Journal of Epidemiology (May 2023)

Sex-specific Relationship Between Stress Coping Strategies and All-cause Mortality: Japan Multi-Institutional Collaborative Cohort Study

  • Mako Nagayoshi,
  • Kenji Takeuchi,
  • Yudai Tamada,
  • Yasufumi Kato,
  • Yoko Kubo,
  • Rieko Okada,
  • Takashi Tamura,
  • Asahi Hishida,
  • Jun Otonari,
  • Hiroaki Ikezaki,
  • Yuichiro Nishida,
  • Chisato Shimanoe,
  • Yuriko N. Koyanagi,
  • Keitaro Matsuo,
  • Haruo Mikami,
  • Miho Kusakabe,
  • Daisaku Nishimoto,
  • Keiichi Shibuya,
  • Sadao Suzuki,
  • Takeshi Nishiyama,
  • Etsuko Ozaki,
  • Isao Watanabe,
  • Kiyonori Kuriki,
  • Naoyuki Takashima,
  • Aya Kadota,
  • Kokichi Arisawa,
  • Sakurako Katsuura-Kamano,
  • Kenji Wakai

DOI
https://doi.org/10.2188/jea.JE20210220
Journal volume & issue
Vol. 33, no. 5
pp. 236 – 245

Abstract

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Background: Stress coping strategies are related to health outcomes. However, there is no clear evidence for sex differences between stress-coping strategies and mortality. We investigated the relationship between all-cause mortality and stress-coping strategies, focusing on sex differences among Japanese adults. Methods: A total of 79,580 individuals aged 35–69 years participated in the Japan Multi-Institutional Collaborative Cohort Study between 2004 and 2014 and were followed up for mortality. The frequency of use of the five coping strategies was assessed using a questionnaire. Sex-specific, multivariable-adjusted hazard ratios (HRs) for using each coping strategy (“sometimes,” and “often/very often” use versus “very few” use) were computed for all-cause mortality. Furthermore, relationships were analyzed in specific follow-up periods when the proportion assumption was violated. Results: During the follow-up (median: 8.5 years), 1,861 mortalities were recorded. In women, three coping strategies were related to lower total mortality. The HRs for “sometimes” were 0.81 (95% confidence interval [CI], 0.67–0.97) for emotional expression, 0.79 (95% CI, 0.66–0.95) for emotional support-seeking, and 0.80 (95% CI, 0.66–0.98) for disengagement. Men who “sometimes” used emotional expression and sometimes or often used problem-solving and positive reappraisal had a 15–41% lower HRs for all-cause mortality. However, those relationships were dependent on the follow-up period. There was evidence that sex modified the relationships between emotional support-seeking and all-cause mortality (P for interaction = 0.03). Conclusion: In a large Japanese sample, selected coping strategies were associated with all-cause mortality. The relationship of emotional support-seeking was different between men and women.

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