The Adolescent Suicide Risk of Japanese International Students in - - PDF document

CAPS-I Conference (Teachers’ Conference) May 27, 2014

• The Adolescent Suicide Risk of Japanese International Students

in Victoria B.C.

• Introduction : Reality behind Suicide in Japan
• Total Suicide Statistics in Japan :
• 1988 - 1997 on average 22,000 (annually)
• 1998 - 2011 on average 32,000 (annually)
• 2012 - 2013 on average 26,000 (annually)
• However, in terms of actual population density, the suicide rate is
• 21.7 per 100,000. World wide, Japan only ranks tenth: lower than
• South Korea (28.1/100,000) and China (22.23/100,000). In
• comparison, Greenland ranks first, with a staggering 83.0/100,000.
• Adolescent (10 - 19 years) Suicide in Japan:
• n average 500 ー 600 (male>female, annually), i.e.,
• 2 % of all completed suicides in Japan
• However, many high school students in Japan have reported that
• they had a history of suicidal ideation (20 - 30 % ) and a history of
• self-harming activities (10%).
• I. Background of Japanese Adolescent Suicide :
• A. Triggers
• 1. academic failure (e.g., failed entrance exam)
• 2. family pressure and insecurity about the future
• 3. loss of, or disrupted relationships with, significant others
• 4. mental disorders (e.g., depression, schizophrenia)
• 5. bullying and/or ostracism
• B. Risk Factors
• 1. history of suicide attempts, self-harming behaviour
• 2. history of mental disorders (depressive mood disorder,
• borderline personality disorder, schizophrenia etc)
• 3. lack of support system
• 4. history of childhood abuse
• 5. personality traits such as

• i. emotionally immature (dependent, insecure personality)
• ii. depressive
• iii. impulsive
• iv. dualistic (all or nothing)
• v. antisocial (destructive, irresponsible)
• II. Signs and Symptoms of Suicide Risk
• A. Subtle Changes in Behaviour
• e.g. poor self care (no shower, no hair care, no change of clothing),
• wrist slashing, accident proneness
• B. Visible Changes in Behaviour
• e.g. missing classes, dropping in academic achievement,
• withdrawing from others, becoming shut-in
• C. Depressive Symptoms
• e.g. sleep disorder, loss of appetite, loss of drive/interest,
• anxiety, restlessness, fatigue, loss of concentration, loss of
• self-esteem, suicidal ideation expressed in drawings, e-mails
• r facebook
• III. Situation of Japanese International Students in Victoria B.C.
• Review of my Counselling Practice
• According to Mr. Jeff Davis, the high schools in Victoria B.C. have
• been hosting an annual average of 100 long term (i.e., with stays exceeding
• ne year) Japanese high school students; this year an increase, about 150.
• Most recently, in 2012, I saw 10 Japanese students; in 2013, 9 students.
• This year (January - April 2014), 2 students were sent to me from SD 61 and
• SD 63 for assessment and counselling. Before the Victoria International
• High School Programs introduced the ATP (Academic Transition
• Programme) in April 2008, I was told that about 25 % of all Japanese
• students had serious psychological and behavioural problems.
• The main reason for referrals was repetitive or habitual school
• absence, combined with symptoms of depression.
• The question of a potential suicide risk was almost always
• linked to the request for an assessment, especially when the host
• ccasionally discovered an overdose of psychotropic medications or
• scarred body parts, caused by superficial cutting with sharp utensils, on
• the part of their home stay student.

• 2012

nameage sex diagnosis

• utcome
• F.Y.

17 f. Bulimia nervosa

• dropped out
• S.K. 16

f. *Adjustment Disorder continued study

• A.H. 17
• m. Adjustment Disorder

continued study

• A.O. 17

f. Adjustment Disorder continued study

• Y.K.

16 f. PTSD

• continued study
• K.K. 19

m. Seasonal Affective Disorder graduated

• H.H. 16

f. Academic Inhibition continued study

• S.Y. 16

m. Adjustment Disorder continued study

• T.H.

18 f. Social Phobia

• continued study

• M.K. 18

f. Adjustment Disorder continued study

• 2013

name age sex diagnosis

• utcome
• A.S. 17

f. Atypical Depression dropped out

• K.M. 17

f. Eating Disorder N.O.S. continued study

• M.U. 17

f. Adjustment Disorder continued study

• H.H. 17

f. Academic Inhibition dropped out

• S.Y.

17 f. Adjustment Disorder continued study

• M.F.

19 f. Adjustment Disorder graduated

• Y.T.

17 m. Mood Disorder N.O.S. graduated

• H.Y.

15 m. Conversion Disorder? returned home

• N.N. 17

f. Dysthymic Disorder continued study


• Y.N.

17 f. Mood Disorder N.O.S. dropped out 


• 2014

name age sex diagnosis

• utcome
• A.H. 19
• m. Academic Inhibition

continued study

• Y.S.

17

• m. Dissociative Disorder

dropped out

• * Clarification of Adjustment Disorder (DSM-V)
• DSM-V definition : The development of emotional or behavioural
• symptoms in response to an identifiable stressor(s) occurring within
• 3 months of the onset of the stressor(s).
• IV. Summary
• As the statistics demonstrate, more than 90 % of the Japanese students in
• Victoria seem to be more or less adjusted to life in Canada.
• Less than 10 % of the total students stood out by irregular behaviours such
• as repetitive or long term school absence or symptoms of depression,
• including self-harming behaviours, and needed assessment and
• counselling.

• Overwhelming majority of them had periods of death wishes in the past, as
• an escape from emotional pressure. Irregular school attendance in Japan
• was not exceptional.
• Less than half of these students had developed self-harming behaviours at
• home, and continued these behaviours in Victoria.
• All of them had already suffered traumatic experiences in their family/
• school in Japan. For them, going abroad was an escape from troubles in
• their home country.
• It is well-established, that previous traumatic experiences without
• proper processing make individuals more vulnerable to re-
• traumatization, and consequently, adjustment disorders can more easily
• ensue. 

• In Victoria, 1% or less of all Japanese international high school
• students have had to be sent back to their home country each year, for
• safety reasons due to a potential or acute suicide risk, as well as for the
• treatment of an underlying mental disorder.
• V. Suicide Prevention
• Goal of Suicide Prevention
• A. Liberation from Isolation
• 1. listen to the story
• 2. give warmth and empathy
• 3. promise to meet again
• 4. if possible, remove the stressor(s)
• B. Building up a Support System
• brain-storming to promote integration in peer activities
• (sports, arts, music, dance etc.)
• Abstract :

In recent years, high schools in Victoria B.C. have been hosting an annual average of 100 to 130 Japanese international students with stays exceeding one year.

• Repetitive or habitual school absence accompanied by symptoms of depression

has been a source of concern for teachers as well as host families. Poor communication skills on the side of the international students, added to cultural barriers, foster concerns about self-harming or potential suicide risk. The author has been working with the Victoria International High School Programs for the past 20 years, seeing troubled Japanese international students in the role of sole Japanese-speaking counsellor in town. About 10 % of all Japanese students in Victoria have in recent years been sent to the author for assessment and counselling, due to the above-mentioned concerns. Crisis intervention has proven successful for the large majority of these. Only

• ne or two of them faced a serious suicide risk. Both discontinued the

educational program in Canada and had to be sent back home. 
 Suicide prevention is briefly reviewed.

• http://www-user.yokohama-cu.ac.jp/~psychiat/WEB_YSPRC/pdf/kyousi.pdf
• http://www.mext.go.jp/b_menu/shingi/chousa/shotou/046/gaiyou/1259186.htm