1. Introduction
Suicide is a public health issue that affects communities, regions, and entire countries. Every year, more than 800,000 people commit suicide―one every 40 seconds [1] . Moreover, suicide has serious impacts on family, friends, and colleagues of the person who commits it. Nevertheless, suicide is a preventable public health problem. Understanding the causes of suicide―that are multiple―will help us find methods to prevent it.
Japan’s suicide rate is the second highest among the countries of the Organisation for Economic Co-operation and Development (OECD) [2] . It increased considerably following the 1998 economic recession [3] ; beginning in 1998, the number of suicides in Japan exceeded 30,000 per year for 14 consecutive years [3] . Although the suicide rate in Japan has been decreasing in recent years [3] , it remains high among developed countries. Japan’s National Police Agency releases the causes of and factors affecting suicides in the “Summary Document Concerned with Suicide” it compiles every year, based on evidence from suicide notes, Internet activity and e-mail communications, and other behavior; causes are determined for about 70% - 75% of the total cases every year. Up to three causes/factors have been recorded for each case since 2007 (and one before that). Additionally, the causes and factors are grouped by type. Until 2006, they were classified into health issues, economic and livelihood issues, family issues, work- related issues, love affairs, school-related issues, other, and unknown; since 2007, they have been divided at a more fine-grained level: for example, work-related issues are divided into career failure, personal relationship at work, change in the work environment, work-related fatigue, and other. Economic and livelihood issues are divided into 11 groups, one of which is insurance money from suicide; over 100 people who committed suicide have been placed in this category in recent years (2007-2010) [4] [5] [6] [7] . Previous studies have discussed suicide from multiple perspectives: mental illness, poverty, unemployment, personal relationships, drugs, and so on [8] [9] [10] [11] ; however, statistics on suicide to gain an insurance payout are rare, and, to our knowledge, no studies have reported on this phenomenon in detail in the Japanese context. Therefore, factors influencing suicide to gain an insurance payout and its measures are not clear.
Suicide is a complex and multifaceted problem, and causes and factors for suicide vary considerably by individual. Thus, for suicide prevention, it is important to provide individualized care and support, which can be achieved through an analysis of suicide committed for the purpose of gaining insurance payouts, as it will improve our understanding of this understudied group.
2. Data Collection and Analysis
We analyzed data on suicides in Japan for the period 2007 to 2015 from the “Summary Document Concerned with Suicide” released by the National Police Agency. The Summary Document Concerned with Suicide is a compilation of the diverse suicide data from across Japan. Since 2007, the Summary Document Concerned with Suicide has reported detailed causes and factors for suicide, as discussed above. We broke down data on suicides for one factor, cited as to gain insurance payouts, according to sex, age group, and year. We also examined average the life insurance death benefits in each age group using data from a national survey of life insurance [12] . Using the Mann-Whitney U-test, we calculated the proportion of people in their 40 s to 60 s and the sex ratio for the cases of suicide committed for gaining insurance payouts in relation to the total cases of suicide. Suicide for gaining insurance payouts is one of the 11 causes and factors in the Summary Document Concerned with Suicide economic and livelihood issues category―namely, bankruptcy, business slump, unemployment, failure to get a job, hardship of life, multiple debts, joint guarantee debt, other debt, stress from debt collection, insurance money from suicide, and other; it was inferred that suicide for the purpose of gaining insurance payouts is strongly associated with these other causes and factors. We examined these causes and factors in males in order to determine their correlations with suicide committed for gaining insurance payouts. Data were analyzed using SPSS version 22 for Windows. All the data used in this study were previously published, and none of the data reveals the identity of the individuals; thus, no institutional review board clearance was required.
3. Results
Table 1 shows the sociodemographic characteristics of suicide for gaining insurance payouts in Japan. The largest number of such cases was 151, in 2007, and the smallest was 65, in 2012; the numbers ranged between 0.32% and 0.65% of all suicides in Japan in their given years. (The percentage of the total number of cases for which causes or factors were identified was between 70.1% and 74.8% of the total.) In males, the age group most widely represented was the 50 s over the entire period studied, and the death benefit of males was larger than that of females in all age groups. It was largest in the 40 s, followed by the 50 s, and then the 30 s. (Figure 1 shows the life insurance death benefit for each age
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Figure 1. Average death benefit in each age group. Source: Japan institute of life insurance “Survey on life security 2016.”
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Table 1. Sociodemographic characteristics of suicide for gaining insurance payouts (category: “Insurance money from suicide”).
Source: National police agency (Japan), “Summary Document Concerned with Suicide”.
group.) The mean (SD) proportion of people who committed suicide for this reason and were in their 40s to 60s was 89.1% (2.18), significantly higher than the proportion of people in this age group who committed suicide in relation to the total number of suicide cases, which was 54.2% (7.32) (p < 0.001) (Table 2). The number of males who committed suicide to gain an insurance payout was larger than the number of females each year; specifically, the mean (SD) sex ratio (male/female) of suicide for the purpose of gaining insurance payouts was 10.67
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Table 2. Characteristics of suicide for gaining insurance payout compared to total number of suicides, 2007-2015.
Mann-Whitney U-test. *p < 0.001.
(2.36), significantly higher than that for the total number of cases (2.31 (0.12)) (p < 0.001) (Table 2). Table 3 shows the correlation coefficients between the number of suicides for gaining insurance payouts and the number of suicides due to various other economic and livelihood causes and factors in males. The causes and factors found to be significantly correlated with suicide for gaining insurance payouts were bankruptcy, business slump, multiple debts, debt because of consigner, other debt, and stress from debt collection.
4. Discussion
Previous study results have shown that the proportion of suicides in Japan for the gaining insurance payouts is less than 1% in any year (Table 1). Although this proportion is low, it is not negligible, adding up to dozens of people each year. In addition, there is a possibility that the true number is undercounted, as suicidal persons trying to gain insurance payouts will not be inclined to mention that fact in a suicide note; neither are they likely to reveal this to anyone, or leave behind other evidence in general.
Our study’s results revealed certain characteristics in the suicides that were committed for gaining insurance payouts. First, the data showed that the majority of people who commit suicide for this reason are in their 40 s to 60 s. Although people in this age group account for 54.2% of all suicides, they account for 89.1% of suicides for gaining insurance payouts (Table 2). This might be influenced by the fact that many in these age groups are married and have families, and that the death benefit in the 70 s is lower than that for other age groups (Figure 1). More noteworthy is the sex ratio; a significantly greater proportion of cases of suicide for gaining insurance payouts were male. Often, as is the case in many countries, in Japan, the male is the family’s principal breadwinner, and male death benefits are larger than those of females [13] (Figure 1), seemingly in order to offset the increased risk to family livelihood in the event of their death. Accordingly, many Japanese males may be strongly motivated by the belief that they are responsible for supporting the household financially [14] . If the male in the family, who is the principal breadwinner, dies, naturally, his household will fall into economic difficulties. Male breadwinners may strongly feel that they do not want to leave their bereaved in economic difficulties after their suicide; thus, they may try to secure a death benefit for them.
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Table 3. Correlation coefficient between number of suicides for gaining insurance payouts and number of suicides due to other causes in males (2007-2015).
Spearman’s rank-correlation coefficient. Note. *p < 0.05, **p < 0.001.
Suicide for gaining insurance payouts was correlated with the following other factors in males: bankruptcy, business slump, multiple debts, joint guarantee debt, other debt, and stress from debt collection. For example, if a man fails in his business, his company goes bankrupt, or debts pile up, he may choose death by suicide in order to gain insurance payouts and fulfill his obligations. Thus, suicide in Japanese males is substantially influenced by economic conditions [14] . For Japanese males, work is an important concern, and there is a high value placed on working [15] . Moreover, when they are under psychological stress due to economic issues, their outlook toward life may become narrow and pessimistic. They may take economic issues seriously to the extent that they choose to die in order to deal with them.
There are several approaches that may help prevent these suicides. First, it is important to promote help seeking by these people, as help-seeking behaviors reduce the risk of suicide [16] [17] . As previous studies show, among the Japanese experiencing suicidal ideation, 73.9% did not seek help, and among those who have attempted suicide, 51.1% did not seek help [18] . For people who think about committing suicide to gain insurance payouts, it will be necessary to consult someone who can solve their economic issues; as this implies, access to and dissemination of debt and financial counseling services needs to be increased. Awareness campaigns promoting help seeking are important too. In addition, persons who are under extreme stress due to economic issues are at risk for developing mental illnesses such as depression. Indeed, in Japan, the most common factor influencing suicide is health problems, including mental illness [19] ; thus, people experiencing mental illness should receive treatment, and for early treatment and prevention, it is important to disseminate correct knowledge about mental illness to society. Finally, one study reported that the suicide ratio decreased with the extension of the suicide-exempted period by insurers [20] ; thus, the structure of insurance policies and eligibility may also help reduce suicide committed in order to access payouts. For people who consider committing suicide in order to gain insurance payouts, being unable to obtain insurance money by doing so will prevent them from achieving this objective. The extension of the suicide-exempted period may be effective to reduce at least this motive for suicide.
One thing that we must add here, for several reasons, is that it is unlikely that taking out a life insurance policy is directly linked to the risk of suicide. The rate of participation in life insurance schemes among people who have attempted suicide is lower than that in the general population in Japan [21] . This may be because people who have attempted suicide are viewed as likely to be mentally ill [18] , which may make it difficult for them to buy life insurance. Moreover, mentally ill people are poorer on average than the general population, which may also present a difficulty. Unemployed persons are common among suicides in Japan―59.6% in 2014 [3] ―and it appears that their participation rate in life insurance may be lower than that of the general population. Shirouzu reported that the suicide mortality ratio is lower among insured people than among the general population [22] ; in contrast, however, Choi et al. reported that the suicide rate is positively correlated with life insurance premium per capita in OECD countries [23] . Several previous studies show that the suicide mortality ratio of Japanese people with life insurance contracts worth at least 50 million yen (about 450,000 US dollars) is higher than that of people without such contracts [20] [24] . Thus, large death benefits may be linked to motivation for suicide. Perhaps suicide for gaining insurance payouts is complexly intertwined with various factors; certainly, it has not been analyzed sufficiently by this study or by previous studies, and additional work is required to develop more effective preventive measures.
5. Conclusion
Our findings on suicide committed for the purpose of gaining insurance payouts in Japan show that the risk is higher among men than among women and higher among people in their 40s through 60s than in other age groups, and it is likely to be associated with debt. Important actions to prevent this kind of suicide will include promoting help seeking, further dissemination of debt counseling and financial counseling services, and extended treatment for mental illness. However, further studies, such as psychological autopsy, which establish the background of suicide for gaining insurance payouts, are required in order to develop more effective preventive measures.
Conflict of Interest
The authors have no conflicts of interest to state for the present manuscript.
Role of Funding Source
This study was supported by the Japan Society for the Promotion of Science (KAKENHI grant 16K12241).