Behavioural Sciences ︱ Professor Fumiko Satoh

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Reasons that drive people to suicide are complex and may differ depending on socio-demographic factors and circumstances. Anin modern ageing society’s crisis :

Suicide, double-suicide, and ouble-suicide, particularly among HOMICIDE-SUICIDE homicide-suicide are a significant couples, was a significant public FREQUENCY ESTIMATES public health concern in Japan. Dhealth concern in Japan after Professor Satoh and colleagues extracted In particular, double-suicide, the Second World War, when arranged data from autopsy reports on unnatural which was relatively common marriages stopped being the norm and deaths that occurred in Kanagawa Chronic illness has been reported as an among lovers immediately after people began to marry partners of their Prefecture (which is second to Tokyo important risk factor for suicide among the the Second World War, has re- choice. Nevertheless, in some cases, as the largest area of Japan in terms of elderly in Hong Kong. Suicide, double-suicide, and homicide- suicide are a significant public health eggeegg/Shutterstock.com emerged in Japan among the parental objections held a significant population) from 1999 to 2011. In their concern in Japan. elderly and their overburdened sway, leading couples to take their lives in study, homicide-suicide was defined as a carers. Professor Fumiko Satoh fear they wouldn’t be able to be together. suicide case following a killing of a family and colleagues from the Kitasato Although social norms have since relaxed, member, spouse, or lover, and details of to ascertain and often require in-depth elderly parents or partners. To address illness), economic and life problems University School of Medicine contemporary Japan is seeing a return demographic and forensic characteristics interviews with the surviving bereaved; this issue, in April 2000, Japan launched (especially relevant among men), have examined prevalence rates of this phenomenon. Japan, currently of all eligible cases were examined. concurrently, previous research has a long-term care (LTC) insurance system and family problems. and proposed likely reasons for ranked seventh in suicide incidence rates Overall, there were 76 homicide-suicide suggested that over half of all homicide- that aimed to solve the problem of caring double-suicide and homicide- worldwide, is grappling with an ageing cases, involving 169 people, with an suicide perpetrators were clinically for the frail elderly by supporting home Chronic illness has been reported as an suicide among the Japanese society where the burden of care over average of 5.8 cases of homicide-suicide depressed at the time of the event. care and reducing caregiver burden. important risk factor for suicide among elderly, identifying health, family, the frail leads to caregiver exhaustion occurring per year. A third of all cases The system was expected to decrease the elderly in Hong Kong. In addition, and economic problems as some that may result in violence. With this in involved married couples, and two-thirds Compared to the rest of the world, the the number of murders on insurance depression, the risk of which increases of the driving forces. mind, the government is taking measures involved parents and their children, suicide rate for Japan in this study was recipients committed by their caring with age, has also been reported as a to understand the scale and address the with an even gender split between higher than for the United States or kin. However, studies have shown that driving force behind suicide among the mechanisms behind double-suicide and the perpetrators. Motivations were the Netherlands, but comparable to instead of decreasing, the number of elderly, suggesting that identifying and homicide-, which, to-date, remain confirmed in 40% of cases, and included Switzerland. In contrast, homicide rate murder cases in this population in fact treating depression among the elderly poorly understood. Fumiko Satoh and pain from sickness, psychiatric disorder, was lower compared to the Netherlands colleagues from the Kitasato University family financial, and couple relationship and United States, but comparable to School of Medicine have examined problems, as well as caregiver and Switzerland. Regarding the homicide- Health, family, and economic problems prevalence rates and proposed likely maternity anxiety. Nevertheless, these suicide rate, the highest rate was explanations for double-suicide among findings should be approached with reported for the United States, with the are some of the forces driving suicide the elderly in Japan. caution, as reasons for suicide are difficult Netherlands, Switzerland, and Japan rates among the Japanese elderly. reporting a comparable rate. The striking differences in the data came when increased, following the introduction of should be high on the public health comparing the gender of perpetrators; this system. A systematic review revealed policy agenda. Policy notwithstanding, while it was evenly split between genders that the most frequent perpetrators of dealing effectively with depression in Japan, the majority of perpetrators such murders are husbands and wives, requires collaboration between in the United States or Switzerland followed by sons or daughters and their physicians, nurses, psychiatrists, and were male. parents. The majority of victims have been administrative organisations. As social reported to be bedridden due to stroke isolation, particularly among the frail SOCIAL PROBLEM or dementia. living in rural areas, can exacerbate Homicide-suicide within families, such symptoms of depression and increase risk as mothers killing their children ahead of REASONS FOR VIOLENCE of suicide, interdisciplinary collaboration taking their own lives, is a significant social Reasons that drive people to suicide is paramount. problem in Japan. At the same time, as are complex and may differ depending the number of the elderly increases, it is on socio-demographic factors and Understanding the other factors that may a problem that is shifting demographics, circumstances. In this particular context, drive suicide rates among the elderly in affecting more and more people who common risk factors for suicide include Japan requires further research. Some crumble under the burden of care for their health problems (e.g., physical or mental reports have proposed that changes in

www.researchoutreach.org www.researchoutreach.org High levels of unemployment and difficulties The autopsy table at Kitasato University finding work are thought to increase the risk of School of Medicine. suicide, particularly among the youth. Behind the Research Professor Fumiko Satoh

E: [email protected] T: +81-42-778-9026 W: https://jssc.ncnp.go.jp/en/index.php

Research Objectives References

As an expert in forensic medicine, Professor Satoh’s research Inoue, T., Fukunaga, T., Okazaki, Y., Ono Y. (2011). Report on transcends the medical, legal, and scientific sectors. Her suicide trends in persons aged 60 or over in Japan: the need work focuses on sudden natural death, morphological for effective prevention measures. Med Sci Law, 51, 32-35. Cultural context is proposed as a set of analysis, developing molecular biology analytical systems, https://doi.org/10.1258/msl.2010.010068 independent risk factors for suicide in sudden infant death syndrome, and the development Japan, for example, the collectivist tradition He, M., Ohrui, T. (2009). Homicides of frail older persons by that prioritises the group over an individual. of drug toxicology analytical assays. their caregivers in Japan. J Am Geriatrics Soc, 57(1), 173-174 Marco Fine/Shutterstock.comMarco Glowonconcept/Shutterstock.com Russell, R., Metraux, D., Tohen, M. (2016). Cultural influences on suicide in Japan. Psych Clin Neurosci, 71, 2-5. doi:10.1111/ the socio-economic wellbeing of the job, compounding the stigma against The Japanese are generally very conscious Detail pcn.12428 elderly persons, especially men, might bankruptcy and increasing the risk of of how they are viewed by their peers, affect their risk of suicide; however, suicide, particularly among individuals and maintaining group harmony, often Department of Legal Medicine, Satoh, F., Osawa, M. (2016). Trend of homicide- whether this is an independent risk factor, whose social network had been at the expense of personal freedom, is Kitasato University School of Medicine, suicide in (Japan): Comparison or whether this is a factor associated with previously restricted to colleagues. Even a widespread expectation. Historically, 1-15-1, Kitasato, Minami-ku, with Western countries. Med Sci Law, 56(4), 258-263. doi:10.1177/0025802416668769 depression, remains to be elucidated. among workers who managed to retain suicide has been viewed as an extreme Sagamihara, Kanagawa, Japan employment, the stress of increased form of restoring social order, dealing ECONOMY AND SUICIDE workload and higher expectations with shame and guilt, and repenting Bio Personal Response Nevertheless, what is currently known is combined with lessening of protections for failures. Suicide has also been Professor Satoh graduated from Tokai University school of that recession is a risk factor for suicide. had resulted in deaths from overwork. romanticised in literature, contributing Medicine in 1994. She received her PhD in Medicine in 2000 Following the economic downturn of to permissive attitudes toward it. Recent before working in Legal Medicine for 19 years. She is What do you think is the role of social isolation/ loneliness in determining double-suicide/homicide- the 1990s, Japan has witnessed a spike CULTURAL CONTEXT research has suggested that, despite some currently Professor and Chairman at Kitasato University suicide trends in Japan? in suicide rates, which, unexpectedly, OF SUICIDE IN JAPAN attitude changes in contemporary Japan, School of Medicine. did not begin to decline when the Addressing the burden of care over the Japanese students, compared to their I believe that Japan’s nuclear family, diminished relationships with neighbours, mental illness, and economic economy began its recovery. High levels elderly is an urgent public health task American counterparts, have a higher level Collaborators hardship all result in increased social isolation. Within this, of unemployment and difficulties finding in Japan, which sits on top of measures of acceptance for suicide, believing that • Motoki Osawa parents and children who are co-dependents on the family, short-term let alone long-term work have required to contain the relatively high suicide can be a conscious and acceptable • Wataru Irie or couples, etc. leads to an increased risk from double- choice. In fact, a separate study has • Chikako Hashimoto suicide or homicide-suicide. reported that, compared to American • Chizu Sasaki Reasons that drive people to suicide are respondents, Japanese respondents were more open to and accepting of the complex and may differ depending on socio- idea that suicide is acceptable for aged demographic factors and circumstances. and infirm persons.

been suggested to increase the risk of suicide rates in the general population. SUICIDE COUNTERMEASURES suicide, particularly among the youth. Cultural context has been proposed as a Despite a complex landscape that In addition to young people struggling set of independent risk factors for suicide may appear conducive toward suicide, for work, recession has also left many in Japan, for example, the collectivist effective preventive actions have been middle-aged, previously prosperous, tradition that prioritises the group over taken in Japan. The Support Centre for and dedicated men without a steady an individual. Suicide Countermeasures was established to implement a comprehensive strategy, according to the YEAR NETHERLANDS SWITZERLAND USA JAPAN, KANAGAWA Basic Law on Suicide Countermeasures, (1992-2006) (1992-2004) (2004-2006) (1998-2011) which came into force in April 2016. As a Homicide rate 1.38 (1.25-1.51) 0.87 (0.80-0.94) 5.06 (4.70-5.43) 0.61 (0.34-0.97) result, regional suicide profiles for each

Suicide rate 9.71 (9.50-9.92) 19.35 (18.58-20.12) 10.76 (9.86-11.65) 19.5 (17.6 -20.8) prefecture have been created, leading to suicide rate reduction. Specifically, suicide Homicide-suicide rate 0.05 (0.04-0.06) 0.09 (0.07-0.12) 0.22 (0.20-0.25) 0.06 (0.03-0.11) rate per 100,000 people has decreased

Incidence rates of murder, suicide and homicide-suicide per 100,000 people in the Netherlands, by 38.9% between 2003 and 2018, Switzerland, the USA and Kanagawa, Japan (95% confidence interval). suggesting a reversal in the trend. yoko_ken_chan/Shutterstock.com

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