Economic Woes and Suicide: Will the United States Follow Japan?

Caroline Cassels

May 19, 2011

May 19, 2011 (Honolulu, Hawaii) — If public response to the economic downturn in the United States mirrors that of Japan, Americans could face an increase in suicide rates that may have already begun, new research suggests.

Presented here at the American Psychiatric Association (APA) 2011 Annual Meeting, investigators from the Itasca Brain and Behavior Association examined suicide rates in Japan in the late 1990s when that country experienced an economic downturn that included a doubling of unemployment, a situation not dissimilar to the current economic situation in the United States, which experienced a significant jump in unemployment in 2009 that has been running between 8% and 10% for the last 2 years.

The investigators note that if US rates of increased suicide approximate those in Japan, the country would experience a yearly increase in deaths due to suicide estimated at 14,610 — 12,965 in males and 1645 in females.

"Based on the economic data we looked at, if there's going to be an increase in suicide similar to Japan's in the United States, it would occur somewhere between 2008 and 2012, possibly extending up to 2016," principal investigator William Yates, MD, PhD, told Medscape Medical News.

The Itasca Brain and Behavior Association is made up of a small group of researchers and psychiatrists in the United States and internationally who have been meeting for the past 5 or 6 years, said Dr. Yates.

He added that the goal of the group is to examine how conducting cross-cultural studies might advance issues in mental health.

Unemployment a Stressor

Dr. Yates said during a group meeting last year he learned from his Japanese colleagues that starting in 1998 there has been a persistent and significant increase in suicide rates in Japan.

Dr. William Yates and Dr. Maki Matsuki

"We began discussing some of the potential factors that may be contributing to this phenomenon, and one of our Japanese colleagues mentioned that some of the psychological autopsy work done by the police in Japan indicated that economic stagnation and unemployment seemed to be a contributing factor, and that's what got us thinking about this issue and whether the US may be at similar risk," said Dr. Yates.

The investigators examined suicide trends in Japan by age, sex, and year in relation to a series of economic variables. Economic trends were then compared by year to estimate the timing of a potential economic effect to estimate the timing of a potential economic effect on US suicide rates.

In 1996-1997 Japan had unemployment rates of between 2% and 3%, but by 2003-2004 the rate had doubled to between 5% and 6%.

The increase in Japanese unemployment began in1998. That same year, said Dr. Yates, Japanese suicide rates also began to increase.

The data show that by 2009, there was approximately a 39% overall increase in suicide rates. When the researchers broke the data down by sex, they found suicide rates in males increased by 47% and by 23% in females. The researchers also found suicide rates were highest among men 50 years and older.

The investigators then applied the Japanese model to the US population based on the 2010 Census. Dr. Yates noted that currently suicide rates in the United States average about 33,000 annually.

"If we had a similar increase in suicide rates [as Japan], it would be somewhere in the order of an additional 14,000 individuals per year, and about 90% of that, according to the Japanese model, would be middle- aged and older men," he said.

Higher Rates in Men

One of the reasons for the higher rates in men, said Dr. Yates, is that they have higher baseline rates of suicide compared with women.

Although the presence of psychiatric illness is the primary driver of suicide risk, it appears from this study and other recent research that economic stress also plays a role.

"The key factor for suicide is presence of a mental illness, and if you have a mood disorder or schizophrenia or a substance abuse problem, that is really the highest marker of risk. But it appears that these kinds of stressors can play a role in modifying risk over time, but we do need to be aware of the additional role economic factors can play in the risk for suicide," said Dr. Yates.

An analysis from the Centers of Disease Control and Prevention (CDC) published in April in the American Journal of Public Health and reported by Medscape Medical News at that time showed business cycles significantly influence suicide rates, decreasing when times are good and increasing when they are bad.

A Warning, Not a Predictor

Drs. Yates and coauthor Maki Matsuki, MD, caution that their research is not necessarily a predictor of what will happen but rather should serve as a warning.

"This is a heads-up that this has been a public health issue in Japan for some time and the US needs to be aware of it and continue to monitor it closely, particularly in older and middle-aged men."

However, he noted, one of the challenges to monitoring is that there is a lag in data reporting. He noted that the most recent national suicide data available from the CDC is from 2007.

"The key takeaway message for clinicians is to be aware of the fact that there have been temporal trends and significant increases in suicide related to the economy in another culture," said Dr. Yates.

Physicians should closely monitor middle-aged and older men and examine particular issues potentially related to unemployment, which may include loss of insurance coverage and subsequent lack of access to medical care and/or medication and how this may affect suicide risk.

"This may be particularly critical in individuals with preexisting mental illness," said Dr. Yates.

At a societal level, he said, there is a need to establish mechanisms that can bridge health coverage for individuals who have lost their jobs and are having financial difficulties.

"We have the community mental health system in the United States, which provides care without insurance, but it is an issue because it is not always an easy system to access," Dr. Yates said.

Commenting on the study, Jeffrey Borenstein, MD, the APA's chair of the Council on Communications, said this research highlights an important issue that warrants attention.

"Whether it be economic distress, natural disasters, or manmade disasters, there is a relationship between stress and psychiatric conditions, and it is important for us to be aware of this, especially during times of stress, such as economic downturns and other disasters, so I think it is a very important study," said Dr. Borenstein.

The study authors and Dr. Borenstein have disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2011 Annual Meeting: Abstract NR04-71. Presented May 15, 2011.

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