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Suicide rates in Japan have jumped in the second wave of the COVID-19 pandemic, particularly among women and children, even though they fell in the first wave when the government offered generous handouts to people, a survey found.

The July-October suicide rate rose 16% from the same period a year earlier, a stark reversal of the February-June decline of 14%, according to the study by researchers at Hong Kong University and Tokyo Metropolitan Institute of Gerontology.

“Unlike normal economic circumstances, this pandemic disproportionately affects the psychological health of children, adolescents and females (especially housewives),” the authors wrote in the study published on Friday in the journal Nature Human Behaviour.

The early decline in suicides was affected by such factors as government subsidies, reduced working hours and school closure, the study found.

But the decline reversed — with the suicide rate jumping 37% for women, about five times the increase among men — as the prolonged pandemic hurt industries where women predominate, increasing the burden on working mothers, while domestic violence increased, the report said.

The study, based on health ministry data from November 2016 to last October, found the child suicide rate spiked 49% in the second wave, corresponding to the period after a nationwide school closure.

Prime Minister Yoshihide Suga this month issued a COVID-19 state of emergency for Tokyo and three surrounding prefectures in a bid to stem the resurgence. He expanded it last week to seven more prefectures, including Osaka and Kyoto.

Taro Kono, administrative and regulatory reform minister, said Thursday that while the government would consider extending the state of emergency, it “cannot kill the economy.”

“People worry about COVID-19. But a lot of people have also committed suicide because they have lost their jobs, they have lost their income and couldn’t see the hope,” he said. “We need to strike the balance between managing COVID-19 and managing the economy.”

If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 119 in Japan for immediate assistance. The TELL Lifeline is available for those who need free and anonymous counseling at 03-5774-0992. You can also visit telljp.com. For those in other countries, visit www.suicide.org/international-suicide-hotlines.html for a detailed list of resources and assistance.

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