HONOLULU – Economic crisis in the United States could lead to an increase in suicides if U.S. trends follow the pattern in Japan during that country’s economic downturn a decade ago, according to Dr. William R. Yates and his colleagues.
If the U.S. experience does mirror that of Japan, Dr. Yates and his colleagues project an increase of more than 14,500 suicides per year in the United States. The Japanese experience suggests that almost 90% of the increase would occur among men, Dr. Yates reported in a poster presentation at the annual meeting of the American Psychiatric Association.
Right now, the U.S. economic outlook parallels Japan’s in the late 1990s, with increased unemployment, a burst housing bubble, and a troubled stock market, said Dr. Yates, lead author of the analysis. As unemployment increased 50% in Japan between 1998 and 1999, suicide rates increased 23.1% among women and 47.3% among men. Men over 50 were especially hard hit. Unemployment and divorce were the first and second leading psychosocial factors, one of Dr. Yates’s Japanese colleagues found. Better suicide reporting did not seem to account for the increase in deaths.
Clinicians should be aware that a similar scenario could occur in the United States – or could already be happening if a recent increase in baby-boomer suicides is any indication, said Dr. Yates, who is affiliated with the University of Oklahoma department of psychiatry in Tulsa and is a former department chairman. Indeed, a recent study shows a connection between U.S. suicide rates and business cycles (Am. J. Public Health 2011;101:1139-46).
"We are not necessarily saying this will occur, but if it should, these would be the patterns that might be seen," he said. "We know psychiatric illness is the primary determinant of suicide, but psychosocial factors can influence overall rates."
To arrive at their figures, Dr. Yates and his colleagues compared economic trends in the United States and Japan, and applied Japanese suicide rates during the downturn to U.S. population figures based on the 2010 Census. "The baseline number of suicides in the U.S. average around 33,000 per year," Dr. Yates wrote in a blog about his poster. "If suicide rates were to increase to the magnitude found in Japan, the number of increased suicides in the U.S." probably surpass 14,000 each year.
Also, based on that model, for instance, they project a possible increase of about 3,000 suicides per year over the next few years in men aged 55-74.
The experience in Japan might not be generalizable to the United States. There are significant cultural differences between the two countries, among other possible confounders that Dr. Yates plans to examine.
Dr. Yates said he is paying more attention to the employment status of his patients and "whether they are at risk of losing their job, and even talking about what they would do if they lose their jobs." The main issue for jobless patients is access to care. He lets patients know they can get help even without insurance from community mental health services, which often have sliding-scale payment schemes, though there might be a lengthy wait.
In addition, Dr. Yates tells his patients that "the worst thing they can do if they are currently being treated and lose insurance would be to stop medical care and medication. That’s the time they need to be followed closely, rather than being out there on their own," he said. He’d also like to see companies mention community mental health services as an option for laid-off employees.
He got the idea for the study from his work with a small, informal group of psychiatrists and researchers that meets in a retreat setting in Itasca State Park in Minnesota and focuses on cross-cultural psychiatric issues. He and his colleagues, who call themselves the Itasca Brain and Behavior Association, started looking into the issue after Japanese members mentioned the jump in Japanese suicides around 1998.
Dr. Yates said he has no relevant disclosures.