Suicide in Medical Patients: Japanese and American Psychiatrist’s Attitudes

Suicide is a common and difficult problem in all societies. Many studies have shown that pain and depression are potential risk factors for suicidal risk in medical patients. Acute changes in medical condition and loss of physical function have also been identified as risk factors, as have agitation and readily available lethal means in this population.

The interface of suicide and euthanasia in medical patients is an area where the attitudes of physicians, and especially psychiatrists are of great importance. One study compared the attitudes of psychiatrists in Japan and the United States in order to investigate their ideas on whether patients in general medical hospitals who have a desire to die should be allowed to, or assisted in this regard, and whether they require psychiatric evaluation and intervention, and the cultural influences on these attitudes.

Japanese and American general hospital psychiatrists' attitudes towards the reasonability of suicide, physician assisted suicide, and removal of life supports under various medical and psychosocial situations were compared. Seventy-two American and sixty-two Japanese psychiatrist's data was collected using the Suicidal Attitudes Inventory (SAI).

The majority of both American and Japanese psychiatrists agreed that there may be times when suicidal ideation, or completed suicide in medical-surgical patients could be reasonable. Significantly more Japanese psychiatrists responded with some agreement to the reasonability of suicide when one is unable to fulfill social role expectations, and had more concern about causing suicidal ideation by informing terminal patients of their diagnosis.

Proper use of antidepressants in appropriate suicidal patients is also necessary to consider. The status of antidepressants in Japan that are approved by the Japanese Authorities is an issue that needs to be followed as it has traditionally lagged far behind the West.