小髙 真美

わが国において、女性の年間自殺者数は男性の約半数である。しかし、日本の女性の自殺死亡率は、OECD加盟国の中で第3位である。特に新型コロナウイルス感染症感染拡大下の2020年は、女性の年間自殺者数が前年から15%ほど増加し、世界的にも注目を集めた。これまでの日本の自殺対策は、中高年男性や若年者に焦点を当てられてきた印象があるが、女性の自殺対策にもなお一層注力すべきである。本論では、これまでに明らかにされている女性の自殺に関する国内外の研究知見を整理し、今後の研究等の課題について検討する。(著者抄録)

【目的】自殺予防のためのゲートキーパー(GK)に最小限必要な知識とスキルを評価する簡便な指標を開発することとした。【方法】内閣府の『ゲートキーパー養成研修用テキスト』からデルファイ法を用いて抽出した、GKに求められる知識とスキルの習得度を評価する尺度を作成した。次にGK研修受講者に研修前後と一週間後に質問紙調査を実施した。質問紙は本研究で開発した尺度(GK知識・GKスキル)、『日本版自殺の知識尺度』『自殺予防におけるゲートキーパー自己効力感尺度(GKSES)』等で構成した。【結果】研修受講者109名から回答を得た。GKスキル得点とGKSES得点に有意な中程度の正の相関が認められた。研修後は研修前よりもGK知識・スキル得点の平均値が有意に高かった。GK知識・GKスキルの各合計得点と研修1週間後の各合計得点には有意な強い正の級内相関が認められた。【考察】本研究で開発した尺度の信頼性と妥当性が確認され、『自殺予防ゲートキーパー知識・スキル評価尺度(GKS)』と命名した。(著者抄録)

ソーシャルワーカーは、あらゆる実践領域で自殺ハイリスク者と関わる可能性が高い。ゆえに自殺ハイリスク者支援に備えるための教育は、ソーシャルワーカー養成課程の段階から積極的に導入すべきである。本研究では、そのための教育プログラムとして、『ソーシャルワーカーにできる自殺予防』を開発し、その実施可能性と効果の予備的検討を行った。その結果、同プログラムには、一定程度の実施可能性があることが示唆された。今後はプログラムの更なる効果検討に加え、プログラムの普及に向けた、プログラム教授法の提案や実施マニュアルの開発等についても検討する必要がある。(著者抄録)

This case-control psychological autopsy study explored suicide risk factors among Japanese individuals. We targeted 102 suicide completers over 20 years of age and 334 living controls matched to suicide cases by gender, age, and residential municipality in Japan. After controlling for other factors, we found significant associations between suicide and mental disorders, sleeping problems, and verbal communication of one's own death. We discuss the importance of sensitive responses to verbal expressions of suicidal ideation.

AimAlthough the female suicide rate in Japan is one of the highest among OECD countries, little has been done to assess the psychosocial and psychiatric characteristics of Japanese female suicide completers. This study aimed to examine sex differences in psychosocial and psychiatric characteristics of suicide completers using a psychological autopsy study method, and to identify female suicide factors and intervention points to prevent female suicides. MethodsA semi-structured interview was conducted with close family members of adult suicide completers. The interview included questions regarding sociodemographic factors, suicide characteristics, previous suicidal behaviors and a family history of suicidal behaviors, financial problems, and physical/psychiatric problems. Fisher's exact test and the Student's t-test were used to explore sex differences in these survey items, and individual descriptive information of female suicide cases was also examined. ResultsOf the 92 suicide completers, 28 were female and 64 were male. Females had a significantly higher prevalence of a history of self-harm/suicide attempts (P < 0.001). The prevalence of eating disorders was significantly higher among females than males (P < 0.01). ConclusionThe findings of this study highlight the importance of providing psychological and social support to caregivers of those who repeatedly attempt suicide and express suicidal thoughts, and to suggest the need to improve community care systems to be aware of suicide risk factors among female suicide attempters.

Suicide is a global public health problem and solutions to it can be found only through a global dialog. The suicide rate in Japan has been alarming, but Japan has made substantial efforts to reduce this rate, making prevention a high priority. This report reviews the developmental stages of a comprehensive policy of suicide prevention in Japan from 1998 to 2013. Our review suggests that suicide prevention activities were facilitated by the 2006 Basic Act for Suicide Prevention and the 2007 General Principles of Suicide Prevention Policy. Along with the establishment of a Special Fund program for local governments, the Basic Act and General Principles led to the development of a comprehensive and multi-sector approach to suicide prevention. Suicide rates in Japan, especially among middle-aged men, decreased consistently after 2009, suggesting that the initiatives were effective. Continuous monitoring is needed to evaluate Japan's suicide prevention policy.

Objective: This case-control psychological autopsy study aimed to explore a relationship between sleep disturbances and suicide among Japanese, as well as determine the importance and usability of screening for sleep disturbances in suicide prevention. Methods: A semi-structured interview was conducted with the close family members of 49 adult suicide completers and 145 gender-, age-, and residential municipality-matched living controls. The survey included sections on demographics, sleep disturbances, and mental disorders. Conditional logistic regression analyses were performed to compare sleep disturbance prevalence between the two groups. Results: A significantly higher prevalence of sleep disturbances was found among the suicide group (75.5%) compared to the controls (11.0%) (odds ratio [OR]=21.6, p < 0.001). The association remained significant after adjusting for mental disorders (OR = 12.7, p < 0.001). The population attributable risk percent of suicide associated with sleep disturbances and mental disorders was estimated to be 56.4% and 35.3%, respectively. Conclusions: The study confirmed that sleep disturbances are an important risk factor of suicide, independent of mental disorders. Sleep disturbances accounted for a greater proportion of suicide cases than did mental disorders in the Japanese population given the higher prevalence, and could thus be considered an important target in suicide prevention in Japan. (C) 2014 Elsevier B. V. All rights reserved.

心理学的剖検の手法を用いて収集した自殺既遂事例のうち、過去に自殺企図歴がない男性47名の自殺既遂事例の情報と、性別・年齢階級・居住地域を一致させた155名の生存対照群の情報とを症例対照研究のデザインで比較し、過去に自殺企図歴のない成人男性の自殺のリスク要因について検討した。多変量解析の結果、過去1年の返済困難な借金の経験、気分障害、物質使用障害が自殺既遂と有意に関連していた。過去に自殺企図歴のない男性の自殺既遂を防ぐためには、精神障害への保健医療的介入に加えて、返済困難な借金に対する社会的支援の重要性が示唆された。(著者抄録)

うつ病は自殺既遂の重要な危険因子とされているが,これまでのところうつ病で精神科外来治療を受けている中高年男性を対象とした研究は見当たらない。そこで本研究では,精神科外来受診歴を持つ中高年男性うつ病患者の自殺のリスク要因について,心理学的剖検を用いた症例対照研究のデザインで検討を行った。本研究の結果,事例群に比べて対照群において休職歴を持つ者の割合や精神科治療を受けるにあたって自立支援医療(精神通院医療)を利用している者の割合が有意に高いという結果が得られた。本研究は予備的な検討にとどまるものの,うつ病という重大な自殺の危険因子を抱えながら精神科に受診している中高年男性の場合には,休職や自立支援医療の利用といった環境調整の手続きを丁寧に行うプロセス自体が,恥やプライドを含む男性特有の防衛的構えを和らげ,本人の治療への動機付けを高め,結果的に自殺予防につながる可能性が推測された。(著者抄録)

本研究では,心理学的剖検の手法により収集された自殺既遂者のうち,生前に自殺関連行動のあった事例の情報をもとに,初回の自殺関連行動から既遂までの生存時間に関わる心理・社会的要因を検討した。その結果,中高年以上の者,アルコール関連障害のある者,自殺関連行動時に医療行為を受けていない者の生存時間が短いことが示された。したがって,後の既遂を防ぐためには,自殺関連行動時に救急医療機関などでの身体的治療に加え,アルコールの問題や精神的な問題についても注意深くアセスメントした上で,早期に適切な精神医学的対応を行っていくことの重要性が示唆された。(著者抄録)

Background: Social workers are expected to play important roles in suicide intervention. Caregiving behaviours of medical personnel to suicidal individuals have been reported to be influenced by their own attitudes toward suicide. In this context, only a limited number of studies have examined social workers' attitudes toward suicide. Aim: The purpose of this study was to explore associations between personal or occupational factors of social workers and their attitudes toward suicide. Methods: A self-administered questionnaire was mailed to 2,999 study participants registered with the Tokyo chapter of the Japanese Association of Certified Social Workers. We adopted the Attitudes Toward Suicide Scale (ATTS) to measure attitudes toward suicide. MANCOVA was used to test for the effects of demographic, personal and occupational factors on ATTS sub-scale scores. Results: Participants with a history of suicidal thoughts had stronger attitudes regarding the right to suicide than those with no history these attitudes were not affected by a history of participating in suicide-prevention training. Conclusions: Our findings suggest that suicide education should incorporate programmes directed at altering permissive attitudes toward suicide. © The Author(s) 2012.

Objectives: We previously reported that many non-psychiatric doctors in Japan believe that treating depression was not part of their duties. Educational interventions must address motivation of physicians to play a role in depression care. In this study, we explored factors associated with perceived feasibility and willingness of non-psychiatric doctors in Japan to treat depression. Methods: The study population included non-psychiatric doctors of the General Physician-Psychiatrist (G-P) Network group in Japan. We explored perceived feasibility and willingness to treat depressed patients, and examined preliminary associations with attitudes toward depression (the Depression Attitude Questionnaire: DAQ) and current depression treatment in routine medical practice. Results: Responses were obtained from 56 non-psychiatric doctors (response rate: 35.4%). The doctors who scored high on the "Professional" and "Pessimism" subscale of the DAQ believed that treating depressed patients was not feasible (chi(2) = 13.6, p < 0.01; chi(2) = 7.3, p < 0.05, respectively) and were not willing to treat depressed patients (chi(2) = 9.4, p < 0.01; chi(2) = 6.6, p < 0.05, respectively) as part of their routine medical practice. The doctors who scored high on the "Professional" subscale referred fewer depressed patients to psychiatrists (r = -0.33, p < 0.05), and those who scored high on the "Pessimism" subscale recognized fewer depressed patients (r = -0.39, p < 0.01). Conclusions: The present study showed that attitudes toward depression were associated with perceived feasibility and willingness to treat depressed patients and with under-diagnosis of depression. Educational interventions optimized for these attitudes should be developed to improve recognition and treatment of depression in Japan.

本研究では,死亡時に無職であった自殺既遂事例24例を心理・社会的特徴によって分類した。その結果,自立困難型,自立失敗型,中高年中途退職型,定年退職型が挙げられた。自立困難型や自立失敗型のような若年の無職者には,精神的な問題を早期に発見し自立を促進することの重要性が示唆された。中高年以上の無職者では,中高年中途退職型の気分障害やアルコール関連問題への対応や,定年退職型の精神面へのサポートといった精神保健的支援の必要性が示唆された。本研究の結果から,無職者の自殺予防対策として関連する心理・社会的問題や精神的な問題に対する精神保健的な対策を重点的に行っていくことの重要性が示唆された。(著者抄録)

Background: Under-recognition of depression is common in many countries. Education of medical staff, focusing on their attitudes towards depression, may be necessary to change their behavior and enhance recognition of depression. Several studies have previously reported on attitudes toward depression among general physicians. However, little is known about attitudes of non-psychiatric doctors in Japan. In the present study, we surveyed nonpsychiatric doctors' attitude toward depression. Methods: The inclusion criteria of participants in the present study were as follows: 1) Japanese non-psychiatric doctors and 2) attendees in educational opportunities regarding depression care. We conveniently approached two populations: 1) a workshop to depression care for non-psychiatric doctors and 2) a general physician-psychiatrist (GP) network group. We contacted 367 subjects. Attitudes toward depression were measured using the Depression Attitude Questionnaire (DAQ), a 20-item self-report questionnaire developed for general physicians. We report scores of each DAQ item and factors derived from exploratory factor analysis. Results: We received responses from 230 subjects, and we used DAQ data from 187 non-psychiatric doctors who met the inclusion criteria. All non-psychiatric doctors (n = 187) disagreed with "I feel comfortable in dealing with depressed patients' needs," while 60 % (n = 112) agreed with "Working with depressed patients is heavy going." Factor analysis indicated these items comprised a factor termed "Depression should be treated by psychiatrists" - to which 54 % of doctors (n = 101) agreed. Meanwhile, 67 % of doctors (n = 126) thought that nurses could be useful in depressed patient support. The three factors derived from the Japanese DAQ differed from models previously derived from British GP samples. The attitude of Japanese non-psychiatric doctors concerning whether depression should be treated by psychiatrists was markedly different to that of British GPs. Conclusions: Japanese non-psychiatric doctors believe that depression care is beyond the scope of their duties. It is suggested that educational programs or guidelines for depression care developed in other countries such as the UK are not directly adaptable for Japanese non-psychiatric doctors. Developing a focused educational program that motivates non-psychiatric doctors to play a role in depression care is necessary to enhance recognition and treatment of depression in Japan. © 2012 Ohtsuki et al. licensee BioMed Central Ltd.

Background: Studies on attitudes toward suicide are of great interest to researchers worldwide. Although various instruments have been developed to measure attitudes toward suicide, psychometric properties of these instruments have not been systematically reviewed and organized. Aim: We aimed to identify valid, reliable and feasible attitudinal scales by systematically reviewing published articles on scale development and validation studies. In particular, this study focused on scales used for a wide range of populations to measure multidimensional attitudes toward suicide and related issues. Methods: Electronic searches of two databases, PubMed and PsychInfo, were performed. Scales with unique names were identified and listed after reviewing selected publications, and then evaluated for psychometric properties, multidimensionality and appropriateness for a wide range of populations. Results: A total of 2,210 publications were identified by the first electronic search. In the final review process of the selected publications, three scales - the Suicide Opinion Questionnaire (SOQ), Suicide Attitude Questionnaire (SUIATT) and Attitudes Toward Suicide (ATTS) - were identified. Conclusion: Each of these scales has its own characteristics and should be used in accordance with research purposes.

Aims: Rest-activity rhythms of human beings generally synchronize to a 24-h time cue. Very few detailed research studies have examined rest-activity rhythms in patients with schizophrenia. The present study aimed to explore (i) rest-activity rhythms in patients with schizophrenia, and (ii) factors relevant to their rhythm characteristics. Methods: We selected only inpatients for this research, because the time cue for inpatients was considered more standardized than that of outpatients. Sixteen inpatients with schizophrenia wore an ActiTrac accelerometer-based activity monitor (IM Systems Inc., Baltimore, USA) for eight consecutive days to measure their activity. We used a chi 2 periodogram to compute rest-activity rhythms from the activity data, whereby the chi 2 value amplitude was regarded as an index of regularity. We conducted non-parametric tests to identify factors relevant to rhythm cycles and patterns. Results: Half of the participants exhibited prolonged rest-activity cycles, and 25% also had irregular rest-activity patterns defined by insufficient chi 2 value amplitude, even though they were clearly under a 24-h time cue. Participants with misaligned rest-activity rhythms had attended daytime non-medical treatment programs less frequently, and had received more anti-anxiety/hypnotic medications than those with proper rhythms. Conclusion: Changes in rest-activity rhythms by optimizing pharmacological and non-pharmacological treatment could improve social adjustment or quality of life in patients with schizophrenia.

The purpose of the present paper was to examine the psychiatric symptom dimensions related to needs of care among patients with schizophrenia in hospital and in the community. Subjects were 217 patients with F2 ICD-10 diagnoses. Hospital patients included 102 inpatients (47.0%) in psychiatric long-term care units. Community patients included 115 outpatients (53.0%) living in their homes or residential facilities. Psychiatrists used the Brief Psychiatric Rating Scale (BPRS) to assess patients' psychiatric symptoms. Formal care providers assessed needs of care using a scale developed by the Committee on Case Management Guidelines for People with Mental Disabilities in Japan. Instrumental Activities of Daily Living (IADL) self-performance and difficulty were also measured using a scale from the Minimum Data Set-Home Care (MDS-HC). Multiple regression analyses were applied, using the symptom dimensions as dependent variables and needs of care as independent variables. Patient group (hospital or community) was also used as an independent variable. Hospital patients demonstrated more severe psychiatric symptoms and greater needs of care than community patients. Multiple regression analyses showed that the total needs of care were greater among male patients (B = 0.142, P = 0.005), hospital patients (B = 0.310, P < 0.001), patients with poor IADL self-performance (B = 0.217, P = 0.047), and patients with severe negative symptoms (B = 0.240, P = 0.002; R-2 = 0.515). The present results suggested an association between negative symptoms and needs of care in schizophrenia. Hospital patients had greater needs of care, even though their psychiatric symptoms were controlled for. Further research should examine the relationships between psychiatric symptoms and needs of care in a cohort study following patients when hospitalized and when living in the community.

Although caregiver burden is not a direct cause of elder abuse and neglect, research in Japan indicates that stressful caregiving relationships can lead to mistreatment and abuse of frail elders by their families. At the present time, there is no formal notification system for elder abuse in Japan. The purpose of this paper is to discuss crisis intervention strategies that are implemented by social workers at Home Care Support Centers when encountering cases of mistreatment, neglect, and abuse in family caregiving situations. We present the demographic background of elders and their families and review findings of elder abuse studies conducted by Japanese researchers. We then offer three cases to illustrate intervention strategies employed by social workers who work at Home Care Support Centers in an agricultural area in northeastern Japan, including (1) ongoing monitoring, (2) arrangements for formal services, and (3) institutionalization. Cultural issues unique to family caregiving situations are also discussed. © The Author 2005. Published by Oxford University Press. All rights reserved.