Spatial statistical analysis of regional disparities in suicide among policy units in Japan: Using the Bayesian hierarchical model

Abstract

Suicide prevention is a crucial policy issue in Japan to be addressed nationally. Nevertheless, if there are regional differences in suicide, even in adjacent sub-regions, measures may need to be taken at the sub-regional level. Previous studies have not compared regional differences in suicide based on the size of policy units, such as prefectures, secondary medical areas, and municipalities. This study used the number of suicides from open data for 10 years from 2009 to 2018 to obtain shrinkage estimates of the standardized mortality ratio (SMR) using the Bayesian hierarchical model. We visualized and compared the regional disparities in suicide for each policy unit. For each gender and policy unit, adjacent regions had similar clusters of SMRs and positive spatial autocorrelation of global Moran’s I (p < 0.001 for each). Comparisons between each policy unit showed that even if the SMR was low for the prefectural units, there were regions with high SMRs in municipalities and secondary medical areas, and vice versa. It was found that assessing suicide solely on a prefecture-by-prefecture basis may overlook regional disparities in suicide. This research emphasizes the need to establish suicide indicators at the secondary medical or municipal level and execute individual suicide prevention interventions in neighboring communities. Prefectures can also play a role in developing collaborative cooperation between neighboring regions by acting as actors.

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“…The suicide rate in Japan is by far the highest among the Group of Seven industrialized nations, and the leading causes have been reported to include anxiety and depression related to mental stress in the workplace 15 . Despite a modest decrease in the number of suicides after the enactment of the Basic Act on Suicide Prevention by the Japanese Government in 2006, the annual number of suicides remains high at 20,000 16 .…”

Regional disparities in suicide among patients with cancer: A nationwide population‐based study in Japan

“…Japan, characterized by high suicide rates among developed nations, 7 has responded to this issue by enacting the Basic Act for Suicide Prevention 8 . In the general Japanese population, the variability in suicide rates across prefectures has received substantial attention, and widespread research has revealed many suicide‐related factors 9–17 . In contrast, no nationwide research has examined such variations among patients with cancer in Japan.…”

“…Japanese population, the variability in suicide rates across prefectures has received substantial attention, and widespread research has revealed many suicide-related factors. [9][10][11][12][13][14][15][16][17] In contrast, no nationwide research has examined such variations among patients with cancer in Japan. The Fourth Basic Plan to Promote Cancer Control Programs, proposed by the Ministry of Health, Labour and Welfare of Japan, necessitates tailored measures considering the unique circumstances of each local community.…”