Suicide mortality and associated factors among university students in Japan: A 5-year nationwide epidemiological study (FY 2020-2024).

Aim: Suicide is the leading cause of death among Japanese youth; however, nationwide data focusing specifically on university students remain limited. This study aimed to elucidate suicide mortality rates, sociodemographic characteristics, and presumed motives among university students in Japan during FY 2020-2024, following the onset of the COVID-19 pandemic. Methods: Data were collected annually through the student affairs divisions of participating universities, covering a cumulative total of 13.5 million students, representing more than 90% of Japan's total university enrollment. We analyzed demographic characteristics, academic history, presumed motives, and campus health service utilization among identified suicide cases. Results: A total of 1526 suicide deaths or suspected suicides were identified. The male suicide rate (13.90 per 100,000) was significantly higher than the female rate (8.16), although the sex difference narrowed over the study period. Undergraduate and master's programs exhibited significantly higher suicide mortality rates compared with doctoral programs. Suicide deaths peaked in September and March, aligning with critical transitions in the Japanese academic calendar. The most common presumed motive was academic failure, followed by career concerns. Approximately 19% of cases involved a history of leave of absence or grade retention, whereas only 13.6% had prior contact with campus health services. Conclusion: Although suicide rates remained higher among men, the sex difference is narrowing. Academic failure and career concerns were prominent risk factors, and the low utilization of campus health services underscores the need for proactive outreach and a socioecological prevention model to enhance campus-wide coordination.