Analysis of all non-fatal self-harm cases in an urban area of Japan during pre- and peri-pandemic periods of COVID-19: a population-based study.

BACKGROUND: This study aimed to examine population-based characteristics of non-fatal self-harm in an urban area during pre- and peri-pandemic periods of COVID-19 by sex, age, and severity of self-harm, using pre-hospital medical emergency records. METHODS: We used a registry of all pre-hospital medical records of self-harm cases that occurred in Kawasaki City, Japan, between January 2018 and December 2021. Adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated using Poisson regression models with the log-transformed population by year, sex, age group, and ward as an offset term. RESULTS: During the 4-year study period, 1,534 patients were transported by ambulance due to non-fatal self-harm and were alive on arrival at the hospital. Among women, the number of non-fatal self-harm cases increased by 1.2-fold in 2021 compared with that in 2018. The incidence rate of "severe" non-fatal self-harm among men aged 19 years or younger in 2021 (IRR 4.82, 95% CI 1.25-18.65) and that among women aged 50-59 years in 2020 (IRR 2.51, 95% CI 1.06-5.95) significantly increased compared with that 2018 and 2019. The incidence rate of "mild" self-harm among women aged 20-29 years tended to be higher in 2021 than in 2018 and 2019 (IRR 1.42, 95% CI 0.95-2.12, P = 0.085). CONCLUSIONS: During the peri-pandemic period of COVID-19, the incidence rate of "severe" non-fatal self-harm among men aged 19 years or younger and women aged 50-59 years, as well as that of "mild" self-harm among women aged 20-29 years, sharply increased compared with that during the pre-pandemic period. Our findings suggest that in urban areas during public health crises such as a pandemic, it is important to take measures to reduce the risk of non-fatal self-harm in young women, in addition to strengthening counseling and support for young women at risk for completed suicide.

Onset and remission of common mental disorders among adults living in temporary housing for three years after the triple disaster in Northeast Japan: comparisons with the general population.

BACKGROUND: People living in temporary housing for long periods after a disaster are at risk of poor mental health. This study investigated the post-disaster incidence and remission of common mental disorders among adults living in temporary housing for the 3 years following the 2011 Great East Japan Earthquake. METHODS: Three years after the disaster, face-to-face interviews were conducted with 1089 adult residents living in temporary housing in the disaster area, i.e., the shelter group, and a random sample of 852 community residents from non-disaster areas of East Japan. The World Health Organization Composite International Diagnostic Interview was used to diagnose DSM-IV mood, anxiety, and alcohol use disorders. Information on demographic variables and disaster experiences was also collected. RESULTS: Response rates were 49 and 46% for the shelter group and the community residents, respectively. The incidence of mood/anxiety disorder in the shelter group was elevated only in the first year post-disaster compared to that of the general population. The rate of remission for mood and anxiety disorders was significantly lower in the shelter group than in the community residents. The proportion seeking medical treatment was higher in the shelter group. CONCLUSIONS: The onset of common mental disorders increased in the first year, but then levelled off in the following years among residents in temporary housing after the disaster. Remission from incident post-disaster mental disorders was slower in the shelter group than in the general population. Post-disaster mental health service could consider the greater incidence in the first year and prolonged remission of mental disorders among survivors with a long-term stay in temporary housing after a disaster.

Association of response rate and prevalence estimates of common mental disorders across 129 areas in a nationally representative survey of adults in Japan.

OBJECTIVE: To investigate the association of area response rate with prevalence estimates of mental disorders in the 2nd World Mental Health Survey (WMHJ2). METHODS: The sample of the WMHJ2 was selected from community residents in 129 areas from three regions of Japan. The surveys were conducted between 2013 and 2015, and 2450 (43.4%) responded. Mental disorders as well as three disorder classes (mood, anxiety, and substance use disorders) were identified using the WHO CIDI/DSM-IV. Response rates and 12-month and lifetime prevalences were calculated for each area. A generalized linear mixed model analysis was conducted to associate area response rate with the prevalence of mental disorders, controlling for sex, age, urbanity, and geographical region. RESULTS: Area response rates ranged from 0.05 to 0.80 across the 129 areas. Area response rate was not significantly associated with 12-month or lifetime prevalence of mental disorder. Lifetime prevalences of substance use disorder were significantly lower in a survey with a higher response rate than a survey of the same area with a lower response rate. CONCLUSION: Response rate may not strongly affect the prevalence estimates of mental disorders in a community-based survey of the prevalence of common mental disorders during a particular time frame. However, a lower response rate could be associated with overestimation of lifetime prevalence of substance use disorder. This needs further elucidation.

Geographical Variation in Psychiatric Admissions Among Recipients of Public Assistance.

BACKGROUND: Understanding the area-specific resource use of inpatient psychiatric care is essential for the efficient use of the public assistance system. This study aimed to assess the geographical variation in psychiatric admissions and to identify the prefecture-level determinants of psychiatric admissions among recipients of public assistance in Japan. METHODS: We identified all recipients of public assistance who were hospitalized in a psychiatric ward in May 2014, 2015, or 2016 using the Fact-finding Survey on Medical Assistance. The age- and sex-standardized number of psychiatric admissions was calculated for each of the 47 prefectures, using direct and indirect standardization methods. RESULTS: A total of 46,559 psychiatric inpatients were identified in May 2016. The number of psychiatric admissions per 100,000 population was 36.6. We found a 7.1-fold difference between the prefectures with the highest (Nagasaki) and lowest (Nagano) numbers of admissions. The method of decomposing explained variance in the multiple regression model showed that the number of psychiatric beds per 100,000 population and the number of recipients of public assistance per 1,000 population were the most important determinants of the number of psychiatric admissions (R2 = 28% and R2 = 23%, respectively). The sensitivity analyses, using medical cost as the outcome and data from different survey years and subgroups, showed similar findings. CONCLUSIONS: We identified a large geographical variation in the number and total medical cost of psychiatric admissions among recipients of public assistance. Our findings should encourage policy makers to assess the rationale for this variation and consider strategies for reducing it.

[The number of deaths by suicide after the Great East Japan Earthquake based on demographic statistics in the coastal and non-coastal areas of Iwate, Miyagi, and Fukushima prefectures].

Objective　The number of deaths by suicide after the Great East Japan Earthquake was surveyed based on demographic statistics. In particular, this study examined whether or not there were excessive deaths due to suicide (excluding people who were injured in the earthquake) after the Great East Japan Earthquake disaster. This examination surveyed municipalities in coastal and non-coastal areas of Iwate, Miyagi, and Fukushima prefectures (referred to below as the "three prefectures").Methods　The demographic statistics questionnaire survey information supplied by Article 33 of the Statistics Act (Ministry of Health, Labour and Welfare's published statistics Vol. 0925 No.4, September 25th, 2014) were used as the basic data with particular reference to the information on the deaths from January 1st, 2010 to March 31st, 2013. The information obtained included the date of death, the municipality where the address of the deceased was registered, the gender of the deceased, age at the time of death, and cause of death codes (International Classification of Disease Codes 10th revision: ICD-10). Additionally, information was gathered about the population based on the resident register from 2009 to 2013 and the 2010 National Census; the number of deaths by suicide was then totalled by period and area. The areas were classified as municipalities within three prefectures and those located elsewhere using the municipality where the address of the deceased was registered.Results　The SMR for suicides did not show a tendency to increase for coastal or non-coastal areas throughout the two-year period after the earthquake disaster (from March 2011 to February 2013).　The SMR for the three prefectures 0-1 years after the disaster compared with the year before the disaster was 0.92 and for 1-2 years after the disaster was 0.93. Both these values were significantly low. Looking at both the non-coastal and coastal areas from each of the three prefectures, the SMR for suicides for 0-1 and 1-2 years after the disaster compared with the year before the disaster ranged from 0.73 to 1.07. None were significantly high.Conclusion　The above results indicate that there was no increase in deaths by suicide in these three prefectures in the two years following the earthquake disaster.

Characteristics of cancer patients who died by suicide in the Tokyo metropolitan area.

The purpose of this study was to investigate the sociodemographic characteristics of cancer patients who died by suicide in comparison with cancer-free cases. Suicide data from the Tokyo Medical Examiner's Office from 2009 to 2013 were extracted retrospectively. A total of 503 (5.1%) out of 9841 people who committed suicide had cancer; age ranged from 26 to 97 years. The cancer patients were significantly older than the cancer-free cases. There were significantly more cancer patients with cohabiters than cancer-free cases with cohabiters. Only half of young to middle-aged subjects had a job in both groups. There were significantly more cancer patients who lived on pensions and welfare assistance, and less cancer patients who drink or smoke than those without cancer. Given the high incidence of suicide in elderly cancer patients, healthcare professionals should pay attention for risk even in cancer patients who have cohabiters, benefit from a pension, and do not drink or smoke.

The role of religious advisors in mental health care in the World Mental Health surveys.

OBJECTIVES: To examine the role of religious advisors in mental health care (MHC) according to disorder severity, socio-demographics, religious involvement and country income groups. METHODS: Face to face household surveys in ten high income (HI), six upper-middle income (UMI) and five low/lower-middle (LLMI) income countries totalling 101,258 adults interviewed with the WMH CIDI plus questions on use of care for mental health problems and religiosity. RESULTS: 1.1% of participants turned to religious providers for MHC in the past year. Among those using services, 12.3% used religious services; as much as 30% in some LLMI countries, around 20% in some UMI; in the HI income countries USA, Germany, Italy and Japan are between 15 and 10% whenever the remaining countries are much lower. In LLMI 20.9% used religious advisors for the most severe mental disorders compared to 12.3 in UMI and 9.5% in HI. For severe cases most of religious providers use occurred together with formal care except in Nigeria, Iraq and Ukraine where, respectively, 41.6, 25.7 and 17.7% of such services are outside any formal care. Frequency of attendance at religious services was a strong predictor of religious provider usage OR 6.5 for those who attended over once a week (p < 0.0001); as seeking comfort "often" through religion in case of difficulties OR was 3.6 (p = 0.004) while gender and individual income did not predict use of religious advisors nor did the type of religious affiliation; in contrast young people use them more as well as divorced and widowed OR 1.4 (p = 0.02). Some country differences persisted after controlling for all these factors. CONCLUSIONS: Religious advisors play an important role in mental health care and require appropriate training and collaboration with formal mental healthcare systems. Religious attitudes are strong predictors of religious advisors usage.

Female suicides: Psychosocial and psychiatric characteristics identified by a psychological autopsy study in Japan.

AIM: Although the female suicide rate in Japan is one of the highest among OECD countries, little has been done to assess the psychosocial and psychiatric characteristics of Japanese female suicide completers. This study aimed to examine sex differences in psychosocial and psychiatric characteristics of suicide completers using a psychological autopsy study method, and to identify female suicide factors and intervention points to prevent female suicides. METHODS: A semi-structured interview was conducted with close family members of adult suicide completers. The interview included questions regarding sociodemographic factors, suicide characteristics, previous suicidal behaviors and a family history of suicidal behaviors, financial problems, and physical/psychiatric problems. Fisher's exact test and the Student's t-test were used to explore sex differences in these survey items, and individual descriptive information of female suicide cases was also examined. RESULTS: Of the 92 suicide completers, 28 were female and 64 were male. Females had a significantly higher prevalence of a history of self-harm/suicide attempts (P < 0.001). The prevalence of eating disorders was significantly higher among females than males (P < 0.01). CONCLUSION: The findings of this study highlight the importance of providing psychological and social support to caregivers of those who repeatedly attempt suicide and express suicidal thoughts, and to suggest the need to improve community care systems to be aware of suicide risk factors among female suicide attempters.

Spatial analysis for regional behavior of patients with mental disorders in Japan.

AIM: The aim of our study was to clarify the geographical movement of patients treated in psychiatric facilities, which can provide important information on the resources and health-care system of psychiatric services. METHODS: We conducted an analysis of nationwide data on psychiatric patients, collected as an additional survey to the conventional '630 survey' in 2014. For the 151 848 initially admitted inpatients during 6 months and the 144 401 outpatients on a specific day, we identified whether a patient was admitted to a psychiatric facility located in the same medical area as his/her residence. We estimated percentages of being from (i) within the medical area, (ii) within the prefecture, and (iii) outside the prefecture, using a Bayesian statistical approach for each secondary medical area. RESULTS: The inpatients moved across wider areas than did the outpatients. Almost all inpatients and outpatients received their medical treatment at hospitals/clinics within their prefecture of residence. CONCLUSION: The current mental health medical system in Japan has been operating according to prefecture unit; thus, it may be appropriate to plan a medical system at a prefectural level.

[Identification of Psychotropic Drugs Attributed to Fatal Overdose--A Case-control Study by Data from the Tokyo Medical Examiner's Office and Prescriptions].

Drug overdose is a serious public health issue and fatal cases have been reported from various fields of medicine. This case-control analysis assessed the comparison between fatal overdose cases in the special wards of Tokyo Metropolitan area and prescribed psychotropic drugs in Tokyo in 2009-2010. It was suggested that the prescribed drugs serve as a direct cause of death in overdose cases. Furthermore, pentobarbital calcium, chlorpromazine-promethazine-phenobarbital, levomepromazine and flunitrazepam were identified as drugs with a high risk of fatal overdose. It is encouraged to prudently verify the intended application and usage of such psychotropic drugs in each case upon their prescription. This is the first study in Japan to identify psychotropic drugs with a high risk of fatal overdose by case-control study.

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.

AIM: In Japan, the Cabinet Office released the 'General Principles of Suicide Prevention Policy' in 2007 and suggested nine initiatives. In 2009, a national fund was launched to help prefectures (the administrative divisions of Japan) and local authorities implement five categories of suicide-prevention programs. This paper examines the impact of the national fund on the establishment of the systems for suicide prevention and the implementation of these initiatives among local authorities. METHODS: The present study included 1385 local authorities (79.5%) from all 47 prefectures that responded to the cross-sectional questionnaire survey. RESULTS: Improved suicide-prevention systems and the implementation of nine initiatives in April 2013 were observed among 265 local authorities (19.1%) that implemented 'Training of community service providers' and 'Public awareness campaigns'; 178 local authorities (12.9%) that implemented 'Face-to-face counseling', 'Training of community service providers' and 'Public awareness campaigns'; and 324 local authorities (23.4%) that implemented 'Trauma-informed policies and practices'. There was no significant difference in suicide-prevention systems and the implementation of nine initiatives between 203 local authorities (14.7%) that implemented only 'Public awareness campaigns' and 231 local authorities (16.7%) that did not implement any suicide-prevention programs. CONCLUSION: The results of our study suggest that the national fund promoted the establishment of community systems for suicide prevention and helped implement initiatives among local authorities. The national suicide-prevention strategy in Japan should explore a standard package of programs to guide community suicide-prevention efforts with a sustained workforce among local authorities.

Statistical aspects of psychiatric inpatient care in Japan: Based on a comprehensive nationwide survey of psychiatric hospitals conducted from 1996 to 2012.

The aim of this review is to clarify the state of psychiatric admissions and discharges in Japan using statistical data collected from 1996 to 2012. We performed a secondary analysis of nationwide data on psychiatric hospitals, which are collected yearly by the Ministry of Health, Labour and Welfare. The latest national figures for indices defined in the 'Reform Vision of Mental Health and Welfare' (originally released in 2004) were 70.9% for 'discharge rate for newly admitted patients' and 23.3% for 'discharge rate for long-term patients', which have target rates of ≥76% and ≥29%, respectively. The national discharge rate for newly admitted patients was roughly on the increase, but appeared to reach a plateau in recent years. [Correction added on 17 July 2015, after first online publication: 'on the decline' has been corrected to 'on the increase' in the sentence above.] The national discharge rate for long-term patients was higher in 2012 than in 1999 and appeared to increase throughout the 2000s, although not enough to reach the target. Some improvements in the discharge rate for newly admitted patients indicated some progress in mental health reform, although problems should continue to be addressed in order to reach the targets. As for discharge rates of long-term admissions in local communities, some problems still remain to be solved in order to achieve the goals of the reform vision.

[Discharge Dynamics and Related Factors of Long-stay Patients in Psychiatric Hospitals].

A longstanding challenge in Japan is prolonged psychiatric hospitalization and the associated difficulty of discharge, lost opportunities for patients' social participation, and stagnant reallocation of medical resources. Although the length of stay has been shortened recently on average, its distribution tends to be polarized into high-turnover and long-stay groups. To resolve these problems, we must understand the discharge dynamics of long-stay patients. Three questionnaires were sent to 733 randomly selected psychiatric hospitals (response rate: 24.3%; 178 hospitals, 2,480 patients). One questionnaire was on hospitalized patient numbers for one-year or longer stays as at the end of June 2007, recording each combination of Group (A or B), diagnosis, and hospitalization type. Group A referred to patients continuously hospitalized as at the end of June 2008; Group B referred to those discharged between July 2007 and June 2008. The second questionnaire was on hospital characteristics (founder, bed number, medical function, etc.), and the third questionnaire was on detailed patient characteristics (residential setting post-discharge, etc., for each Group B patient; a maximum of 20 patients per hospital consecutively in order of discharge). Valid data were obtained from 171 hospitals and 2,419 patients, with the latter increasing to 3,543 after weighting. The annual discharge rate (ADR; B/[A+B]) for the entire sample was 16.3%. Regarding the diagnosis, dementia showed the highest ADR (27.8%) and schizophrenia the lowest (13.5%). The ADRs for depression, bipolar disorder, and alcoholism were 23.9, 20.6, and 23.7% respectively. Regarding the hospitalization type, voluntary hospitalization (16.0%) and hospitalization for medical care and protection (16.8%) showed similar ADRs. Regarding the district, ADRs were high in Kinki (19.9%) and Kyushu (18.8%), and low in Kanto (14.1%) and Chugoku/Shikoku (14.2%). Multivariate analyses revealed that discharge within one year was significantly correlated with the diagnosis, district, hospital founder, and presence of psychiatric emergency or acute-phase treatment (acute-phase-type) wards in hospitals, but not with the hospitalization type, presence of psychiatric long-term care wards, or presence of senile dementia wards. The probability of discharge (odds ratio [95% confidence interval]) regarding the diagnosis was higher in dementia (2.47 [2.23-2.74]), alcoholism (2.09 [1.71-2.55]), depression (2.07 [1.65-2.59]), and bipolar disorder (1.70 [1.35-2.16]) than in schizophrenia (reference). Regarding the district, the probability was higher in Kinki (1.32 [1.12-1.54]) and Kyushu (1.27 [1.14-1.42]) than Kanto (reference). The probability was also lower in private hospitals (0.58 [0.51-0.66]) than in public/university hospitals (reference), and higher in hospitals with acute-phase-type wards (1.24 [1.14-1.35]) than in those without them (reference). The most common residential setting post-discharge for the total sample of weighted Group B patients was temporary hospitalization in another department prearranging psychiatric readmission (THAD, 35.8%), followed by death (18.2%), living with families/relatives (LF/R, 11.3%), a residential care facility for the aged (RCF-A, 9.5%), residential care facility for the disabled (RCF-D, 8.6%), hospitalization in another psychiatric hospital (7.4%), living alone (LA, 4.3%), permanent hospitalization in another department (PHAD, 4.3%), and others (0.7%). In dementia, death was common (31.0%) ; LF/R (1.8%) and LA (0.0%) were rare. As the age increased, the proportions of LF/R, LA, RCF-D, RCF-A, PHAD, and death changed; particularly, LA decreased and death increased markedly with age. Additionally, THAD amounted to approximately 40% in every age class of 40 years or older, contrasting with 11.4% in those under 40 years. The study's limitations include a low response rate, the elapsed time after the survey, and lack of attention paid to symptom severity. Nevertheless, it provides valuable insights into long-stay patients, including that discharge is least likely in schizophrenia and most likely via transfer or death for dementia. These results may encourage the efficient promotion of discharge and prevention of prolonged hospitalization according to patients' demographic, clinical, and social conditions.

[Expectation for JSPN's contribution following revision of General Principles for Suicide Prevention Policy].

Japan's national suicide prevention efforts following the 1998 surge in the number of suicide deaths can be divided into three stages: the first stage administrated mainly by the health ministry (1998-2005), the second and transitional stage when it was upgraded to a full governmental issue (2005-2006), and the third and present stage following the promulgation of the Basic Act for Suicide Prevention in 2006. In June 2007, the General Principles for Suicide Prevention Policy (GPSP), a guideline on how the national government should act to promote suicide prevention, was announced, urging local governments to tackle the problem of suicide. The GPSP was set to be revised after around five years from its publication, and, thus, a revised GPSP was published in August of 2012. Based on the five years of challenges, the revised GPSP states that suicide prevention strategies should move on to more practical and community-oriented ones. The National Center of Neurology and Psychiatry (NCNP), through its Center for Suicide Prevention, played a coordinating role in putting forward a proposal for the revision, working with 29 academic societies including the Japanese Society of Psychiatry and Neurology (JSPN). In February 2013, by further developing the relationships with academic societies, etc., which were forged in the above-mentioned process, NCNP set up the Preparatory Committee for the Evidence-based Suicide Prevention Consortium in order to contribute to suicide prevention strategies from an academic perspective. Meanwhile, in the World Health Organization's 66th World Health Assembly held in May 2013, the Comprehensive Mental Health Action Plan 2013-2020 was approved. Its core principle is "no health without mental health", and it has the following four objectives: (1) to strengthen effective leadership and governance for mental health; (2) to provide comprehensive, integrated, and responsive mental health and social care services in community-based settings; (3) to implement strategies for promotion and prevention in mental health; and (4) to strengthen information systems, evidence, and research for mental health. In these, objective (3) includes a numerical target for the future global suicide rate. The WHO also plans to publish its first World Suicide Report on the World Suicide Prevention Day in September 2014. Today, suicide prevention forms an important part of mental health. The evolution of suicide prevention from mental health perspectives and its integration into society require comprehensive efforts.

[Metabolic and lithium monitoring in Japanese psychiatric outpatient clinics].

OBJECTIVE: Various guidelines recommend that the risks of diabetes mellitus, dyslipidemia, and lithium intoxication should be appropriately managed by regular monitoring of blood sugar and serum lipid levels in patients treated with atypical antipsychotics, and regular monitoring of serum lithium concentrations in patients treated with lithium carbonate. However, in Japan, these recommendations are not always observed. The present study used a database, constructed from research on medical policies performed in 2006, to investigate the frequencies of blood sugar, serum lipid, and serum lithium monitoring in psychiatric outpatients in Japan. METHODS: This database contained the health insurance claims of 3,674 psychiatric outpatients extracted from the 47 prefectures throughout Japan. The present study examined two subordinate surveys: 1) the frequency of monitoring blood sugar and serum lipid levels in those on atypical antipsychotics during a period of one month (February) in 2006; 2) the frequency of monitoring the serum lithium concentration in those on lithium carbonate, also obtained during February 2006. RESULTS: In Survey 1, the subjects were 228 male and 271 female recipients, with an average age of 45.1 years; 86.8% of these subjects suffered from psychosis. In Survey 2, the subjects were 70 male and 64 female recipients, with an average age of 49.9 years; 57.5% of these subjects suffered from mood disorder and 36.6% suffered from psychosis. In Survey 1, the blood sugar level, HbA1c, and urinary sugar were monitored in 28 (5.6%), 5 (1.0%), and 8 (1.6%) subjects, respectively. At least one of these three tests was performed in 32 subjects (6.4%). The serum lipid level was monitored in 40 subjects (8.0%). In Survey 2, no serum lithium concentrations were measured. The frequency of monitoring the serum lithium concentration per month was estimated to be below 2.2%. CONCLUSIONS: The Maudsley Prescribing Guidelines recommend that both blood sugar and serum lipid levels should be monitored at least once a year (equivalent to a measurement frequency of 8.3% per month). Survey 1 revealed that, although the actual frequency of monitoring the serum lipid level agreed with the recommendation, that of monitoring the blood sugar level was lower than recommended. However, when compared with the results of a study in the U.S.(equivalent to a measurement frequency of 2-17% per month), the frequency of monitoring the blood sugar level was not that low in Japan. The frequency of monitoring the serum lithium concentration per month was estimated to be below 2.2%. The guidelines and package inserts recommend that the serum lithium concentration should be monitored once every 2-6 months. Therefore, the frequency of monitoring the serum lithium concentration in psychiatric outpatients treated in Japan was considered to be too low from the standpoint of medical safety.

Psychosocial and psychiatric characteristics of suicide completers with psychiatric treatment before death: a psychological autopsy study of 76 cases.

AIM: The present study was conducted to examine differences in psychosocial and psychiatric characteristics between suicide completers with and without a history of psychiatric treatment within the year before death, using a psychological autopsy method. METHODS: A semi-structured interview was administered by a psychiatrist and other mental health professionals for the closest bereaved of 76 suicide completers. RESULTS: Suicide completers with a history of psychiatric treatment (n = 38) were significantly younger than those without (n = 38) (P < 0.01), and a significantly higher proportion of cases in the treatment group were estimated to be suffering from schizophrenia. Further, in 57.9% of the treatment group, the fatal suicidal behavior involved overdose with prescribed psychotropic drugs. In addition, female suicide completers in the treatment group were more likely to have a history of self-harm or non-fatal suicidal behavior. CONCLUSION: Many suicide completers who received psychiatric treatment were young adults. It was common for suicide completers to overdose on prescribed drugs as a supplementary means of suicide, and many experienced self-harming behavior before death. In addition, a higher proportion of the treatment cases suffered from schizophrenia.

Lay diagnoses and views on causes, coping strategies, and treatment for schizophrenia.

We aimed to clarify the relationship between lay diagnoses and perspectives on schizophrenia regarding causes, coping strategies, treatments, prognosis with and without the help of specialists. Our study sample was 500 adults in Japan. Participants read a vignette that depicted moderate to severe schizophrenic symptoms and yielded lay diagnoses. They also expressed their perspectives on the cause of the status in the vignette and coping strategies. We examined the relationship between lay diagnoses and the perspectives. Participants labeled the vignette as 'stress' held low expectations for the effectiveness of mental health professionals and psychiatric treatment. To enhance mental health literacy, it is important to help people distinguish a mental illness from mere stress. Lay diagnoses do not necessary have to be detailed, as long as people recognize a situation as an illness.

[State of suicide and effective efforts in suicide prevention in psychiatric hospitals and clinics].

Although factors related to suicide are complicated, mental health disorders are an important risk factor. It is anticipated that suicide prevention measures will be implemented from the perspective of improved psychiatric medicine. No national-scale study has been carried out in Japan on the state of psychiatric medicine and its influence on suicide since 2000. Moreover, many efforts not intended for suicide prevention have been shown to be effective for this purpose. Here, we conducted surveys to obtain basic data on suicide prevention and improvements in mental health care among 1,728 psychiatric hospitals and clinics in Japan in 2010. The incidence of suicide in psychiatric hospitals and clinics from January to December 2009 was estimated to be 100.5 for outpatients and 154.5 for inpatients per 100,000 patients. Regarding the duration from consultation to suicide, 87% of outpatients committed suicide less than one month following their last consultation. Moreover, approximately two-thirds of patients had undergone consultations for more than one year. A number of suicides in psychiatric hospitals and clinics occurred while patients were continuously undergoing treatment. Efforts shown to be effective in suicide prevention included risk assessment with multiple medical staff (i.e., doctors and nurses), a 24-hour crisis line, and a follow-up system for discontinued outpatients. We expect that the results of this survey will aid in the implementation of effective suicide prevention in psychiatric medicine.