OJPM  Vol.5 No.2 , February 2015
Self-Efficacy as a Suicidal Ideation Predictor: A Population Cohort Study in Rural Japan
Background: Self-efficacy has been widely studied in suicide, both in its causality and treatment effects. However, the evidence of causality is still ambiguous and there is a lack of generalizability. The aim of this study was to examine the relationship between self-efficacy and suicidal ideation through a population cohort study. Methods: The community-based household survey using a self-administered questionnaire was conducted in a rural area of Japan, Happo Town, in Akita Prefecture with community residents aged 30 and over at two respective time points by local health volunteers. The baseline survey was conducted in 2010 with a response rate of 88.9% (n = 6044). Among them, 3812 residents met the inclusion criteria for the follow-up survey in 2012 where the response rate was 75.3% (n = 2869). Exposure variables to suicidal ideation included demographic details, depression and self-efficacy. The Institutional Review Board and the Ethics Committee of Akita University approved the study protocol and all subjects signed informed consent. Results: A total number of 2105 participants (76.4%) without suicidal ideation in the baseline study were enrolled into the follow-up study, and 8.2% of them had developed suicidal ideation. These participants with suicidal ideation were significantly less likely to be married/cohabitant; they had worse subjective health, poorer self-perceived economic status, stronger depressive mood, and lower self-efficacy scores. The odds ratio of the self-efficacy scores at follow-up survey for participants who had developed suicidal ideation were about 2 times lower than at baseline (95% confidence interval = 1. 53 - 3.06). After adjusting for all confounding factors, the association was still significant (OR = 1.66, 95% CI = 1.15 - 2.42). Conclusion: This result suggests that suicidal ideation may be prevented by increasing self-efficacy. We suggest that self-efficacy can be an effective tool for identifying people with suicidal ideation, and increasing self-efficacy can be strategically beneficial for larger suicide prevention.

Cite this paper
Kobayashi, Y. , Fujita, K. , Kaneko, Y. and Motohashi, Y. (2015) Self-Efficacy as a Suicidal Ideation Predictor: A Population Cohort Study in Rural Japan. Open Journal of Preventive Medicine, 5, 61-71. doi: 10.4236/ojpm.2015.52007.
[1]   World Health Organization (WHO) (2014) Preventing Suicide: A Global Imperative.

[2]   Cabinet Office, Government of Japan (2014) The White Paper on Suicide Prevention Policy 2014. (In Japanese)

[3]   Ministry of Health, Labour and Welfare (2010) Vital Statistics of Japan 2010. Health and Welfare Statistics Association, Tokyo.

[4]   Japan National Police Agency Traffic Bureau (2014) The Outbreak Situation Of A Traffic Accident in 2013. (In Japanese)

[5]   Cavanagh, J.T., Carson, A.J., Sharpe, M. and Lawrie, S.M. (2003) Psychological Autopsy Studies Of Suicide: A Systematic Review. Psychological Medicine, 33, 395-405.

[6]   Sirey, J.A., Bruce, M.L., Alexopoulos, G.S. and Perlick, D.A. (2001) Stigma as a Barrier to Recovery: Perceived Stigma and Patient-Rated Severity of Illness as Predictors of Antidepressant Drug Adherence. Psychiatric Services, 52, 1615-1620.

[7]   Livingston, J.D. and Boyd, J.E. (2010) Correlates and Consequences of Internalized Stigma for People Living with Mental Illness: A Systematic Review and Meta-Analysis. Social Science &Medicine, 71, 2150-2161.

[8]   Ando, S., Yamaguchi, S., Aoki, Y. and Thornicroft, G. (2013) Review of Mental-Health-Related Stigma in Japan. Psychiatry ClinNeurosci, 67, 471-482.

[9]   Cutrona, C.E. and Troutman, B.R. (1986) Social Support, Infant Temperament, and Parenting Self-Efficacy: A Mediational Model of Postpartum Depression. Child Development, 57, 1507-1518.

[10]   Ehrenberg, M.F., Cox, D.N. and Koopman, R.F. (1991) The Relationship between Self-Efficacy and Depression in Adolescents. Adolescence, 26, 361-374.

[11]   McFarlane, A.H., Bellissimo, A. and Norman, G.R. (1995) The Role of Family and Peers in Social Self-Efficacy: Links to Depression in Adolescence. American Journal of Orthopsychiatry, 65, 402-410.

[12]   Maciejewski, P.K., Prigerson, H.G. and Mazure, C.M. (2000) Self-Efficacy as a Mediator between Stressful Life Events and Depressive Symptoms Differences Based on History of Prior Depression. The British Journal of Psychiatry, 176, 373-378.

[13]   Rothmann, S. and van Rensburg, P. (2002) Psychological Strengths, Coping and Suicide Ideation in the South African Police Services in the North West Province. SA Journal of Industrial Psychology, 28, 39-49.

[14]   Valois, R.F., Zullig, K.J. and Hunter, A.A. (2013) Association between Adolescent Suicide Ideation, Suicide Attempts and Emotional Self-Efficacy. Journal of Child and Family Studies, 24, 237-248.

[15]   Jongen, P.J., Ruimschotel, R., Heerings, M., Hussaarts, A., Duyverman, L., van der Zande, A., et al. (2014) Improved Self-Efficacy in Persons with Relapsing Remitting Multiple Sclerosis after an Intensive Social Cognitive Wellness Program with Participation of Support Partners: A 6-Months Observational Study. Health and Quality of Life Outcomes, 12, 40.

[16]   Hyun, M.S., Chung, H.I. and Lee, Y.J. (2005) The Effect of Cognitive-Behavioral Group Therapy on the Self-Esteem, Depression, and Self-Efficacy of Runaway Adolescents in a Shelter in South Korea. Applied Nursing Research, 18, 160-166.

[17]   Nash, V.R., Ponto, J., Townsend, C., Nelson, P. and Bretz, M.N. (2013) Cognitive Behavioral Therapy, Self-Efficacy, and Depression in Persons with Chronic Pain. Pain Management Nursing, 14, e236-e243.

[18]   Pasha, H., Faramarzi, M., Esmailzadeh, S., Kheirkhah, F. and Salmalian, H. (2013) Comparison of Pharmacological and Nonpharmacological Treatment Strategies in Promotion of Infertility Self-Efficacy Scale in Infertile Women: A Randomized Controlled Trial. Iranian Journal of Reproductive Medicine, 11, 495-502.

[19]   Czyz, E.K., Bohnert, A.S., King, C.A., Price, A.M., Kleinberg, F. and Ilgen, M.A. (2014) Self-Efficacy to Avoid Suicidal Action: Factor Structure and Convergent Validity among Adults in Substance Use Disorder Treatment. Suicide and Life Threatening Behavior, 44, 698-709.

[20]   Kessler, R.C., Andrews, G., Colpe, L.J., Hiripi, E., Mroczek, D.K., Normand, S.L., et al. (2002) Short Screening Scales to Monitor Population Prevalences and Trends in Non-Specific Psychological Distress. Psychological Medicine, 32, 959-976.

[21]   Kessler, R.C., Barker, P.R., Colpe, L.J., Epstein, J.F., Gfroerer, J.C., Hiripi, E., et al. (2003) Screening for Serious Mental Illness in the General Population. Archives of General Psychiatry, 60, 184-189.

[22]   Kessler, R.C., Green, J.G., Gruber, M.J., Sampson, N.A., Bromet, E., Cuitan, M., et al. (2010) Screening for Serious Mental Illness in the General Population with the K6 Screening Scale: Results from the WHO World Mental Health (WMH) Survey Initiative. International Journal of Methods in Psychiatric Research, 19, 4-22. http://dx.doi.org/10.1002/mpr.310

[23]   Furukawa, T.A., Kawakami, N., Saitoh, M., Ono, Y., Nakane, Y., Nakamura, Y., et al. (2008) The Performance of the Japanese Version of the K6 and K10 in the World Mental Health Survey Japan. International Journal of Methods in Psychiatric Research, 17, 152-158.

[24]   Schwarzer, R. (1992) Self-Efficacy: Thought Control of Action. Hemisphere, Washington DC.

[25]   Schwarzer, R. and Jerusalem, M. (1995) Generalized Self-Efficacy scale. In: Weinman, J., Wright, S. and Johnston, M., Eds., Measures in Health Psychology: A User’s Portfolio. Causal and Control Beliefs, NFER-NELSON, Windsor, 35-37.

[26]   Malfent, D., Wondrak, T., Kapusta, N.D. and Sonneck, G. (2010) Suicidal Ideation and Its Correlates among Elderly in Residential Care Homes. International Journal of Geriatric Psychiatry, 25, 843-849. http://dx.doi.org/10.1002/gps.2426

[27]   Viner, R., Patten, S.B., Berzins, S., Bulloch, A.G. and Fiest, K.M. (2014) Prevalence and Risk Factors for Suicidal Ideation in a Multiple Sclerosis Population. Journal of Psychosomatic Research, 76, 312-316. http://dx.doi.org/10.1016/j.jpsychores.2013.12.010

[28]   Coon, D.W., Thompson, L., Steffen, A., Sorocco, K. and Gallagher-Thompson, D. (2003) Anger and Depression Management: Psychoeducational Skill Training Interventions for Women Caregivers of a Relative with Dementia. The Gerontologist, 43, 678-689. http://dx.doi.org/10.1093/geront/43.5.678

[29]   Trouillet, R., Gana, K., Lourel, M. and Fort, I. (2009) Predictive Value of Age for Coping: The Role of Self-Efficacy, Social Support Satisfaction and Perceived Stress. Aging and Mental Health, 13, 357-366. http://dx.doi.org/10.1080/13607860802626223

[30]   Howell, E.A., Mora, P.A., DiBonaventura, M.D. and Leventhal, H. (2009) Modifiable Factors Associated with Changes in Postpartum Depressive Symptoms. Archives of Women’s Mental Health, 12, 113-120. http://dx.doi.org/10.1007/s00737-009-0056-7

[31]   Chang, Y., Wang, P.C., Li, H.H. and Liu, Y.C. (2011) Relations among Depression, Self-Efficacy and Optimism in a Sample of Nurses in Taiwan. Journal of Nursing Management, 19, 769-776.

[32]   Sawatzky, R.G., Ratner, P.A., Richardson, C.G., Washburn, C., Sudmant, W. and Mirwaldt, P. (2012) Stress and Depression in Students: The Mediating Role of Stress Management Self-Efficacy. Nursing Research, 61, 13-21.

[33]   Naganuma, Y., Tachimori, H., Kawakami, N., Takeshima, T., Ono, Y., Uda, H., et al. (2006) Twelve-Month Use of Mental Health Services in Four Areas in Japan: Findings from the World Mental Health Japan Survey 2002-2003. Psychiatry and Clinical Neurosciences, 60, 240-248.

[34]   Waza, K., Graham, A.V., Zyzanski, S.J. and Inoue, K. (1999) Comparison of Symptoms in Japanese and American Depressed Primary Care Patients. Family Practice, 16, 528-533.

[35]   Schreiner, A.S., Hayakawa, H., Morimoto, T. and Kakuma, T. (2003) Screening for Late Life Depression: Cut-Off Scores for the Geriatric Depression Scale and the Cornell Scale for Depression in Dementia among Japanese Subjects. International Journal of Geriatric Psychiatry, 18, 498-505.