Suicidal Mortality and Motives Among Middle-School, High-School, and University Students.
Suicidal Mortality and Motives Among Middle-School, High-School, and University Students.
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DOI：
10.1001/jamanetworkopen.2023.28144
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发表时间：
2023-08-01
影响因子：
13.8
通讯作者：
Motomura, Eishi
中科院分区：
文献类型：
--
作者：
Okada, Motohiro;Matsumoto, Ryusuke;Shiroyama, Takashi;Motomura, Eishi
在COVID-19大流行期间，日本30岁以下的自杀人数增加与哪些因素有关？在这项对12396名初中、高中和大学生的横断面研究中，从2007年到2022年，自杀死亡率自2010年代末以来一直在上升，主要相关因素包括与学校有关的、与健康有关的和与家庭有关的问题;然而，与学生自杀相关的因素根据他们的生命阶段（即生命周期）而变化。这些研究结果表明，设计和实施以学校为基础的自杀预防计划，是有效的特定脆弱性的心理和社会发展阶段的初中，高中和大学生可以有助于预防自杀的学生。这项横断面研究调查了2007年至2022年日本初中、高中和大学生自杀死亡率和自杀动机的趋势和相关因素。日本每10万人的自杀死亡率（SMRP）在COVID-19疫情爆发前持续下降，其后于疫情期间意外上升。然而，对潜在的机制仍然知之甚少。确定2007年至2022年日本学生自杀死亡率和自杀动机的趋势和相关因素。本横断面研究从警察厅的自杀统计数据库“自杀统计”中获得了日本初中、高中和大学生的SMRP数据。分别使用线性混合效应和联合点回归模型分析了年度SMRP的年龄依赖性和时间波动，按自杀动机（7个类别和52个亚类别）、性别和学校分类。2007年至2022年的自杀总人数如下：男中学生760人，女中学生635人，男高中生2 376人，女高中生1 566人，男大学生5 179人，女大学生1 880人。2007年至2022年的平均（SD）学生人数如下：男中学生1 752 737（81 334）人，女中学生1 675 572（78 824）人，男高中生1 648 274（67 520）人，女高中生1 614 828（60 032）人，男大学生1 652 689人（32 724人），女大学生1 229 142人（57 484人）。在男生中，主要的动机是与学校有关的因素（成绩不佳和担心未来），其次是与家庭有关的动机和与健康有关的动机。在女生中，与学校和家庭有关的动机减少，但与健康有关的动机表现出年龄依赖性增加。初中男生和女生的SMRP基本相同（平均值[SD]，2.7 [1.0] vs 2.4 [1.4]），但男生SMRP的年龄依赖性增加明显（平均值[SD]，高中与大学男生，9.1 [2.4] vs 19.6 [3.0];高中与大学女生，6.1 [2.4] vs 9.6 [1.8]）。然而，与健康相关动机相关的高中生自杀发生率在女生中更高。大多数与重大影响性自杀动机（与学校有关、与健康有关和与家庭有关的动机）有关的自杀事件在大流行之前就开始增加。与人际关系相关的SMRP变化，如与同学或父母的冲突，并不显著，但在大流行期间，该比率大幅上升。学校相关、健康相关和家庭相关的问题是主要的动机，而健康相关和家庭相关的动机的影响随着年龄的增长而增加和减少。值得注意的是，大多数与主要影响动机（成绩不佳、与父母或同学冲突以及精神疾病）相关的SMRP在2010年代后期已经开始增加，这表明最近学龄人群SMRP的增加与流行病相关因素以及流行病发生前影响这一代人的其他因素有关。将基于学龄期个体的研究结果统一应用于以初中、高中和大学学生为对象的学校自杀预防项目可能是不合适的。
What factors are associated with the increasing number of suicides among individuals younger than 30 years in Japan during the COVID-19 pandemic? In this cross-sectional study of 12 396 middle-school, high-school, and university students, from 2007 to 2022, suicide mortality rates have consistently increased since the late 2010s, with major associated factors including school-related, health-related, and family-related problems; however, the factors associated with suicide among students change according to their life stage (ie, life cycle). These findings suggest that designing and implementing school-based suicide prevention programs that are effective for the specific vulnerabilities in psychological and social developmental stages of middle-school, high-school, and university students can contribute to suicide prevention for students. This cross-sectional study examines trends in and factors associated with suicidal mortality and motives among middle-school, high-school, and university students in Japan, from 2007 to 2022. The suicide mortality rate per 100 000 population (SMRP) consistently decreased before the COVID-19 pandemic outbreak in Japan and then unexpectedly increased during the pandemic. However, the underlying mechanisms remain poorly understood. To identify trends in and factors associated with suicidal mortality and motives among students in Japan from 2007 to 2022. In this cross-sectional study, data on SMRPs among Japanese middle-school, high-school, and university students were obtained from the government suicide database Suicide Statistics of the National Police Agency. Age-dependent and temporal fluctuations in annual SMRPs, disaggregated by suicidal motive (7 categories and 52 subcategories), sex, and school, were analyzed using linear mixed-effect and joinpoint regression models, respectively. Total suicide numbers from 2007 to 2022 were as follows: 760 male middle-school students, 635 female middle-school students, 2376 male high-school students, 1566 female high-school students, 5179 male university students, and 1880 female university students. The mean (SD) student populations from 2007 to 2022 were as follows: 1 752 737 (81 334) male middle-school students, 1 675 572 (78 824) female middle-school students, 1 648 274 (67 520) male high-school students, 1 614 828 (60 032) female high-school students, 1 652 689 (32 724) male university students, and 1 229 142 (57 484) female university students. Among male students, the leading motives were school-related factors (underachievement and worrying about the future), followed by family-related and health-related motives. Among female students, school-related and family-related motives decreased, but health-related motives showed an age-dependent increase. The SMRPs of middle-school male students and female students were almost equal (mean [SD], 2.7 [1.0] vs 2.4 [1.4]), but the age-dependent increase in SMRPs among male students was pronounced (mean [SD], high-school vs university male students, 9.1 [2.4] vs 19.6 [3.0]; high-school vs university female students, 6.1 [2.4] vs 9.6 [1.8]). However, the incidence of suicide among high-school students associated with health-related motives was greater in female students. The majority of suicides associated with major impactable suicidal motives (school-related, health-related, and family-related motives) began increasing before the pandemic. Changes in SMRP associated with interpersonal relationships, such as conflict with classmates or parents, were not significant, but the rates increased greatly during the pandemic. School-related, health-related, and family-related problems were major motives, whereas the impacts of health-related and family-related motives increased and decreased with age, respectively. Notably, most SMRPs associated with major impactable motives (underachievement, conflict with a parent or classmate, and mental illnesses) had already begun increasing in the late 2010s, indicating that recent increasing SMRPs among school-aged individuals were associated with pandemic-related factors and other factors affecting this generation before the pandemic. It may be inappropriate to uniformly apply research findings based on school-aged individuals to school-based suicide prevention programs for students in middle school, high school, and university.
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