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.