Research report
Coping behaviors in relation to depressive symptoms and suicidal ideation among middle-aged workers in Japan

https://doi.org/10.1016/j.jad.2012.05.011Get rights and content

Abstract

Background

In Japan, the annual number of deaths by suicide markedly increased in 1998 and leveled off at approximately 30,000 per year thereafter. The coping behaviors used to deal with stress may have implications for the prevention of depression and suicidal ideation. This study examined coping behaviors in relation to depression and suicidal ideation.

Methods

In this cross-sectional study, a total of 6762 workers (40–60 years of age; 4119 males and 2643 females) completed both the Center for Epidemiologic Studies Depression scale (CES-D) and a questionnaire measuring suicidal ideation. A cut-off score of 19 was used to define probable depression for the CES-D. Stress-coping behaviors were surveyed via an inventory of 14 items that reflected of actual behaviors covering problem-focused, emotion-focused, and avoidant strategies.

Results

In relation to depression, logistic regression analyses revealed that in both genders, the highest odds ratios (OR) for avoidant coping strategy and the lowest OR was associated with a problem-focused strategy after adjusting for covariates. After making the same adjustments, logistic regression analyses revealed that in both genders, the highest OR were for emotional distraction coping strategies in relation to suicidal ideation.

Limitations

The cross-sectional nature of this study does not allow for causal assumptions regarding the sequential nature of the relationship between coping behaviors and the onset of depressive symptoms or suicidal ideation.

Conclusions

These findings indicate that coping behaviors may affect both depressive symptoms and suicidal ideation. Furthermore, gender differences in coping behaviors among middle-aged workers were identified. Additional studies are needed to examine the relationships among coping behaviors, depression and suicidal ideation using a longitudinal design.

Introduction

In Japan, the annual number of deaths by suicide markedly increased in 1998 and leveled off at approximately 30,000 per year thereafter (Ministry of Health, Labor and Welfare, Japan, 2005). During this period, the increase was especially remarkable among individuals in their 40 s to 60 s and became a grave public health issue (Kawakami, 2003). In particular, the increased incidence of suicide among the middle aged population in Japan caused the largest drop of average male life expectancy since the Second World War.

Both the degree and recency of stress have been shown to be significant predictors of suicidal ideation (Huff, 1999). Coping behaviors are potentially important as both moderators and mediators in the bidirectional relationship of psychosocial stress with depression and suicidal ideation (Seiffge-Krenke, 2004). Coping has been described as a process in which cognitive or behavioral strategies are developed to manage specific internal and/or external sources of psychological stress (Folkman and Lazarus, 1980, Folkman et al., 1986).

The most widely used categories of coping are problem-solving, emotional distraction, and avoidant strategies (Compas et al., 2001, Endler and Parker, 1990). A problem-solving strategy is one in which an individual takes action to change the circumstances that are causing stress; an emotional distraction strategy is one in which an individual works to alter their own experience of negative emotion that results from a stressful source; and an avoidant strategy is one in which an individual works to orient himself/herself away from the source of stress.

Previous studies have shown that although some coping behaviors are associated with successful outcomes, others are not (Kohn et al., 1994, Ravindran et al., 1996, Roy-Byrne et al., 1980, Whatley et al., 1998). Failure to cope with or adjust to stress may cause mental problems (Folkman et al., 1986). Further studies are needed to evaluate the relative contributions of coping behaviors to depressive symptoms and suicidal behaviors within clinical populations and the community in general. To the best of our knowledge, there have been no studies of the link between coping behaviors and suicidal tendencies among a middle-aged population in Japan.

The objectives of this investigation were (1) to evaluate the relationship of coping behaviors to depressive symptoms and suicidal ideation among middle-aged workers and (2) to examine the gender specific contributions of coping behaviors in the prediction of depressive symptoms and suicidal ideation.

Section snippets

Participants

The present study was a part of the survey conducted by the Aomori Occupational Health Promotion Center in 2004. The current study is a cross-sectional study of middle-aged workers (40–60 years of age) who were recruited from companies in the Aomori Prefecture. In total, 6762 workers (4119 men and 2643 women) from 764 randomly selected companies participated.

The investigation was approved by the Aomori Occupational Health Promotion Center and as part of the prefecture enterprise. Informed

Characteristics of participants

Using a score of 19, identified by Wada et al. (2007) as the optimal cut-off point for identifying possible cases of depression among working individuals, the frequency of probable clinical depression in the current sample was 24.2% in males (n=998) and 25.4% in females (n=671) (p>0.05). Overall, the mean CES-D score was 14.2±7.8 for males and 14.5±7.8 for females (p>0.05). Table 1 shows the responses to the item “Have you ever been severely depressed and thought about suicide?” among

Discussion

The present study assessed the relationship between coping behaviors and depressive symptoms as measured by the CES-D and suicidal ideation among middle-aged workers in Japan. We found various types of gender differences with respect to the prevalences of coping behaviors for each type of strategy. About the Problem-solving strategy, “Making plans to take time off” had a higher prevalence in males than in females. Among the emotion-focused strategies, “Engaging himself/herself in leisure

Role of funding source

Funding for this study was provided by the Hirosaki Research Institute for the neurosciences; the Hirosaki Research Institute for the neurosciences had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

All of the authors read and approved the manuscript. None of the authors had a conflict of interest.

Acknowledgments

We are grateful to all of the volunteers who participated in this study. The authors would also like to express their gratitude to Dr. Hiroichi Tasaki for his help with this study.

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