Economic Distress and Suicide: Japan and U.S.

My colleagues and I are presenting a new research poster presentation this week at the 2011 American Psychiatric Association meeting in Honolulu. I wanted to use this post to summarize some of the current research related to our presentation as well as highlight the findings from our poster.

Over the last few years, I have had the opportunity to meet yearly with a group of Japanese and American researchers and psychiatrists in a retreat setting in Itasca State Park in Minnesota. This group has recently been named the Itasca Brain and Behavior Association. The goal of the group is to promote international research collaboration in clinical neuroscience and areas of psychosomatic medicine.

I learned from my Japanese colleagues last year that suicide rates in Japan increased significantly around 1998--a increase that has continued now for the last 12 years. The figure below documents the trend in suicide rates in Japan as well as the U.S.   Suicide rates increased to a larger percent in males (47%) compared to females (23%) in this period. My Japanese colleagues reported that psychological autopsy information suggested unemployment and divorce as common factors felt to be contributing to this increased rate of suicide.

Epidemiological work has now supported a link between regional unemployment in Japan and increased rates of suicides.

Japan has experience a prolonged economic malaise since 1998. Several sources have suggested the U.S. and Japanese economic cycles may be similar with the U.S. trailing the pattern in Japan by 10 to 15 years. Unemployment began increasing in Japan in 1998 and jumped dramatically in the U.S. beginning in 2008. The housing bubble in Japan peaked in 1996 and in the U.S. peaked in 2008. The possibility that the U.S. is entering a prolonged economic downturn similar to Japan raises the question of the mental health and suicide rate response. Is the U.S. vulnerable to an increased rate of suicides similar to that found in Japan? If so, what would a similar response look like and could mental health clinicians and public health officials do anything to reduce of minimize this type of risk.

Our research focused on looking at the age and gender distribution of increased rates of suicide in Japan and applying those rates to the U.S. population based on the 2010 Census. The baseline number of suicides in the U.S. average around 33,000 per year. If suicide rates were to increase to the magnitude found in Japan, the number of increased suicides in the U.S. would be about 14,000 per year. Interestingly, our model found that approximately 90% of the increased number of suicides would occur in men as men have higher baseline rates and experienced a greater increase in Japan after 1998.

A recent manuscript published in the American Journal of Public Health looked at suicide rates in relation to economic cycles between 1929 and 2007. This analysis suggested that suicide rates in the U.S. do vary with economic cycles and need to be consider in public health planning.

The presence of a primary psychiatric disorder (major depression, bipolar disorder, schizophrenia, substance dependence) is the primary determinant of risk for suicide. Our research does not predict a dramatic increase in suicide rates but rather is a warning to U.S. clinicians and public health officials. The take home messages from our collaborative research would be:

The U.S. should be alert for the potential for economic crisis and unemployment to increase risk of suicide deaths

Elevated risk for suicide related to unemployment appears highest in middle to older aged men

Adults with pre-existing mental disorders losing there job may also lose prescription benefits as well as re-imbursement for mental health services. Efforts should be made to identify these individuals and provide alternate pathways to mental health care

Employers should examine the support services provided those involved in layoffs with an effort to provide psychiatric and psychological services to these vulnerable populations

Link to Copy of APA Poster is Here.


Chang SS, Gunnell D, Sterne JA, Lu TH, & Cheng AT (2009). Was the economic crisis 1997-1998 responsible for rising suicide rates in East/Southeast Asia? A time-trend analysis for Japan, Hong Kong, South Korea, Taiwan, Singapore and Thailand. Social science & medicine (1982), 68 (7), 1322-31 PMID: 19200631

Luo F, Florence C, Quispe-Agnoli M, Ouyang L, & Crosby A (2011). Impact of Business Cycles on US Suicide Rates, 1928-2007. American journal of public health PMID: 21493938