0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter   |    
Ryo Abe; Toshiki Shioiri; Toshiyuki Someya
Psychiatric Services 2007; doi: 10.1176/appi.ps.58.7.1013

To the Editor: Many previous studies have found mental disorders to be the most powerful risk factor for suicide in all age groups, accounting for 80% to 90% of all completed suicides (1,2,3). To inform prevention efforts, it is important to determine the rate of psychiatric treatment among persons who commit suicide and to document demographic characteristics of those who do not receive treatment. However, to our knowledge no longitudinal study has examined these issues in a large sample over a long period.

We examined data on gender, age, and psychiatric treatment for all suicide victims over 21 years of age (N=5,161) from 1981 to 2001 in the city of Kobe, Japan (population of approximately 1.5 million in 2003). Data were compiled by the Medical Examiner's Office of Hyogo Prefecture and published in its annual reports. Statistical analysis was performed by using t tests and chi square tests. A probability level of .05 was regarded as statistically significant. The data were analyzed with SPSS software, release 10.07J. This study was approved by the ethical committee of Niigata University Graduate School of Medical and Dental Sciences.

Three-quarters of persons who completed suicide (73.7%) did not receive psychiatric treatment in the year before the suicide. The rates of psychiatric treatment in the sample were almost constant over the study period. Psychiatric treatment was more common among females than males (39.9% and 19.3%, χ2=252.0, df=1, p<.001). Elderly persons who completed suicide, especially those in their seventies and eighties, were significantly less likely than younger persons to receive psychiatric treatment in the year before suicide (χ2=195.3, df=1, p<.001). Middle-aged persons —those in their forties and fifties—who did not receive psychiatric treatment in the year before suicide accounted for 30% of all completed suicides; more than 80% of this high-risk group was male.

The psychiatric treatment rate in this study was much lower than those in previous studies, which ranged from 45% to 60% (4). However, Asukai (4) found a treatment rate of 22.9% among Japanese persons who attempted but did not complete suicide, although the sample was very small. Thus Japanese persons who attempt suicide tend to be less likely to receive psychiatric care than those in Western countries. Recently, Kobe has become one of several large Japanese cities in which many psychiatric clinics are available. Despite this trend, three-quarters of those who committed suicide over the past two decades in Kobe did not receive psychiatric treatment. Although low rates of psychiatric treatment among persons who commit suicide can sometimes be attributed to a lack of psychiatric clinics, this is not the case in Japan. In addition, suicide does not void large payouts by life insurance companies in Japan (5), which may spur some persons to commit suicide to maintain the economic welfare of their families. In Japan, therefore, it is very important to build a system of public health care and encourage persons with suicidal ideation to consult a psychiatrist. Efforts to improve suicide prevention strategies among middle-aged men are especially needed.

The authors are affiliated with the Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

This study was supported by grant 19203031 from the Japan Society for the Promotion of Science and by a grant from the Research Center for Natural Hazards and Disaster Recovery, Niigata University, Japan. The authors thank Akiyoshi Nishimura, M.D., Ph.D., Hideyuki Nushida, M.D., and Yasuhiro Ueno, M.D., Ph.D., for their special contributions in advancing this study.

The authors report no competing interests.

Rich CL, Young D, Fowler RC: San Diego suicide study: I. young vs old subjects. Archives of General Psychiatry 43:577—582, 1986
 
Henriksson MM, Aro HM, Marttunen MJ, et al: Mental disorders and comorbidity in suicide. American Journal of Psychiatry 150:935—940, 1993
 
Moscicki EK: Identification of suicide risk factors using epidemiologic studies. Psychiatric Clinics of North America 20:499—517, 1997
 
Asukai N: Mental disorder as a risk factor in suicide: a clinical study of failed suicides [in Japanese]. Psychiatrica et Neurologia Japonica 96:415—443, 1994
 
Lamar J: Suicides in Japan reach a record high. British Medical Journal 321:528, 2000
 
+

References

Rich CL, Young D, Fowler RC: San Diego suicide study: I. young vs old subjects. Archives of General Psychiatry 43:577—582, 1986
 
Henriksson MM, Aro HM, Marttunen MJ, et al: Mental disorders and comorbidity in suicide. American Journal of Psychiatry 150:935—940, 1993
 
Moscicki EK: Identification of suicide risk factors using epidemiologic studies. Psychiatric Clinics of North America 20:499—517, 1997
 
Asukai N: Mental disorder as a risk factor in suicide: a clinical study of failed suicides [in Japanese]. Psychiatrica et Neurologia Japonica 96:415—443, 1994
 
Lamar J: Suicides in Japan reach a record high. British Medical Journal 321:528, 2000
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Web of Science® Times Cited: 7

Related Content
Books
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 62.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 2.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 62.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 1.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 2.  >
Topic Collections
Psychiatric News
APA Guidelines