20-39 significantly increased during the pandemic, but unexpectedly had already slowed decreasing trends before the pandemic onset. Furthermore, before the pandemic, a higher complete unemployment rate contributed to increasing suicide mortality of both sexes, whereas during the pandemic, the positive relationship between females suicide mortalities and complete unemployment rates was not observed.

Analyzing the changing relationship between personal consumption and suicide mortality during COVID-19 pandemic in Japan, using governmental and personal consumption transaction databases.

During the early stages of the ongoing COVID-19 pandemic, suicides did not increase in most countries/regions. Japan, however, was an exception to this, reporting increased numbers of female suicides with no changes in male suicide. To explore the trends of increasing suicides, the fluctuations of personal consumption (as an indicator of lifestyle) and standardized suicide death rate (SDR) disaggregated by age, sex, and prefecture, were determined using a linear mixed-effect model. Additionally, fixed effects of personal consumption on SDR during the pandemic were also analyzed using hierarchical linear regression models with robust standard errors. During the first wave of the pandemic, SDR for both sexes decreased slightly but increased during the second half of 2020. SDR of females younger than 70 years old and males younger than 40 years old continued to increase throughout 2021, whereas SDR for other ages of both sexes did not increase. Personal consumption expenditures on out-of-home recreations (travel agencies, pubs, and hotels) and internet/mobile communication expenses decreased, but expenditures on home-based recreations (contents distribution) increased during the pandemic. Increased expenditures on internet/mobile communication were related to increasing SDR of both sexes. Increasing expenditures on content distributions were related to increasing females' SDR without affecting that of males. Decreasing expenditures on pubs were related to increasing SDR of both sexes in the non-metropolitan region. These findings suggest that transformed individual lifestyles, extended time at home with a decreased outing for contact with others, contributed to the progression of isolation as a risk of suicide. Unexpectedly, increasing compensatory contact with others using internet/mobile communication enhanced isolation resulting in increased suicide risk.

Bidirectional Causality between Spreading COVID-19 and Individual Mobilisation with Consumption Motives across Prefectural Borders in Japan.

A combination of pharmaceutical and non-pharmaceutical interventions as well as social restrictions has been recommended to prevent the spread of coronavirus disease 2019 (COVID-19). Therefore, social contact surveys play an essential role as the basis for more effective measures. This study attempts to explore the fundamental basis of the expansion of COVID-19. Temporal bidirectional causalities between the numbers of newly confirmed COVID-19 cases (NCCC) and individual mobilisations with consumption motives across prefecture borders in three metropolitan regions in Japan were analysed using vector autoregression models. Mobilisation with consumption in pubs from Kanto to Tokai contributed to the spread of COVID-19 in both regions. Meanwhile, causal mobilisation with consumption motives in Kansai also contributed to the expansion of COVID-19; however, the pattern was dependent on the industrial characteristics of each prefecture in Kansai. Furthermore, the number of pub visitors in Kanto immediately decreased when NCCC increased in Kanto. In contrast, the causal mobilisations for the expansion of COVID-19 in the Tokai and Kansai regions were unaffected by the increasing NCCC. These findings partially proved the validity of the conventional governmental measures to suppress pub visitors across prefectural borders. Nevertheless, the individual causal mobilisations with consumption motives that contributed to the increasing COVID-19 cases are not identical nationwide, and thus, regional characteristics should be considered when devising preventive strategies.

Exploring characteristics of increased suicide during the COVID-19 pandemic in Japan using provisional governmental data.

Background: The Japanese age-standardised death rate of suicide (SDR) had decreased during 2009-2019, but increased in 2020-2021, during the COVID-19 pandemic. Methods: This study aimed to explain the trend change in the SDR during the pandemic, disaggregated by prefecture, gender, suicide method and household, as compared to predicted SDR derived from pre-pandemic data, using linear mixed-effect and hierarchical linear regression models with robust standard error analyses. Findings: The SDR was lower during March-June 2020 (during the first wave of the pandemic), but higher during July-December 2020 than the predicted SDR. In 2021, males' SDR was nearly equal to the predicted SDR, whereas females' SDR in the metropolitan-region (17.5%: 95% confidence interval: 13.9-21.2%) and non-metropolitan-region (24.7%: 95% confidence interval: 22.8-26.7%) continued to be higher than the predicted SDR. These gender- and region-dependent temporal fluctuations of SDR were synchronised with those of SDRs caused by hanging, at home and single-person-households. Additionally, the rising number of infected patients with the SARS-CoV-2 and polymerase chain reaction (PCR) diagnostic examinations were positively (ß = 0.024) and negatively (ß =-0.002) related to the SDR during the pandemic, respectively. Interpretation: Japanese suicide statistics have previously established that the predominant method and place of suicide were by hanging and at the individual's home, respectively. The present findings suggest that transformed lifestyles during the pandemic, increasing time spent at home, enhanced the suicide risk of Japanese people by hanging and at home. Funding: Regional Suicide Countermeasures Emergency Enhancement Fund of Mie Prefecture (2021-40).

Analysing the Impacts of Financial Expenditure of Prefectures on Methods of Suicide Completion in Japan

Recently, several studies reported that the governmental financial expenditures play important roles in the prevention of increasing suicide mortalities;however, the specific regional policies, designed dependent on regional cultural, economic, education and welfare backgrounds, affect suicide mortality by a specific suicidal means. Therefore, the present study determined the impacts of the regional governmental expenditure of six major divisions, “public health”, “public works”, “police”, “ambulance/fire services”, “welfare” and “education” on suicide mortalities by five major suicidal means, “hanging”, “poisoning”, “charcoal burning”, “jumping” and “throwing”, across the 47 prefectures in Japan during 2009–2018 using fixed-effect analysis of hierarchal linear regression with robust standard error. The expenditures of “ambulance/fire services” and “education” indicated the negative relation to suicide mortalities by wide-spectrum suicidal means, whereas expenditures of “public works” did not affect suicide mortalities. In the education subdivisions, expenditure of “kindergarten” and “elementary school” indicated the impacts of reduction of suicide mortalities, whereas the expenditures of “special school” for individuals with disabilities unexpectedly contribute to increasing suicide mortalities by poisoning, charcoal burning and throwing of females. Regarding subdivisions of welfare, expenditure of “child welfare” and “social welfare” contributed to a reduction in suicide mortalities, but expenditure of “elderly welfare” surprisingly contributed to increasing suicide mortalities. Furthermore, expenditures of welfare subdivision abolished the negative impacts of the expenditures of educational subdivisions, kindergarten and elementary school, but the positive impact of expenditure of special school on female suicide mortalities was not affected. These results suggest that most Japanese people are struggling to care for children even in the situation of an increasing elderly population with a decreasing birthrate. Therefore, it is important to enhance the investment welfare policy for the future to improve the childcare environment. The results demonstrated by this study suggest that the scientifically evidence-based redistributions of welfare expenditure in regional government, at least partially, provide improvement of Japanese society and welfare systems, under the continuous severe Japanese social concerns associated with increasing elderly population with a decreasing birthrate.

Determining What Changed Japanese Suicide Mortality in 2020 Using Governmental Database.

The pandemic of 2019 novel coronavirus disease (COVID-19) caused both COVID-19-related health hazards and the deterioration of socioeconomic and sociopsychological status due to governmental restrictions. There were concerns that suicide mortality would increase during the COVID-19 pandemic; however, a recent study reported that suicide mortality did not increase in 21 countries during the early pandemic period. In Japan, suicide mortality was reduced from 2009 to 2019, but both the annual number of suicide victims and the national suicide mortality rates in 2020 increased compared to that in 2019. To clarify the discrepancy of suicide mortality between the first and second half of 2020 in Japan, the present study determines annual and monthly suicide mortality disaggregated by prefectures, gender, age, means, motive, and household factors during the COVID-19 pandemic and pre-pandemic periods using a linear mixed-effects model. Furthermore, the relationship between suicide mortality and COVID-19 data (the infection rate, mortality, and duration of the pandemic) was analysed using hierarchal linear regression with a robust standard error. The average of monthly suicide mortality of both males and females in all 47 prefectures decreased during the first stay-home order (April-May) (females: from 10.1-10.2 to 7.8-7.9; males: from 24.0-24.9 to 21.6 per 100,000 people), but increased after the end of the first stay-home order (July-December) (females: from 7.5-9.5 to 10.3-14.5; males: from 19.9-23.0 to 21.1-26.7 per 100,000 people). Increasing COVID-19-infected patients and victims indicated a tendency of suppression, but the prolongation of the pandemic indicated a tendency of increasing female suicide mortality without affecting that of males. Contrary to the national pattern, in metropolitan regions, decreasing suicide mortality during the first stay-home order was not observed. Decreasing suicide mortality during the first stay-home order was not observed in populations younger than 30 years old, whereas increasing suicide mortality of populations younger than 30 years old after the end of the first stay-home order was predominant. A decrease in suicide mortality of one-person household residents during the first stay-home order was not observed. The hanging suicide mortality of males and females was decreased and increased during and after the end of the first stay-home orders, respectively; however, there was no decrease in metropolitan regions. These results suggest that the suicide mortality in 2020 of females, younger populations, urban residents, and one-person household residents increased compared to those of males, the elderly, rural residents, and multiple-person household residents. Therefore, the unexpected drastic fluctuations of suicide mortality during the COVID-19 pandemic in Japan were probably composed of complicated reasons among various identified factors in this study, and other unknown factors.

Effects of Financial Expenditure of Prefectures/Municipalities on Regional Suicide Mortality in Japan.

In Japan, suicide mortality has been improving from 2009; however, suicide remains one of the leading causes of death. Although previous studies identified solid relationships between governmental financial support for social welfare systems and suicide mortality, little attention is paid to how specific regional policies, designed according to regional cultural, economic, and social welfare situations, affect suicide mortality. Therefore, the present study analyses the relationships between the regional governmental expenditure of six major divisions and suicide mortality across the 47 prefectures in Japan from 2009 to 2018 using fixed-effect analysis of hierarchal linear regression with robust standard error. The expenditure in "public health", "police", "ambulance/fire services", "welfare" and "education" is associated with reduction in suicide mortality, at least in some statistical indicators, whereas expenditure of "public works" indicated the influence of increasing suicide mortality or had no effect. Welfare expenditure was the most predominantly effective among the six major divisions of regional governmental expenditure. In the welfare subdivisions, expenditure of "child welfare" and "social welfare" was effective in a reduction in suicide mortality, but expenditure of "elderly welfare" surprisingly contributed to increasing suicide mortality. Child welfare expenditure negatively impacted suicide mortality in wide-ranging generations of both males and females; the positive effects of elderly welfare expenditure reached were limited as working-age populations increased, but unexpectedly did not affect the suicide mortality of elderly populations. The relatively increasing expenditure of elderly welfare with the relatively decreasing child welfare are unavoidable due to the Japanese social issues associated with a declining birth rate and ageing population. Furthermore, the budget of that regional government that can modify its expenditure structure by making its own policies is limited since most regional governmental expenditure is composed of essential expenditure for maintaining and operating regional social welfare systems. Although severe social situations in Japan are still unoptimised, the present results suggest that scientific-evidence-based redistributions of welfare expenditure in regional governments can at least partially improve Japanese society and welfare systems.