[Quick review] Literature list on suicide in Japan during the COVID-19 pandemic (Updated April 13)

To grasp the overall picture in a limited amount of time and track current topics longitudinally, I select a single theme and translate the titles and abstracts of related papers into Japanese. Because the goal is to get a general overview, I post machine translations (mainly from DeepL) almost as-is. In the hope of inspiring future research themes, I also include the Limitations sections for open-access papers. This time, the theme is "Suicide in Japan during the COVID-19 pandemic."

Current theme: "Suicide in Japan during the COVID-19 pandemic"

Search formula

(suicid*[Title/Abstract]) AND (japan*[Title/Abstract]) AND [COVID-19 search formula]

As of April 6, 2021, the search returned 9 results.

Update: As of April 13, 2021, the search results increased to 10.

The results are here, listed from newest to oldest.

This paper provides a comprehensive analysis of the relationship between age, gender, and suicide during the COVID-19 pandemic. Published in Nature Human Behaviour (IF: 12). The press release (https://t.co/DABRefl6Wk ) and Japanese summary (https://t.co/Dc9hAFWhWJ ) are well-organized, so I recommend checking them first. https://t.co/DFalKf6lD0
— Shoei (@shoei05) April 6, 2021

Nomura S, Kawashima T, Harada N, et al. Trends in suicide in Japan by gender during the COVID-19 pandemic, through December 2020. Psychiatry Res. 2021;300:113913. doi:10.1016/j.psychres.2021.113913
Okubo R, Yoshioka T, Nakaya T, et al. Urbanization level and neighborhood deprivation, not COVID-19 case numbers by residence area, are associated with severe psychological distress and new-onset suicidal ideation during the COVID-19 pandemic. J Affect Disord. 2021;287:89-95. doi:10.1016/j.jad.2021.03.028
Yoshioka T, Okubo R, Tabuchi T, Odani S, Shinozaki T, Tsugawa Y. Factors Associated with Serious Psychological Distress during the COVID-19 Pandemic in Japan. medRxiv. Published online March 1, 2021. doi:10.1101/2021.02.27.21252458
Nomura K, Minamizono S, Maeda E, et al. Cross-sectional survey of depressive symptoms and suicide-related ideation at a Japanese national university during the COVID-19 stay-home order. Environ Health Prev Med. 2021;26(1):30. doi:10.1186/s12199-021-00953-1
Sakamoto H, Ishikane M, Ghaznavi C, Ueda P. Assessment of Suicide in Japan During the COVID-19 Pandemic vs Previous Years. JAMA Netw Open. 2021;4(2):e2037378. doi:10.1001/jamanetworkopen.2020.37378
Tanaka T, Okamoto S. Increase in suicide following an initial decline during the COVID-19 pandemic in Japan. Nat Hum Behav. 2021;5(2):229-238. doi:10.1038/s41562-020-01042-z
Anzai T, Fukui K, Ito T, Ito Y, Takahashi K. Excess Mortality From Suicide During the Early COVID-19 Pandemic Period in Japan: A Time-Series Modeling Before the Pandemic. J Epidemiol. 2021;31(2):152-156. doi:10.2188/jea.JE20200443
Nomura S, Kawashima T, Yoneoka D, et al. Trends in suicide in Japan by gender during the COVID-19 pandemic, up to September 2020. Psychiatry Res. 2021;295:113622. doi:10.1016/j.psychres.2020.113622
Kiuchi K, Kishi K, Araki K. A Foundational Assessment of the Effects of the Spread of COVID-19 Virus Infection and Related Activity Restrictions on Mental and Physical Health, Psychological Distress, and Suicidal Ideation in Japan. Asia Pac J Public Health. 2020;32(8):463-466. doi:10.1177/1010539520965449
Isumi A, Doi S, Yamaoka Y, Takahashi K, Fujiwara T. Do suicide rates in children and adolescents change during school closure in Japan? The acute effect of the first wave of COVID-19 pandemic on child and adolescent mental health. Child Abuse Negl. 2020;110(Pt 2):104680. doi:10.1016/j.chiabu.2020.104680

Trends in suicide in Japan by gender during the COVID-19 pandemic, through December 2020

Nomura S, Kawashima T, Harada N, et al. Trends in suicide in Japan by gender during the COVID-19 pandemic, through December 2020. Psychiatry Res. 2021;300:113913. doi:10.1016/j.psychres.2021.113913

A follow-up report to the previous paper (Nomura S, Kawashima T, Yoneoka D, et al. Trends in suicide in Japan by gender during the COVID-19 pandemic, up to September 2020. Psychiatry Res. 2021;295:113622. doi:10.1016/j.psychres.2020.113622 ). No abstract.

The 10th paper on COVID-19 and suicide in Japan. Like the previous study (https://t.co/ULhU5uEAjV ), it analyzes data through December 2020 using a quasi-Poisson regression model and the Farrington algorithm (https://t.co/XCw4tMVvh7 ;https://t.co/DGCKgxNaY3 ). Among women, excess mortality was observed almost every month starting in July. https://t.co/ZEwJ10I76A
— Shoei (@shoei05) April 12, 2021

As in our previous study, we used a quasi-Poisson regression model to estimate the expected monthly number of suicide deaths and the upper and lower bounds of the two-sided 95% prediction interval (Farrington, 1996; Noufaily, 2013).

From September 2020 onward, excess mortality continued to be observed almost every month among women. Notably, there were 879 suicides in October 2020, representing 344.00–401.91 excess deaths (72.10–84.25% excess; see Supplementary Figure 1).

Among men from January 2020 onward, excess mortality was first identified in October 2020 (108.00–234.49; 9.95–21.60% excess), with none observed thereafter.

For the period through September 2020 covered in the previous study, excess deaths among women in July, August, and September were updated to include delayed reports of suicide cases. The figures were 108.00–165.54 deaths (21.71–33.28% excess) in July, 103.00–177.07 (20.77–35.70% excess) in August, and 102.00–174.04 (21.30–36.34% excess) in September. Among men, no excess mortality was observed between July and September.

Urbanization level and neighborhood deprivation, not COVID-19 case numbers by residential area, are associated with severe psychological distress and new-onset suicidal ideation during the COVID-19 pandemic

Okubo R, Yoshioka T, Nakaya T, et al. Urbanization level and neighborhood deprivation, not COVID-19 case numbers by residence area, are associated with severe psychological distress and new-onset suicidal ideation during the COVID-19 pandemic. J Affect Disord. 2021;287:89-95. doi:10.1016/j.jad.2021.03.028

Background: Recent studies indicate an urgent need to address mental health problems during the COVID-19 pandemic. However, the association between broader environmental factors, such as living environments, and mental health problems during the pandemic remains unclear.

Methods: We conducted a nationwide cross-sectional internet survey in Japan from August to September 2020 and examined the association between urbanization level, neighborhood deprivation (as living environment factors), and COVID-19 case numbers by prefecture. Prevalence ratios (PRs) for severe psychological distress, suicidal ideation, and new-onset suicidal ideation during the pandemic were adjusted for potential confounders.

Results: Among 24,819 respondents, the prevalence of mental health problems was 9.2% for severe psychological distress and 3.6% for new-onset suicidal ideation. The PR for severe psychological distress was significantly associated with higher urbanization levels (highest PR = 1.30, 95% CI = 1.08–1.56). The PR for new-onset suicidal ideation was significantly associated with higher urbanization (highest PR = 1.83, 95% CI = 1.37–2.45) and greater neighborhood deprivation (highest PR = 1.35, 95% CI = 1.06–1.72). Severe psychological distress and new-onset suicidal ideation were also significantly more common in areas with both high urbanization and low neighborhood deprivation (PR = 1.34 [1.15–1.56] and 1.57 [1.22–2.03], respectively).

Conclusions: These findings suggest that high urbanization and high neighborhood deprivation (low neighborhood-level socioeconomic status), rather than COVID-19 case numbers by residential area, are associated with severe psychological distress and new-onset suicidal ideation during the pandemic. These findings partially differ from evidence obtained before the pandemic.

Limitation

The strengths of this study include its evaluation of various individual-level factors and living environments, as well as its large sample size covering all prefectures in Japan (N = 28,000); however, we acknowledge several limitations. First, the data were obtained from an internet survey, and the response rate was relatively low (12.5%). Therefore, we used an external nationally representative sample to adjust for potential bias in the collected sample as much as possible (see Supplementary Methods). Second, the cross-sectional design cannot establish the direction of causality. However, the aim of this study was not to determine causal direction, but to examine the association between living environments and mental health during the COVID-19 pandemic and identify vulnerable populations under these circumstances. Thus, we do not believe the cross-sectional design adversely affects the validity of our results. Third, there was a mismatch in the time spans of the living environment variables. COVID-19 case numbers were from the time of the survey, whereas Densely Inhabited Districts (DID) were based on the 2015 census, and the Area Deprivation Index (ADI) was based on the 2010 census and individual surveys (Nakaya et al., 2014). However, these datasets were the most recent available at the time of the survey. The national census is conducted every five years, most recently in 2020, but because those data will not become available until 2022, the 2015 census was the latest available. Calculating the ADI requires detailed census responses across multiple regions to estimate coefficients. Due to an increase in missing values in the 2015 census, the ADI calculated from the 2010 census remained the most up-to-date. Our results may be compromised by this mismatch in the time spans of the living environment variables and should be verified with more recent data.

Press release

Clarifying the impact of residential area on mental health during the COVID-19 pandemic: From a large-scale nationwide internet survey in Japan. National Center of Neurology and Psychiatry. Accessed April 6, 2021. https://www.ncnp.go.jp/topics/2021/post_4.html

"People living in areas with higher population density (urban areas) and areas with higher levels of deprivation had higher rates of deteriorating mental health. For suicidal ideation emerging after the onset of the COVID-19 pandemic, the rate was 1.83 times higher in the most densely populated areas and 1.35 times higher in the most deprived areas." https://t.co/7RP8ZCcSpY
— Shoei (@shoei05) April 7, 2021

Journal (Journal of Affective Disorders)

The Journal of Affective Disorders publishes papers on affective disorders in the broad sense, including depression, mania, mood spectrum, emotions and personality, anxiety, and stress. The Journal of Affective Disorders is interdisciplinary and aims to bring together different approaches for a diverse readership. High-quality papers addressing any aspect of affective disorders are accepted, including neuroimaging, cognitive neuroscience, genetics, molecular biology, experimental and clinical neuroscience, pharmacology, neuroimmunoendocrinology, and intervention and treatment trials.

Factors associated with severe psychological distress during the COVID-19 pandemic in Japan

Yoshioka T, Okubo R, Tabuchi T, Odani S, Shinozaki T, Tsugawa Y. Factors Associated with Serious Psychological Distress during the COVID-19 Pandemic in Japan. medRxiv. Published online March 1, 2021. doi:10.1101/2021.02.27.21252458

The coronavirus disease 2019 (COVID-19) pandemic is said to have harmed public mental health in many countries, potentially leading to higher suicide rates. However, little is known about the risk factors associated with worsening mental health during the COVID-19 pandemic.

Objective: To investigate factors associated with severe psychological distress (SPD) during the COVID-19 pandemic in Japan.
Design, setting, and participants: A cross-sectional study using a large-scale internet survey conducted in Japan from August 25 to September 30, 2020.

Exposures: Demographics (age, sex, marital status, family structure, caregiving burden), socioeconomic status (income level, employment type, educational attainment), experience of domestic violence (DV), state of emergency, fear of COVID-19, and COVID-19-related stigma.

Main outcomes and measures: Prevalence of SPD (defined as a Kessler 6 scale score ≥13).

Results: Among the 25,482 individuals who participated in this study, 2,556 (10%) met the criteria for SPD. Overall, being female (adjusted odds ratio [aOR], 1.59; 95% CI, 1.17-2.16; P = .003), aged 15-29 years (aOR compared with aged 45-59 years, 2.35; 95% CI, 1.64-3.38; P < .001), having low income (aOR compared with middle income, 1.70; 95% CI, 1.16-2.49; P = .007), caregiving for family members (aOR, 5.48; 95% CI, 3.51-8.56; P < .001), experiencing DV (aOR, 5.72; 95% CI, 3.81-8.59; P < .001), and fear of COVID-19 (aOR, 1.96; 95% CI, 1.55-2.48; P < .001) were associated with higher rates of SPD. Among women aged 15-29 years, who had the highest rate of experiencing SPD, caregiving, DV, fear of COVID-19, and COVID-19-related stigma were associated with higher rates of SPD, whereas economic situation (income level and employment type) and social isolation (marital status) were not associated with the prevalence of SPD.

Conclusions and relevance: During the COVID-19 pandemic, economic situation, caregiving burden, DV, and fear of COVID-19 were independently associated with SPD. Among young women, who are at high risk of suicide during the COVID-19 pandemic in Japan, similar factors—excluding economic situation—were associated with a high rate of SPD. Targeted interventions tailored to age and sex may be more effective in mitigating the negative impact of the COVID-19 pandemic on public mental health.

Limitation

Our study has limitations. First, because this survey was conducted from August to September 2020, our findings might have been different had we used more recent data. However, these data were collected just before October 2020, when suicides among young women actually increased in Japan, and our findings may therefore reflect the most critical period regarding the underlying reasons for the increased suicide rate in Japan. Second, because this study used self-reporting, not all variables were based on validated questionnaires. For example, COVID-19-related stigma, an important risk factor for SPD among young women, was collected using a single-item questionnaire we developed, so a detailed stigma profile could not be obtained. However, this survey used items (the K-6 scale) whose reliability and validity have been verified in previous studies. Third, because the data come from an internet-based survey, respondents may differ in meaningful ways from non-recruited individuals. Finally, these results may not be generalizable to populations in other countries.

Cross-sectional survey on depressive symptoms and suicide-related ideation during the COVID-19 stay-at-home period at a national university in Japan

Nomura K, Minamizono S, Maeda E, et al. Cross-sectional survey of depressive symptoms and suicide-related ideation at a Japanese national university during the COVID-19 stay-home order. Environ Health Prev Med. 2021;26(1):30. doi:10.1186/s12199-021-00953-1

Background: We aimed to estimate the prevalence of depressive symptoms as well as suicide-related ideation among Japanese university students during the stay-at-home orders necessitated by the coronavirus disease 2019 pandemic in Japan, and to provide evidence supporting interventions for future depression and suicide prevention strategies for university students.

Methods: Data for this cross-sectional study were obtained from the Student Mental Health Survey conducted at a national university in Akita Prefecture from May 20 to June 16, 2020. Of the 5,111 students recruited, 2,712 participated in this study (response rate, 53%; mean age ± standard deviation, 20.5 ± 3.5 years; male, 53.8%). Depressive symptoms were identified using the Patient Health Questionnaire-9 (PHQ-9).

Results: The prevalence of moderate depressive symptoms (a PHQ-9 score of 10 or higher) was 11.7%, and the prevalence of suicide-related ideation (including thoughts of both suicide and self-harm, with a score of 1 or higher on PHQ-9 item 9) was 6.7%. In multivariate logistic regression analysis, risk factors for depression included being female, smoking, drinking alcohol, and social network communication via video or voice. For suicidal ideation, drinking alcohol was the sole risk factor. Exercising and having someone to consult about worries were associated with a reduced risk of both depressive symptoms and suicide-related ideation.

Conclusion: Negative lifestyle habits such as smoking and drinking alcohol, as well as being female, appear to be important risk factors for depressive symptoms, whereas exercising and having someone to consult about worries appear to be protective factors.

Limitation

Despite its strengths, this study has several limitations that must be addressed. First, because the study was set at a single university in Japan, the generalizability of the findings is limited. However, this limitation may be offset by the response rate exceeding 50% and the large sample size. Second, because participation was voluntary, the prevalence of depressive symptoms may be underestimated. For example, students with depressive symptoms may have found it difficult to complete a 51-item questionnaire. Furthermore, despite repeated explanations that the purpose of this study was to screen high-risk individuals for prompt intervention, some students may have hesitated to report their health information to the university. Third, because Japan has a relatively low fatality rate, depressive symptoms may have been less severe. Even when prefectural governors called for people to stay indoors, going out for essential purposes—such as visiting medical institutions, buying necessary supplies, or commuting to essential jobs—was permitted. If the COVID-19 situation worsens, the severity and frequency of depressive symptoms may become more pronounced. Fourth, because 85% of students from prefectures other than Akita lived alone, there was a high correlation between these two variables. To check for collinearity issues in the multivariate analysis, we excluded those living alone or those from outside Akita Prefecture, but the results did not change. Finally, because the data are cross-sectional, we could not infer causal relationships between the variables.

Journal of publication (Environmental Health and Preventive Medicine)

Environmental Health and Preventive Medicine (EHPM), the official journal of the Japanese Society for Hygiene, provides a comprehensive approach to prevention and environmental health in relation to medical, biological, molecular biological, genetic, physical, psychosocial, chemical, and other environmental factors.

Environmental Health and Preventive Medicine features definitive research on human health sciences, providing comprehensive and unique information to readers worldwide.

International authors published in Environmental Health and Preventive Medicine can apply for a discount on the journal's article processing charge (APC) from the Japanese Society for Hygiene if their manuscript is accepted. This discount must be requested at the time of manuscript submission by entering a code obtainable from the society secretariat (jsh@nacos.com).

Assessment of suicide in Japan during the COVID-19 pandemic and comparison with prior years

Sakamoto H, Ishikane M, Ghaznavi C, Ueda P. Assessment of Suicide in Japan During the COVID-19 Pandemic vs Previous Years. JAMA Netw Open. 2021;4(2):e2037378. doi:10.1001/jamanetworkopen.2020.37378

There are concerns that suicide rates may have increased during the coronavirus disease 2019 (COVID-19) pandemic.

Objective: To assess whether suicide rates in Japan increased from April to November 2020 compared with previous years.

Design, setting, and participants: This cross-sectional study used national data obtained from the Ministry of Health, Labour and Welfare on the monthly number of individuals who died by suicide in Japan from January to November in the years 2016 to 2020.

Exposures: Comparison of 2020 with previous years.

Main outcomes and measures: The main outcome was the monthly suicide rate, calculated by dividing the number of individuals who died by suicide by the total population. A difference-in-differences regression model was used to estimate changes in monthly suicide rates from April to November 2020 versus those months in 2016 to 2019.

The results are as follows. The analysis included 90,048 individuals (61,366 [68.1%] men) who died by suicide from 2016 to 2020. In the difference-in-differences analysis for men, suicide rates from April to September 2020 did not increase compared with these months in 2016 to 2019, but suicide rates increased in October (difference-in-differences, 0.40 suicide deaths per 100,000 population [95% CI, 0.14 to 0.67]) and November (difference-in-differences, 0.34 suicide deaths per 100,000 population [95% CI, 0.07 to 0.60]). Among women, suicide rates in 2020 compared with 2016 to 2019 increased in July (difference-in-differences, 0.24 suicide deaths per 100,000 population [95% CI, 0.09 to 0.38]), August (difference-in-differences, 0.30 suicide deaths per 100,000 population [95% CI, 0.16 to 0.45]), September (difference-in-differences, 0.29 [95% CI, 0.15 to 0.44] suicide deaths per 100,000 population), October (difference-in-differences, 0.62 [95% CI, 0.48 to 0.77] suicide deaths per 100,000 population), and November (difference-in-differences, 0.29 [95% CI, 0.15 to 0.44] suicide deaths per 100,000 population). In secondary analyses comparing 2020 suicide rates with expected rates based on trends from 2011 to 2019, the increases in suicide rates were most pronounced among men younger than 30 years (eg, November: observed vs expected rate ratio [RR], 1.48 [95% CI, 1.26-1.71]) and among women younger than 30 years (eg, October: observed vs expected RR, 2.14 [95% CI, 1.76-2.52]) and aged 30 to 49 years (eg, October: observed vs expected RR, 2.30 [95% CI, 2.01-2.58]).
Conclusions and Relevance: These findings suggest that compared with previous years, suicide rates in Japan in 2020 increased in October and November for men and in July through November for women.

Limitation

This study has limitations. Suicide rates may have been affected by factors unrelated to the pandemic, and the observed changes in monthly suicide rates may partly reflect random fluctuations. Importantly, although we evaluated whether suicide rates increased starting in April 2020, the increases in suicide rates occurred in the latter half of the year for both men and women. These findings were not part of our prespecified hypotheses and should be interpreted with caution. Moreover, we evaluated suicide rates for each month separately and did not examine whether the total number of individuals who died by suicide increased during the pandemic. Although there is evidence from past pandemics that a short-term decrease in suicide rates can occur initially, suicide rates decreased in April among women younger than 30 years and men aged 30 to 49 years, and in May among men aged 50 to 69 years. Future research is needed on the association between the pandemic and suicide rates. Also, because of a lack of individual-level longitudinal data, we could not examine the association between pandemic-related occupational changes and suicide risk.

Press release

The University of Tokyo. Changes in the number of suicides in Japan during the COVID-19 pandemic. Accessed April 6, 2021. http://www.m.u-tokyo.ac.jp/news/admin/release_20210208.pdf

Journal (JAMA Network Open)

JAMA Network Open is an international, peer-reviewed, open access, general medical journal that publishes research on clinical care, innovation in health care, health policy, and global health across all health disciplines and countries for clinicians, investigators, and policy makers. JAMA Network Open is a member of the JAMA Network, a consortium of peer-reviewed, general medical and specialty publications.

Increased suicide mortality in Japan during the COVID-19 pandemic after an initial decline

Tanaka T, Okamoto S. Increase in suicide following an initial decline during the COVID-19 pandemic in Japan. Nat Hum Behav. 2021;5(2):229-238. doi:10.1038/s41562-020-01042-z

There are growing concerns that the coronavirus disease 2019 (COVID-19) pandemic may harm psychological health and exacerbate suicide risk. In this study, we assessed whether suicide mortality changed during the pandemic based on month-level suicide records covering the entire Japanese population across 1,848 administrative units. Using difference-in-differences estimation, we found that monthly suicide rates declined by 14% during the first five months of the pandemic (February to June 2020). This could be due to a complex combination of reasons, including generous government subsidies, reduced working hours, and school closures. By contrast, monthly suicide rates increased by 16% during the second wave (July to October 2020), with a larger increase among females (37%) and children and adolescents (49%). While the adverse effects of the COVID-19 pandemic may remain in the long term, its modifiers (such as government subsidies) may not be sustained. Effective prevention of suicide, particularly among vulnerable populations, is therefore an important public health issue.

Limitation

Finally, we would like to acknowledge the limitations of this study. First, although our study proposed potential mechanisms linking the pandemic and suicide, it is challenging to separate the contributions of each factor. Doing so would require variation in the timing and intensity of each contributor (e.g., disease prevalence, government interventions, economic shocks, financial support, and working conditions). However, the COVID-19 pandemic affected almost every community and citizen simultaneously, and our analysis could not fully exploit such variations.
Moreover, we could not investigate the effects among specific subgroups. For instance, there is great concern about the mental health consequences for healthcare workers, given the extraordinary burden they have been forced to bear during the pandemic. Similarly, suicide effects among those with high mortality risk related to COVID-19 (those with comorbidities), those facing severe financial burdens (low-skilled or low-income workers), and those who are socially isolated (including those needing mental health care or those with cognitive impairments) need to be carefully monitored.
Furthermore, suicide data may not be precise because some suicides might not have been discovered or might have been reported with a delay. In addition, suicides may have been misclassified as other causes of death because the pandemic disrupted the reporting process.
Lastly, we want to emphasize that the results of our study may not apply to other regions or countries because our study is founded on the unique public health, economic, cultural, and social context of Japan. Particularly, during our study period, the number of confirmed COVID-19 cases per population in Japan was only 2.9% of that in the United States and 12.7% of that in Germany (Supplementary Fig. 3a). Moreover, the Japanese government's health interventions were among the most lenient, based on 'requests' rather than 'enforcement,' ensuring a high degree of individual freedom (Supplementary Fig. 3b). On the other hand, the national government provided generous fiscal support to households and businesses, amounting to 10% of its annual GDP (Supplementary Fig. 3c). The combination of these policies may create differences in the extent to which the epidemic affects mental health. Therefore, to protect global mental health and prevent increases in suicide rates, it is crucial to continuously assess the impact of the pandemic in each society.

Press release

<Press release> "Suicide rates during the COVID-19 pandemic fell during the first wave of infections, then rose during the second wave, particularly among women, children, and adolescents" | Tokyo Metropolitan Institute of Gerontology. Accessed April 6, 2021. https://www.tmghig.jp/research/release/2021/0118.html

Journal (Nature Human Behaviour)

Nature Human Behaviour is a subscription-based journal with a 6-month self-archiving policy following online publication. Although Nature Human Behaviour does not offer an open access license option for articles, certain types of articles may be made freely open access because of their high value to the community. Application of an open access license is at the editors' discretion, and full policy details are provided on the self-archiving and license to publish page.

This paper provides a comprehensive look at the relationship between age, gender, and suicide during the COVID-19 pandemic. Published in Nature Human Behaviour (IF: 12). The press release (https://t.co/DABRefl6Wk) and Japanese summary (https://t.co/Dc9hAFWhWJ) are well organized, so I recommend checking those first. https://t.co/DFalKf6lD0
— Shoei (@shoei05) April 6, 2021

Excess mortality from suicide during the early stage of the COVID-19 pandemic in Japan: pre-pandemic time-series modeling

Anzai T, Fukui K, Ito T, Ito Y, Takahashi K. Excess Mortality From Suicide During the Early COVID-19 Pandemic Period in Japan: A Time-Series Modeling Before the Pandemic. J Epidemiol. 2021;31(2):152-156. doi:10.2188/jea.JE20200443

Background: Suicide amid the coronavirus disease (COVID-19) pandemic is an important issue. In Japan, the number of suicides in April 2020 decreased by nearly 20% compared with 2019. Excess mortality is often discussed to evaluate the impact of an infectious disease pandemic. Our main objective is to evaluate excess mortality from suicide in Japan during the early stage of the pandemic.

Methods: We used data on suicides collected by the National Police Agency up to June 2020. Using a time-series model of suicide counts before the pandemic, we estimated excess mortality during the early stage of the pandemic (March to June 2020). A quasi-Poisson model was adopted for estimation. Excess mortality was evaluated by age and sex, as well as by prefecture.

Results: No significant excess mortality was observed during the early stage of the pandemic; instead, a downward trend in suicide counts was found for both sexes. For males, negative excess mortality below the lower bound of the 95% prediction interval was observed in April and May. For females, negative values below the lower bound of the 95% prediction interval were observed in April and May, whereas excess mortality in June showed a positive value higher than in April and May. In Tokyo, the number of suicides remained below the lower bound throughout the entire period.

Conclusion: These findings suggest that shifts in communication and social conditions during the early COVID-19 pandemic contributed to a drop in suicides in Japan. However, assessing the pandemic's long-term impact on suicide will require ongoing monitoring.

Limitation

This study has several limitations. It could not identify the specific factors that reduced suicide deaths during the pandemic. Future research should investigate the factors that prevent suicide. In addition, this study evaluated excess mortality only during the early stage of the pandemic, whereas the COVID-19 pandemic may affect suicide over the long term. Ongoing monitoring and evaluation are therefore needed.

Journal (The Journal of Epidemiology)

The Journal of Epidemiology is the official open-access academic journal of the Japan Epidemiological Association. It aims to promote communication among those engaged in epidemiological research and those who apply epidemiological findings.

Trends in suicide deaths by sex in Japan during the COVID-19 pandemic through September 2020

Nomura S, Kawashima T, Yoneoka D, et al. Trends in suicide in Japan by gender during the COVID-19 pandemic, up to September 2020. Psychiatry Res. 2021;295:113622. doi:10.1016/j.psychres.2020.113622

Suicide is an extreme consequence of the psychological burden associated with coronavirus disease 2019 (COVID-19) countermeasures. Applying quasi-Poisson regression to monthly suicide mortality data obtained from the National Police Agency, the authors estimated excess and non-excess suicide deaths by sex during the COVID-19 pandemic in Japan through September 2020. The results showed excess suicide deaths among women in July, August, and September, but none among men. These findings point to the importance of COVID-19-related suicide prevention, especially for women. Along with optimal treatment for mental illness, timely access to psychiatric care and economic and social support are urgently needed.

Limitation

One limitation of this analysis is that no age- or occupation-level data could be included in the estimation model, making it impossible to analyze those factors individually. Identifying which age groups and occupations face a higher risk of suicide during the COVID-19 pandemic would yield more valuable policy lessons. Although it is possible to estimate weekly or daily excess suicide deaths and mortality by age and sex using microdata from the Vital Statistics of the Ministry of Health, Labour and Welfare, such statistics take several months to be published, making timely analysis difficult (Leon, 2020). The monthly suicide data from the National Police Agency used in this study have a publication lag of only a few weeks, allowing for the most timely analysis.

Journal (Psychiatry Research)

Psychiatry Research rapidly publishes full-length research reports and reviews in the field of psychiatry.

The scope of the journal includes:

Biochemical, physiological, neuroanatomical, genetic, neurocognitive, and psychosocial determinants of psychiatric disorders.
Diagnostic assessment of psychiatric disorders.
Hypothesis-driven assessments of the causes of psychiatric disorders.
Evaluation of pharmacological and non-pharmacological psychiatric treatments.
Basic neuroscience research related to animal and neurochemical models of psychiatric disorders.
Methodological advances such as instruments, clinical scales, and assays directly applicable to psychiatric research.
Reviews of timely topics in psychiatric research.

Letters to the editor cover case reports, commentary on previously published papers, and analyses of secondary data.

Baseline assessment of the impact of the spread of COVID-19 infection and associated activity restrictions on physical and mental health, psychological distress, and suicidal ideation in Japan

Kiuchi K, Kishi K, Araki K. A Foundational Assessment of the Effects of the Spread of COVID-19 Virus Infection and Related Activity Restrictions on Mental and Physical Health, Psychological Distress, and Suicidal Ideation in Japan. Asia Pac J Public Health. 2020;32(8):463-466. doi:10.1177/1010539520965449

No abstract available.

Journal (Asia Pacific Journal of Public Health)

Asia Pacific Journal of Public Health (APJPH) is a peer-reviewed journal focusing on health issues in the Asia-Pacific region, published eight times a year. APJPH publishes original articles on public health-related issues, including their implications for practical application to professional education and services for public health and primary health care of interest and relevance to the Asia-Pacific region. The journal is a member of the Committee on Publication Ethics (COPE).

Did child and adolescent suicide rates change during school closures in Japan? The acute impact of the first wave of the COVID-19 pandemic on child and adolescent mental health

Isumi A, Doi S, Yamaoka Y, Takahashi K, Fujiwara T. Do suicide rates in children and adolescents change during school closure in Japan? The acute effect of the first wave of COVID-19 pandemic on child and adolescent mental health. Child Abuse Negl. 2020;110(Pt 2):104680. doi:10.1016/j.chiabu.2020.104680

Background: Coronavirus disease 2019 (COVID-19) has profoundly affected the lives of children and adolescents. School closures—one of the major changes during the first wave of the COVID-19 pandemic—reduced social contact for children and adolescents while increasing time spent with family. This can have both positive and negative effects on suicide, a key mental health outcome. However, the impact of the COVID-19 crisis on children and adolescents in terms of suicide remains unclear.

Objective: This study investigates the acute impact of the first wave of the COVID-19 pandemic on child and adolescent suicide during school closures in Japan.

Data: Total monthly suicides among children and adolescents under age 20 between January 2018 and May 2020.

Methods: Using Poisson regression, the authors examined whether suicides increased or decreased during the school closures from March to May 2020 compared with the same period in 2018 and 2019. Robustness checks were conducted using the full dataset from January 2018 to May 2020. Negative binomial regression, a model that accounts for overdispersion, was also performed.

Results: No significant change in suicide rates was found during the school closure period (incidence rate ratio (IRR) = 1.15, 95% confidence interval (CI): 0.81–1.64). There was a significant main effect of month—suicides increased significantly in May compared with March (IRR: 1.34, 95% CI: 1.01–1.78)—but the interaction term between month and school closure was not significant (p > 0.1).

Conclusion: As a preliminary finding, this study suggests that the first wave of the COVID-19 pandemic did not have a significant impact on child and adolescent suicide rates during the period of school closures in Japan.

Limitation

This study has several limitations. First, it should be noted that these are preliminary findings on the acute impact of the first wave of the COVID-19 pandemic on child and adolescent suicide during school closures. Future studies will need to collect and examine data on child suicide over a longer time span as they become available. Because suicides among children and adolescents in Japan have been reported to peak at the beginning of a school term, suicide rates may have risen when schools reopened in June 2020. Future research also needs to consider the long-term effects of the COVID-19 pandemic on children's mental health. Second, because there are no data that regularly monitor suicidal tendencies among children and adolescents—such as hospitalization rates for suicide attempts—this study did not examine suicidality, including suicide attempts and suicidal ideation, in this population. Finally, the motives for suicide cannot be determined from these publicly available aggregate data. Suicides that occurred during the school closures may therefore have been influenced by other factors not directly related to the COVID-19 crisis, such as past trauma, personality or temperament, or previous suicide attempts (Carballo et al., 2020; Hoekstra, 2020).

Journal (Child Abuse & Neglect)

Child Abuse & Neglect is an international, interdisciplinary journal that publishes articles on child welfare, health, humanitarian aid, justice, mental health, public health, and social service systems. The journal recognizes that child protection is a global concern that continues to evolve. Accordingly, it aims to serve scholars, policymakers, concerned citizens, advocates, and professional practitioners across countries that vary in wealth, culture, and the nature of their formal child protection systems. Child Abuse & Neglect welcomes submissions from a global perspective as well as those grounded in the traditions of specific cultures and settings. Article formats include empirical reports, theoretical and methodological reports, and invited reviews.