More deaths from suicide than from covid-19 in Japan. Why?

World Suicide Prevention Day 2:04

Tokyo (CNN) -

Eriko Kobayashi has attempted suicide four times.

The first time, she was just 22 years old with a full-time job in the publishing industry that didn't pay enough to cover rent and supermarket bills in Tokyo.

"I was very poor," said Kobayashi, who spent three days unconscious in the hospital after the incident.

Now 43, Kobayashi has written books on his mental health problems and has a steady job at an NGO.

But the coronavirus is giving you back the stress you used to feel.

"They cut my salary and I can't see the light at the end of the tunnel," he said.

"I constantly feel a sense of crisis that I could fall back into poverty."

Experts have warned that the pandemic could trigger a mental health crisis.

Mass unemployment, social isolation and anxiety are taking their toll on people around the world.

In Japan, government statistics show that suicide claimed more lives in October than COVID-19 for the entire year to date.

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The monthly number of suicides in Japan rose to 2,153 in October, according to the Japan National Police Agency.

As of Friday, the total number of deaths from COVID-19 in Japan was 2,087, the Health Ministry said.

Japan is one of the few major economies to release timely data on suicides;

the most recent national data for the US, for example, is from 2018. Japanese data could provide other countries with information on the impact of pandemic measures on mental health and which groups are the most vulnerable.

"We didn't even have a lockdown, and the impact of covid is minimal compared to other countries ... But we still see this huge increase in the number of suicides," said Michiko Ueda, associate professor at Waseda University in Tokyo and suicide expert. .

"That suggests that other countries could see a similar or even greater increase in the number of suicides in the future."

Eriko Kobayashi has struggled with her mental health in the past.

She says the pandemic has once again brought her an intense fear of falling into poverty.

The number of covid victims among women

Japan has long struggled with one of the highest suicide rates in the world, according to the World Health Organization.

In 2016, Japan had a suicide death rate of 18.5 per 100,000 people, second only to South Korea in the Western Pacific region and almost double the annual global average of 10.6 per 100,000 people.

While the reasons for the high suicide rate in Japan are complex, long working hours, school pressure, social isolation, and a cultural stigma surrounding mental health issues have been cited as contributing factors.

But for the 10 years leading up to 2019, the number of suicides had been declining in Japan, falling to around 20,000 last year, according to the Health Ministry.

It is the lowest number since the country's health authorities began keeping records in 1978.

The pandemic appears to have reversed that trend, and the rise in suicides has disproportionately affected women.

Although they account for a smaller proportion of all suicides than men, the number of women taking their own lives is increasing.

In October, female suicides in Japan increased by almost 83% compared to the same month last year.

By comparison, male suicides rose nearly 22% over the same time period.

There are several potential reasons for this.

Women make up a higher percentage of part-time workers in the hotel, food service and retail industries, where layoffs have been deep.

Kobayashi said that many of his friends have been fired.

"Japan has been ignoring women," he said.

"This is a society where the weakest people are cut off first when something bad happens."

In a global study of more than 10,000 people, conducted by the international nonprofit aid organization CARE, 27% of women reported greater mental health problems during the pandemic, compared with 10% of men.

Compounding those income concerns, women have been grappling with skyrocketing unpaid care burdens, according to the study.

For those who retain their jobs, when children are sent home from school or daycare, it is often up to mothers to assume those responsibilities, as well as their normal job duties.

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: Six ways in which the coronavirus pandemic has affected women more than men

Increased anxiety about the health and well-being of children has also placed an additional burden on mothers during the pandemic.

Akari, a 35-year-old woman who did not want to use her real name, said she sought professional help this year when her premature son was hospitalized for six weeks.

"I was pretty worried 24 hours," Akari said.

'I had no history of mental illness before.

But I could see myself very, very anxious all the time.

Her feelings worsened as the pandemic intensified and she was concerned that her son would contract COVID-19.

"I felt like there was no hope, I felt like I was always thinking about the worst case scenario," he said.

«A Place For You»

In March, Koki Ozora, a 21-year-old college student, opened a 24-hour mental health hotline called Anata no Ibasho (A Place For You).

He said the hotline, a nonprofit organization funded by private donations, receives an average of more than 200 calls a day and that the vast majority of the callers are women.

"They lost their jobs and need to raise their children, but they had no money," said Ozora.

"So they tried to commit suicide."

Most calls are received during the night, from 10 pm to 4 am.

The 600 volunteers of the non-profit organization live around the world in different time zones and are awake to answer them.

But there aren't enough volunteers to keep up with the volume of messages, Ozora said.

College student Koki Ozora started a 24-hour volunteer-run mental health hotline in March, now receiving more than 200 calls a day.

They prioritize the messages that are most urgent, searching for keywords like suicide or sexual abuse.

He said they respond to 60% of text messages in five minutes and volunteers spend an average of 40 minutes with each person.

Anonymously, through online messages, people share their deepest struggles.

Unlike most mental health hotlines in Japan, which accept applications over the phone, Ozora says that many people, especially the younger generation, are more comfortable asking for help via text message.

In April, she said the most common messages were from mothers feeling stressed about raising their children.

And some confessed to having thoughts of killing their own children.

These days, she says messages from women about job loss and financial hardship are common, as is domestic violence.

"I've been getting messages like 'My father rapes me' or 'My husband tried to kill me,'" Ozora said.

“Women send these types of text messages almost every day.

And it is increasing.

He added that the increase in messages is due to the pandemic.

Before, there were more places to "escape," like schools, offices, or friends' houses.

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Pressure on children

Japan is the only G-7 country where suicide is the leading form of death for 15- to 39-year-olds.

And suicides among those under the age of 20 had increased even before the pandemic, according to the Health Ministry.

As pandemic restrictions pull children out of school and out of social situations, they are dealing with abuse, stressful home lives and pressure to fall behind on homework, Ozora said.

Some children as young as five had sent messages to the hotline, he added.

School closings during the pandemic in the spring have contributed to a backlog of homework.

Children also have less freedom to see their friends, which also contributes to stress, according to Naho Morisaki of the National Center for Child Health and Development.

The center recently conducted an online survey of more than 8,700 parents and children and found that 75% of Japanese school-age children were showing signs of stress due to the pandemic.

Morisaki says she thinks there is a great correlation between children's anxiety and their parents.

"Children who injure themselves have stress, and then they can't talk to their family because they probably see that their moms or dads can't hear them."

Stigma of solving the problem

In Japan, there is still a stigma against admitting loneliness and struggle.

Ozora said that it is common for women and mothers to start the conversation with her service with the phrase: "I know it is bad to ask for help, but can I speak?"

Ueda says the "shame" of talking about depression often holds people back.

"It's not something you talk about in public, you don't talk about it with your friends or anything," he said.

(It) could lead to a delay in seeking help, so that's a potential cultural factor that we have here.

Akari, the mother of the premature baby, agrees.

She had previously lived in the United States, where she says it seems easier to seek help.

"When I lived in the United States, I knew people who did therapy, and it is something more common to do, but in Japan it is very difficult," he said.

Following the financial crisis of the 1990s, Japan's suicide rate soared to a record high in 2003, when approximately 34,000 people took their own lives.

Experts say that the embarrassment and anxiety of the layoffs, mostly men at the time, contributed to the depression and increased suicide rates.

In the early 2000s, the Japanese government accelerated investment and efforts around suicide prevention and support for survivors, including the passage of the Basic Law for Suicide Prevention in 2006 to support the affected by the problem.

But both Ozora and Kobayashi say that it has not been enough: reducing the suicide rate requires that Japanese society change.

"It's shameful that others know about your weakness, so you hide everything, put it away and put up with it," Kobayashi said.

"We need to create a culture where it is okay to show its weakness and misery."

Celebrity suicides

Several Japanese celebrities have taken their own lives in recent months.

While the Japanese media rarely recounts the details of such deaths, without deliberately dwelling on the method or motive, the mere reporting of these cases often leads to an increase in suicides in the general public, according to experts such as Ueda.

Hana Kimura, a 22-year-old professional wrestler and star of the reality show "Terrace House," committed suicide over the summer after social media users bombarded her with hateful messages.

Hana's mother, Kyoko Kimura, says she was aware that media reports of her daughter's death may have affected other people who were feeling suicidal.

Kyoko Kimura said coronavirus restrictions prevented her daughter from practicing wrestling.

Hana was overwhelmed by negative comments on social media and, as a result, committed suicide.

"When Hana died, I repeatedly asked the police not to reveal any concrete situation of her death, but still, I see the information report that only the police knew about," Kimura said.

"It's a chain reaction of pain."

Kimura said the pandemic led her daughter to spend more time reading toxic social media messages as she was unable to fight due to coronavirus restrictions.

Kimura is now creating an NGO called "Remember Hana" to raise awareness about cyberbullying.

«She found her reason to live as a professional fighter.

It was a big part of her.

I was in a really difficult situation because I couldn't fight, ”Kimura said.

"The coronavirus pandemic made society more suffocating."

Professional wrestler Hana Kimura committed suicide in the summer.

The third wave

In recent weeks, Japan has reported record daily cases of Covid-19, as doctors warn of a third wave that could intensify in the winter months.

Experts worry that the high suicide rate will worsen as the economic fallout continues.

"We have not even experienced all the economic consequences of the pandemic," Ueda said.

“The pandemic itself can get worse, then maybe there will be semi-confinement again.

If that happens, then the impact can be huge. '

Compared to some other nations, Japan's coronavirus restrictions have been relatively relaxed.

The country declared a state of emergency but never imposed strict confinement, for example.

And its quarantine restrictions on international arrivals have not been as inflexible as China's.

But as cases increase, some worry that more severe restrictions will be needed, and they worry about how that could affect mental health.

"We didn't even have a lockdown, and the impact of covid is minimal compared to other countries ... But we still see this huge increase in the number of suicides," Ueda said.

"That suggests that other countries could see a similar or even greater increase in the number of suicides in the future."

Despite having to deal with a pay cut and constant financial insecurity, Kobayashi says he now handles his anxiety much better.

She hopes that by speaking out publicly about her fears, more people will do the same and realize they are not alone, before it's too late.

"I go out in public and say that I have been mentally ill and suffered from depression in the hope that others might be encouraged to speak up," Kobayashi said.

“I am 43 years old now and life starts to get more fun in the middle of my life.

So I feel like it's good to be still alive.

How to get help: In the US, call the National Suicide Prevention Line at 1-800-273-8255.

The International Association for Suicide Prevention and Befrienders Worldwide also provide contact information for crisis centers around the world.

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