Sociodemographic and environmental characteristics associated with thoughts of death and suicidal ideation in community-dwelling residents of a rural town in Japan: analyses from a perspective of accompanying problems.

OBJECTIVE: Suicide prevention has been focused on primary prevention as a group rather than individuals. However, we aimed to identify sociodemographic and environmental characteristics of individuals with suicidal thoughts among rural residents in Japan. METHODS: In 2015, a cross-sectional home visit survey was conducted in a rural town in Akita Prefecture. A total of 1,844 residents aged ≥ 20 years (response rate, 65%) answered a self-administered questionnaire about suicidal thoughts in the past one month. Multivariate logistic regression analyses were used to investigate sociodemographic and environmental characteristics associated with suicidal thoughts in models with accompanying problems for human relations problems (HRP), health problems (HP), and financial problems (FP), or with no accompanying problems. RESULTS: In total, 218 (men 9.4%, women 13.8%) had suicidal thoughts with accompanying problems for HRP (n = 104), HP (n = 112), and FP (n = 72). The risk characteristics were Kessler Psychological Distress Scale scores ≥ 9 in models with HRP, HP, and FP or with no accompanying problems; being a woman and current smoking with no accompanying problems; absence of a person for help in a model of FP; and absence of family member for help in a model of HRP or with no accompanying problems. The mitigating factor were being optimistic (a domain of resilience skills identified by factor analysis) in models of HRP, HP, and FP or with no accompanying problems; being aged 70-79 and being aged ≥ 80 in a model of HRP. CONCLUSIONS: Suicidal thoughts among rural residents in Japan were associated with multifactorial sociodemographic and environmental characteristics.

Conditions and characteristics of older adults and primary caregivers who use short-stay services: a comparison between long-term and short-term service groups by service type.

Objective: This study was conducted to examine the conditions and characteristics of older adults who use short-stay services as well as those of their primary caregivers by categorizing them into long-term use and short-term use groups. Patients and Methods: We conducted logistic regression analyses on the data of 679 short-term residential care (short-stay) users using the χ2 test, with the type of use as the dependent variable. Results: The results of the comparison show that users in long-term care were likely to be men, ≥95 years old, live alone, and require care for severe dementia (level three or more). Primary caregivers lived farther away from the user's neighborhood, felt burdened by and lacked knowledge about providing care, and preferred that the patient continue to receive care in a facility or be hospitalized. Conclusion: It was suggested that care support specialists in charge of elderly persons requiring severe nursing care who live alone may be adjusting to the long-term use of short stays, which is not usually expected, because they are influenced by the nursing care burden of the primary caregiver who lives far away, the level of knowledge and skills of nursing care, and the primary caregiver's willingness to continue caring, and because they cannot immediately enter a facility when they are no longer able to live alone.

Characteristics of and gender difference factors of hikikomori among the working-age population: A cross-sectional population study in rural Japan.

Objectives　This study aimed to assess the relevance of hikikomori to a variety of socio-demographic characteristics and socio-psychological conditions and examined these relationships by gender.Methods　The study employed a cross-sectional design. A questionnaire survey was conducted among 2,459 participants aged 15-64 years and living in Happo-cho, Akita. The outcome variable, hikikomori, was characterized by "not having participated in any social events nor interacted with others besides family members for more than six months." Exposure variables included sex, age, marital status, occupational status, outdoor frequencies, health, socio-psychological well-being, and availability of social support. Using Chi-square test of independence and multiple logistic regression, the results indicated the impact of the individual factors and the combined impact of all potential variables on the likelihood of being hikikomori in both participant groups: men and women.Results　The effective response rate was 54.5%. Those who socially withdrew for six months or more (n=164 (6.7%); 53.7% men, 46.2% women) were classified as being hikikomori; of these, 45.7% had been withdrawn for more than 10 years. Hikikomori men were more likely to have severe symptoms of mental illness, poorer overall self-rated health, feelings of distress, and passive suicidal ideation than non-hikikomori men, but not hikikomori women. Furthermore, after adjusting for all tested variables as possible confounding factors, being jobless and having fewer outdoor frequencies were associated with being a hikikomori man, and being a homemaker and having no social support were associated with being a hikikomori woman.Conclusion　Occupational status and outdoor frequencies are relevant factors for assessing the likelihood of being a hikikomori. Characteristics of hikikomori manifest differently in men and women. Having social support may help women avoid transitioning into a hikikomori. Incorporating emotional and mental health management into intervention programs may help better target potential beneficiaries among Japanese men.

A decrease in suicide rates in Japanese rural towns after community-based intervention by the health promotion approach.

A community-based intervention study for suicide prevention was conducted in six towns (total population 43,964) in Akita Prefecture of Japan according to a quasi-experimental design to reduce suicide rates in rural towns. Public awareness raising activities using a health promotion approach emphasizing the empowerment of residents and civic participation were conducted. The welfare measures of promoting a sense of purpose among senior citizens and creating a community network were also taken. As a result, the suicide rate per 100,000 in the intervention towns decreased from 70.8 before intervention (1999) to 34.1 after intervention (2004). The suicide rate per 100,000 in the control towns was 47.8 before intervention and 49.1 after intervention.

Prevalence of depressive symptoms and related risk factors for depressive symptoms among elderly persons living in a rural Japanese community: a cross-sectional study.

To clarify the prevalence of depression in a rural community in Japan and to evaluate the social and familial risk factors for depression, with the goal of suicide prevention, a questionnaire survey was conducted on a total of 2,763 elderly persons. The determined prevalence of depressive symptoms (Zung's self-rated depression scale score of 50 points or more) was 10.4%. Logistic regression analysis showed associations between depressive symptoms and age, absence of a friendly companion, irritation with one's family, frequent loneliness, the opinion that stress has a large impact on one's life, suicide ideation, and poor subjective physical and mental health.

Community-based suicide prevention program in Japan using a health promotion approach.

Suicide prevention programs at a national level in developed countries were briefly reviewed, and the community-based suicide prevention programs in Akita Prefecture, in the Tohoku Region of Japan, were also outlined. Suicide prevention programs were proposed in Western countries in the 1980s. A famous example is the national prevention program in Finland that was started in 1986. The national suicide prevention programs in Western countries share some common features such as their comprehensiveness and diversity. Typical policies of suicide prevention programs were categorized according to primary, secondary and tertiary prevention. Regarding community-based suicide prevention programs using a health promotion approach, the Akita prefectural government incorporated a suicide prevention program into the local health promotion strategy "Health Akita 21" in 2001. An outline of the four action programs was as follows: to raise awareness of suicide prevention, to increase opportunities for mental health consultation, to promote both primary and secondary prevention of depression, and to create a supportive environment for mental health promotion. Community-based suicide prevention programs were started in some communities of model projects that are financially supported by Akita Prefectural government. Efforts to evaluate the effectiveness of community-based suicide prevention programs are needed in the future.