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Original research
Diabetes and suicide: a nationwide longitudinal cohort study among the Japanese working-age population
  1. Yoshikazu Komura1,
  2. Kosuke Inoue1,2,
  3. Nana Ishimura1,
  4. Daisuke Taura3,
  5. Norio Harada4,
  6. Nobuya Inagaki3,5,
  7. Naoki Kondo1
  1. 1Department of Social Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
  2. 2The Hakubi Project, Kyoto University, Kyoto, Kyoto, Japan
  3. 3Faculty of Medicine, Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
  4. 4Department of Endocrinology and Metabolism, University of Fukui School of Medical Sciences, Yoshida-gun, Fukui, Japan
  5. 5Kitano Hospital Medical Research Institute, Osaka, Osaka, Japan
  1. Correspondence to Dr Kosuke Inoue; koinoue{at}ucla.edu

Abstract

Background Although the mental health burden of diabetes has received substantial attention, there is limited evidence on whether the risk of suicide—a severe consequence of mental health problems—increases among individuals with diabetes. Therefore, this study investigated the association between diabetes and suicide in Japan.

Methods This nationwide longitudinal cohort study included adults aged 18–74 years, who were enrolled in the Japan Health Insurance Association’s health insurance programme between 2015 and 2022. Individuals newly diagnosed with diabetes were matched in a 1:1 ratio with those without diabetes, based on age and sex. We employed multivariable Cox proportional hazard models to estimate the hazard ratios for suicide in relation to the diagnosis of diabetes, adjusting for potential confounders, such as sociodemographic characteristics, history of psychiatric disorders, physical measurements, health behaviours and laboratory data.

Results Among 4 210 272 individuals in the matched-pair cohort, we observed 337 deaths by suicide among those with diabetes and 250 deaths by suicide among those without diabetes. After conditioning on potential confounders, diabetes diagnosis was linked to an increased risk of suicide (HR (95% CI) = 1.25 (1.06 to 1.47)). The association tended to be larger among those aged younger than 40 years and among women (among those aged 18–39 years, HR=1.69 (95% CI 1.05 to 2.73); among women, HR=1.56 (95% CI 0.92 to 2.64)).

Conclusion Diabetes diagnosis may increase suicide risk among the working-age population, even after conditioning on potential confounders. Our findings underscore the importance of psychosocial support following a diagnosis.

  • DIABETES MELLITUS
  • SUICIDE
  • MENTAL HEALTH

Data availability statement

Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available from the Japan Health Insurance Association; however, we used these under license for the current study, and so the data are not publicly available.

https://doi.org/10.1136/jech-2024-222701

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available from the Japan Health Insurance Association; however, we used these under license for the current study, and so the data are not publicly available.

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    Footnotes

    • X @ki_endoepi, @naoki_kondo

    • Contributors Dr YK and Dr KI had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: YK, KI, NK. Acquisition, analysis or interpretation of data: YK, KI, NanaI, NK. Drafting of the manuscript: YK, KI, NK. Critical revision of the manuscript for important intellectual content: YK, KI, NanaI, DT, NH, NobuyaI, NK. Statistical analysis: YK, KI, NanaI. Guarantor: KI

    • Funding This study was supported by grants from the Japan Health Insurance Association. KI was also supported by grant 23KK0240 from the Japan Society for the Promotion of Science, the Japan Science and Technology (JPMJPR23R2), the Japan Agency for Medical Research and Development (AMED; JP22rea522107) and the Program for the Development of Next-generation Leading Scientists with Global Insight (L-INSIGHT) sponsored by the Ministry of Education, Culture, Sports, Science and Technology (MEXT), Japan. Study sponsors were not involved in study design, data interpretation, writing or the decision to submit the article for publication.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.