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 � � � T otal 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: � � � on 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 � � � or 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 � one 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 � � � occasionally 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 � � name � age sex � diagnosis � � � outcome � � � � 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 � � � outcome � � � � 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 � � � outcome � � � � 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. �