健康支援
第19巻2号

157‑165，2017

日本の大学一年生に見られる自殺願望―SOC および親や親しい友人との関係との関連性―
Nadzirah Ahmad Basri １, ２，本田 貴紀３, ４，陳Atin Supartini １，平野（小原） 裕子６，一宮

三妹５

厚７，熊谷 秋三１, ７

A wish to die among Japanese university freshmen: its association withthe sense of coherence and relationship with parents and close friends
Nadzirah Ahmad Basri １, ２，Takanori Honda ３, ４，Sanmei Chen ５Atin Supartini １，Yuko O. Hirano ６，Atsushi Ichimiya ７，Shuzo Kumagai １, ７
抄録
背景：日本の若年層の死因第一位は自殺である。このため自殺願望に関連した要因を特定することは、自殺の早期予防に対する手掛かりとなる。
目的：本研究の目的は、わが国の大学一年生を対象として、SOC（sense of coherence: 首尾一貫感覚）や、親や親しい友人との関係が、抑うつ症状とは独立して自殺願望と関係するか否かを明らかにすることである。
方法：わが国のある国立大学で一年生を対象に実施されたメンタルヘルス研究における横断データを使用し（n ＝2,036）、SOC、親との関係、親しい友人の有無と、自殺願望との関連を、多重ロジスティック回帰分析を行い検討した。
結果： SOC が高いほど自殺願望を有する確率は低く、その関係は抑うつ症状とは独立していた。同様に、親との関係が良好であると自殺願望を持つ確率が低く、また親しい友人がいないと確率が高くなった。
結論：自殺する恐れのある生徒を学校医が特定するために、SOC スケールが有用である可能性が示唆された。また、学生の対人スキルの強化や親との関係性改善も自殺願望を防止するうえで重要である。
キーワード：自殺願望、自殺、日本人新入生、SOC、抑うつ症状
1 Department of Behavioral and Health Sciences, Graduate School of Human-Environment Studies, Kyushu University, 6-1 Kasuga kouen, Kasuga City,
Fukuoka Prefecture 816-8580, Japan.
nadzirahbasri@gmail.com
zamzabila@hotmail.com
2 Department of Psychiatry, Kulliyyah of Medicine, International Islamic University Malaysia, Jalan Hospital, 25100 Kuantan, Pahang, Malaysia.
nadzirahbasri@gmail.com
3 Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka City,
Fukuoka Prefecture 812-8582, Japan.
4 Research Fellow of the Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan.
honda-t@eph.med.kyushu-u.ac.jp
5 Xiangya Nursing School of Central South University, 172 Tongzipo Road, Changsha, Hunan, 410013, China
sanmei.chen@kyudai.jp
6 Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8520 Japan.
hirano@nagasaki-u.ac.jp
7 Faculty of Arts and Science, Kyushu University, 6-1 Kasuga kouen, Kasuga City, Fukuoka Prefecture 816-8580, Japan.
ichimiya@artsci.kyushu-u.ac.jp
shuzo@ihs.kyushu-u.ac.jp
Corresponding author:Shuzo Kumagai, PhD, Professor
Faculty of Arts and Science, Kyushu University, 6-1, Kasuga-kouen, Kasuga, Fukuoka, 816-0811 JAPAN.
Phone: +81-92-583-7853 Fax: +81-92-583-7853 Email address: shuzo@ihs.kyushu-u.ac.jp

157

健康支援
第19巻2号

157‑165，2017

Introduction

die among freshmen at the transition of just entering

Suicide is a major public health concern in Japan. It

university in order to understand them better.

was the leading cause of death for youths in the age

Threats to university studentsʼ sense of having a co-1）

herent self in relationship to the world have been pos-with 7 . 3 deaths by suicide per 100 , 000 for youths aged

tulated to play an important role in the development

15 - 19 , and 19 . 7 per 100 , 000 for youths aged 20 - 24 .

of suicidal thoughts and behaviors. 11） The Sense of

Meanwhile in the United States, adolescents and young

Coherence（SOC）was also found to buffer the associa-

adults aged between 15 - 24 years had a suicide rate oftions among coping style, suicide ideation, self-reported

11 . 6 deaths per 100 , 000 US Americans in 2014 . 2） The

suicide attempts, and self-reported likelihood of futuremagnitude of the suicidal phenomenon among Japanesesuicidal behavior among university students. 12） Ac-

youths requires a better understanding of the charac-

cording to Anotnovsky, 13） SOC is a global orientation

teristics of youths with suicidal tendencies, in order tothat reflects a personʼ s coherent understanding of thefind more effective solutions to prevent and reduce sui-world which comprises of three components: the ability

cidal thoughts and behaviors.

for people to understand what happens around themIn the literature, the term “wish to die” has been de-（comprehensibility）, to what extent they were able toscribed to be encompassed under the broad spectrum

manage the situation on their own or through signif-of suicide（ranging from a wish to die, to suicidal

icant others in their social network（manageability）,

ideation, suicidal plans, suicide attempts, and suicide

and the ability to find meaning in the situation（mean-groups of 15 ‒ 19 and 20 ‒ 24 years in the year 20143）

as a preliminary step to a pathway toward

ingfulness）. Therefore it is likely that a student withsuicide 4） and often precedes suicide attempts. 5） A

high SOC has a better ability to understand their situa-wish to die differs from suicidal ideation because de-tion, use inner and external resources to manage theirspite having a strong desire to die, it does not involve

problems more effectively, and make meaning out of athoughts of harming or killing oneself, as suicidal ide-

problem situation, hence lowering the odds of suicidal-

death）,

6）

It was contended that a wish to die canity. SOC is tested and reinforced mainly in childhood

lead towards suicidal acts and death behaviors whenand early adulthood; with the years before the age ofthere is an imbalance between the wish to die and the

30 being the most important period regarding the de-7）velopment of SOC. 13 , 14） University freshmen belong toation does.

wish to live with abnormal developmental processes.

Therefore, it is significant to identify and intervene on

this group.

the wish to die early on; as a simple wish to die may be

Previous studies have also showed associations be-a warning in disguise and a strong predictor of a more

tween SOC and suicidality among military trainees

serious suicide intent. 8） For the purpose of this study,

and parasuicides, 15 , 16） demonstrating SOCʼ s ability to

we define a wish to die as having thoughts of reallypredict suicidal ideation and future attempts 17） and its

wanting to die.

potential to be a marker of risk for high suicidality inThis study focuses on university freshmen, who were

the aftermath of a suicide attempt. 18） However, despite

mostly going through a significant transition in their

the accumulating studies on SOC and suicidality, most

lives due to the transition from living at home to livingof the studies on SOC in Japanese youth have notaway from home. For many of them, having to inde-

been targeted at understanding the suicidal problem.

pendently manage their lives; establish new friends;

Instead, studies on SOC among university students inadjust to new schedules and succeed in academic andJapan have focused on health, 19 , 20） and depression. 21 , 22）athletic pursuits is an overwhelming task. Furthermore

Therefore, this study intends to explore if similar asso-in Japan, incoming freshmen had just been through a

ciations exist between SOC with a wish to die, as it has

highly competitive university entrance examination,with suicidal ideation and behaviors.

which was found to have contributed towards a highIn addition to SOC, studies have also linked suicidality

rate of depression among freshmen 9） and a high suicidewith relationship with parents and peers. Dissociated10）

Thus, this study intends

relationship with parents was found to be an early risk

to explore the characteristics associated with a wish to

factor for suicide 23） whilst suicidal adolescents showed

rate among young Japanese.

158

健康支援
第19巻2号

157‑165，2017

less close relationships to their parents. 24） Loneliness

from, or decline their participation at any time with nowas found to moderate the relationship between peer

negative consequences. We found 2 , 631 freshmen to berelationship and suicide ideation and attempt 25） whileeligible for the study. From these, 81 . 3 %（n= 2 , 139）

having four or more friends were associated with agave consent to participate. We excluded 103 partici-

lower risk of suicide in Japanese adults.

26）

While anpants due to incomplete data and finally, a total of 2 , 036

inverse association was found between close relation-（77 . 4 %）participants were included in the analyses.

ship with parents and peers with suicidality, there has
yet to be a study that explores the association with a（）. The SOC scale waswish to die. Therefore, as an attempt to fulfil the above

developed by Antonovsky; 13） it assesses the way indi-

mentioned gaps, this study is conducted with the fol-viduals perceive life and its challenges that lead to in-lowing aims: 1）to examine the association between acreased coping and resiliency from stress. The present

wish to die with SOC, 2）to examine the association

study uses the short version of the SOC, the（Japanese）

between a wish to die with relationship with parents,

13 -item SOC questionnaire 27） with scores ranging fromand 3）to examine the association between a wish to

13 - 91 with a higher score indicating a stronger sense

die with absence of close friends among Japanese uni-of coherence. Validity and reliability of this scale withversity freshmen. All associations were controlled forJapanese university students has been established. 21 , 28）age, sex, self-rated health, sleep quality and depressive

In this study, Cronbachʼ s alpha of the SOC scale was

symptoms. Based on the findings previously reviewed,. 79 .

we hypothesized that: i）higher SOC is associated with

. An item from the health questionnaire

lower odds of a wish to die, ii）close relationship with

developed by the university among the students wasparents is associated with lower odds of a wish to die

asked, “Sometimes I have thoughts that I really want

and iii）absence of close friends is associated with high-to die,”（with the answer option of yes or no）.

er odds of a wish to die.

.

Materials and Methods

Two items from the communication scale for university students was asked, “The relationship with myThis cross-sectional study was conducted among fresh-

parents are going well” and “I have many friends, but I

men who were recruited from a public university indonʼ t have anyone who I can call a close friend”（withthe southeastern part of Japan. The study utilized thethe answer option of yes or no）.

data drawn from a baseline study（of an epidemiologic（

study conducted in the university）called the EQUSITE）is a 20 -item self-admin-study（Enhancement of Q-University Students InTEl-

istered test of the frequency of depressive symptoms

ligence study）; it was a study originally developed bywithin the previous week. 29） Globally, a cutoff score of

the university, which aimed to improve the mental

16 is used to indicate the presence of depressive symp-

health of university students. The baseline study data

toms. The Japanese version of the CES-D 30） was usedwere collected between May and June 2010 . Thisin this study. The item on

study was approved by the ethics committee of thethe participants would rate their physical health inuniversity. All participants provided written informed

general. Participants were categorized into two groups:

consent.

unhealthy and healthy.

asked how（）31） was used to

We distributed a set of health questionnaires to stu-measure sleep quality, with a cutoff point of > 5 . 5 fromdents in Physical Education class, a compulsory subject

the global score to signify poor sleep quality. 32） They

for incoming freshmen. Explanation about the objec-

were used as covariates because: i）major depressive

tives of the questionnaires was stated at the beginning

disorder have been found to be associated with a highof the questionnaire, along with informed consent ofpercentage of suicides, 33） and depressive symptoms isparticipation. Participants were informed that theirhighly correlated and, they possibly overlap with theparticipation was voluntarily and they can withdraw

SOC, 34） ii）poor self-rated health has been found to be a
159

健康支援
第19巻2号

157‑165，2017

significant correlate to suicidality 35） and increased the36）

founders that were associated with a wish to die in theand iii）

previous bivariate analyses at a p-value cut-off point of

low sleep quality has been associated with suicide ide-

< 0 . 2040） and in accordance to previous evidence. SOC

ation among Japanese university students. 37） Therefore,

was used as a continuous variable. 13） All analyses wereby controlling for these possible confounders, we would

performed using SAS version 9 . 3（SAS Institute Inc.,

ensure that the odds ratio for a wish to die explained

Cary, N.C., USA）, with a significance level of p= 0 . 05 .

by SOC and relationship with parents and close friends

Resultsrisk of death wishes and suicidal ideation,

were not influenced by these possible confounders.
The mean age of the freshmen was 18 . 4（SD= 1 . 1）
Chi-square tests were performed to assess the associa-

years（within the age range of 18 ‒ 32 years）. Indepen-tions of demographic, health behavior and psychosocial

dent sample t-test indicated that there was no signifi-

variables with a wish to die. We also calculated the ef-cant difference in wish to die with the age of the fresh-

fect size to quantify the size of the difference betweenmen（t（122 . 6）=‑ 1 . 32 , p= 0 . 19）, but a significant

the two groups by using Cohenʼ s d 38） for continuous

difference appeared in SOC score between students

variables and Cramerʼ s V for categorical variables 39）.

with and without a wish to die（t（2034）= 14 . 09 ,We used the multivariate logistic regression analyses

p<. 001）. The mean SOC score for the sample wasto evaluate the influence of SOC, relationship with

54 . 7（SD= 10 . 6）. Males made up 69 . 2 % of the par-parents and absence of close friends on a wish to die,ticipants. Having a wish to die was reported by 5 . 8 %fitting all variables simultaneously in a single model（n= 118）of the freshmen. Depressive symptoms wereusing the forced entry method. We adjusted for con-observed in 27 %（n= 550）of the freshmen,（CES-D

Table 1 Demographic, health and psycho-social characteristics by a wish to die (N=2,036)
Variablesa

P valueb

Students with a wish

Students without ato die (n=118)

wish to die (n= 1,918)

Age, mean (SD)18.4 (0.6)

18.4 (0.8)

0.41

0.

Sex (male), n (%)

81 (68.6)

1,327 (69.2)

0.90

0.003

SOC score, (continuous measure), mean (SD)42 (9.5)

55.5 (10.2)<.001*

1.37

Good relationship with parents (yes), n (%)

93 (78.8)

1,803 (94.0)<.001*

0.14

Absence of close friends (yes), n (%)

52 (44.1)

354 (18.5)<.001*

0.15

High depressive symptoms (CES-D≥16), n (%)

86 (72.9)464 (24.2)<.001*

0.26

Self-rated health, healthy (vs. unhealthy), n (%)

83 (70.3)

1689 (88.1)<.001*

0.12

Sleep quality, poor (vs. good) (PSQI>5.5), n (%)

68 (57.6)

614 (32.0)<.001*

0.13

Tend to be absent in lectures (yes), n (%)

9 (7.6)99 (5.2)

0.25

0.03

a

Effectsizec

Ȯ2 test for proportions and Student t-test for continuous measure.

b*

p<.001cEffect size were measured using Cohen’s d for continuous variables, and Cramer’s v for categorical variables.

SD (Standard Deviation); CES-D (Centre for Epidemiologic Studies- Depression scale); PSQI (Pittsburgh Sleep Index
Quality)160

健康支援
第19巻2号

157‑165，2017

median= 11 . 0 , interquartile range= 10 . 0）.

to die independent of confounding factors and the significance remained when depressive symptoms was

Chi-square analyses showed in Table 1 indicated that

confounded（OR= 0 . 46 , 95 % CI= 0 . 25 ‑ 0 . 82）. Students

SOC score was found to be significantly lower in stu-that did not have close friends had higher odds of hav-

dents with a wish to die compared to their counter-ing a wish to die in both models before and after de-parts without a wish to die. Students with a wish topressive symptoms were adjusted（OR= 1 . 72 , 95 % CI

die were found to be less close to their parents, and= 1 . 11 ‑ 2 . 68）.

reported a higher tendency to have no close friends.

Discussion

Students with a wish to die reported higher depressive

This studyʼs main aim was to examine whether SOC

symptoms and poorer health and sleep quality thanhas an independent effect on a wish to die, beyond sig-

their counterparts. No significant difference appeared

nificant confounders such as depressive symptoms inin being absent in lectures and the age of participants

incoming freshmen. Accordingly, our results indicate

among the two groups.

that a high SOC was associated with decreasing oddsof having a wish to die, independent of all confounders.
Our findings indicated that with each unit of increase

In Table 2 , model 1 , we adjusted for age, sex, self-rat-in the SOC score, the odds of having a wish to die de-ed health and sleep quality and found that the higher

creased by 11 %.

the SOC score（measured by one-unit increment）, thePrevious reports have also associated low SOC withlower the odds were of having a wish to die（OR= 0 . 88 ,increased risk of suicidal ideation 16 , 41） and low associ-95 % CI= 0 . 85 ‑ 0 . 90）. In model 2 , when we added

ation of SOC with suicidality even after adjusting fordepressive symptoms as a confounder, the SOC scoremajor depression during follow-up. 42） The results wereremained significantly associated with a wish to die

also consistent with a previous study among university（OR= 0 . 89 , 95 % CI= 0 . 87 ‑ 0 . 92）.

students, which demonstrated that SOC was a protective quality that could decrease the risk of students toenter the continuum of suicidality. 11） It was postulat-

Table 2 showed that students with a good relationshiped that a significant number of students began theirwith their parents had lower odds of having a wish

university experience with preexisting vulnerabilities

Table 2 Associations between the Sense of Coherence, relationship with parents and absence of close friends with a wish
to die according to multiple logistic regression analysis (N=2,036)
Odds Ratio (95% Confidence Interval)

SOC score (one unit increment)

Model 1Model 20.88 (0.85-0.90)***0.89 (0.87-0.92)***

Good relationship with parents (reference: no) 0.50 (0.28-0.90)*

0.46 (0.25-0.82)**

Absence of close friends (reference: no)1.72 (1.11-2.68)*

1.84 (1.19-2.85) ***p<.05**p<.01***p<.001
Model 1: adjusted for age, sex, self-rated health and sleep quality
Model 2: adjusted for co-variates in model 1 plus depressive symptoms
161

健康支援
第19巻2号

157‑165，2017

that have the potential to intersect with stressful life

Results also indicated that our third hypothesis was

events to trigger or accelerate pathogenic processes,

supported. The absence of close friends was found tohence predicting entry onto suicidality particularly forincrease the odds of having a wish to die after adjust-11）

ing for significant confounders（OR 1 . 72 , 95 % CI= 1 . 11 ‑Our results indicated that students with low SOC were

2 . 68）. Our findings were consistent with a previous

also at higher risk for having a wish to die; consistentreport that demonstrated the significance of peer re-with previous findings on suicidal ideation and behav-

lationships in preventing against suicide ideation andior. This could be due to the reason that students withattempt 25） and the findings that dissociated relationshiphigh SOC were less concerned with the feeling that life

with friends was an early risk factor for suicide. 23）Pre-

was not worth living even though they are in a stress-

vious studies have offered possible explanations for the

ful situation, as they view stressors in their lives asabsence of close friends among the Japanese students.

those who are low in SOC and social connectedness.

13）

These results highlight

It was suggested that Japanese in general have a fear

the importance for university clinicians to nurture theof relationships, regardless of whether they have any

seeds of SOC in incoming freshmen with a wish to die

cognitive distortions or not, as for most of them, whenand sustain them in the following years to prevent a

in a relationship, people are required to pay closer at-wish to die from entering into a more severe continu-

tention to the other personʼ s thoughts and feelings, 45）

um of suicide. If Antonovskyʼ s theory holds true thatand this could bring about elevated fear and anxiety

the SOC will more or less be stable after one reaches

to build close relationships. Japanese students weremanageable and meaningful.

ththeir 30 age,13）

it is highly timely that encouragement

also suggested to have extremely high communication

to foster the sense of coherence into youth be giv-

apprehension levels, 46） particularly classroom commu-

en at around the age of this present studyʼ s sample.

nication fear. 47） These results indicate the significanceFurthermore, school-based awareness programs havefor faculty members to create opportunities for com-shown to be effective in reducing suicide ideation andmunication among students, preferably outside theattempts.

43）classroom to prevent classroom communication fear.

The results also supported our second hypothesis; thatIndeed, interpersonal skills are significant for university

a close relationship with parents would be associatedstudents, as interpersonal difficulties have been foundwith decreasing odds of having a wish to die. We foundto play a pivotal role in the development of suicidalthat having a good relationship with parents decreased

behavior in late adolescence and early adulthood. 48）

the odds of a wish to die by 54 %（OR= 0 . 46 , 95 %Furthermore, it has been reported that establishing

CI= 0 . 25 ‑ 0 . 82）than having a poor parental relation-interpersonal relations marked by cooperation would

ship. This is consistent with prior evidence among ado-

be able to intensify the SOC in young people, 49） and alescents which demonstrated that suicidal adolescentsprevious study demonstrated that both SOC and social

were less close to their parents 24） and that dissociatedconnectedness are protective factors for suicide ide-

relationship with parents is an early risk factor for sui-ation and behaviors among university students. 11）

cide. 23） Findings in a previous study demonstrated that

Future studies may adopt longitudinal studies, whichsignificantly more adolescents who characterized their

could further explore if a wish to die in university

parental relationship as dissociated stated that they

students would lead to suicidal ideation and attempts

ʻwanted to dieʼ , compared with both the entire study

and the factors associated with it. Pre and post study

group and the subgroup with close parental relation-measuring the SOC of incoming freshmen after the23）

Another study suggested that poor communica-

implementation of intervention programs could also betion with parents is a risk factor for future suicide at-

useful to help school clinicians to improve current pre-ships.

tempts.

44）

These previous findings were in line with theventive interventions of suicide.

present studyʼ s results which indicated the importanceof fostering a good relationship with parents which

To our knowledge, this is the first study to explore thecould lower the risk of having a wish to die among thecharacteristics of incoming freshmen and a wish to die.

incoming freshmen.

We examined a range of potential confounders, and this
162

健康支援
第19巻2号

157‑165，2017

study included a large sample size and relatively high17 , 2016）.

response rate. However, this study should also be in-２）Suicide Rates by Age: American Foundation for

terpreted with some limitations in mind. A wish to die,

Suicide Prevention, Suicide Statistics, 2016 . https://relationship with parents and close friends were only

afsp.org/about-suicide/suicide-statistics/（Accessedmeasured by a single dichotomous question which limit

November 9 , 2016）.

the interpretation of the results, while depressive symp-３）Bakhiyi CL, Calati R, Guillaume S, Courtet P: Do

toms were measured by self-reported questionnaires

reasons for living protect against suicidal thoughts

rather than by clinical observations. The cross-sectionaland behaviors? A systematic review of the litera-

design did not allow us to determine causal direction

ture. J Psychiatr Res., 2016 ; 77 : 92 - 108 .

between each of the characteristics and a wish to die.

４）Lester D: A scale to measure the desire to be dead.

The present results were also not representative of theOmega（Westport）, 2013 ; 67 : 323 - 327 .

entire Japanese university freshmen population. The

５）Gupta MA, Schork NJ, Gupta AK, Kirkby S, Ellistiming of the survey, which was conducted between

CN: Suicidal ideation in psoriasis. Int J Dermatol.,

one and two months after the participantsʼ enrollment

1993 ; 32 : 188 - 190 .

in the university may be a stressful time than others

６）Institute of Medicine: Reducing Suicide: A National

and thus may not able to yield a valid tendency for a

Imperative. National Academic Press, Washington

wish to die in freshmen.

DC. 2002 .

Conclusions７）Manor I, Vincent M, Tyano S: The wish to die andThis study indicates that high SOC and good parental

the wish to commit suicide in the adolescent: tworelationships are associated with lower odds of having a

different matters? Adolescence, 2004 ; 39 : 279 - 293 .

wish to die, whilst absence of close friends is associated８）Muhammad Gadit AA: Death wish or suicidal ide-with higher odds of having a wish to die, independent

ation: implications for management. Journal of theof confounding factors such as depressive symptoms.

Pakistan Medical Association, 2007 ; 57 : 156 - 157 .

These findings highlight the importance of enhancing

９）Tomoda A, Mori K, Kimura M, Takahashi T, Ki-

SOC and interpersonal skills among incoming freshmen

tamura T: One-year prevalence and incidence ofas well as improving parental relationship that may

depression among first-year university students incontribute towards prevention of a wish to die among

Japan: a preliminary study. Psychiatry Clin Neuros-

the students.

ci., 2000 ; 54 : 583 - 588 .

Acknowledgement10）Iga M: Suicide of Japanese youth. Suicide Life

This study was supported by a research grant fromThreat Behav., 1981 ; 11 : 17 - 30 .

Kyushu University Interdisciplinary Programs in Edu-

11）Drum DJ, Brownson C, Hess EA, Denmark AB,

cation and Projects in Research Development（P&P）toTalley AE: College studentsʼ sense of coherence andShuzo Kumagai. We greatly appreciate the help of theconnectedness as predictors of suicidal thoughts

EQUSITE team for helping to collect the data especial-

and behaviors. Arch Suicide Res, 2016 ; 0 : 1 - 16 .

ly the help of Ms. Megumi Omagari. Nadzirah Ahmad

12）Edwards MJ, Holden RR: Coping, Meaning in Life,

Basri is supported by the Malaysian Ministry of Higher

and Suicidal Manifestations: Examining Gender Dif-

Education. Takanori Honda is supported by the Japa-

ferences. J Clin Psychol, 2001 ; 57 : 1517 - 1534 .
13）Antonovsky A: Unraveling the Mystery of Health,nese Society for the Promotion of Science.

How People Manage Stress and Stay Well. Jossey

Conflict of Interest

Bass, San Francisco. 1987 .

The authors declare that there is no conflict of interest14）Honkinen PL, Aromaa M, Suominen S, et al.: Early

regarding the publication of this paper.
Referenceschildhood psychological problems predict a poor

１）Vital, Health and Social Statistics Office: Ministry ofsense of coherence in adolescents. A 15 year follow-up study. Health Psychol., 2009 ; 14 : 587 - 600 .

Health, Labor and Welfare, Tokyo, Vital Statistics
http://www.e-stat.go.jp/SG 1 /es-

15）Mehlum L: Suicidal ideation and sense of coherence

tat/ListE.do?lid= 000001137965（Accessed August

in male conscripts. Acta Psychiatr Scand, 1998 ; 98 :of Japan, 2016 .

163

健康支援
第19巻2号

157‑165，2017487 - 492 .

The Japan Public Health Center（JPHC）- based16）Giotakos O: Suicidal ideation, substance use, andprospective study. J Psychiatr Res., 2011 ; 45 : 1545 -sense of coherence in Greek male conscripts. Mil

1550 .

Med, 2003 ; 168 : 447 - 450 .

27）Yamazaki Y: A new view of health provided by

17）Petrie K, Brook R: Sense of coherence, self-esteem,

salutogenesis and a Sense of Coherence（SOC）.

depression and hopelessness as correlates of reat-

Quality Nursing, 1999 ; 5 : 825 - 832（In Japanese）.

tempting suicide. Br J Clin Psychol., 1992 ; 31（Pt 3）:28）Togari T, Yamazaki Y, Nakayama K, Yamaki CK,

293 - 300 .

Sasaki TT: Construct validity of Antonovkyʼ s sense18）Sjöström N, Hetta J, Waern M: Sense of coherenceof coherence scale: stability of factor structure andand suicidality in suicide attempters: a prospective

predictive validity with regard to the well-being ofstudy. J Psychiatry Ment Health Nurs., 2012 ; 19 :Japanese undergraduate students from two-year

62 - 69 .

follow up data. Japanese Journal of Health and Hu-

19）Togari T, Yamazaki Y, Takayama TS, Yamaki CK,

man Ecology, 2008 ; 74 : 71 - 86 .

Nakayama K: Follow-up study on the effects of29）Radloff LS: The CES-D Scale: A self-report depres-sense of coherence on well-being after two years insion scale for research in the general population.

Japanese university undergraduate students. Pers

Appl Psychol Meas, 1977 ; 1 : 385 - 401 .

Individ Dif., 2008 ; 44 : 1335 - 1347 .

30）Shima S, Shikano T, Kitamura T, Asai M: New20）Mikami A, Matsushita M, Adachi H, et al.: Sense

self-rating scales for Depression. Clinical Psychiatry,of coherence, health problems and presenteeism in1985 ; 27 : 717 - 723（In Japanese）.

Japanese university students. Asian J Psychiatr.,

31）Doi Y, Minowa M, Uchiyama M, Okawa M: Devel-2013 ; 6 : 369 - 372 .

opment of the Japanese Version of the Pittsburgh21）Sakano J, Yajima Y: Factor structure of the SOC

Sleep Quality Index. Japanese Journal of Psychiatry

scale 13 -item version in Japanese university stu-

Treatment, 1998 ; 13 : 755 ‒ 763（In Japanese）.

dents. Nihon Koshu Eisei Zasshi, 2005 ; 52 : 34 - 4532）Buysse DJ, Reynolds CF 3 rd, Monk TH, Berman SR,
Kupter DJ: Pittsburgh Sleep Quality Index: A new（In Japanese）.

instrument for psychiatric practice and research.

22）Koyama A, Matsushita M, Ushijima H, Jono T,

Psychiatry Res, 1989 ; 28 : 193 ‒ 213 .

Ikeda M: Association between depression, examination-related stressors and sense of coherence: the33）John MJ, Apter A, Bertolote J: Suicide Prevention

ronin-sei study. Psychiatry Clin Neurosci., 2014 ; 68 :Strategies: A Systematic Review. JAMA, 2005 ;294 : 2064 - 2074 .

441 - 447 .
23）Hedeland RL, Teilmann G, Jørgensen MH, Thiesen

34）Haukkala A, Konttinen H, Lehto E et al.: Sense of

LR, Andersen J: Study-Associated Pediatric Depart-

Coherence, Depressive Symptoms, Cardiovascularments. Risk factors and characteristics of suicide

Diseases, and All-Cause Mortality. Psychosom Med.,

attempts among 381 suicidal adolescents. Acta Pae-

2013 ; 75 : 429 - 435 .
35）Cheung T, Lee PH, Yip PSF: Suicidality among

diatr., 2016 Oct; 105 : 1231 - 1238 . Epub 2016 May

Hong Kong nurses: prevalence and correlates. J

31 .

Adv Nurs., 2016 ; 72 : 836 - 848 .

24）Kandel DB, Raveis VH, Davies M: Suicidal Ideationin Adolescence: Depression, Substance Use, and36）Ladwig KH, Klupsch D, Meisinger C, et al.: Gender

Other Risk Factors. J Youth Adolesc., 1991 ; 20 :differences in risk assessment of death wishes and289 - 307 .

suicidal ideation in the community: results from25）Cui S, Cheng Y, Xu Z, Chen D, Wang Y: Peer rela-

the KORA Augsburg F 3 study with 3079 men andtionships and suicide ideation and attempts among

women, 35 to 84 years of age. J Nerv Ment Dis.,
2010 ; 198 : 52 - 58 .

Chinese adolescents. Child Care Health Dev., 2010 ;37）Supartini A, Honda T, Basri NA et al.: The impact

37 : 692 - 702 .
26）Poudel-Tandukar K, Nanri A, Mizoue T et al.: Socialof sleep timing, sleep duration, and sleep quality on

support and suicide in Japanese men and women-

depressive symptoms and suicidal ideation amongst
164

健康支援
第19巻2号

157‑165，2017

Japanese freshmen: The EQUSITE Study. Sleep

Health Psychology Report, 2015 ; 3 : 293 - 299 .

Disorders, 2016 ; 2016 : 10 pages.
38）Ferguson CJ: An effect size primer: A guide for clinicians and researchers. Prof Psychol Res Pr., 2009 ;40 : 532 - 538 .
39）Trusty J, Thompson B, Petrocelli JV: Practical
Guide for Reporting Effect Size in Quantitative
Research in the Journal of Counseling and Development. J Couns Dev., 2004 ; 82 : 107 - 110 .
40）Mickey RM, Greenland S: The impact of confounderselection criteria on effect estimation. Am J Epidemiol., 1989 ; 129 : 125 - 137 .
41）Sjöström N: Sleep, sense of coherence and suicidality in suicide attempters [dissertation]. University ofGothenburg, 2009 .
42）Sjöström N, Hetta J, Waern M: Sense of coherence
and suicidality in suicide attempters: a prospective
study. J Psychiatr Ment Health Nurs., 2012 ; 19 : 62 69 .
43）Zalsman G, Hawton K, Wasserman D et al.: Suicide
Prevention strategies revisited: 10 year systematic
review. Lancet Psychiatry, 2016 ; 3 : 646 - 659 .
44）Gould MS, Fisher P, Parides M, Flory M, Shaffer
D: Psychosocial risk factors of child and adolescentcompleted suicide. Arch Gen Psychiatry, 1996 ;
53 : 1155 - 1162 .
45）Sakurai A, Nagata T, Harai H et al.: Is relationshipfear unique to Japan? Symptom factors and patientclusters of social anxiety disorder among the Japanese clinical population. J Affect Disord., 2005 ;87 : 131 - 137 .
46）McCroskey J, Gudykunst WB, Nishida T: Communication apprehension among Japanese students
in native and second language. Commun Res Rep.,
1985 ; 1 .
47）Keaten J, Kelly L, Pribyl CB: Communication
apprehension in Japan: grade school through secondary school. Int J Intercult Relat., 1997 ; 29 : 319 343 .
48）Johnson JG, Cohen P, Gould MS et al.: Childhood
adversities, interpersonal difficulties, and risk forsuicide attempts during late adolescents and early
adulthood. Arch Gen Psychiatry, 2002 ; 59 : 741 749 .
49）Kulik A: Sense of coherence and the style of interpersonal functioning and coping in adolescents.
165