Ejihpe 13 00193 v3

Article
Trends in Suicidal Mortality and Motives among Working-Ages

Individuals in Japan during 2007–2022
Ryusuke Matsumoto 1 , Eishi Motomura 1 , Toshiaki Onitsuka 2 and Motohiro Okada 1, *
1 Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University,

Tsu 514-8507, Japan; matsumoto-r@clin.medic.mie-u.ac.jp (R.M.); motomura@clin.medic.mie-u.ac.jp (E.M.)
2 Department of Psychiatry, NHO Sakakibara National Hospital, Tsu 514-1292, Japan;
onitsuka.toshiaki.vc@mail.hosp.go.jp
* Correspondence: okadamot@clin.medic.mie-u.ac.jp; Tel.: +81-59-231-5018
Abstract: Suicides in Japan consistently decreased from 2009–2019, but increased during the COVID-
19 pandemic. To identify causes of increasing suicides, age-dependent and temporal fluctuations of
suicide mortality rate per 100,000 (SMRP) in working-age generations (20–59 years) disaggregated by
suicidal motives (7-categories; 52-subcategories) and sex from 2007 to2022, were analyzed by analysis
of variance and joinpoint regression, respectively, using the government suicide database “Suicide
Statistics”. The SMRP of 20–29 year-old males and 20–49 year-old females began to increase in the
late 2010s. SMRPs of these high-risk groups for suicides caused by depression (the leading suicidal
motive for all groups) began increasing in the late 2010s. Economic-related, employment-related,
and romance-related problems contributed to the increasing SMRPs in 20–29 males in the late 2010s.
Romance-related and family-related problems contributed to the increasing SMRPs of 20–29 females
in the late 2010s. Increasing SMRPs caused by child-raising stress in 20–39 year-old females from
the late 2010s was a remarkable finding. In contrast, SMRPs of 30–59 year-old males consistently
decreased until 2021; however, in these groups, SMRPs for suicides caused by various motives sharply
increased in 2022. The consistent increase in SMRPs of high-risk groups from the late 2010s to the
Citation: Matsumoto, R.; Motomura, pandemic suggest recent socioeconomic and psychosocial problems in Japan possibly contributed
E.; Onitsuka, T.; Okada, M. Trends in to the increasing SMRPs in these high-risk groups independently of pandemic-associated factors,
Suicidal Mortality and Motives whereas the SMRPs of males of 30–59 years were probably associated with the ending of the pandemic
among Working-Ages Individuals in rather than pandemic-associated factors.
Japan during 2007–2022. Eur. J.
Investig. Health Psychol. Educ. 2023, Keywords: suicide; COVID-19; Japan; working-age; child-raising
13, 2795–2810. https://doi.org/
10.3390/ejihpe13120193
Academic Editors: Lovorka Brajković,

Vanja Kopilaš and María del Mar 1. Introduction
Molero Jurado Following the asset bubble collapse (1991), Great Hanshin earthquake (1995), and
Asian economic crisis (1997), annual suicides in Japan drastically increased from 24,391
Received: 10 October 2023
Revised: 8 November 2023
(1997) to 32,863 (1998) [1–6]. Until 2009, the annual number of suicides exceeded 30,000 in
Accepted: 22 November 2023
Japan [7–9]. In this background, the Japanese government enacted the ‘Basic Act on Sui-
Published: 27 November 2023
cide Prevention’ (2006) and ‘General Policies for Comprehensive Measures against Suicide’
(2007) [1], and the Ministry of Health, Labor and Welfare (MHLW) started to contribute funds
to prefectures/municipalities to enhance regional suicide prevention programs in the form
of ‘Emergency Fund to Enhance Community-Based Suicide Countermeasure’ [1,6,10–14].
Copyright: © 2023 by the authors. Since 2009, annual suicides have consistently decreased to 20,169 (2019) [2–5,15]. How-
Licensee MDPI, Basel, Switzerland. ever, they increased after the COVID-19 pandemic outbreak [16–29]. In the initial stage of
This article is an open access article the pandemic (2020–2021), although annual male suicides continuously decreased from
distributed under the terms and
14,055 (2019) to 13,939 (2021), female suicides increased from 6091 (2019) to 7068 (2021).
conditions of the Creative Commons
Conversely, in 2022, the annual suicides of both males (14,746) and females (7135) in-
Attribution (CC BY) license (https://
creased [1,22,30]. Recently, various statistical analyses have reported that the younger
creativecommons.org/licenses/by/
generation (<30 years) [31] and females of 30–49 years were at risk for suicide during the
4.0/).
Eur. J. Investig. Health Psychol. Educ. 2023, 13, 2795–2810. https://doi.org/10.3390/ejihpe13120193 https://www.mdpi.com/journal/ejihpe
Eur. J. Investig. Health Psychol. Educ. 2023, 13 2796
pandemic [16–22]. These high-risk groups historically have relatively fewer suicide mortal-
ities in comparison to working-age males, and the associated psychosocial/socioeconomic
factors remain to be clarified [32–37].
Our recent analysis revealed fluctuations in the suicide mortality rate per 100,000
(SMRP) in the young generation showed at least three temporal patterns, the onset of
increasing suicide before the pandemic, synchronized with the pandemic outbreak (2020),
and in the late phase of the pandemic (2022) [18,20–23,38,39]. Therefore, although national-
level suicides in Japan increased approximately six months after the pandemic outbreak
(October 2020) [18,19,21], it cannot be definitively concluded that the pandemic is a primary
impactable factor associated with increasing suicide in high-risk groups [20,22,23]. Valid
analyses of the causality of these increases in high-risk groups could contribute to evidence-
based suicide prevention programs [20–22,40–42]. Therefore, to identify factors associated
with the recent increasing suicides in Japan, we analyzed a government suicide database to
determine the temporal fluctuations in the SMRPs of working-age generations caused by
suicidal motives disaggregated by age/sex in 2007–2022.
2. Materials and Methods

This cross-sectional study adhered to the Strengthening the Reporting of Observational
Studies in Epidemiology (STROBE) Reporting Guidelines. The Medical Ethics Review
Committee of Mie University waived the requirement for informed consent and ethical
approval because the government data are publicly available.
2.1. Database
Annual suicide numbers disaggregated by motive, sex (males and females), and age
(20–29, 30–39, 40–49, and 50–59 years) in Japan between 2007 and 2022 were obtained
from the ‘Suicide Statistics’ (SSNPA) database, which is collected by the National Po-
lice Agency [7,30,39,43]. The SSNPA provides annual suicide numbers disaggregated
by suicidal motives (seven categories: family-related, health-related, economic-related,
employment-related, romance-related, school-related, and other motives, with 52 subcate-
gories) (Supplementary Tables S1–S4) [1,7,11,30,39,43].
The police must investigate the personal characteristics and background factors of
each suicide case. Since it is impossible to collect suicide motives from the victims them-
selves, to eliminate subjectivity as much as possible, the police investigate suicide motives
based on evidence, suicide notes, official documentation (e.g., medical certificates and
clinical recordings) and testimony from the victim’s family [7,39,43,44]. The results of this
investigation discuss the different motives for suicide, and these motives are compared
to previously compiled lists of motives for suicide (52 subcategories in SSNPA). The ma-
jority of suicides have diverse causes, backgrounds and complications, and occur with
interactions among various factors. Therefore, the SSNPA is permitted to count multiple
probable causes/motives per a suicide. The SSNPA published the annual suicide numbers
disaggregated by 52 suicidal motives, sex (males and females) and age (20–29, 30–39, 40–49,
and 50–59 years old) during 2007–2022. Detailed explanations of the suicide motives have
been described in previous reports [11,39,43], and detailed lists of categories and standard
suicide rates per 100,000 population disaggregated by motive, sex, and age are described in
Supplementary Tables S1–S4.
The populations in Japan disaggregated by sex (males and females) and age (20–29,
30–39, 40–49, and 50–59 years old) during 2007–2022 were obtained from the “Surveys
of Population, Population Change and the Number of Households based on the Basic
Resident Registration” of the System of Social and Demographic Statistics generated by the
Statistics Bureau of the Ministry of Internal Affairs and Communications (SBMIAC) [45].
The average annual incomes of permanent and non-permanent employees, disaggregated
by age and sex, were obtained from the ‘Basic Survey on Wage Structure’ of the MHLW [46].
Employment rates of working-age males and females were obtained from the ‘White Paper
on Gender Equality 2023’ [47–49] published by the Cabinet Office. Annual employment
rates of males and females during 2007–2022 were obtained from the “White Paper on
Gender Equality 2023” published by the Cabinet Office [47–50].
2.2. Statistical Analysis

The suicide mortality rate per 100,000 (SMRP) was calculated by dividing the an-
nual suicide numbers of the target group by the annual populations of the same target
group in the same year. SSNPA released annual suicide numbers for which motives were
determined [20,22].
The trends, discontinuity, and their effect size of SMRPs and complete employment
rates (CURs) from 2007 to 2022 were analyzed by joinpoint regression analysis (JPRA)
using Joinpoint Regression Program v5.0.2 (National Cancer Institute, Bethesda, MD,
USA) [19,22,51–54]. JPRA fits the simplest joinpoint model that the trend data allows and
identifies significant points where trends change. This is a powerful statistical method
for detection of unknown joinpoints (transformed trends and discontinuities) [52]. A
comprehensive review of the statistics and underlying methodology applied in JPRA have
been explained in a review report [52]. The detailed description of the methods used in the
Joinpoint Regression Software is described in the user manual published by the National
Cancer Institute (NCI) [51]. In this background, the present study analyzed the fluctuations
in SMRP during the 2007–2022 using JPRA. A p value of <0.05 (two-tailed) was considered
to indicate statistical significance.
The differences in SMRPs from 2007 to 2022 were compared using two-way analysis
of variance (ANOVA) with Scheffe’s post-hoc-test by SPSS for Windows version 27 (IBM,
Armonk, NY, USA) [19,21]. When the F value was significant (p < 0.05), the F value
of ANOVA was analyzed using Scheffe’s post-hoc analysis [19,21]. A p value of <0.05
(two-tailed) was considered to indicate statistical significance.
3. Results
3.1. SMRPs Disaggregated by Se, Age and Suicidal Motives from 2007–2022
The SMRPs of all age groups consistently decreased in the early 2010s. Joinpoints of
female SMRPs (from decreasing to increasing) of 20–29, 30–39, 40–49, and 50–59 years were
detected in 2016, 2018, 2019, and 2020, respectively (Figure 1). In particular, the SMRP for
20–29 females displayed positive discontinuation synchronized with the COVID-19 out-
break. Accordingly, among females, 20–29 females showed the largest SMRP in 2020–2021.
Joinpoints of male SMRPs (from decreasing to non-statistically significant changes) for
30–39 and 40–49 years were detected in 2016 and 2018, respectively (Figure 1). These groups
displayed sharply (drastic but non-significant) increasing in 2022. Similarly, the SMRP of
50–59 males consistently decreased until 2021, but sharply increased in 2022 (Figure 1). The
joinpoint of SMRPs (from decreasing to increasing) of 20–29 males was detected in 2019
(Figure 1).
3.2. Age- and Sex-Dependent Impacts of Suicidal Motives

Among categorized motives, health-related problems were the leading suicidal motive
of all groups (Figure 2). Economic-related and family-related problems were the second
leading motives for males and females of 30–59 years, respectively, whereas romance-
related problems were the second leading motive for 20–29 females (Figure 2). SMRPs
caused by health-related motives at 20–29 years were almost equal in males and females,
whereas other SMRPs of males were larger than those of females (Figure 2). SMRPs caused
by family-, health- and economic-related motives increased in an age-dependent manner
in both sexes; however, SMRPs caused by romance-related motives decreased in an age-
dependent manner in both sexes (Figure 2). Female SMRPs caused by employment-related
motives also decreased in an age-dependent manner, whereas those of males did not change
(Figure 2).
COVID-19 outbreak. Accordingly, among females, 20–29 females showed the largest
SMRP in 2020–2021. Joinpoints of male SMRPs (from decreasing to non-statistically sig-
nificant changes) for 30–39 and 40–49 years were detected in 2016 and 2018, respectively
(Figure 1). These groups displayed sharply (drastic but non-significant) increasing in 2022.
Similarly,
Eur. J. Investig. Health Psychol. Educ. 2023, 13, x FORthe SMRP
PEER of 50–59 males consistently decreased until 2021, but sharply in-
REVIEW 4
creased in 2022 (Figure 1). The joinpoint of SMRPs (from decreasing to increasing) of 20–
29 males was detected in 2019 (Figure 1).
panels (A) and (B), abscissas indicate years. Red, blue, green, and black circles indicate the observed
annual SMRPs of 20–29, 30–39, 40–49, and 50–59, respectively. Solid and dotted lines indicate the
significant (p < 0.05) and non-statistically significant trends of SMRPs detected by joinpoint regres-
sion analysis (JPRA), respectively. In panel (C), a: p < 0.05 relative to same age range males, b: p <
0.05 statistically significant age-dependency, using two-way analysis of variance (ANOVA) with
Scheffe’s post-hoc test.
3.2. Age- and Sex-Dependent Impacts of Suicidal Motives

Among categorized motives, health-related problems were the leading suicidal mo-
tive of all groups (Figure 2). Economic-related and family-related problems were the sec-
ond
Figureleading motives
Figure1.1.Average
Averageand
for males and
and fluctuations
fluctuations of
females
of SMRPs
SMRPs ofof
of
30–59 years,
working-age
working-age
respectively,
generation
generation from
from
whereasTemporal
2007–2022.
2007–2022.
romance-
Temporal
related problems
fluctuations of SMRPswere in the second
working-age leading motive
generation of for
males 20–29
(A) and females
fluctuations of SMRPs in working-age generation of males (A) and females (B) and averagefemales (Figure
(B) and 2). SMRPs
average
of of
caused
SMRPs by health-related motives at 20–29 years were almost equal in males
SMRPs (C) from 2007 to 2022 in Japan. Ordinates indicate the SMRPs (per 100,000 population). In In
(C) from 2007 to 2022 in Japan. Ordinates indicate the SMRPs (per 100,000 and females,
population).
whereas
panels (A) other
and SMRPs of males
(B), abscissas were
indicate larger
years. Red,than
blue,those
green,of
andfemales (Figure
black circles 2). SMRPs
indicate caused
the observed
byannual
family-,SMRPshealth- and 30–39,
of 20–29, economic-related motives
40–49, and 50–59, increased
respectively. Solidinand
an dotted
age-dependent manner
lines indicate the
insignificant
both sexes; however, SMRPs caused by romance-related motives decreased
(p < 0.05) and non-statistically significant trends of SMRPs detected by joinpoint regressionin an age-
dependent manner
analysis (JPRA), in both In
respectively. sexes
panel(Figure
(C), a: p 2). Female
< 0.05 SMRPs
relative to samecaused
age rangebymales,
employment-re-
b: p < 0.05
lated motives
statistically also decreased
significant in an age-dependent
age-dependency, manner,
using two-way analysis whereas(ANOVA)
of variance those ofwith
males did not
Scheffe’s
change
post-hoc (Figure
test. 2).
SMRPscaused
Figure2.2.SMRPs
Figure causedbyby major
major 77 categorized
categorized motives
motivesofofmales
males(filled
(filledcolumns)
columns) and females
and females
(striped columns). Red, blue, green and black columns indicate the average
(striped columns). Red, blue, green and black columns indicate the average of SMRPs from of SMRPs from 2007 to
2007
2022 of
to2022 of 20–29,
20–29,30–39,
30–39,40–49,
40–49,andand50–59
50–59populations,
populations, respectively.
respectively.Ordinate
Ordinate indicates mean
indicates ± SD
mean of of
± SD
SMRPsfrom
SMRPs from2007
2007to
to2022. a: pp << 0.05
2022. a: 0.05 relative to
to males
malesofofsame
sameage
agegroup,
group, p <p 0.05
b: b: statistically
< 0.05 statistically
significant
significantage-dependency
age-dependencyin in males,
males, c: p << 0.05
0.05 statistically
statisticallysignificant
significantage-dependency
age-dependency in in females
females
detected
detectedby bytwo-way
two-wayANOVA
ANOVA with with Scheffe’s post-hoctest.
Scheffe’s post-hoc test.
Among subcategorised
Among subcategorised motives,
motives,depression
depressionwas was
the leading impact impact
the leading factor in factor
all groups.
in all
SMRP caused by depression was slightly higher in males, although depression
groups. SMRP caused by depression was slightly higher in males, although depression contributed
30% of the 30%
contributed total of
female SMRPs
the total (vs. SMRPs
female 15% in males)
(vs. 15%(Figure 3). Other
in males) mental
(Figure illnessmental
3). Other and
physical illness were the second leading motive for individuals of 20–29 and 50–59 years,
illness and physical illness were the second leading motive for individuals of 20–29 and
respectively, in both sexes (Figure 3). The impact of depression and physical illness in-
50–59 years, respectively, in both sexes (Figure 3). The impact of depression and physical
creased in an age-dependent manner. SMRPs for individuals of 20–29 and 30–39 years
illness increased in an age-dependent manner. SMRPs for individuals of 20–29 and 30–39
caused by depression and physical illness were almost equal in males and females, whereas
years
thesecaused
rates inby depression
40–59 andhigher
males were physical
thanillness were
those in almost
females equal
(Figure 3).inConversely,
males andSMRPs females,
whereas these rates in 40–59 males were higher than those in females (Figure
caused by other mental illnesses decreased in an age-dependent manner and were almost 3). Con-
versely,
equal inSMRPs caused
males and by other
females mental
of 20–29 yearsillnesses decreased in an age-dependent manner
(Figure 3).
and were almost equal in males and females of 20–29 years (Figure 3).
Eur. J. Investig. Health Psychol. Educ. 2023, 13, x FOR PEER REVIEW 5
Figure
Figure3.3.SMRPs
SMRPscaused
caused by
by subcategorized health-relatedmotives
subcategorized health-related motivesofofmales
males (filled
(filled columns)
columns) andand
females
females(striped
(stripedcolumns).
columns). Red,
Red, blue, green,and
blue, green, andblack
blackcolumns
columnsindicate
indicatethethe mean
mean ± SD
± SD of SMRPs
of SMRPs
from
from2007
2007toto2022
2022ofof 20–29,
20–29, 30–39, 40–49, and
30–39, 40–49, and50–59
50–59populations,
populations,respectively.
respectively. Ordinate
Ordinate indicates
indicates
mean
mean ± SD of SMRPs from 2007 to 2022. a: p < 0.05 relative to males of same age group, b: p <p0.05
± SD of SMRPs from 2007 to 2022. a: p < 0.05 relative to males of same age group, b: < 0.05
statistically significant age-dependency in males, c: p < 0.05 statistically significant age-dependency
in females detected by two-way ANOVA with Scheffe’s post-hoc test.
Among
Amongsubcategories
subcategories in
in family-related motives,marital
family-related motives, maritalconflict
conflict was
was anan impactable
impactable
motive,
motive,followed
followedbybychild-raising stress in
child-raising stress in20–49
20–49females
females(Figure
(Figure4).4).
TheThe SMRP
SMRP forfor marital
marital
conflict
conflictpeaked
peakedatat40–49
40–49 years
years in both
both sexes,
sexes,whereas
whereasthetheSMRP
SMRPforforchild-raising
child-raising stress
stress
peaked at 30–39 years in females (Figure
peaked at 30–39 years in females (Figure 4). 4).
Economic problems were impactable motives for males but were limited for females
(Figure 5). Among economic-related motives, economic hardship was the leading im-
pactable motive, followed by debt overload in males of 30–39 years. SMRPs caused by
these factors increased in an age-dependent manner. However, in 20–29 males, inability to
find employment was the leading motive, followed by overload with debt and economic
hardship (Figure 5). SMRPs caused by the inability to find employment decreased in an
age-dependent manner in both sexes (Figure 5).
3.3. Fluctuations in SMRPs Caused by Health-Related Motives

The joinpoint of SMRPs caused by health-related motives in females of 30–59 years
was detected in 2019, whereas it was observed at 20–29 years before the pandemic. The
joinpoints of male SMRPs of 30–59 years caused by health-related motives were also
observed after the pandemic outbreak, but that of 20–29 years males was in 2019 (Figure 6).
The joinpoints of SMRPs caused by depression in 30–59 years males were observed after
the pandemic outbreak, whereas they were observed at 20–29 years in males and females
in 2019 and 2016, respectively (Figure 6). SMRPs caused by health-related motives and
depression in females of 20–29 years were the lowest until the early 2010s, but were larger
than those in 30–39 year-old females during the pandemic. In the late 2010s, SMRPs caused
by other mental illness increased at 20–29 and 50–59 years, but indicated no significant
change at 30–49 years (Figure 6). During the pandemic, SMRPs caused by other mental
illnesses increased sharply in all groups (Figure 6).
3.4. Fluctuations in SMRPs Caused by Family-Related Motive

Male SMRPs caused by family-related subcategories sharply increased after the pan-
demic outbreak, whereas exceptionally, suicide caused by conflict with parent/child in
males of 20–29 years began increasing in 2017 (Figure 7). In contrast, female SMRPs caused
by family-related motives began increasing before the pandemic. In particular, SMRPs
caused by child-raising stress in females of 20–29 and 30–39 years began increasing in
Figure 4. SMRPs caused by subcategorized family-related motives of males (filled columns) and
2015 and
females 2018,columns).
(striped respectively,
Red, whereas females
blue, green, of 40–59
and black yearsindicate
columns showed thea mean
sharp±increase in
SD of SMRPs
from 2007 to 2022 of 20–29, 30–39, 40–49, and 50–59 populations, respectively. Ordinates indicate
mean ± SD of SMRPs from 2007 to 2022. a: p < 0.05 relative to males of same age group, b: p < 0.05
Figure 3. SMRPs caused by subcategorized health-related motives of males (filled columns) and
females (striped columns). Red, blue, green, and black columns indicate the mean ± SD of SMRPs
from 2007 to 2022 of 20–29, 30–39, 40–49, and 50–59 populations, respectively. Ordinate indicates
Eur. J. Investig. Health Psychol. Educ.mean ± SD of SMRPs from 2007 to 2022. a: p < 0.05 relative to males of same age group, b: p2800
2023, 13 < 0.05
2022 (Figure 7). SMRPs caused by marital conflict in females of 20–39 years also began
Amongbefore
increasing subcategories in family-related
the pandemic, whereas femalesmotives, marital
of 40–59 showedconflict
a sharpwas an impactable
increase during
motive,
the pandemic (Figure 7). SMRPs caused by conflict with parent/child began for
followed by child-raising stress in 20–49 females (Figure 4). The SMRP marital
increas-
conflict peaked at 40–49 years in both sexes, whereas the SMRP for child-raising
ing in 20–29 year-old males in 2017. In contrast, females showed positive discontinuity stress
peaked at 30–39
synchronized years
with thein females (Figure
pandemic outbreak4).(Figure 7).
Figure
Figure4.4.SMRPs
SMRPscaused
caused by
by subcategorized family-relatedmotives
subcategorized family-related motivesofofmales
males (filled
(filled columns)
columns) andand
females (striped columns). Red, blue, green, and black columns indicate the mean ±
females (striped columns). Red, blue, green, and black columns indicate the mean ± SD of SMRPsSD of SMRPs
from
from2007
2007toto2022
2022 of
of 20–29, 30–39, 40–49,
20–29, 30–39, 40–49,and
and50–59
50–59populations,
populations,respectively.
respectively. Ordinates
Ordinates indicate
indicate
mean
mean ± SD of SMRPs from 2007 to 2022. a: p < 0.05 relative to males of same age group, b: p <p0.05
± SD of SMRPs from 2007 to 2022. a: p < 0.05 relative to males of same age group, b: < 0.05
in females detected by two-way ANOVA with Scheffe’s post-hoc test. Panel (A) indicates the SMRPs
caused by conflict with parent/child, maternal conflict, conflict with other family members, death of
family and hopeless for family. Panel (B) indicates SMRPs caused by severe verbal reprimand, stress
of raising children, physical and/or verbal abuse and exhaustion from caring for infirm family.
3.5. Fluctuations in SMRPs Caused by Economy-Related Motive

In males of 20–29 years, SMRPs caused by economic-related motives began increasing
in 2018, whereas males of 30–59 years showed a sharp increase in 2022. SMRPs caused
by economic hardship consistently decreased in all male groups before the pandemic, but
increased with the pandemic (Figure 8). In particular, SMRPs caused by inability to find
employment and overload with debt in 20–39 year-old males began to increase before the
pandemic (Figure 8). In females, SMRPs caused by economic-related motives began increas-
ing before the pandemic in all age groups (Figure 8). SMRPs caused by economic hardship
began increasing before the pandemic in 20–49 year-old females (Figure 8). However, the
annual incomes of permanent and non-permanent workers were almost equal between
2007 and 2021 (Figure 9).
Economic problems were impactable motives for males but were limited for females
(Figure 5). Among economic-related motives, economic hardship was the leading im-
pactable motive, followed by debt overload in males of 30–39 years. SMRPs caused by
these factors increased in an age-dependent manner. However, in 20–29 males, inability
to find employment was the leading motive, followed by overload with debt and eco-
nomic hardship (Figure 5). SMRPs caused by the inability to find employment decreased
in an age-dependent manner in both sexes (Figure 5).
Figure
Figure5.5.SMRPs
SMRPs caused
caused byby
subcategorized
subcategorizedeconomy-related
economy-relatedmotives
motivesofofmales
males(filled
(filledcolumns)
columns)and
females (striped
and females columns).
(striped Red, blue,
columns). green,green,
Red, blue, and black columns
and black indicate
columns the mean
indicate the mean± SD±ofSD SMRPs
of
from 2007 to 2022 of 20–29, 30–39, 40–49, and 50–59 populations, respectively.
SMRPs from 2007 to 2022 of 20–29, 30–39, 40–49, and 50–59 populations, respectively. OrdinatesOrdinates indicate
mean ± SD
indicate of SMRPs
mean ± SD of from 2007from
SMRPs to2022.
2007a:to2022.
p < 0.05a:relative
p < 0.05torelative
males toof males
same ofagesame
group,
ageb: p < 0.05
group,
b: p < 0.05 statistically significant age-dependency in males, c: p < 0.05 statistically significant age-
independency
females detected by two-way
in females ANOVA
detected by with
two-way Scheffe’s
ANOVA withpost-hoc
Scheffe’stest. Paneltest.
post-hoc (A)Panel
indicates the SMRPs
(A) indicates
caused by bankruptcy, business struggling, unemployment, inability to find employment
the SMRPs caused by bankruptcy, business struggling, unemployment, inability to find employment
and eco-
nomic hardship. Panel (B) indicates SMRPs caused by overloaded with debt, assumption of exces-
and economic hardship. Panel (B) indicates SMRPs caused by overloaded with debt, assumption of
sive debt, debt (other), harassment by debt-collectors and suicide for death benefit.
excessive debt, debt (other), harassment by debt-collectors and suicide for death benefit.
3.3.
3.6.Fluctuations
Fluctuationsin
in SMRPs
SMRPs Caused by Employment-Related
Caused by Health-Related Motives
and Romance-Related Motives
SMRPs
The caused
joinpoint of by employment-related
SMRPs motives inmotives
caused by health-related individuals of 20–29
in females years be-
of 30–59 years
gandetected
was increasing in before the pandemic
2019, whereas it wasinobserved
both sexesat(males/females: 2018/2016),
20–29 years before whereasThe
the pandemic.
30–59 males
joinpoints showed
of male an increase
SMRPs in 2022
of 30–59 years(Figure
caused10). Employment rates
by health-related of working-age
motives were also ob-
served after the pandemic outbreak, but that of 20–29 years males was in2022,
males increased between 2007–2019, but did not change between 2019 and 2019whereas
(Figure 6).
those
The of females
joinpoints of consistently
SMRPs causedincreased betweenin
by depression 2007 andyears
30–59 2022,males
resulting in observed
were these being
after
almost equal during the pandemic (Figure 11). Romance-related motives decreased in an
the pandemic outbreak, whereas they were observed at 20–29 years in males and females
age-dependent manner in the seven major suicidal motives (heartbreak was the leading
in 2019 and 2016, respectively (Figure 6). SMRPs caused by health-related motives and
motive). In 20–29 year-old males, SMRPs caused by romance-related motive began increas-
ing in 2020, whereas a consistent decrease was observed in males of 30–59 years (Figure 10).
In contrast, SMRPs caused by heartbreak began increasing in 20–39 year-old females in
2017 (Figure 10).
depression in females of 20–29 years were the lowest until the early 2010s, but were larger
than those in 30–39 year-old females during the pandemic. In the late 2010s, SMRPs
caused by other mental illness increased at 20–29 and 50–59 years, but indicated no sig-
Eur. J. Investig. Health Psychol. Educ.nificant
2023, 13 change at 30–49 years (Figure 6). During the pandemic, SMRPs caused by2802 other
mental illnesses increased sharply in all groups (Figure 6).
Fluctuations of
Figure6.6.Fluctuations
Figure of SMRP caused
causedby byhealth-related
health-relatedmotives
motives from
from2007–2022.
2007–2022. Fluctuations of of
Fluctuations
SMRPs
SMRPscaused
causedby by health-related motive (A),
health-related motive (A),physical
physicalillness
illness(B),
(B),depression
depression (C)(C)
andand other
other mental
mental
illness
illness(D)
(D) of working-age
working-agemales
males and
and females.
females. Red,Red,
blue,blue, green,
green, and circles
and black black indicate
circles indicate the ob-
the observed
served annual SMRPs of 20–29, 30–39, 40–49, and 50–59 populations, respectively.
annual SMRPs of 20–29, 30–39, 40–49, and 50–59 populations, respectively. Solid and dotted linesSolid and dotted
lines indicate the significant (p < 0.05) and non-statistically significant trends of SMRPs
indicate the significant (p < 0.05) and non-statistically significant trends of SMRPs between 2007–2022 between
Eur. J. Investig. Health Psychol. Educ.2007–2022
2023, 13, x FOR
detected by PEER REVIEW
detected
JPRA, by JPRA, respectively.
Ordinates indicate the indicate
SMRP (per the100,000
SMRP population).
(per 100,000 Abscissas 8
population).
Abscissas indicate
indicate years. years.
3.4. Fluctuations in SMRPs Caused by Family-Related Motive

Male SMRPs caused by family-related subcategories sharply increased after the
pandemic outbreak, whereas exceptionally, suicide caused by conflict with parent/child
in males of 20–29 years began increasing in 2017 (Figure 7). In contrast, female SMRPs
caused by family-related motives began increasing before the pandemic. In particular,
SMRPs caused by child-raising stress in females of 20–29 and 30–39 years began increasing
in 2015 and 2018, respectively, whereas females of 40–59 years showed a sharp increase in
2022 (Figure 7). SMRPs caused by marital conflict in females of 20–39 years also began
increasing before the pandemic, whereas females of 40–59 showed a sharp increase during
the pandemic (Figure 7). SMRPs caused by conflict with parent/child began increasing in
20–29 year-old males in 2017. In contrast, females showed positive discontinuity
synchronized with the pandemic outbreak (Figure 7).
Figure
Figure 7.7. Fluctuations
Fluctuationsof ofSMRP
SMRPcaused
causedbybyfamily-related
family-related motives
motives between
between 2007–2022.
2007–2022. Fluctuations
Fluctuationsof
of SMRPs
SMRPs caused
caused by by family-related
family-related motive
motive (A),(A), marital
marital conflict
conflict (B),(B), child-raising
child-raising stress
stress (C) (C)
andand con-
conflict
flict with
with parent/child
parent/child (D) of(D) of working-age
working-age males males and females.
and females. Red,green,
Red, blue, blue,and
green,
blackand blackindicate
circles circles
indicate the observed annual SMRPs of 20–29, 30–39, 40–49, and 50–59 populations,
the observed annual SMRPs of 20–29, 30–39, 40–49, and 50–59 populations, respectively. Solid and respectively.
Solid and
dotted linesdotted lines
indicate theindicate the (p
significant significant
< 0.05) and(p non-statistically
< 0.05) and non-statistically significant
significant trends of SMRPstrends
fromof
SMRPs from 2007 to 2022 detected by JPRA, respectively. Ordinates indicate the SMRP (per 100,000
2007 to 2022 detected by JPRA, respectively. Ordinates indicate the SMRP (per 100,000 population).
population). Abscissas indicate years.
Abscissas indicate years.
3.5. Fluctuations in SMRPs Caused by Economy-Related Motive

In males of 20–29 years, SMRPs caused by economic-related motives began
increasing in 2018, whereas males of 30–59 years showed a sharp increase in 2022. SMRPs
caused by economic hardship consistently decreased in all male groups before the
pandemic, but increased with the pandemic (Figure 8). In particular, SMRPs caused by
inability to find employment and overload with debt in 20–39 year-old males began to
increase before the pandemic (Figure 8). In females, SMRPs caused by economic-related
motives began increasing before the pandemic in all age groups (Figure 8). SMRPs caused
by economic hardship began increasing before the pandemic in 20–49 year-old females
inability to find employment and overload with debt in 20–39 year-old males began to
increase before the pandemic (Figure 8). In females, SMRPs caused by economic-related
motives began increasing before the pandemic in all age groups (Figure 8). SMRPs caused
by economic hardship began increasing before the pandemic in 20–49 year-old females
Eur. J. Investig. Health Psychol.8).
(Figure Educ. 2023, 13 the annual incomes of permanent and non-permanent workers were
However, 2803
almost equal between 2007 and 2021 (Figure 9).
Eur. J. Investig. Health Psychol. Educ. 2023, 13, x8.FOR

Figure PEER REVIEW
Fluctuations 9
of SMRP caused by economic-related motives from 2007–2022. Fluctuations of
Figure 8. Fluctuations of SMRP caused by economic-related motives from 2007–2022. Fluctuations
of SMRPs caused SMRPs caused by economic-related
by economic-related motive (A),
motive (A), economic economic
hardship (B),hardship (B), with
overloaded overloaded with debt (C)
debt (C)
and employment
and inability to find inability to find
(D)employment
of working-age (D) males
of working-age males
and females. Red,and females.
blue, green, Red, blue, green, and
and black
black circles
circles indicate
indicate the observed
the observed annual annual
SMRPsSMRPs of 30–39,
of 20–29, 20–29,40–49,
30–39,and
40–49, andpopulations,
50–59 50–59 populations,
respec-
respectively.
tively. Solid
Solid and and dotted
dotted lines indicate
lines indicate the significant
the significant (p and
(p < 0.05) < 0.05) and non-statistically
non-statistically significant
significant trends
of SMRPs
trends from 2007
of SMRPs from to
20072022 detected
to 2022 by JPRA,
detected respectively.
by JPRA, Ordinates
respectively. Ordinatesindicate
indicatethe
theSMRP
SMRP (per
(per
100,000 population). Abscissas
Abscissas indicate
indicate years.
years.
Figure 9. Comparison of annual incomes of males (A) and females (B) between 2007 and 2021. Aver-
Figure 9. Comparison of annual incomes of males (A) and females (B) between 2007 and 2021. Av-
age ofof
erage annual
annualincomes
incomesin in
2007 (black)
2007 andand
(black) 2021 (blue).
2021 Ordinates
(blue). indicate
Ordinates the incomes
indicate (x 10,000
the incomes JPY).
(x 10,000
Panels
JPY). (A) and
Panels (A)(B)
andindicate malesmales
(B) indicate and females, respectively.
and females, respectively.
3.6. Fluctuations in SMRPs Caused by Employment-Related and Romance-Related Motives

SMRPs caused by employment-related motives in individuals of 20–29 years began in-
creasing before the pandemic in both sexes (males/females: 2018/2016), whereas 30–59 males
showed an increase in 2022 (Figure 10). Employment rates of working-age males increased
between 2007–2019, but did not change between 2019 and 2022, whereas those of females
consistently increased between 2007 and 2022, resulting in these being almost equal during
the pandemic (Figure 11). Romance-related motives decreased in an age-dependent manner
in the seven major suicidal motives (heartbreak was the leading motive). In 20–29 year-old
males, SMRPs caused by romance-related motive began increasing in 2020, whereas a con-
sistent decrease was observed in males of 30–59 years (Figure 10). In contrast, SMRPs caused
by heartbreak began increasing in 20–39 year-old females in 2017 (Figure 10).
between 2007–2019, but did not change between 2019 and 2022, whereas those of females
consistently increased between 2007 and 2022, resulting in these being almost equal during
the pandemic (Figure 11). Romance-related motives decreased in an age-dependent manner
in the seven major suicidal motives (heartbreak was the leading motive). In 20–29 year-old
males, SMRPs caused by romance-related motive began increasing in 2020, whereas a con-
sistent decrease was observed in males of 30–59 years (Figure 10). In contrast, SMRPs caused
by heartbreak began increasing in 20–39 year-old females in 2017 (Figure 10).
Figure 10.
Figure 10. Fluctuations of SMRP caused by employment-related
employment-related and romance-related
romance-related motives
motives from
from
2007–2022. Fluctuations of SMRPs caused by employment-related motive (A) and romance-related
2007–2022. Fluctuations of SMRPs caused by employment-related motive (A) and romance-related (B)
(B) motive
motive of working-age
of working-age malesmales and females.
and females. Red, Red,
blue, blue,
green,green, and black
and black circlescircles
indicateindicate the ob-
the observed
served annual SMRPs of 20–29, 30–39, 40–49, and 50–59 populations, respectively. Solid and dotted
annual SMRPs of 20–29, 30–39, 40–49, and 50–59 populations, respectively. Solid and dotted lines
lines indicate the significant (p < 0.05) and non-statistically significant trends of SMRPs from 2007 to
indicate the significant (p < 0.05) and non-statistically significant trends of SMRPs from 2007 to 2022
202213,detected
Eur. J. Investig. Health Psychol. Educ. 2023, by joinpoint
x FOR PEER REVIEW regression analysis (JPRA), respectively. Ordinates indicate the SMRP 10
detected by joinpoint
(per 100,000 regression
population). Abscissasanalysis (JPRA),
indicate years. respectively. Ordinates indicate the SMRP (per
100,000 population). Abscissas indicate years.
Figure
Figure 11.
11. Fluctuations
Fluctuations of of employment
employment rates
rates for
for males
males and
and females
females from
from 2007 to 2022. RedRed and
and blue
blue
circles
circles indicate
indicate the
the observed
observed annual
annual employment
employment raterate of
of females
females and
and males,
males, respectively.
respectively. Solid
Solid and
and
dotted
dotted lines
lines indicate
indicate the
the significant
significant (p
(p <<0.05)
0.05)and
andnon-statistically
non-statistically significant
significant trends
trends of
of employment
employment
rates
rates from 2007 to
from 2007 to 2022
2022detected
detectedbybyjoinpoint
joinpointregression
regression analysis,
analysis, respectively.
Ordinates indicate
indicate the
the employment rate (%). Abscissas indicate years.
employment rate (%). Abscissas indicate years.
4.
4. Discussion
Discussion
This
This study
study identified
identified several
several contributing
contributing suicidal
suicidal motives
motives for for increasing
increasing suicides
suicides in in
high-risk
high-risk groups
groups(males
(malesofof20–2920–29years
yearsand
andfemales
females ofof20–49
20–49 years)
years)during
during thethe
COVID-19
COVID-
pandemic
19 pandemic in Japan.
in Japan.First,First,
SMRPs of high-risk
SMRPs groups
of high-risk beganbegan
groups increasing in the late
increasing 2010s,
in the late
2010s, whereas
whereas SMRPs SMRPs
of malesofofmales30–59ofyears
30–59didyears did not increase
not increase until the until
earlythe
stageearly stage
of the pan- of
the pandemic,
demic, but sharply
but sharply (non-significantly
(non-significantly but drastically)
but drastically) increased increased
in 2022.inIncreasing
2022. Increasing
trends
trends
of SMRPs of SMRPs were pronounced
were pronounced at 20–29atyears
20–29inyears in both
both sexes in sexes in comparison
comparison to other to other
ages, in
ages, in the early stage of the pandemic (from 2020–2021), females
the early stage of the pandemic (from 2020–2021), females showed their highest SMRP at showed their highest
SMRPyears,
20–29 at 20–29 years,
while the while
SMRPthe SMRP of
of males of 20–29
malesyears
of 20–29
wasyears
almost was almost
equal equal
to that of to that of
males of
males years.
30–49 of 30–49 years.the
Second, Second,
leadingthemotive
leadingofmotive of allwas
all groups groups was internalization
internalization symp-
symptoms/dis-
toms/disorders
orders (mainly depression).
(mainly depression). SMRPs causedSMRPsby caused by depression
depression in malesinofmales
20–29ofyears
20–29andyears
all
and all groups
female female groups began increasing
began increasing in the
in the late late 2010s.
2010s. The SMRPThe SMRP caused caused by depression
by depression was
was slightly
slightly higherhigher in males,
in males, but SMRPs
but SMRPs caused caused by depression
by depression contributed
contributed 30% of 30%
theoftotal
the
total female SMRPs and 15% of total male SMRPs. Third, the
female SMRPs and 15% of total male SMRPs. Third, the second leading suicidal motive of second leading suicidal
motive of
females wasfemales was family-related
family-related motives, whichmotives,
beganwhich began toinincrease
to increase the late in the late
2010s. 2010s.
Notably,
Notably, among family-related motives, child-raising stress was an
among family-related motives, child-raising stress was an impactable motive for females impactable motive for
females
of 20–49 of 20–49
years, and years, and theofSMRPs
the SMRPs of 20–39caused
20–39 females females bycaused by child-raising
child-raising stress began stress
in-
began increasing in the late 2010s. Fourth, in individuals of 20–29
creasing in the late 2010s. Fourth, in individuals of 20–29 years economic- and romance- years economic- and
related problems were the second leading motives in males and females, respectively.
They also began increasing before the pandemic outbreak. These results suggest the pos-
sibility that recent (from before the pandemic outbreak) socioeconomic/psychosocial
problems in Japan may play important roles in increasing SMRPs in males of 20–29 years
romance-related problems were the second leading motives in males and females, respec-
tively. They also began increasing before the pandemic outbreak. These results suggest the
possibility that recent (from before the pandemic outbreak) socioeconomic/psychosocial
problems in Japan may play important roles in increasing SMRPs in males of 20–29 years
and females of 20–49 years (high-risk groups during the pandemic), whereas, exception-
ally, SMRP of 20–29 years females might be increased by pre-pandemic factors added to
pandemic-associated factors during the pandemic. In contrast, the SMRPs of males of
30–59 years were probably affected by factors associated with the ending of the pandemic
rather than pandemic-associated factors.
Regarding the increasing SMRPs of females of 20–49 years, work–life balance possibly
plays important roles in increasing suicide in these groups. The shared suicidal motives
for associated with the increase in SMRPs in females of 20–39 years before the pandemic
were depression, child-raising stress, and employment-related motives. In other words, the
situation in which role models for housework, child-raising, and social advancement for
females have not been established in Japanese society might manifest itself as increasing
suicides among at-risk individuals in the child-raising generation. The Japanese gender
gap index did not improve from 0.645 (2006) to 0.684 (2023) [47,55]; however, the employ-
ment rate of females in the child-raising generation (25–44 years) increased from 65% in
2007 to approximately 80% in 2022, which was almost equal to the rate of working-age
males (85%). Improving gender inequality is considered to be achieved by establishing
a societally valued “traditionally masculine” roles and liberating them from societally
devalued “traditional feminine” roles such as “housework” [56–60]. However, in Japan, it
is well known supporting social capital for child-raising has been vulnerable for mothers
who wish to prioritize parenting or aspire to balance child-raising and employment in
Japan [57,61,62]. Therefore, when parents engage in work that is incompatible with child-
care, alternate arrangements for care of their children must be made, leading to increased
stress among mothers [63,64]. Additionally, some mothers are unwilling to leave childcare,
since childcare represents an investment in the future, and relationships with children
are irreplaceable and lifelong [56,65]. Based on the relevant literature, females in Japan
participate in the workforce, but from the perspective of work–life balance, they place much
higher priority on childcare than employment. Indeed, although the employment rates
of males and females were almost equal, the impacts of employment-related motives on
females SMRPs were limited compared to those of males.
Internalising symptoms/disorders were reported as major causes of increasing student
suicides in the late 2010, in Japan [23,66]. Internalising symptoms/disorders are established
suicidal risks for adolescents and young generations [23,33,67–69], and their prevalence has
been increasing in Japan [23,66]. Therefore, the recent increase in suicides among the young
generation involves similar causalities to the increase among adolescents worldwide [33].
Increases in SMRPs caused by other mental illnesses could not be detected in males of
30–49 years or females. Considering the age of onset of internalising disorders was approxi-
mately 15 years [70–72], this discrepancy between 30–49 years and <30 years suggested that
increasing suicides caused by internalising symptoms/disorders in the younger generation
may have emerged in the last decade. The increasing SMRPs of females of 20–29 years
caused by romance-related and employment-related motives can be interpreted as impair-
ments of inter-relationships via diminished self-concept in internalising symptoms [73].
This assumption may also apply to the increase in SMRPs of males of 20–29 years. Internal-
ising symptoms/disorders and socioeconomic/psychosocial impairments are known to
enhance each other [74–76]. Although the employment rate and incomes did not decrease
at 20–29 years, the increasing SMRPs of males of 20–29 years caused by inability to find em-
ployment, economic hardship, overload with debt, and heartbreak were also explained by
internalized feelings of personal responsibility for socioeconomic/psychosocial failure [77].
The sharp increase in SMRPs in 2022 requires further consideration. Several studies
comparing mental issues before and after the lockdown to explore the long-term conse-
quences of the pandemic reported interesting and comparable findings [78–80]. The mental
issue was larger during the initial stages of the lockdown but tended to decrease with
adaptation [78,79]. However, higher-level mental issue were recorded when transitioning
to the post-lockdown stage, where individuals were required to integrate the return to a
pre-pandemic lifestyle with newly acquired needs (e.g., “new normal”) [80–82]. Thus, a
part of individuals might suffer from large stress due to transforming their lifestyles among
periods, pre-pandemic, restriction during the pandemic and transitioning to new normal
after the pandemic.
This study has several limitations. As it is impossible to directly collect suicide motives
from victims, the suicide numbers disaggregated by suicidal motives in the SSNPA may
be incorrectly estimated due to a potential bias. However, to eliminate subjectivity as
much as possible, the judicial police investigate suicide motives based on various pieces
of evidence, suicide notes, official documentation (e.g., medical certificates and clinical
recordings), and testimony from the victim’s family. Although motive-unidentified suicides
were homogeneous among sex/age groups, when the actual motives in motive-unidentified
suicides are biased toward specific motives, the results of the analysis may be overestimated
or underestimated. Despite these limitations, the SSNPA is considered the most reliable
governmental suicide database in Japan, since data were collected by the NPA using
consistent investigation methods from 2007 to 2022.
5. Conclusions
This study revealed the age/sex-dependent impacts of suicidal motives on SMRP
fluctuations of the working-age generation in Japan from 2007 to 2022. Mental health prob-
lems were the leading motives with an age-dependent increase in their impact on SMRPs.
Economic-related, employment-related, and romance-related problems contributed to the
increasing SMRPs of males of 20–29 years in the late 2010s. Romance- and family-related
problems contributed to the increasing SMRPs of females of 20–29 in the late 2010s. In
particular, despite decreasing birthrates, the increasing SMRPs of females of 20–39 years
caused by child-raising stress also continuously increased from the late 2010s. The dis-
crepancy between SMRPs of high-risk groups and males of 30–59 years suggests recent
socioeconomic/psychosocial problems contribute to increasing SMRPs in these groups
independently of pandemic-associated factors, but the SMRPs of males of 30–59 years
were probably affected by factors associated with the ending of the pandemic rather than
pandemic-associated factors.
Supplementary Materials: The following supporting information can be downloaded at:

https://www.mdpi.com/article/10.3390/ejihpe13120193/s1, Supplementary Table S1: SMRPs of
20–29 years disaggregated by motives and sex during 2007–2022; Supplementary Table S2: SMRPs of
50–59 years disaggregated by motives and sex during 2007–2022.
Author Contributions: M.O. conceptualized the study, contributed to the study design and method-
ology, drafted and re-viewed the manuscript. R.M. contributed to the study design and methodology,
verified the underlying data, performed the statistical analysis and generated figures, drafted and
reviewed the manuscript. E.M. contributed to the study design and methodology, coordinated
extraction of the data. T.O. contributed to the study design, drafted and re-viewed the manuscript.
All authors have read and agreed to the published version of the manuscript.
Funding: This study is supported by Japan Society for the Promotion of Science (23K06987) and
Regional Suicide Countermeasures Emergency Enhancement Fund of Mie Prefecture (2023-40).
Institutional Review Board Statement: The Medical Ethics Review Committee of Mie University
waived the need for ethical approval due to the use of publicly available governmental data.
Informed Consent Statement: Participants consent was waived due to the use of publicly available
governmental data.
Data Availability Statement: All raw data are publicly available to any persons via Japanese national
databases from national databases of the ‘Suicide Statistics’ (SSNPA) collected by the National Police
Agency, the ‘Regional Statistics Database’ of Statistics Bureau of the Ministry of Internal Affairs and
Communications (SBMIAC), the ‘Basic Survey on Wage Structure’ of MHLW and the ‘White Paper
on Gender Equality 20230 of Gender Equality Bureau in Cabinet Office.
Conflicts of Interest: The authors declare the research was conducted in the absence of any com-
mercial or financial re-lationships that could be construed as a potential conflict of interest. The
funder had no role in the design and conduct of the study; collection, management, analysis, and
interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit
the manuscript for publication. The authors declare no conflict of interest.
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Article

Trends in Suicidal Mortality and Motives among Working-Ages

1 Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University,

Academic Editors: Lovorka Brajković,

2. Materials and Methods

2.2. Statistical Analysis

3.2. Age- and Sex-Dependent Impacts of Suicidal Motives

3.2. Age- and Sex-Dependent Impacts of Suicidal Motives

3.3. Fluctuations in SMRPs Caused by Health-Related Motives

3.4. Fluctuations in SMRPs Caused by Family-Related Motive

3.5. Fluctuations in SMRPs Caused by Economy-Related Motive

3.4. Fluctuations in SMRPs Caused by Family-Related Motive

3.5. Fluctuations in SMRPs Caused by Economy-Related Motive

almost equal between 2007 and 2021 (Figure 9).

Eur. J. Investig. Health Psychol. Educ. 2023, 13, x8.FOR

3.6. Fluctuations in SMRPs Caused by Employment-Related and Romance-Related Motives

Supplementary Materials: The following supporting information can be downloaded at:

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