Coping behaviors and suicide in the middle-aged and older Japanese general population: the Japan Public Health Center-based Prospective Study

Svensson, Thomas

Coping behaviors and suicide in the middle-aged and older Japanese general population: the Japan Public Health Center-based Prospective Study

Tuesday, 19 August 2014

Exhibit hall (Dena'ina Center)

Thomas Svensson, MD , Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan

Manami Inoue, PhD , Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan

Hadrien Charvat, PhD , Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan

Norie Sawada, PhD , Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan

Motoki Iwasaki, PhD , Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan

Shizuka Sasazuki, PhD , Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan

Taichi Shimazu, PhD , Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan

Taiki Yamaji, PhD , Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan

Ai Ikeda, PhD , Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan

Noriyuki Kawamura, PhD , Gyokikai Medical Corporation, Tokyo, Japan

Masaru Mimura, PhD , Keio University School of Medicine, Tokyo, Japan

Shoichiro Tsugane, PhD , Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan

INTRODUCTION: Cross-sectional studies have shown an association between different coping styles and suicidal behavior. It is unknown whether there is any prospective association between coping behaviors and suicide in the general population.

METHODS: The study population consisted of participants of the Japanese Public Health Center-based prospective study (JPHC Study). In the 10-year follow-up questionnaire, subjects aged 50-79 were asked how they handle daily problems. Coping behaviors were used to determine two coping strategies (approach coping and avoidance coping). Out of 99,439 subjects that returned the 10-year follow-up questionnaire, 70,213 subjects provided complete answers on coping and were included in our analyses. Cox regression models, adjusted for confounders, were used to determine the risk of committing suicide according to coping style. Mean follow-up time was 8.8 years.

RESULTS: During 620,026 person-years of follow-up, 172 suicides occurred. Age-standardized suicide rates (as per 100 000 individuals) of our entire study population, males and females were 26.8, 38.8 and 16.2 respectively.
The coping behaviors adopted by the highest and lowest proportion of participants were positive reappraisal (22.9%) and avoidance (4.0%). Planning was used mostly by men, with the remaining coping behaviors used predominantly by women. The avoidance coping strategy was significantly more likely to be adopted by women, and the approach coping strategy used to an equal extent by both men and women.
Two coping behaviors were significantly associated with suicide over time: planning (HR=0.64, 95% CI, 0.41, 0.98), and self-blame (HR=2.20, 95% CI, 1.29, 3.76).
For the two coping strategies, the association with suicide was inverse for approach oriented coping (HR=0.64, 95% CI, 0.38, 1.06), and significant positive for avoidance coping (HR=2.45, 95% CI, 1.24, 4.85).

CONCLUSIONS: For the first time two coping behaviors and one coping strategy have been shown to have a significant prospective association with suicide in a general population.