In Japan, suicide ranks as the first leading cause of death among students. It is reported that one of the reasons for this is that Japanese children have lower self-esteem than children in most Western countries. Schools are expected to provide appropriate opportunities for suicide prevention. Evidence supported that suicide vulnerability in youth can be reduced when school-based programs teach coping skills and positive ways of self-esteem. Moreover, it is also important for students when seeking help how they communicate with adults nearby. However, few study reported the association between student's relationship with adults nearby and their help-seeking behavior. In order to provide school-based suicide prevention program promoting self-esteem in students, we tried to clarify the association between student's relationships with familiar adults and help-seeking behavior of students.

We assigned 434 students of primary and junior high schools in Adachi City, Tokyo to participate school-based program during 2017 school years. This program was specially designed for primary and junior high school students and was presented in one session (45-minutes) by a public-health nurse and teachers. Students were asked to complete self-administered questionnaires before implementing the program. Questionnaires asked about their relationships with adults nearby such as parents, teachers, and neighbors and their intention to seek support when they have some trouble.

A total of 181 valid responses were obtained. Among them, 25% of participants are primary school students and 75% are junior high school students. Boys are 29.8% of respondents. Over half of the students (59.6%) answered that they had/have had some troubles, most of which was concern about the study. When students feel troubled, 68.5% of them consult with someone or ask someone's advice. Students who recognized adults nearby as reliable people have more consulted with others when they had some troubled (P-value=0.017). The self-esteem was significantly higher among students who had reliable adults than students who answered they have no reliable adult close to them (P-value<0.001).

The findings of this study suggested that building a reliable relationship with adults close to students can influence their help-seeking behaviors and their higher self-esteem. In view of primary suicide prevention strategy, it could be more effective for students to learn how to find supportive adults and to seek to help them when problems arise, in addition to coping skills. Further study is needed to evaluate the school-based programs, which teach students adaptive ways of help-seeking behavior.