During the COVID-19 pandemic, suicide rates in Japan first dropped and then rose. What can we learn from this?

Author: Zhu Yehua

Just like the respiratory tract, the outbreak and continued spread of the epidemic can also cause psychological "illness".

Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, once said: "The COVID-19 epidemic has affected the mental health of millions of people around the world, causing anxiety and fear, and disrupting mental health services. Globally, mental health has become a neglected health issue."

In January 2021, a study published in Nature Human Behavior showed that suicide rates in Japan first dropped and then rose during the COVID-19 pandemic in 2020, which is worthy of vigilance. This also reminds us to pay special attention to our own (and others') mental health during the pandemic.

As the epidemic continues to develop, Japan's suicide rate first drops and then rises

Japan has always been one of the countries with high suicide rates in the world, but according to data from the Japanese Ministry of Health, the number of suicides in Japan has been declining in the 10 years ending in 2019. However, the COVID-19 pandemic seems to have reversed this trend. Under the shadow of the COVID-19 pandemic in 2020, Japan's suicide rate showed a trend of first falling and then rising.

Researchers from the Hong Kong University of Science and Technology and the Tokyo Institute of Urban Gerontology analyzed and compared the changes in Japan's suicide rates during the two waves of the epidemic in 2020 based on data collected by the Japanese Ministry of Health from November 2016 to October 2020. The results showed that in the first wave of the epidemic (February-June), Japan's monthly suicide rate fell by 14% compared with the same period last year, but in the second wave of the epidemic (July-October), the suicide rate rose by 16% compared with the same period last year, especially among women, children and adolescents, with a greater increase in suicide rates among women, 37% and 49% among children and adolescents.

The drop in suicide rates early in the pandemic may seem surprising at first, but similar phenomena have occurred in previous national disasters. For example, suicide rates also dropped in the aftermath of Hurricane Katrina in 2005. This initial drop in suicide rates is known as the “clustering effect” or “honeymoon effect.” Therefore, it is not surprising that suicide rates dropped early in the COVID-19 public health crisis.

In Japan's first wave of the pandemic, government subsidies, reduced working hours, and school closures all contributed to a decline in early suicide rates. The Japanese government gave all citizens a $940 cash subsidy until June, and from April to May, both full-time and part-time workers saw a significant drop in working hours (10-20%), which reduced risk factors for suicide such as overwork and commuting. School closures and home learning have reduced the incidence of school violence, reduced the psychological burden on children and adolescents, and can prevent suicide to a certain extent.

There may be several potential reasons for the rebound in suicide rates in the second wave of the epidemic. The decline in government intervention has affected more young workers, who are more likely to be low-skilled and work under relatively insecure contracts, and therefore have a higher unemployment rate. For children and adolescents, the timing of the second outbreak coincided with the reopening of schools after closures. Students have not been to school for several months, and the pressure of returning to school has increased, which may aggravate psychological depression.

For women, the pandemic continues to affect female-dominated industries more, such as the hotel, food service and retail industries, where layoffs are severe, and women also account for a larger proportion of part-time employees. In addition to concerns about income, women also need to cope with a sharp increase in the burden of unpaid care - during the pandemic, women bear a higher proportion of household labor indicators such as cleaning, childcare, cooking, shopping, etc. than men.

Although this study has limitations, it provides many important insights into suicide mortality during the pandemic that may be instructive even after returning to normal life. Large-scale government subsidies and benefits may help prevent suicides in the early stages of the epidemic, but such generous financial support is not sustainable in the long term. Therefore, overall suicide trends must be monitored in order to consider immediate policy responses. In addition, the study found that only cities with lower suicide rates previously saw an increase in suicide deaths during the pandemic, so suicide prevention strategies may need to target these vulnerable groups and locations.

In Japan's second wave of the epidemic, the suicide rates among women, children and adolescents increased more significantly. ｜cbsnews

What is the impact of the epidemic on suicide rates?

In addition to Japan, under the influence of the "new crown" epidemic in 2020, the suicide rates in many countries around the world have fluctuated slightly.

According to data from the Korea Suicide Prevention Center, 1,924 girls and women died by suicide in South Korea between January and June, an increase of 7.1% over last year. The suicide rate among U.S. military personnel has also increased during the pandemic. In Norway, the United Kingdom, Germany, and Peru, the suicide rate has decreased. In countries or regions that are under strict lockdown, such as Greece, Massachusetts (USA), Victoria (Australia), and China (except Wuhan), there has been no significant change in the suicide rate, while the suicide rate in Nepal has increased.

An article in the British Medical Journal tracked and analyzed the published research on the epidemic and suicide rates, and pointed out that we should carefully interpret the literature on the impact of the "new crown" epidemic on suicide. Because most of the existing research is published in the form of preprints and has not been peer-reviewed; and the few peer-reviewed research results are not enough to support the conclusion that the epidemic will increase the suicide rate, so further research is needed. However, based on the published research, factors related to the epidemic, such as social isolation, school closures, unemployment and other economic concerns, as well as the threat of the disease itself, may have played a negative role.

A study analyzed COVID-19-related suicide cases in the United States, Italy, the United Kingdom, Germany, Saudi Arabia, India, and Bangladesh, and summarized four main risk factors:

One is that the isolation caused by social distancing is unsettling for many people and may exacerbate existing mental health conditions, including depression and suicidal tendencies.

Second, the economic recession caused by the COVID-19 lockdown may exacerbate the risk of suicide associated with unemployment and economic hardship. At the end of March 2020, a German finance minister committed suicide near Frankfurt, reportedly because he was desperate about the economic impact of the COVID-19 pandemic.

Third, during the COVID-19 pandemic, healthcare providers are at increased risk of mental illness. Extreme stress, fear of illness, helplessness, and the trauma of witnessing the lonely death of patients may increase the risk of suicide among healthcare professionals.

Fourth, the stigma and discrimination faced by COVID-19 patients may increase the chance of suicide. A study published in The Lancet also found that nearly 20% of COVID-19 patients experienced mental health problems such as depression, anxiety or dementia within three months of diagnosis. The researchers evaluated the health records of 69 million people in the United States, including more than 62,000 patients diagnosed with COVID-19. Compared with those who were not infected, their risk of developing mental illness doubled.

Fighting the epidemic scientifically, but not neglecting mental health

One event may cause stress, but it will not make a person commit suicide suddenly. When physiological, psychological, environmental and other factors are combined, the motivation for suicide may be stronger. As the global epidemic continues to develop, we should place mental health protection on the same level of importance as drug development and vaccine promotion.

In the United States, where the epidemic is relatively severe, people call the collective psychological problems caused by the epidemic the "second wave of the epidemic." After analyzing the information of more than 5,400 American adults over the age of 18, the Centers for Disease Control and Prevention found that during the "new crown" pandemic, anxiety, depression, and suicidal thoughts surged, and young people were particularly prone to these conditions. Compared with a survey conducted in the same period in 2019, it can be found that the proportion of the population with symptoms of anxiety disorders in 2020 increased by about 3 times, and the proportion reporting symptoms of depressive disorders increased by about 4 times.

A study by the Boston University School of Public Health found that as of mid-April 2020, 27.8% of American adults had symptoms of depression, compared with 8.5% before the COVID-19 pandemic. The study said that income and savings were the most significant predictors of depression symptoms during the pandemic.

In my country, China News Network reported that an online survey involving tens of thousands of people nationwide showed that during the COVID-19 epidemic, mental health problems among the general public were prominent, with about 30% of the respondents experiencing depression, anxiety, insomnia, and acute stress symptoms. The mental health of medical staff is particularly worthy of attention.

All signs indicate that we need to take measures to scientifically respond to mental illnesses that may arise during the epidemic.

First, we need to establish or strengthen appropriate safety nets for those facing financial difficulties and adopt active labor market policies to help the unemployed find jobs.

The second is to focus on monitoring people with mental illnesses.

Third, the media should play their due social responsibility in reporting on the epidemic, take care to eliminate panic rather than amplify it, correct prejudice rather than indulge it, raise questions constructively based on facts rather than incite emotions and create problems, and avoid sensational and speculative headlines.

The New Year holiday is approaching. Whether we go back to our hometown or stay in the city where we live to celebrate the New Year alone, for us personally, we still cannot take the epidemic lightly in the new year. In addition to daily protection, we must always pay attention to our own mental health, remember to cheer ourselves up frequently, and contact more relatives and friends.

Editor | Chen Tianzhen

Editor | Gao Peiwen

References

[1] https://www.nature.com/articles/s41562-020-01042-z

[2]Trends in suicide during the covid-19 pandemic | The BMJ https://www.bmj.com/content/371/bmj.m4352.

[3]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177120/pdf/main.pdf.

[4]https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm.

[5]https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770146.

The article was published by the public account "Ten Points Science" (ID: Science_10). Please indicate the source when reprinting.