Psychological distress and completed suicide in Japan: A comparison of the impact of moderate and severe psychological distress

It has already been established that severe psychological distress is a major risk factor for completed suicide. However, the impact (population attributable fraction; PAF) of moderate psychological distress on completed suicide has not been clarified. The present study investigated the association between various severities of psychological distress and completed suicide. We analyzed follow-up data covering a 7.3-year period (2006-2014) for 43,473 adults (aged >= 40 years) participating in a community-based, prospective cohort study. Psychological distress was measured using the K6 psychological distress scale at the baseline. Participants were classified into three groups according to their K6 score (low: 0-4; moderate: 5-12; severe: 13-24). Completed suicide was determined from a Japanese national database. The Cox model was used to estimate hazard ratios (HRs) for completed suicide. The PAFs of moderate and severe psychological distress for completed suicide were also estimated. The multivariate-adjusted HRs (95% confidence interval) for completed suicide were 2.37 (1.49-3.78) among participants with moderate psychological distress, and 4.16 (2.13-8.15) among those with severe psychological distress, relative to those with low psychological distress (P for trend < 0.001). The PAF of the moderate group for completed suicide was 26.8%, whereas that of the severe group was 10.9%. Not only severe but also moderate psychological distress was significantly associated with an increased risk of completed suicide. The PAF of moderate psychological distress for completed suicide was larger than that of severe psychological distress. Public health actions for suicide prevention should focus on moderate as well as severe psychological distress.