Welfare policy and suicide: The role of "supporting the self-reliance of persons in need" program in Japan.

Background: Japan experienced a substantial decrease in suicide rates in the 2010s. During this period, the "Supporting the Self-Reliance of Persons in Need" program was initiated to target individuals struggling to meet basic needs. The program provides personalized consultations and subprograms that address the residence issues, necessities, employment needs, and household finance management problems. This study evaluates whether this program is related to the decline in Japan's suicide rates in the 2010s. Methods: The first analysis employs a difference-in-differences approach, using the monthly suicide rates in 815 cities across Japan from 2009 to 2015. Policy exposure refers to the period after pilot programs were introduced in cities between 2013 and 2015. The second analysis examines whether the number of subprograms application counts is associated with the suicide rates by fiscal year. Results: The introduction of self-reliance support in cities is related to a monthly reduction of 0.066 and 0.041 in suicide rates among men and women, respectively. The associations are found among the population under 60 years, particularly strong for males and the middle-aged. The second analysis suggests that the employment training program shows the strongest association with lower suicide rates. An additional employment training application per 100,000 population is associated with a 0.256 reduction for males and 0.169 for females in the annual suicide rates. Conclusions: The introduction of self-reliance support is associated with reduced suicide rates, mainly among males and the middle-aged. The employment training subprogram demonstrates the strongest association with lower suicide rates.