Statistical aspects of psychiatric inpatient care in Japan: Based on a comprehensive nationwide survey of psychiatric hospitals conducted from 1996 to 2012.

The aim of this review is to clarify the state of psychiatric admissions and discharges in Japan using statistical data collected from 1996 to 2012. We performed a secondary analysis of nationwide data on psychiatric hospitals, which are collected yearly by the Ministry of Health, Labour and Welfare. The latest national figures for indices defined in the 'Reform Vision of Mental Health and Welfare' (originally released in 2004) were 70.9% for 'discharge rate for newly admitted patients' and 23.3% for 'discharge rate for long-term patients', which have target rates of ≥76% and ≥29%, respectively. The national discharge rate for newly admitted patients was roughly on the increase, but appeared to reach a plateau in recent years. [Correction added on 17 July 2015, after first online publication: 'on the decline' has been corrected to 'on the increase' in the sentence above.] The national discharge rate for long-term patients was higher in 2012 than in 1999 and appeared to increase throughout the 2000s, although not enough to reach the target. Some improvements in the discharge rate for newly admitted patients indicated some progress in mental health reform, although problems should continue to be addressed in order to reach the targets. As for discharge rates of long-term admissions in local communities, some problems still remain to be solved in order to achieve the goals of the reform vision.

Suicide risk among individuals with sleep disturbances in Japan: a case-control psychological autopsy study.

OBJECTIVE: This case-control psychological autopsy study aimed to explore a relationship between sleep disturbances and suicide among Japanese, as well as determine the importance and usability of screening for sleep disturbances in suicide prevention. METHODS: A semi-structured interview was conducted with the close family members of 49 adult suicide completers and 145 gender-, age-, and residential municipality-matched living controls. The survey included sections on demographics, sleep disturbances, and mental disorders. Conditional logistic regression analyses were performed to compare sleep disturbance prevalence between the two groups. RESULTS: A significantly higher prevalence of sleep disturbances was found among the suicide group (75.5%) compared to the controls (11.0%) (odds ratio [OR]=21.6, p<0.001). The association remained significant after adjusting for mental disorders (OR=12.7, p<0.001). The population attributable risk percent of suicide associated with sleep disturbances and mental disorders was estimated to be 56.4% and 35.3%, respectively. CONCLUSIONS: The study confirmed that sleep disturbances are an important risk factor of suicide, independent of mental disorders. Sleep disturbances accounted for a greater proportion of suicide cases than did mental disorders in the Japanese population given the higher prevalence, and could thus be considered an important target in suicide prevention in Japan.

Prevalence of problematic drinking among outpatients attending general hospitals in Tokyo.

AIM: Although some studies about the prevalence of alcohol-related problems in general hospitals have been conducted in Japan, it may seem that some of Japanese physicians and surgeons appear to have less interest in alcohol-related problems. We investigated the prevalence of problematic drinking among outpatients visiting general hospitals in Tokyo, and examined factors associated with problematic drinking in such outpatients. METHOD: This study used a self-report questionnaire. Subjects (N = 1826, 814 were male) were recruited from all adult outpatients in January 2011 from seven general hospitals in the Tokyo metropolitan area. We used the third question of the Alcohol Use Disorder Identification Test (AUDIT) to screen for "heavy drinking", and the CAGE to screen for "suspected alcohol dependence". RESULTS: The prevalences of "heavy drinking" and "suspected alcohol dependence" were 7.1% and 14.1%, respectively. Multivariate analyses revealed that being middle-aged and male were significantly associated with both "suspected alcohol dependence" and "heavy drinking". Consultations with the departments of internal medicine, surgery, or obstetrics and gynecology were significantly associated with subjects having "suspected alcohol dependence". CONCLUSION: Screening problematic drinking in general hospitals is required for early detection and treatment of alcohol-related problems for outpatients, especially for men, visiting internal medicine or surgery departments and for women visiting obstetrics and gynecology department.

Psychosocial and psychiatric characteristics of suicide completers with psychiatric treatment before death: a psychological autopsy study of 76 cases.

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.

Mental disorders and suicide in Japan: a nation-wide psychological autopsy case-control study.

BACKGROUND: The purpose of the present nationwide psychological autopsy case-control study is to identify the association between mental disorders and suicide in Japan, adjusting for physical conditions. METHODS: A semi-structured interview was conducted of the closest family members of 49 suicide completers and 145 gender-, age-, and municipality-matched living controls. The interview included sections of socio-demographic characteristics, physical conditions, and a psychiatric interview producing DSM-IV diagnoses of mental disorders prior to suicide (or at survey). We compared prevalences of mental disorders between the two groups, using conditional logistic regression. RESULTS: A significantly higher proportion with any mental disorder was found in the suicide group (65.3%) compared to the control group (4.8%) (p=0.003, odds ratio [OR]=7.5). The population attributable risk proportion associated with mental disorder was 0.24. Mood disorder, particularly major depressive disorder, was the most strongly associated with suicide (p<0.001). Anxiety disorder, alcohol-related disorder, and brief psychotic disorder were also significantly associated with suicide (p<0.05). These patterns were unchanged after adjusting for serious chronic physical conditions. LIMITATIONS: The present study had some limitations, such as small sample size, sampling bias and information bias. CONCLUSIONS: Most mental disorders, particularly mood disorder, were significantly associated with a greater risk of suicide in Japan, independent of physical conditions. Mental disorders are a major target of suicide prevention programs in Japan.

[State of suicide and effective efforts in suicide prevention in psychiatric hospitals and clinics].

Although factors related to suicide are complicated, mental health disorders are an important risk factor. It is anticipated that suicide prevention measures will be implemented from the perspective of improved psychiatric medicine. No national-scale study has been carried out in Japan on the state of psychiatric medicine and its influence on suicide since 2000. Moreover, many efforts not intended for suicide prevention have been shown to be effective for this purpose. Here, we conducted surveys to obtain basic data on suicide prevention and improvements in mental health care among 1,728 psychiatric hospitals and clinics in Japan in 2010. The incidence of suicide in psychiatric hospitals and clinics from January to December 2009 was estimated to be 100.5 for outpatients and 154.5 for inpatients per 100,000 patients. Regarding the duration from consultation to suicide, 87% of outpatients committed suicide less than one month following their last consultation. Moreover, approximately two-thirds of patients had undergone consultations for more than one year. A number of suicides in psychiatric hospitals and clinics occurred while patients were continuously undergoing treatment. Efforts shown to be effective in suicide prevention included risk assessment with multiple medical staff (i.e., doctors and nurses), a 24-hour crisis line, and a follow-up system for discontinued outpatients. We expect that the results of this survey will aid in the implementation of effective suicide prevention in psychiatric medicine.

Psychosocial and psychiatric aspects of suicide completers with unmanageable debt: a psychological autopsy study.

This study examined the psychosocial and psychiatric features of 16 Japanese suicide completers with unmanageable debt compared with 23 suicide completers without such debt at time of death, using a psychological autopsy method. The individuals with unmanageable debt were more likely to have been self-employed and to have experienced divorce. They were less likely to have engaged in help-seeking behavior, despite having mental health problems. Our findings suggest that providing comprehensive support and promoting help-seeking behavior may be important for suicide prevention in middle-aged men.

[Suicide-related phenomena and mental health status in alcoholics: a survey of Danshu-kai].

Alcohol abuse is a well-known risk factor for suicide, as alcohol-related problems can deteriorate the medical and psychosocial conditions of individuals. Furthermore, the pharmacological effect of alcohol can cause impulsive behavior. However, few studies have investigated the association of alcohol-related problems with suicide or suicide-related mental health problems in a Japanese population. This study aimed to investigate suicidal behavior and factors influencing the mental health of people with alcohol-related problems. We conducted a self-reporting survey of members of alcohol abstinence self-help groups in Japan, "Danshu-kai". Of those members who attended meetings held during April and June 2009, 4,616 (rate of consent, 85.1%; 4064 males, 518 females, and 34 undetermined; mean age +/- SD, 60.2 +/- 10.9 years) participated in our study. The questionnaire sought the following information: gender, age, living with someone, marriage, jobs, present family relationships, health condition, history of attending the Danshu-kai meeting, family histories of alcohol-related problems, duration of abstinence, and history of suicide-related phenomena. A total of 44.2% of the subjects reported they had experienced suicidal thoughts, 24.6% had planned suicide, with 21.6% having attempted suicide. Seventy parcent of these phenomena occurred before participation in Danshu-kai. We also collected Kessler 10 (K10) scores, the self reporting scale for screening depressive and anxiety disorders. We classified subjects into two groups, those with a poor or favorable mental health according to the total K10 score cutoff, and analyzed factors predicting the present mental health condition. Multivariate logistic regression analyses demonstrated that age, physical health, and parental histories of alcohol-related problems were significantly associated with the present mental health condition in both genders. However, jobs, present family relationships, history of attending the Danshu-kai meeting, and duration of abstinence were also significantly associated, but only in males. In conclusion, it is important to cooperate with self help groups such as Danshu-kai to highlight the association between alcohol-related problems and suicide. Furthermore, early intervention for individuals with alcohol-related problems before there is progression of any medical and/or psychosocial damage may prevent future suicides among alcoholics.

[Psychosocial classification of suicide completers by employment situation: a psychological autopsy study].

OBJECTIVE: This study sought to clarify psychosocial and psychiatric differences of suicide-completers dependent on their employment situation. METHODS: Since December 2007, we have been conducting a Japan-wide study on suicide-completers using a psychological autopsy method, a semi-structured interview by a psychiatrist and a mental health professional including a public health nurse with the closest bereaved. Items questioned included family environment, suicide situation, life history f, labor situation, economic problems, and psychiatric diagnosis according to DSM-IV criteria at the time of death. As of July 2009, we had collected psychosocial and psychiatric information for 46 Japanese suicide cases. RESULTS: More than half of 31 suicide-completers with a job at the time of their death were married men aged 40-59 (mean age 48.1 +/- 12.6). Many had social difficulties such as alcohol-related problems or debt (38.7% and 41.9%, respectively). More than sixty percent of the 15 unemployed suicide-completers were unmarried and aged 20-39 (mean age 43.4 +/- 19.9). The percentage of women in the unemployed suicide-completers was significantly higher than that for women with a job. Although social problems were not confirmed in the unemployed, the prevalence of alcohol use disorders was significantly higher in suicide-completers with ajob than in those who were unemployed. However, the prevalence of schizophrenia was significantly higher in the unemployed. CONCLUSIONS: Our findings suggest that to prevent suicide of those with ajob, enhanced mental health support in the workplace and a better understanding of the association between alcohol use disorders and suicide are required. To prevent suicide of those who are unemployed, mental health support for the younger generation, particularly in cases with schizophrenia, is recommended.

[Psychosocial features of suicide cases with alcohol problem: a psychological autopsy study].

AIMS: Alcohol use disorder is a well-known risk factor for suicide, as alcohol problems can deteriorate the medical and psychosocial conditions of individuals. Furthermore, the pharmacological effect of alcohol can cause impulsive behavior in individuals. However, few studies have investigated the association of alcohol problems with suicide in Japan. The purpose of the present study was to investigate psychosocial and psychiatric features of suicide-completers with alcohol problems in last one year before their death. METHODS: Since December 2007, we have been conducting a Japan-wide study on suicide-completers using a psychological autopsy method, a semi-structured interview by a psychiatrist and a mental health professional including a public health nurse with the closest bereaved. Items questioned included family environment, suicide situation, history of life, labor situation, economic problems, and psychiatric diagnosis according to DSM-IV criteria at the time of death. As of December 2009, we had collected psychosocial and psychiatric information about 76 Japanese suicide cases. RESULTS: 16 suicide-completers with alcohol problems ("Alcohol problem" group 21.1%) were all males and almost middle-aged workers. The percentages of debt and accident proneness in "Alcohol problem" group were significantly higher than "Non-alcohol problem" group. In "Alcohol problem group", none of them have had treatment of alcohol dependence. The prevalence of alcohol use disorders in "Alcohol problem group" was significantly higher than in "Nonalcohol problem" group (81.2% vs. 0%). CONCLUSION: The findings of the present study suggest that it is important to improvement of psychiatric care in alcohol dependence for prevention future suicides among alcoholics. Furthermore, enlightenment the association between alcohol problems and suicide to the public and medical doctors is required.