Coping strategies and their correlates with depression in the Japanese general population

Abstract

This study's aim was to examine the relation between depression and stress-coping strategy among the general population. The survey was conducted in June 2000, using a large sample representative of the Japanese general population. A total of 24,551 responses from individuals aged 20 years or older were analyzed. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess the prevalence of depression with two different cut-off points; 16 and 26. Stress-coping strategies were asked based on given examples of actual behaviors covering problem-focused, emotion-focused, and avoidant ones. There was no marked gender difference in the prevalence of a problem-solving strategy, while various types of gender differences were found with respect to the prevalence of emotion-focused and avoidant strategies. In relation to depression, multivariate logistic regression analyses revealed the significantly highest odds ratios (OR) for avoidant coping strategies and the lowest OR for problem-focused ones in both genders. The fact that depression was associated positively with avoidant strategies but negatively with problem-solving strategies indicates that individual stress-coping strategies have their own significance with respect to depression, and may be utilized in establishing an evidence-based cognitive behavioral approach to depressive patients.

Introduction

Stress and coping are essential determinant factors to mental health, and coping styles play an important role in individual well-being. Coping has been described as an individual's attempts to use cognitive and behavioral strategies to manage and regulate pressures, demands and emotions in response to stress (Folkman and Lazarus, 1980, Lazarus and Folkman, 1984, Folkman et al., 1986). It has been described extensively in the literature that some coping strategies are associated with successful outcomes (Ravindran et al., 1996, Kohn et al., 1994, Roy-Byrne et al., 1980, Whatley et al., 1998), but that others are not (Ravindran et al., 1996, Kohn et al., 1994, Roy-Byrne et al., 1980, Whatley et al., 1998). Failure of coping to deal adaptively with stress may lead to mental problems (Lazarus and Folkman, 1984, Folkman et al., 1986). Therefore, an epidemiological survey on coping strategy gives important information on mental health status in the targeted population.

Previous studies have pointed out many factors that potentially cause depression: neurotransmitter abnormalities, disturbed sleep patterns, gender hormone imbalance, use of medication, chronic illness, stressful life event, life style, and premorbid personality (Ebmeier et al., 2006, Sadock and Sadock, 2002, Tamres, 2002). However, the causal relationship with these factors is still unknown, since it is difficult to identify the cause of the condition. Therefore, the social, psychological and biological etiology of depression remains to be clarified. Among the various hypothetical etiologies (Kohn et al., 1994), a diathesis-stress model is most widely accepted, in which an underlying trait such as personality, behavioral characteristics, or cognitive patterns interacts with life events or stress to lead to depressive illness. This model can answer in part the question why some people experience depression in relation to a stressful life event, but others do not.

It is widely documented that successful adaptation to the environment in an individual requires strategies to cope with stressful situations (Taylor and Stanton, 2007). Depression, as a final consequence of poor stress management, may be related to certain coping behaviors (Christensen and Kessing, 2005). Types of stress-coping strategies are likely to be associated with susceptibility to depression. Several studies conducted in the clinical settings reported that approach/problem-solving coping strategies were associated with decreased risk of depression, and avoidant/emotion-focused coping strategies were associated with increased risk of depression (Beck et al., 1979, Billings and Moss, 1984, Nolen-Hoeksema, 1987, Uehara et al., 1999, Dekker and Ormel, 1999, Piccinelli and Wilkinson, 2000, Tamres, 2002, Lam et al., 2003). Cognitive behavioral therapy (CBT) for depression is based on the assumption that re-achievement of proper skills to cope with life stress prevents one from suffering from depression (Beck et al., 1979, Gloaguen et al., 1998, Scott, 2001). However, the prior clinical studies did not provide evidence concerning the question of which types of coping strategy may prevent or facilitate depression among the general population.

An epidemiological survey on depression and stress-coping strategies was conducted among a large sample from the general population of Japan. We here investigate whether there is any correlation between depression and stress-coping strategy among the general population in Japan. To identify characteristic coping strategies positively or negatively associated with depression was our particular interest.