The social implementation of research on suicide prevention.

Abstract

Suicide has been recognized as a serious global public health issue and now the influence of the COVID-19 pandemic on suicide rates is a concern around the world. According to the monthly suicide occurrence data in Japan, the number of suicides has been gradually increasing since July 2020 compared to the same months in the past 3 years.1 Increases in suicide rates following previous pandemics have been reported. This increase in suicide might be late-onset (i.e., occurring several months later), as is the case in natural disasters, but detailed data have been lacking, and the mechanisms have not yet been fully analyzed. Japan has experienced significant fluctuations in suicides rates since records began. The most recent sharp increase in suicides occurred in 1998: the number of suicides increased by more than 34% from 24 391 in 1997 to 32 863 in 1998, and remained at more than 30 000 for another 13 years. In 2006, The National Diet enacted the Basic Act for Suicide Prevention.2 In the previous year, The Japan Ministry of Health, Labour, and Welfare had chosen suicide prevention as a subject for its strategic research project, envisaging establishment of evidenced-based health policy for preventing suicide. Thus, the ‘Japanese Multimodal Intervention Trials for Suicide Prevention (J-MISP)’ program was launched. The J-MISP contained two trials: (i) a community intervention trial of a multimodal suicide-prevention program in Japan (NOCOMIT-J);3 and (ii) a randomized, controlled, multicenter trial of post-suicide attempt case management for the prevention of further attempts in Japan (ACTION-J).4 Suicide attempt is a potent risk of later suicide, therefore, the ACTION-J study focused on preventing suicide attempters admitted to the emergency departments from committing further attempts. The study aimed to clarify the effectiveness of the assertive-case-management intervention based on psychiatric diagnoses, social risks, and the needs of patients. In the case-management group, a significant decrease in the incidence of recurrent suicide attempt was observed up to 6 months.4 The successful development of an evidence-based psychosocial intervention, not only for suicide prevention, but for psychiatric practice more broadly, is rare. Thus, the ACTION-J intervention program was adopted for the national medical payment scheme by the Ministry of Health, Labour, and Welfare. The success of the intervention is ensured by the scheme's comprehensive training program for medical staff who care for suicide attempters. The training program itself has significantly improved attitudes, self-efficacy, and skills for suicide prevention among medical personnel.5 Secondary analysis of the ACTION-J study is now underway,6 and this issue includes a description of how the ACTION-J intervention program is currently being carried out in the real-world clinical settings.7 Suicide is a complex phenomenon; no two processes of suicide are the same. The ACTION-J strategy is considered to be applicable to various individuals affected by the COVID-19 pandemic and at risk of suicide. It is expected that further dissemination and implementation of the evidence-based program will progress via collaboration among the Ministry, local governments, and medical sites in Japan. It is also expected that additional robust studies will replicate the effectiveness of the case-management intervention for preventing suicide and verify the importance of psychiatry.