Several limitations in our study need
Several limitations in our study need to be considered when interpreting its results. As mentioned above, we did not examine social capital as a construct, which is comprised of a wider range of factors than the items that were included in our study. We also are unable assert that fewer social connections cause a greater risk of future suicide, since the present study is a cross-sectional observational study, despite their significant association with suicide and attempted suicide. Common to most case–control studies relying on self-report, recall bias associated with differences in responses between cases and controls may be contributing to the associations between social connectedness and suicide found here (Pouliot & De Leo, 2006). These issue may compounded by interviewers who ask questions differently depending on whether the proxy or first person was a case or a control, thus introducing interviewer bias into the results. Nonetheless, there are numerous advantages of conducting interviews with proxies, as researchers are able to tailor questions to match the information provided for cases, and increase the number of factors for investigation.
We have used a combined endpoint of suicidal behaviour, which included suicide death and suicide attempt. There may be differential associations for each of these endpoints when considered separately, which would modify the estimate of association for the combined endpoint. However, we tested this and found results to be broadly similar. A strength of the study (compared to previous research) (e.g., Beautrais, Joyce, & Mulder, 1997; Brent et al., 1993; Charlton, 1995; Lesage et al., 1994) is that it methylergometrine manufacturer used population-based cases and controls, which reduces the likelihood of biased exposure information and sample selection bias. Other strengths include its relatively large sample size compared to other case–control studies of suicide among adolescents and young adults (Beautrais et al., 1997; Brent et al., 1993; Charlton, 1995; Lesage et al., 1994); and the capacity to provide detailed information on risk and protective factors for suicidal behaviour. Past studies also have not had been able to examine both suicide attempt and deaths at the same time.
Introduction The psychological health of workers is a great policy concern in Japan, where increased productivity is critical to maintening the fiscal health of the social security system in an aging society (Brinton, 1993; Shire, 2008). Occupational position is known to be a determinant of psychological health, but evidence suggests that Consensus sequemce may have a stronger association with psychological health for men than women, particularly in the Japanese context (Sekine, Chandola, Martikainen, Marmot, & Kagamimori, 2006; Sekine, Chandola, Martikainen, Marmot, & Kagamimori, 2009). Literature indicated that gender inequality in the labour market may contribute to gender specific patterns in the prevalence of poor psychological health (Palència et al., 2014; Seedat et al., 2009; Sekine et al., 2009). Nevertheless, previous study of the potential role of psychosocial work characteristics in gender specific association of psychological health among Japanese workers have so far been restricted to job control amongst civil servants (Sekine et al., 2006, 2009). The aims of this study was to examine gender specific associations between occupational position and psychological health in Japan, and the potential mediating effects of job control and effort–reward imbalance in these associations.
Theory Campos-Serna, Ronda-Perez, Artazcoz, Moen, and Benavides (2013) described two types of gender inequality in occupations: ‘horizontal’ and ‘vertical’ occupational divisions. Horizontal division refers to the unequal distribution of occupational position between men and women, while vertical division refers to the unequal distribution of tasks, authority, and career opportunities between men and women within the same occupational position. As more women have entered occupations that have previously been dominated by men in Japan and elsewhere (Cabinet Office, 2014; Feuvre, 2010), horizontal occupational differences between men and women may become less salient. On the other hand, vertical occupational division would continue to exist if gendered social norms and practices contribute to the gender inequality in work characteristics (Campos-Serna et al., 2013). Based on this assumption, we hypothesised that the association of occupational positions with psychological health was gender specific in contemporary Japan, because the distribution of work-related psychosocial stressors would differ between genders due to the persistence of gendered norms and practices in the Japanese society.