Trends in suicide in Japan by gender during the COVID-19 pandemic, through December 2020.

Dear editor

Suicide is a rising concern during the COVID-19 pandemic worldwide (Gunnell, 2020). A recent analysis found, for the first time, excess suicide deaths among women in July, August and September 2020 in Japan, and no such elevated mortality for men (Nomura, 2021). This report updates these estimates of the gender-specific burden of suicide death related to COVID-19 in Japan up until December 2020.

Monthly mortality data from December 2010 to December 2020 were obtained from the National Police Agency, Japan (National Police Agency, 2021). In exactly the same way as Nomura et al. (2021) (Nomura, 2021), a quasi-Poisson regression model was used to estimate the expected monthly number of deaths from suicide and the upper and lower bounds of the two-sided 95% prediction interval for these deaths (Farrington, 1996; Noufaily, 2013). This point estimate and the upper and lower bounds were set as thresholds for excess and exiguous deaths, respectively. We present a range for excess and exiguous deaths, which is obtained from the differences between the observed deaths and each of these thresholds. We also define the percent excess and deficit as the number of excess and exiguous deaths divided by their respective thresholds.

After September 2020, excess deaths continued to be observed every month in women. Particularly in October, 2020 there were 879 suicides, which represents 344.00 – 401.91 excess deaths (72.10–84.25% excess; see Supplementary Figure 1). For men after January 2020, excess deaths were observed for the first time in October, 2020 (108.00–234.49, percent excess 9.95–21.60), but have not been identified since then. Through September, 2020, the period covered in our previous study, female excess deaths for July, August, and September were updated to include additional suicide cases due to delayed reporting: 108.00–165.54 excess deaths (21.71–33.28% excess) in July; 103.00–177.07 excess deaths (20.77–35.70% excess) in August; and 102.00–174.04 excess deaths (21.30–36.34% excess) in September. In men, no excess was observed during the July-September period.

The measures taken to contain the spread of COVID-19 have raised concerns that suicide rates may increase as a result of economic downturn, deteriorating existing mental health, increased social and emotional loneliness (Gunnell, 2020; Reger, 2020; Kawohl, 2020). Women in Japan are more likely than men to be employed as lower-paid temporary workers under unstable labor contracts; the particular increase in suicides among such women may be partially due to the deterioration in economic conditions caused by the spread of COVID-19. An internet survey that recruited a large, demographically representative sample of adult New Zealanders demonstrated a substantial increase in psychological distress associated with unemployment or a reduction in work as a result of the COVID-19 pandemic (Every-Palmer et al., 2020). A national, longitudinal cohort study in the United Kingdom also showed disproportionate psychological distress among women during the pandemic (Pierce, 2020).

In addition, social distancing and travel restrictions imposed to manage the COVID-19 situation have also led to a disproportionate increase in domestic violence, additional unpaid care burden, and other family problems among women worldwide (Usher, 2020). The Ministry of Health, Labour and Welfare of Japan has set up a consultation desk for psychological problems caused by COVID-19, and reports that the number of cases of women seeking consultations due to family problems as well as living difficulties has been increasing (Yomiuri Shimbun, 2020). As of January 22, 2021 in Japan, more than 84,000 people have lost their jobs due to COVID-19 (Ministry of Health, 2021), about a 30% increase in the three months since October, 2020. In response to the resurgence of COVID-19, the Japanese government declared a state of emergency for the second time in Tokyo and several other prefectures on January 7, 2021. The declaration was originally scheduled to be lifted on February 7, but the lifting was postponed to March 7 at the longest, and another two-week postponement was also declared for some prefectures. The damage to the economy and to vulnerable citizens, including women, youths and the unemployed, will become even more serious (Tanaka, 2021).

As previous studies have urged (Nomura, 2021; Sakamoto, 2021), we strongly emphasize the importance of addressing the increase in suicides associated with COVID-19 in Japan, especially among women. Measures to mitigate the negative economic impact of COVID-19 on women include direct income support, tax concessions, support for women's income security to close the gender wage gap (Deady, 2020). Furthermore, measures against prolonged social isolation and provision of adequate access to quality mental health services are also important, and in recent years, attention has been focused on the potential usefulness of digital interventions (Torok, 2020). Continuous timely monitoring of suicide risk must be maintained, and developing effective measures to prevent suicide is one of today's top public health challenges.

Declaration of Competing Interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.