In Japan, deaths from suicide declined during the early phase of the COVID-19 pandemic but later increased, especially among women and people younger than 40 years [1]. Depression and hopelessness are key predictors of suicidal ideation and behavior [2,3].

Recently, ikizurasa (“pain of living”) has drawn attention as a factor in adolescent mental health issues, including hikikomori (“being confined,” a term used to describe deep social isolation) and suicide [4]. Ikizurasa was defined by the Japanese Neuropsychiatric Society as “impairment and suppression of independent social relationship formation.” It has also been described as involving solitude, anxiety, low self-esteem, hopelessness, and anger [5]. However, quantitative research focusing on ikizurasa remains scarce.

Social media behavior has been linked to mental health, particularly among youth. A cross-sectional study in Japan found that posting phrases like “want to die” on X (formerly Twitter) was significantly associated with suicidal thoughts and behaviors [6]. A meta-analysis also reported that frequent social media and smartphone use correlates with suicidal tendencies [7].

This study aimed to examine how often ikizurasa was expressed and when these expressions peaked on X in Japan, which has the second-largest X user base after the United States. In 2023, X was used by 65.7% of teenagers, and 81.6% of people in their 20s—much higher rates than among older generations or on other platforms [8]. As X allows anonymous, text-based posting, it offers a space where users may express their emotional distress openly.

In 2023, 1,399,746 posts mentioned ikizurasa; 397,517 were organic (ie, excluding reposts or quotes). Figure 1 shows the daily number of posts. The overall average was 3835, with a peak of 26,063 on April 29. Organic posts averaged 1089, peaking at 3414 on July 13, with another peak in late February.

On April 28, an interview article titled “Difficulties in Life as a Minority” [9] was published, reporting on the experiences of discrimination of an ethnically Uyghur member of the House of Representatives, Eri Arfiya, and many X users mentioned the article. On July 12, the news of the death (by presumed suicide) of a well-known transgender celebrity, Ryuchell, was shared with the X community. Many mentioned the news by discussing ikizurasa as a transgender person and expressing their shock at Ryuchell’s sudden death that day.

The late February peak was triggered by a post from a US celebrity in Japan, who noted that the lack of English on train tickets may cause foreigners to feel ikizurasa.

Table 1 shows the age distribution of the X users who posted using the term ikizurasa. Most users who posted ikizurasa were in their 20s and 30s.

This study aimed to examine the frequency and timing of posts using the term ikizurasa on X in Japan, where the platform is particularly popular among younger generations. Our results showed that over 1.3 million posts containing the term ikizurasa were recorded in 2023, with notable peaks in late April and mid-July. These peaks appeared to coincide with news events involving ethnic and gender minorities, suggesting that expressions of ikizurasa may be linked to the stress of being part of a minority group.

Previous studies have documented strong associations between minority status—such as ethnicity or gender—and poor mental health outcomes [10,11]. Consistent with this literature, our findings indicate that individuals from minority backgrounds may be more likely to experience and publicly express feelings of ikizurasa, reflecting psychological distress tied to discrimination and marginalization.

This study has limitations. It focused only on posts using specific Japanese terms, possibly excluding other expressions of distress. As the analysis relied on public social media data, user authenticity, intent, and demographics could not be verified, limiting interpretation.

Even so, the findings suggest that social media can serve as a real-time indicator of psychological distress, especially among younger and marginalized groups. Integrating such monitoring into public health strategies may help detect emerging mental health issues and support timely, targeted responses.