In Japan, more people died from suicide last month than from Covid in all of 2020. And women have been impacted most
By Selina Wang, Rebecca Wright and Yoko Wakatsuki, CNN，Updated 0507 GMT (1307 HKT) November 29, 2020
作者：Selina Wang，Rebecca Wright和Yoko Wakatsuki，CNN，更新於2020年11月29日
Tokyo (CNN) Eriko Kobayashi has tried to kill herself four times.
東京（CNN）小林惠子曾四次自殺。
The first time, she was just 22 years old with a full-time job in publishing that didn't pay enough to cover her rent and grocery bills in Tokyo. "I was really poor," said Kobayashi, who spent three days unconscious in hospital after the incident.
第一次，她只有22歲，有一份全職的出版業工作，工資不足以支付她在東京的房租和雜貨費。」我當時真的很窮，」小林說，事發後她在醫院昏迷了三天。
Now 43, Kobayashi has written books on her mental health struggles and has a steady job at an NGO. But the coronavirus is bringing back the stress she used to feel.
現年43歲的小林已經寫書講述她的心理健康問題，並在一家非政府組織有一份穩定的工作。但是新冠疫情令她再次感受到以前的壓力。
"My salary was cut, and I cannot see the light at the end of the tunnel," she said. "I constantly feel a sense of crisis that I might fall back into poverty."
「我的工資被削減了，我看不到這一切的盡頭是否曙光，」她說。「我經常感到一種危機感：覺得自己可能會再次陷入貧困。」
Experts have warned that the pandemic could lead to a mental health crisis. Mass unemployment, social isolation, and anxiety are taking their toll on people globally.
專家警告說，新冠大流行病可能導致精神健康危機。大規模失業、社交孤立和焦慮正在給全球人民造成後果。
In Japan, government statistics show suicide claimed more lives in October than Covid-19 has over the entire year to date. The monthly number of Japanese suicides rose to 2,153 in October, according to Japan's National Police Agency. As of Friday, Japan's total Covid-19 toll was 2,087, the health ministry saiD.
在日本，政府統計數據顯示，10月份自殺死亡人數比一年來Covid-19死亡人數還要多。據日本警察廳（統計，10月份日本人每月自殺人數升至2153人。日本衛生部說，截至周五，日本Covid-19的總死亡人數為2087人。
Japan is one of the few major economies to disclose timely suicide data -- the most recent national data for the US, for example, is from 2018. The Japanese data could give other countries insights into the impact of pandemic measures on mental health, and which groups are the most vulnerable.
日本是為數不多的及時披露自殺數據的主要經濟體之一，拿美國來說，美國最新的國家數據是2018年的數據。日本的數據可以讓其他國家了解新冠大流行措施對心理健康的影響，以及了解哪些群體最脆弱。
"We didn't even have a lockdown, and the impact of Covid is very minimal compared to other countries ... but still we see this big increase in the number of suicides," said Michiko Ueda, an associate professor at Waseda University in Tokyo, and an expert on suicides.
「我們甚至沒有進行封鎖，與其他國家相比，新冠的影響其實非常小。。。但我們仍然看到自殺人數的大幅增加，」東京早稻田大學副教授、自殺問題專家上田美子說。
"That suggests other countries might see a similar or even bigger increase in the number of suicides in the future."
「這表明其他國家未來自殺人數可能會出現類似甚至更大的增長。」
Eriko Kobayashi has struggled with her mental health in the past. She says the pandemic has brought back intense fears of falling into poverty.
圖片：小林惠子過去一直在掙扎於自己的心理健康問題。她說，新冠大流行已給她重新帶來對陷入貧困的強烈恐懼感。
Covid's toll on women
新冠對女性的傷害
Japan has long struggled with one of the highest suicide rates in the world, according to the World Health Organization. In 2016, Japan had a suicide mortality rate of 18.5 per 100,000 people, second only to South Korea in the Western Pacific region and almost triple the annual global average of 10.6 per 100,000 people.
據世界衛生組織稱，日本長期以來都是世界上自殺率最高的國家之一。2016年，日本的自殺死亡率為每10萬人18.5人，僅次於西太平洋地區的韓國，幾乎是全球年平均每10萬人10.6人的三倍。
While the reasons for Japan's high suicide rate are complex, long working hours, school pressure, social isolation and a cultural stigma around mental health issues have all been cited as contributing factors.
雖然日本自殺率高的原因是複雜的，但長時間工作、學業壓力、社交孤立以及圍繞心理健康問題的文化汙名都被認為是促成因素。
But for the 10 years leading up to 2019, the number of suicides had been decreasing in Japan, falling to about 20,000 last year, according to the health ministry -- the lowest number since the country's health authorities started keeping records in 1978.
但據日本衛生部統計，在2019年之前的10年裡，日本自殺人數一直在下降，去年下降到約2萬人，這是該國衛生當局1978年開始保持記錄以來的最低數字。
The pandemic appears to have reversed that trend, and the rise in suicides has disproportionately affected women. Although they represent a smaller proportion of total suicides than men, the number of women taking their own lives is increasing. In October, suicides among women in Japan increased almost 83% compared to the same month the previous year. For comparison, male suicides rose almost 22% over the same time period.
但新冠大流行似乎扭轉了這一趨勢，女性中自殺率不成比例地上升。儘管她們在自殺總人數中所佔比例比男性小，但自殺的女性人數卻在增加。10月份，日本女性自殺率比去年同期增長了近83%。相比之下，同期男性自殺率上升了近22%。
There are several potential reasons for this. Women make up a larger percentage of part-time workers in the hotel, food service and retail industries -- where layoffs have been deep. Kobayashi said many of her friends have been laid off. "Japan has been ignoring women," she said. "This is a society where the weakest people are cut off first when something bad happens."
這有幾個潛在的原因。在酒店、食品服務和零售業，女性在兼職工人中所佔的比例更大，這些行業的失業率近來一直很高。小林說她的許多朋友都被解僱了。「日本一直忽視女性，」她說。「這是一個每有不好的事情發生時，最弱勢的人群會首先被裁掉的社會。」
In a global study of more than 10,000 people, conducted by non-profit international aid organization CARE, 27% of women reported increased challenges with mental health during the pandemic, compared to 10% of men.
在一項由非營利的國際援助組織CARE進行的全球研究中，報告顯示，在新冠大流行期間，27%的婦女精神健康方面的困難增加，而男性只有10%。
Compounding those worries about income, women have been dealing with skyrocketing unpaid care burdens, according to the study. For those who keep their jobs, when children are sent home from school or childcare centers, it often falls to mothers to take on those responsibilities, as well as their normal work duties.
研究顯示，女性一直面臨著不斷增加的無酬勞護理負擔，這加劇了人們對收入的擔憂。對於那些保住工作的人來說，當孩子們從學校或託兒所送回家時，這些責任和正常的工作職責通常都落在母親的肩上。
Increased anxiety about the health and well-being of children has also put an extra burden on mothers during the pandemic.
在新冠大流行期間，對兒童健康和福祉的日益焦慮也給母親帶來了額外的負擔。
Akari, a 35-year-old who did not want to use her real name, said she sought professional help this year when her premature son was hospitalized for six weeks. "I was pretty much worried 24 hours," Akari said. "I didn't have any mental illness history before, but I could see myself really, really anxious all the time."
35歲的阿卡裡不想使用自己的真名，她說她今年尋求專業心理幫助，因為她早產的兒子有六周在住院，「我24小時都在擔心，」阿卡裡說。「我以前沒有精神病史，但我一直明白自己非常非常焦慮。」
Her feelings got worse as the pandemic intensified, and she worried her son would get Covid-19.
隨著新冠大流行的加劇，她的情緒變得更糟，她也擔心兒子會感染Covid-19。
"I felt there was no hope, I felt like I always thought about the worst-case scenario," she said.
她說：「我覺得沒有希望了，我覺得我總是想著最壞的情況。」
"A Place for You"
「給你一席之地」
In March, Koki Ozora, a 21-year-old university student, started a 24-hour mental health hotline called Anata no Ibasho (A Place for You). He said the hotline, a nonprofit funded by private donations, receives an average of over 200 calls a day, and that the vast majority of callers are women.
今年3月，21歲的大學生括基－奧佐拉開通了一個24小時的心理健康熱線，名為Anata no Ibasho（一個適合你的地方）。他說，這條由私人捐款資助的非營利組織熱線，平均每天接到200多個電話，而且絕大多數電話都是女性。
"They lost their jobs, and they need to raise their kids, but they didn't have any money," Ozora said. "So, they attempted suicide."
「她們自己失業了，仍需要撫養孩子，但又沒有錢。」奧佐拉說。「所以，他們企圖自殺。」
Most of the calls come through the night -- from 10 p.m. to 4 a.m. The nonprofit's 600 volunteers live around the world in different timezones and are awake to answer them. But there aren't enough volunteers to keep up with the volume of messages, Ozora said.
大部分的電話都是晚上打來的——從晚上10點到凌晨4點。這家非營利性組織的600名志願者生活在世界不同的時區，他們醒著接聽電話。但奧佐拉說，沒有足夠的志願者跟上信息量。
University student Koki Ozora started a 24-hour mental health hotline staffed by volunteers in March. They now get more than 200 calls a day.
圖片：三月份，大學生Koki Ozora開通了一個由志願者組成的24小時心理健康熱線。他們現在每天接到200多個電話。
They prioritize the texts that are most urgent -- looking for keywords such as suicide or sexual abuse. He said they respond to 60% of texts within five minutes, and volunteers spend an average of 40 minutes with each person.
他們把最緊急的簡訊放在優先位置——尋找諸如自殺或性虐待之類的關鍵詞。他說，平均每個人發40分鐘的簡訊。
Anonymously, over online messaging, people share their deepest struggles. Unlike most mental health hotlines in Japan, which take requests over the phone, Ozora says many people -- especially the younger generation -- are more comfortable asking for help via text.
通過匿名的方式、通過在線信息方式，人們在分享他們最深的心路掙扎。奧佐拉說，與日本大多數心理健康熱線不同，許多人——尤其是年輕一代——更願意通過簡訊尋求幫助。
In April, he said the most common messages were from mothers who were feeling stressed about raising their kids, with some confessing to thoughts of killing their own children. These days, he says messages from women about job losses and financial difficulties are common -- as well as domestic violence.
四月份，他說，最常見的簡訊是來自那些對撫養孩子感到身心倦極的母親們，甚至有人坦白他們都有想殺死自己的孩子的想法。他說，這些天來，女性關於失業和經濟困難的信息很普遍，家庭暴力問題信息也很常見。
"I've been accepting messages, like 'I'm being raped by my father' or 'My husband tried to kill me,'" Ozora said. "Women send these kinds of texts almost every day. And it's increasing." He added that the spike in messages is because of the pandemic. Before, there were more places to "escape," like schools, offices or friend's homes.
「我一直在接受到這種信息，比如『我被父親強姦』或者『我丈夫想殺了我』，」奧佐拉說。「女人幾乎每天都發這種簡訊。而且信息量還在激增。」 他補充說是因為新冠大流行病的原因。以前，有更多的地方可以「逃離」這些不順心，比如學校、辦公室或朋友的家，而現在，女性們無處可逃地在遭受這些傷痛。
Pressure on children
對兒童的壓力
Japan is the only G-7 country where suicide is the leading manner of death for young people aged 15 to 39. And suicides among those under 20 had been increasing even before the pandemic, according to health ministry.
日本是七國集團中唯一一個15至39歲年輕人以自殺為主要死亡方式的國家。衛生部稱，20歲以下人群的自殺率甚至在新冠大流行之前就一直在增加。
As pandemic restrictions take children out of school and social situations, they're dealing with abuse, stressful home lives, and pressures from falling behind on homework, Ozora said. Some children as young as five years old had messaged the hotline, he added.
奧佐拉說，由於新冠大流行性病的限制，孩子們無法上學、也沒有社交，他們面臨著虐待、緊張的家庭生活和家庭作業落後帶來的壓力。他還說，甚至一些年僅5歲的孩子都給熱線發了簡訊。
School closures during the pandemic in the spring have contributed to homework piling up; kids also have less freedom to see friends, which is also contributing to stress, according to Naho Morisaki, of the National Center for Child Health and Development. The center recently conducted an internet survey of more than 8,700 parents and children and found that 75% of Japanese schoolchildren showed signs of stress due to the pandemic.
國家兒童健康與發展中心的Naho Morisaki說，春季新冠大流行期間學校關閉導致家庭作業積壓；孩子們見朋友的自由也減少，這也加劇了壓力。該中心最近對8700多名家長和兒童進行了一項網際網路調查，發現75%的日本學童因新冠大流行而表現出壓力。
Morisaki says he thinks there's a big correlation between the anxiety of children and their parents. "The children who are self-injuring themselves have the stress, and then they can't speak out to their family because probably they see that their moms or dads are not able to listen to them."
森崎駿說，他認為孩子的焦慮和他們的父母有很大的關聯。「自殘的孩子有這種壓力，而且他們還不能和家人說出這種壓力，因為他們可能也只能看到他們的父母聽不進去的結果。」
Stigma of solving the problem
解決問題的恥辱感
In Japan, there is still a stigma against admitting loneliness and struggle. Ozora said it's common for women and parents to start the conversation with his service with the phrase: "I know it's bad to ask for help, but can I talk?"
在日本，承認孤獨和困境掙扎仍然是一種恥辱。奧佐拉說，女性和家長們在與他的心理服務開始對話時通常都會說：「我知道尋求幫助是不好的，但我能談談嗎？」
Ueda says the "shame" of talking about depression often holds people back.
Ueda說，談論抑鬱症的「羞恥感」常常使人們退縮。
"It's not something that you talk about in public, you don't talk about it with friends or anything," she said. "(It) could lead to a delay in seeking help, so that's one potential cultural factor that we have in here."
「這不是你在公共可以場合談論的事情，你不會和朋友談論這件事或任何事情，」她說。「（這）可能導致人們延遲尋求幫助，因此這是我們這裡存在的一個潛在的文化因素。」
When I lived in America, I knew people who went through therapy, and it's a more common thing to do, but in Japan it's very difficult，－Akari
當我在美國生活時，我認識一些接受過心裡治療的人，這是一件比較常見的事情，但在日本，心裡治療就非常困難，－阿卡裡
Akari, the mother of the premature baby, agrees. She had previously lived in the US, where she says it seems easier to seek help. "When I lived in America, I knew people who went through therapy, and it's a more common thing to do, but in Japan it's very difficult," she said.
早產嬰兒的母親Akari對此表示同意。她以前生活在美國，她說在那裡尋求心理幫助似乎更容易。「當我在美國生活時，我認識一些接受過治療的人，這是一件比較常見的事情，但在日本，這種治療非常困難，」她說。
Following the financial crisis in the 1990s, Japan's suicide rate surged to a record high in 2003, when roughly 34,000 people took their own lives. Experts say the shame and anxiety from layoffs, of mostly men at the time, contributed to depression and increased suicide rates. In the early 2000s, the Japanese government accelerated investment and efforts around suicide prevention and survivor support, including passing the Basic Act for Suicide Prevention in 2006 to provide support to those affected by the issue.
上世紀90年代的金融危機之後，日本的自殺率在2003年飆升至歷史最高水平，當時約有3.4萬人自殺。專家們說，裁員帶來的羞恥感和焦慮感是導致抑鬱和自殺率上升的主要原因。在21世紀初，日本政府加快了圍繞自殺預防和倖存者支持的投資和努力，包括在2006年通過了《防止自殺基本法案》，向受自殺影響的人提供支持。
But both Ozora and Kobayashi say it has not been nearly enough: reducing the suicide rate requires Japanese society to change.
但小澤和小林都表示，這還遠遠不夠：降低自殺率需要日本社會做出改變。
"It's shameful for others to know your weakness, so you hide everything, hold it in yourself, and endure," Kobayashi said. "We need to create the culture where it's OK to show your weakness and misery."
「讓別人知道你的軟弱是很可恥的事情，所以你通常會把一切藏在心裡，自己獨自消化、獨自承受，「小林說：「我們需要創造一種文化，那就是讓人們知道你的弱點和痛苦是完全可以且正常的。」
Celebrity suicides
名人自殺
A succession of Japanese celebrities have taken their lives in recent months. While the Japanese media rarely details the specifics of such deaths -- deliberately not dwelling on method or motive -- the mere reporting on these cases often causes an increase in suicide in the general public, according to experts such as Ueda.
最近幾個月接連有日本名人自殺。雖然日本媒體很少詳細說明這類死亡事件的具體細節，但據Ueda等專家稱，僅僅報導這些案件都往往會導致普通民眾自殺人數的增加。
Hana Kimura, a 22-year-old professional wrestler and star of the reality show "Terrace House," died by suicide over the summer, after social media users bombarded her with hateful messages. Hana's mother, Kyoko Kimura, says she was conscious that media reports on her daughter's death may have affected others who were feeling suicidal.
22歲的職業摔跤手、真人秀《露臺屋》的主演Hana Kimura在社交媒體用戶用仇恨的信息對她狂轟濫炸之後，於今年夏天自殺身亡。Hana的母親木村京子（Kyoko Kimura）說，她意識到媒體對她女兒死亡的報導可能影響到了其他有自殺傾向的人。
Kyoko Kimura says coronavirus restrictions prevented her daughter, Hana, from wrestling. Hana became overwhelmed by negative comments on social media and subsequently took her own life.
圖片：木村京子說，新冠病毒的限制使她的女兒Hana無法摔跤。Hana被社交媒體上的各種負面評論淹沒，隨後自殺。
"When Hana died, I asked the police repeatedly not to disclose any concrete situation of her death, but still, I see the reporting of information only the police knew," Kimura said. "It's a chain reaction of grief."
「當Hana死後，我一再要求警方不要透露她死亡的任何具體情況，但我還是看到了只有警方才應該知道的信息報告，」木村說。「這是悲傷連鎖反應。」
Kimura said the pandemic led her daughter to spend more time reading toxic social media messages, as she was unable to wrestle because of coronavirus restrictions. Kimura is now setting up an NGO called "Remember Hana" to raise awareness about cyberbullying.
木村說，新冠大流行導致她的女兒花更多的時間去閱讀那些有毒的社交媒體信息，因為新冠病毒的限制她無法去參加各種摔跤活動。木村現在正在成立一個名為「記住Hana」的非政府組織，以提高人們對網絡欺凌的認識。
"She found her reason to live by fighting as a professional wrestler. It was a big part of her. She was in a really tough situation as she could not wrestle," Kimura said. "The coronavirus pandemic made society more suffocating."
」她找到了作為一名職業摔跤手而生活的理由。這是她很大的一部分人生。她當時處境非常艱難，因為她不能摔跤，」木村說。「而新冠病毒大流行使得這個社會更加令人窒息。」
Professional wrestler Hana Kimura took her own life over the summer.
圖片：職業摔跤手Hana Kimura在夏天自殺了。
The third wave
第三波
In recent weeks, Japan has reported record-high daily Covid-19 cases, as doctors warn of a third wave that could intensify in the winter months. Experts worry that the high suicide rate will get worse as the economic fallout continues.
最近幾周，日本報告了創紀錄的日均Covid-19病例，醫生警告說，第三波可能在冬季加劇。專家們擔心，隨著經濟影響的持續，高自殺率會變得更糟。
"We haven't even experienced the full economic consequences of the pandemic," Ueda said. "The pandemic itself can get worse, then maybe there's a semi-lockdown again; if that happens, then the impact can be huge."
「我們甚至還沒有經歷新冠大流行帶來的全部經濟後果，」Ueda說。"新冠大流行本身可能會變得更糟，然後可能會再次出現半封閉狀態；如果發生這種情況，那麼這一影響可能是巨大的。」
Compared with some other nations, Japan's coronavirus restrictions have been relatively relaxed. The country declared a state of emergency but has never imposed a strict lockdown, for example, and its quarantine restrictions for international arrivals have not been as unbending as those in China.
與其他一些國家相比，日本對新冠病毒的限制相對寬鬆。例如，該國宣布進入緊急狀態，但從未實施過嚴格的封鎖，而且其對國際入境者的檢疫限制也不像在中國等國家那樣一成不變。
But as cases rise, some worry harsher restrictions will be needed -- and are concerned about how that could affect mental health.
但隨著病例的增加，一些人擔心將需要更嚴格的限制，並擔心這會對精神健康產生怎樣的影響。
"We didn't even have a lockdown, and the impact of Covid is very minimal compared to other countries ... but still we see this big increase in the number of suicides," Ueda said. "That suggests other countries might see a similar or even bigger increase in the number of suicides in the future."
「我們甚至沒有實施封鎖，與其他國家相比，新冠的影響非常小。。。但我們仍然看到自殺人數的大幅增加這表明，其他國家未來自殺人數可能會出現類似甚至更大的增長。」
Despite having to deal with a salary cut and constant financial insecurity, Kobayashi says she is now much better at managing her anxiety. She hopes that by speaking publicly about her fears, more people will do the same and realize they are not alone, before it's too late.
小林說，儘管不得不面對減薪和持續的經濟不安全感，但她現在能更好地控制自己的焦慮。她希望通過公開談論她的恐懼，會有更多的人也這樣做，並得以意識到他們並不是獨自在掙扎，以免為時已晚。
"I come out to the public and say that I have been mentally ill and suffered from depression in the hope that others might be encouraged to speak out," Kobayashi said. "I am 43 now and life starts to get more fun in the middle of my life. So, I feel it's good that I am still alive."
「我對公眾說，我有精神病，患有抑鬱症，希望能鼓勵其他人說出來，」小林說。「我現在43歲了，人生可以在我的中年開始變得更加有趣。所以，我覺得自己仍然活著還是很美好。」