Creating a system to quickly determine cause of death,and efforts that should be made to elucidate the circumstances of suicides

In Japan, the first General Principles of Suicide Prevention (ver. 1.) was approved by the Cabinet in June 2007, and it has been reviewed every 5 years since, i.e., in August 2012 (ver. 2) and July 2017 (ver. 3). The latest/fourth version of the General Principles of Suicide Prevention (ver. 4) was approved by the Cabinet in October 2022. ¹ Suicide by women and young people has increased in recent years, and the fourth version of the General Principles proposes enhanced measures to prevent suicide among those populations. We have also cited the need to promote efforts measures to prevent suicide among people who live alone. ²

All four versions of the General Principles of Suicide Prevention include a suggestion describing the need for "research to elucidate the circumstances of suicide. ¹ Since version 3, the category “promoting research to help promote general principles of suicide prevention” has included “in conjunction with a system to determine the cause of death.” The first Plan to Promote Determination of the Cause of Death was approved by the Cabinet in June 2014, and the latest version of this Plan was approved in June 2021. ³ In order to promote the determination of causes of death, accurate cause-of-death statistics must be obtained. ⁴ Several years have passed since the suggestion was made to ascertain the circumstances of suicide in conjunction with a system to determine causes of death ⁴ ; however, sufficient preparations are yet to be made, and apparently more time is necessary until such a system is definitively implemented.

In order to implement preventive measures in accordance with the circumstances of suicide, studies of suicide prevention measures that are based on motives for suicide are necessary, as such motives would be closely associated with the determination of the circumstances of suicide. Two sets of suicide statistics are published in Japan: statistics reported by the National Police Agency (NPA), and the Vital Statistics reported by the Ministry of Health, Labour and Welfare. Only the statistics reported by the NPA list the motive for suicide. Prior to 2006, the NPA statistics provided a presumed motive for each suicide based on a suicide note or other corroborating documents, and since 2007 the NPA has provided up to three motives for suicide. ⁵ The current statistics better reflect the reasons for suicide compared to the previous statistics, but the main motive for many suicides cannot be ascertained. It would thus be helpful to refer to both the currently reported statistics on suicide motives and previous statistics indicating the main motive in order to devise effective measures for the prevention of suicide.

Urgently needed measures to prevent suicide could be devised by compiling a statistical report on the motives for suicide as reported by the NPA, and this compilation could be done promptly. In order to implement truly effective measures to prevent suicide, the medical system (social medicine, basic medicine, and clinical medicine), government agencies, the police, and personnel in other relevant fields need to work together more closely to create a system to determine causes of death in conjunction with ascertaining the circumstances of suicides and to specifically examine the results of that system.