Notes on suicide in Japan after the quake

The Japanese suicide rate is around one person every 15 minutes. It's one of the highest in the developed world.

Below is a summary of useful links and papers. In short there is good evidence behind the suggestion that the suicide rate in Japan will increase in the medium to long term because of the quake.

This is a useful short article from the Economist.
http://www.economist.com/node/11294805

This short article also has some information about the suicide trends.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118433/

Wikipedia has two useful pages for background information.
http://en.wikipedia.org/wiki/Suicide_in_Japan
and
http://en.wikipedia.org/wiki/Seppuku


Previous suicide trends in Japan have related to unemployment and economic recessions. The quake in the short term may not significantly increase the suicide rate however the impact of the quake on the economy during a worldwide economic crisis may increase the suicide rate based on previous trends (https://www.ncbi.nlm.nih.gov/pubmed/17197228 - I can only get the abstract of this paper however it concludes the suicide rate is linked to the unemployment rate in Japan). Natural disasters can cause mental ill health and these can lead to suicide in the medium to long term.

There is also a significant stigma of mental illness in Japan as well as a culturally acceptable mode of death, Seppuku  (though this method is rarely used in modern times) as well as the Kamikaze pilots of WWII who were seen as heroes.. Edwin Shneidman noted constriction was the most common cognitive state in suicide, e..g. thinking "death before dishonour" and my guess is this is common. Dishonour may mean loss of status or job.

The stigma means help-seeking happens less often. I believe the problem is related to shame, i.e. the shame of mental illness, but also the culture places a lot of shame on failure or not meeting expectations. I'm unaware of how this has changed over time with Westernisation.

I'd suggest the best paper on the issue of suicide and natural disasters is this one published in the New England Journal of Medicine. The NEJM is one of the most reputed journals I know. I'm afraid the study uses American data and there's an important correction.. There's a review paper available however the abstract was very poor quality and I couldn't find a version of the full paper.
http://www.nejm.org/doi/full/10.1056/NEJM199802053380607 (A free access version can be found here - http://www.hawaii.edu/hivandaids/Suicide%20after%20Natural%20Disasters.pdf)

However the authors made a retraction after finding an error in their calculations.
http://www.nejm.org/doi/full/10.1056/NEJM199901143400213

Their conclusions after the correction are surprising.
"The new results for counties affected by a single natural disaster do not support the hypothesis that suicide rates increase after natural disasters. However, it is important to note that suicides are an extreme sign of psychological distress. Prior research shows that victims of severe disasters may suffer less extreme forms of psychological distress, such as anxiety, depression, and post-traumatic stress disorder."

However they still conclude
"Our original conclusion that “mental health support is needed after severe disasters” remains consistent with this body of knowledge."

Given previous trends related to unemployment and recessions in Japan I feel there may be an increase in suicides in the years after the quake as a result of the economic impact of the quake rather than the direct psychological impact.