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

Abstract

Purpose: 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. In the 10-year follow-up questionnaire, subjects aged 50-79 years were asked how they handle daily problems. Coping behaviors were used to determine two coping strategies (approach coping and avoidance coping). 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: Two coping behaviors were significantly associated with suicide over time: planning (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.41-0.98) and self-blame (HR, 2.20; 95% CI, 1.29-3.76). Of the coping strategies, only the avoidance coping strategy was significantly associated with suicide (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.

Keywords: Approach; Avoidance; Coping; Japan; Planning; Self-blame; Suicide.