May 19, 2011 (Honolulu, Hawaii) — If public response to the economic downturn in the United States mirrors that of Japan, Americans could face an increase in suicide rates that may have already begun, new research suggests.
Presented here at the American Psychiatric Association (APA) 2011 Annual Meeting, investigators from the Itasca Brain and Behavior Association examined suicide rates in Japan in the late 1990s when that country experienced an economic downturn that included a doubling of unemployment, a situation not dissimilar to the current economic situation in the United States, which experienced a significant jump in unemployment in 2009 that has been running between 8% and 10% for the last 2 years.
The investigators note that if US rates of increased suicide approximate those in Japan, the country would experience a yearly increase in deaths due to suicide estimated at
14,610 [of which] 12,965 [would be] in males and 1645 in females.
"Based on the economic data we looked at, if there's going to be an increase in suicide similar to Japan's in the United States, it would occur somewhere between 2008 and 2012, possibly extending up to 2016," principal investigator William Yates, MD, PhD, told Medscape Medical News.
Unemployment a Stressor
"We began discussing some of the potential factors that may be contributing to this phenomenon, and one of our Japanese colleagues mentioned that some of the psychological autopsy work done by the police in Japan indicated that economic stagnation and unemployment seemed to be a contributing factor, and that's what got us thinking about this issue and whether the US may be at similar risk," said Dr. Yates.
The investigators examined suicide trends in Japan by age, sex, and year in relation to a series of economic variables. Economic trends were then compared by year to estimate the timing of a potential economic effect to estimate the timing of a potential economic effect on US suicide rates.
In 1996-1997 Japan had unemployment rates of between 2% and 3%, but by 2003-2004 the rate had doubled to between 5% and 6%. The increase in Japanese unemployment began in 1998. That same year, said Dr. Yates, Japanese suicide rates also began to increase.
The data show that by 2009, there was approximately a 39% overall increase in suicide rates. When the researchers broke the data down by sex, they found suicide rates in males increased by 47% and by 23% in females. The researchers also found suicide rates were highest among men 50 years and older.
The investigators then applied the Japanese model to the US population based on the 2010 Census. Dr. Yates noted that currently suicide rates in the United States average about 33,000 annually.
"If we had a similar increase in suicide rates [as Japan], it would be somewhere in the order of an additional 14,000 individuals per year, and about 90% of that, according to the Japanese model, would be middle- aged and older men," he said.
One of the reasons for the higher rates in men, said Dr. Yates, is that they have higher baseline rates of suicide compared with women.
Although the presence of psychiatric illness is the primary driver of suicide risk, it appears from this study and other recent research that economic stress also plays a role. "The key factor for suicide is presence of a mental illness, and if you have a mood disorder or schizophrenia or a substance abuse problem, that is really the highest marker of risk. But it appears that these kinds of stressors can play a role in modifying risk over time, but we do need to be aware of the additional role economic factors can play in the risk for suicide," said Dr. Yates.
An analysis from the Centers of Disease Control and Prevention (CDC) published in April in the American Journal of Public Health and reported by Medscape Medical News at that time showed business cycles significantly influence suicide rates, decreasing when times are good and increasing when they are bad.
Commenting on the study, Jeffrey Borenstein, MD, the APA's chair of the Council on Communications, said this research highlights an important issue that warrants attention.
"Whether it be economic distress, natural disasters, or manmade disasters, there is a relationship between stress and psychiatric conditions, and it is important for us to be aware of this, especially during times of stress, such as economic downturns and other disasters, so I think it is a very important study," said Dr. Borenstein.