Attitudes Japan In current research, there are two

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towards Suicide and Treatment Approaches: USA vs Japan

International University, San Diego














towards Suicide and Treatment Approaches: USA vs Japan

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Research suggests that as of 2015, there were
788,000 deaths by suicide reported worldwide annually with a rate of 10.7 per
100,000 (WHO, 2015).  According to the
National Center of Health Statistics, over the past decade, rates of suicide in
Unites States increased approximately 24% to 13.0 per 100,000, with rates among
male population remaining four times higher, than among female population
(NCHS, 2014).  In Japan alone, while
suicide rates have been decreasing, last reports suggest a rate of 26 per
100,000, with approximately 26,000 deaths by suicide annually (Fushimi,
Sugawara & Saito, 2006).  This
represents approximately three times the number of people dying or being killed
in traffic accidents each year.  With
such high number, comes great responsibility. 
Over the last decade both Japan and Unites States have been working its
way towards creating effective suicide interventions and raising awareness
about those suffering from suicidal ideations (Nakanishi, Yamauchi &
Takeshima, 2015).

of Suicide in Japan

In current research, there are two large
statistical datasets concerning suicide that are widely available; one is a
statistical report by the national police agency and the other is a report by
the Japanese Ministry of Health, Labor and Welfare (MHLW) (Oyama et al., 2008).  According to MHLW, the annual suicide rate in
2002 alone was 23.8 deaths per 100,000 individuals, with 70% suicides done by
males.  Recently, research also looked at
the rates related to the families of victims who died by suicide.  It appeared that there were approximately
five bereaved family members per one suicide in 2006, and about 90,000 children
who have lost a parent to suicide (Chen, Choi, Mori, Sawada & Sugano,

Although in Japan
suicide rates have traditionally been highest among elderly male population,
research suggested that the suicide count or middle-aged males appeared to be
higher since 1998, thus suggesting that such an issue is affecting all members
of the society in Japan and not just one specific population (Fushimi, Sugawara
& Saito, 2006).  Males were also seen
as more prone to attempting suicide than women in Japan.

of Suicide in US

·       Not

Attitude towards Suicide
in Japan

Suicide is known to be surrounded by
feelings such as shame, fear, guilt, and uneasiness (Kageyama, 2012).  These feelings and similar defense mechanisms
give rise to various incorrect or inappropriate views on suicide, such as
suicide being inevitable, permissible, and unpreventable.  While professional mental health workers in
Japan might be in search of successful interventions, there is a major
potential barrier that comes in the way of people attending to those
interventions (Oyama et al., 2010).

Stigma against mental health has been
around for ages and is still effecting a large number of individuals (Kageyama,
2012).  Japanese people also have certain
views on suicide.  It is often could be
heard in Japan that suicide is an issue that cannot be helped.  These inappropriate views and ideas about
suicide possibly promote maladaptive coping strategies, such as emotional
inexpressiveness, reluctance to seek help, or potential alcohol abuse
(Nakanishi, Yamauchi & Takeshima, 2015). 
Hesitation in seeking help from anyone when distressed may compromise an
individual’s mental health.  Research
suggested that men in Japan are more likely to have inappropriate views on
suicide, than women (Nakanishi, Yamauchi & Takeshima, 2015).  In addition, it was discovered that
middle-aged individuals are more likely to think that suicide is acceptable and
can be performed easily by self-choice, while elder population often considers
suicide to be the act of a ‘week mind’.

Having correct and adequate information,
knowledge and beliefs on suicide is part of mental health literacy, which
enables individuals to gain access to, understand, and use information in ways
that promote and maintain good mental health (Kageyama, 2012).  It should also be noted that inappropriate
views on suicide such as ‘suicidal behaviors are due to a weak mind’ often hurt
those who are bereft over the loss of loved ones to suicide (Nakanishi,
Yamauchi & Takeshima, 2015).  Thus,
taboos regarding suicide and emotions evoked by it in individuals likely hinder
the implementation of suicide prevention programs (Fushimi, Sugawara &
Saito, 2006).

Attitudes towards suicide
in US

·       Not

Suicide Risk Factors in

Suicide victims are often a subject to
various stress factors, in addition to other motives to end their lives (Shiho
et al., 2005).  Suicide risk factors are
often divided into three categories: biopsychosocial, environmental and
sociocultural.  Among the most commonly
identified in Japan are: living with family, school bulling, substance use, and
lowered self-esteem (Oyama et al., 2008). 
As mentioned earlier, one of the largest datasets on suicide is national
police agency (Shiratori et al., 2014). 
The police rates count the number of suicide victims in each region
under the jurisdiction of the local police stations.  Usually police investigates personal
characteristics as well as background factors for each individual case.

Those factor often include motives for
each suicide, which are then compared to a previously compiled list of suicide
motives (Shiratori et al., 2014).  From
there the investigation identifies up to three potential motives for an
individual suicide, based upon evidence, such as suicide notes or other
information.  If these combinations of
motives from different suicide cases are not simply aggregated but analyzed as
a network, it is then possible to reveal the hierarchies and correlations of the
motives for suicide.

Recently, Japanese researchers developed a
network analysis in order to clarify complex correlations among multiple
factors (Shiratori et al., 2014).  Using
this analysis technique, we can uncover the structure of correlations involved
in multiple events like suicides.  This
type of network analysis has been previously successfully applied to medical
research, but to date its application in social sciences has been limited.  Current research on suicide in Japan has been
focusing on biopsychosocial factors such as family, health and finances as
prevalent risk factors (Fushimi, Sugawara & Saito, 2006).  To understand the interaction that occurs
between these risk factors one study suggested using network analysis to model
a hierarchy which explains the correlation among complex biopsychosocial risk
factors and motives (Shiratori et al., 2014).

Motives for suicide were classified into
eight major categories using the format of police statistics: family problems,
health problems with mental or physical, economic and livelihood problems,
work-related problems, romantic problems, school-related problems, others, and
unknown (Shiratori et al., 2014).  Each
major category was then subdivided into 53 minor categories with up to three
minor motivation categories recorded for each case of suicide.  According to the results physical illness and
depression were the most important motives, while family problems and economic
and livelihood problems were identified around these two large motives (Fig.

Another potential risk factor been highly
research that is more uniquely prevalent in Japan than in other countries, is
suicide-related internet use (Sueki, 2013). 
This can be defined as browsing internet in search of suicide related
content such as: methods, statistics, and live examples.  With internet gaining popularity each day as
a source of information, controlling such an influential risk factor is almost
impossible.  Research suggested that such
information induces suicide among those who are susceptible (Thompson,
2001).  While in response to websites
filled with content related to dying by suicide researcher attempted to improve
the content of suicide prevention websites, the problem is still ongoing.  One study looking at how suicide-related web
search can affect individual’s suicide ideations suggested that suicide
ideations, depression, anxiety and loneliness can be increased (Sueki,
2013).  Thus, making internet search a
potential threat to those suffering from suicidal thoughts.

Suicide Risk Factors in

·       not

Treatment Options in
Japan and US















Chen, J., Choi, Y. J., Mori, K., Sawada, Y., &
Sugano, S. (2009). Those who are left behind: An estimate of the number of
family members of suicide victims in Japan. Social Indicators Research, 94(3),
535-544. doi:10.1007/s11205-009-9448-3

Fushimi, M., Sugawara, J., & Saito, S. (2006).
Comparison of completed and attempted suicide in Akita, Japan. Psychiatry
And Clinical Neurosciences, 60(3), 289-295.

Ishi, T., Hashimoto, E., Ukai, W., Kakutani, Y.,
Sasaki, R., & Saito, T. (2014). Characteristics of attempted suicide by
patients with schizophrenia compared with those with mood disorders: A case-controlled
study in northern Japan. Plos ONE, 9(5)

Kageyama, T. (2012). Views on suicide among middle?aged and elderly
populations in Japan: Their association with demographic variables and feeling
shame in seeking help. Psychiatry And Clinical Neurosciences, 66(2),
105-112. doi:10.1111/j.1440-1819.2011.02313.x

Kato, T. A., Suzuki, Y., Sato, R., Fujisawa, D.,
Uehara, K., Hashimoto, N., & Otsuka, K. (2010). Development of 2-hour
suicide intervention program among medical residents: First pilot trial. Psychiatry
And Clinical Neurosciences, 64(5), 531-540.

Ono, Y., Sakai, A., Otsuka, K., Uda, H., Oyama, H.,
Ishizuka, N., & Yonemoto, N. (2013). Effectiveness of a multimodal
community intervention program to prevent suicide and suicide attempts: A
quasi-experimental study. Plos ONE, 8(10)

Nakanishi, M., Yamauchi, T., & Takeshima, T.
(2015). National strategy for suicide prevention in Japan: Impact of a national
fund on progress of developing systems for suicide prevention and implementing
initiatives among local authorities. Psychiatry And Clinical Neurosciences,
69(1), 55-64. doi:10.1111/pcn.12222

Oyama, H., Sakashita, T., Hojo, K., Ono, Y., Watanabe,
N., Takizawa, T., & Tanaka, E. (2010). A community-based survey and
screening for depression in the elderly: The short-term effect on suicide risk
in Japan. Crisis: The Journal Of Crisis Intervention And Suicide Prevention,
31(2), 100-108. doi:10.1027/0227-5910/a000007

Oyama, H., Sakashita, T., Ono, Y., Goto, M., Fujita,
M., & Koida, J. (2008). Effect of community-based intervention using
depression screening on elderly suicide risk: A meta-analysis of the evidence
from Japan. Community Mental Health Journal, 44(5), 311-320.

Shiho, Y., Tohru, T., Shinji, S., Manabu, T., Yuka,
T., Eriko, T., & Naoki, W. (2005). Suicide in Japan: Present condition and
prevention measures. Crisis: The Journal Of Crisis Intervention And Suicide
Prevention, 26(1), 12-19. doi:10.1027/0227-5910.26.1.12

Shiratori, Y., Tachikawa, H., Nemoto, K., Endo, G.,
Aiba, M., Matsui, Y., & Asada, T. (2014). Network analysis for motives in
suicide cases: A cross?sectional
study. Psychiatry And Clinical Neurosciences, 68(4), 299-307.

Sueki, H. (2013). The effect of suicide-related
Internet use on users’ mental health: A longitudinal study. Crisis: The
Journal Of Crisis Intervention And Suicide Prevention, 34(5),
348-353. doi:10.1027/0227-5910/a000201

Thompson, S. (2001). Suicide and the internet. Psychiatric
Bulletin, 25(10), 400. doi:10.1192/pb.25.10.400-a



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