Suicidal Ideation Coping Responses

across studies. Thus the nomenclature for suicidal ideation and behavior

has been the subject of considerable international attention and debate (De

Leo, 2006). The nomenclature of suicide behaviors without fatal outcome

varies as well. Sometimes they are referred to as "suicidality" while others

term these as "suicide related behaviors" or "suicidal behavior" (Van Orden

et al., 2010).

According to Gvion and Apter (2012), suicide is a complex and

multidimensional phenomenon stemming from the interaction of several

factors. Suicide remains an important and major cause of death in various

populations' samples varying in age, nationality, and clinical severity. It cuts

through nosological boundaries and across psychiatric diagnoses; it also

characterizes non-psychiatric populations. Moreover, they also stated that a

stressful life event can produce mental pain, depression, and hopelessness.

Persons with good communication skills may gain support from friends and

family; others may use suicidal behavior as a means of communication.

When social communication is blocked, however, the person may feel

“trapped”. The pernicious combination of unbearable mental pain and

inability to signal one’s distress to others can lead to a serious attempt to kill

oneself.

Three factors, often in combination, can trigger a serious suicidal

attempt among people. The first is an acute event such as a disciplinary

crisis. An example would be an adolescent who has been caught stealing

UNIVERSITY OF SANTO TOMAS PAGE

UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL

20

20

and who is told by the police that the family will be informed. Other acute

stressors include humiliating events or breaking up with a girl or boy friend.

The second trigger is any factor that alters the adolescent’s state of mind.

These include marked hopelessness, rage, or intoxication with drugs or

alcohol. The third proximate factor is the opportunity for suicide. The method

that young people use to kill themselves varies according to where they live,

suggesting that it is in part determined by availability. The wider social

context, such as societal taboos or role models, can also influence the

liability to suicidal behavior (Harington, 2001).

Mental pain is a concept that entails the feeling of thwarted

belongingness and that one’s existence burdens the family and friends. This

feeling is central to the etiology of suicide (Joiner, 2005). However, the

capability to engage in suicidal behavior is separate from the desire to

engage in suicidal behavior. The capability to die by suicide is acquired

through a process of habituation that allows the individual to overcome the

pain and fear associated with suicidal behavior. Pre-existing factors

sometimes accelerate the process (Joiner, 2005). Impulsivity is only distally

related to suicide: impulsive individuals may be more likely to have

experiences that are painful or provocative which, in turn, confer an

increased risk of suicidal behavior via habituation (Joiner, 2005).

However, there is a wide spectrum of suicidal behavior, ranging from

low-level suicide ideation (occasionally thinking about suicide) through to a



21

21

deliberate action that actually results in death (Retterstol, 1993). Attempted

suicide is the term most often used to describe self-harm where there is

apparently an intention to kill oneself but death does not occur. Retterstol

(1993) defined this type of suicidal behavior as any deliberate act of self-

damage, or potential self-damage, where the individual cannot be sure of

survival.

Becker and Grilo (2007) studied the effect of gender on the prediction

of suicidality and violent behavior among both male and female subjects.

Moreover, females attempt suicide three times more often than males, but

males carry out suicide three times more often than females, mainly because

they choose “harder means” (e.g. shooting or hanging themselves). Suicide

rates seem to be influenced also by occupation: suicide risk is higher among

students than among workers or trainees. The most frequent combination of

two methods was drug and alcohol and the most frequent combination of

three methods was drug, alcohol and cutting (Michel, Ballinari, Bille-brahe,

Bjerke, Crepet, De Leo, & Wasserman, 2000).

Evenden (1999) stated that suicide attempts are often impulsive and

many studies have identified impulsivity as a common correlate and risk

factor for suicidal behavior. Impulsivity, a prominent construct in most

theories of personality, encompasses a broad range of behaviors that reflect

impaired self-regulation, such as poor planning, premature responding

before considering consequences, sensation-seeking, risk-taking, an inability



22

22

to inhibit responses, and preference for immediate over delayed rewards

(Evenden, 1999).

Oldham (2006) had highlighted the significant role of interpersonal risk

factors in suicide. People who are able to share their difficulties with family,

friends or others benefit in various ways. Frisina, Borod, and Lepore (2004)

stated that communication enhances intimate relationship and helps to cope

with stress and traumatic events. People who communicate their difficulties

to their environment are less likely to kill themselves. On the other hand,

when communication fails, the risk for suicide arises. Thus it appears that

difficulties in communication are a meaningful factor influencing suicidal

behavior in general and lethal suicide attempts in particular (Frisina et al.,

2004).

Suicidal Ideation

Each year, all over the world, across various settings, reports of

suicidal ideation have increased thoroughly. This problem represents serious

health problems, especially in the youth (O’Neil, Puleo, Benjamin, Podell, &

Kendall, 2012). It can be formally defined as “thoughts about self-

destruction, including the idea that life is not worth living, wishing to be dead,

and specific plans to end one's own life. It is generally a sign of severe

emotional distress and is among the most powerful predictors of subsequent



23

23

suicide attempts and completed suicide” (Dugas, Low, Burrows, Contreras,

Chaiton, & O’Loughlin, 2012).

Many suicidal researches have been aimed at identifying the factors

that can determine those individuals at risk for suicide for early detection and

prevention. In a study conducted by Min, Jon, Jung, Hong, Song, Kim, and

Hong (2012) the prevalence of suicide increases as the individual develops

cognitive abilities.

A significant predictor of future attempt of suicide is a continuous

suicidal ideation. Also, it had been reported that a factor that can predict

suicidal ideation can be traced back to familial roots. A precursor of early

onset suicidal behavior is impulsive aggression, which has been implicated

in the phenomenology and familial transmission of suicidal behavior (Min et

al., 2012). In a study conducted by Dugas et al. (2012), they have identified

potential predictor variables of suicidal ideation. These variables include

depression symptoms, worry or stress, cigarette smoking, alcohol use,

participation in sports teams at school, and participation in sports teams

outside school. Inasmuch as early detection can help prevention and thereby

decrease cases of suicidal ideation, many probable solutions have been

suggested by countless authors based on studies they have conducted.

Each one has to individually discover the meaning of each particular

situation. Each meaning is unique to each person. The basic striving of man

is to find the meaning in life (Dogra et al., 2011). Considering that the topic of



24

24

discussion is how this concept can be applied to college students, the same

study conducted had shown that adopting this concept and living it out had

shown significant results in helping reduce suicidal ideation among this

population.

Suicidal Ideation Among College Students

Within the higher educational context, adjusting to a college

environment and undergoing a significant life course transition may be

challenging for some students. College students encounter a variety of

biopsychosocial, environmental, and sociocultural factors which could

increase risk of developing suicidal behaviors (SPRC, 2001). If the transition

to college is not successfully navigated, it may have far-reaching

psychological consequences down the line such as depression, academic

failure, and so on. College students are at elevated risk of suicidal thoughts

and behaviors, perhaps because of the numerous developmental challenges

(internal) and psychosocial changes (external) they experience. These

challenges include exploring or developing their identity (eg, making career

choices), navigating the transition from a state of full dependence to a state

of semi-dependence on their parents, creating social relationships in a dif-

ferent environment, managing the financial burden of increasingly high

college tuition, and leaving their primary support system (Nyer et al., 2013).

As a result, most of them may feel incompetent and could face difficulty in



25

25

coping with life style in universities, which may in turn cause psychological

distress including high test anxiety, lower academic self-efficacy, poor time

management, and use of study resources (Jemal, 2012); and in the worst

case scenario, students may commit suicide, 'the second leading cause of

death” in western colleges and universities (National Alliance on Mental

Illness, 2012).

Lifetime prevalence of suicide among adolescent girls ranges from

5.7% (The Netherlands) to 17% (Australia) compared with 2.4% (The

Netherlands) to 6.5% (Belgium) among boys (Madge et al., as cited in Tarchi

& Colucci, 2013). The school based CASE study (Child and Adolescent

Self-harm in Europe), on which this study is based, reported that 9.1% of

Irish adolescents (13.9% of girls and 4.3% of boys) surveyed had harmed

themselves at some point, of whom just under half reported repeated

episodes (Morey, Corcoran, Arensman, & Perry, 2008). Rates have shown

that thirteen per cent of deaths among 15-24 year olds in 2008, suicide

remains the third leading cause of mortality among youth, resulting in the

loss of nearly 4,300 lives annually (Web-based Injury Statistics Query and

Reporting System, 2011). Even more disturbing is that large proportions

(14.5%) of students interviewed in national surveys report having seriously

considered attempting suicide during the past 12 months (Youth Risk

Behavior Surveillance, 2010). It also indicated that 6.3% of students had

attempted suicide once or more in the previous year and 13.8% had



26

26

considered suicide over the same period (Centers for Disease Control and

Prevention, 2010).

A noteworthy issue that has been addressed in studies of life events

and adolescents who attempted suicide involves types of events. A study

suggested that family problems appear to be the most prominent reported

precipitants of suicide attempts, followed by other negative events such as

romantic boy/girlfriend conflicts and school problems (Pompili Innamorati,

Szanto, Di Vittorio, Conwell, Lester, & Amore, 2011). This was in line with

the study of Kolves, Varnik, Schneider, Fritze and Allik (2006), about the

comparison between Germany and Lettonia, as they reported that recent

unfavorable life events are normally associated with increased risk of

suicide: younger age groups experience more often interpersonal losses,

devaluating feelings, internal anxiety, conflicts and financial troubles.

However, according to Adams and Adams (1996) such adolescents

were more likely to consider suicide in response to prospects of “losing a

close friend”, as compared to prospects of “parental breakup” or “academic

failure”. Sexual, physical abuse and psychological abuse are another

prevalent negative life event which may lead to a number of serious

psychological problems, including suicide attempt (Kendall-Tackett et al.;

Yang & Clam, as cited in Thompson, Proctor, English, Dubowitz,

Narasimhan, & Everson, 2012). Several empirical studies have

demonstrated associations between lethal suicidal behavior and various



27

27

facets of communication difficulties, including loneliness, social withdrawal

and isolation, lack of self-disclosure, living alone and having few social

supports (Dejong, Overholser, & Stockmeier, 2010). Along the same lines,

Witte Merill, Bernert, and Stellrecht (2008) proposed that certain behaviors

may promote the individual’s capability of committing lethal suicide, such as

prostitution, drug use, self-mutilation, and violence.

Furthermore, study of Irish university students reported that those with

suicidal thoughts had significantly poorer problem-solving scores than those.

Reporting findings of the multi-centre CASE study, Portzky, De Wilde, and

Van Heeringen (2007) found that emotion-oriented coping was associated

with deliberate self-harm in a sample of Dutch and Belgian adolescents. The

English CASE study investigators reported that adolescents with a history of

suicide attempts reported more coping methods considered to be “emotion-

focused”, while those without any attempted suicide were more likely to

report “problem-focused” approaches (Evans, Hawton, & Rodham, 2005).

However, incidence of suicide is underreported in the world due to a

number of reasons. In some instances, and for different reasons, for

example religious and/or social reasons, suicide as the cause for death

might be hidden; in some areas it is completely unreported (Bertolete &

Fleischmann, 2002).



28

28

Student Suicide in the Philippines

In the Philippines, the suicide rate has been going up for the past 21

years among the young and adults, most of them killing themselves by

strangulation, in the morning during summer and during the Lenten Season.

The suicide rate from 1984 to 2005 went up from 0.46 to seven out of every

200,000 men; up from 0.24 to two for every 200,000 women, the National

Statistics Office told the Inquirer. According to Dr. Dinah Nadera (as cited in

Dacanay, 2012) there is an increasing trend of suicide among the youth,

particularly in the age group 5 to 14 and 15 to 24. Suicides occurred

between 8:01am and noon on weekdays, when other people were not

around in their homes, adding that the least suicide cases occurred between

12:01am and 4am, based on studies made on 300 cases from hospitals and

the police in 2008 and 2009. Cases showed that many of them decided to kill

themselves by hanging, strangulation, suffocation, poisoning (mainly

ingestion of silver cleaner), and exposure to chemicals and noxious

substances. However, suicide rates in the Philippines still remain

insignificant compared with records in other countries.

For the past months, college students committing suicide have been

on the headlines. This includes Kristel Tejada, a behavioral science student

who drank silver cleaner inside their home, after school administrators told

her to take a leave of absence from her studies for failing to pay her tuition

amounting to P10,000. Another is a mechanical engineering student who



29

29

failed to graduate this school year and so as a physical therapy freshman

who found out that he got failing grades in four subjects, and will be

transferred to another school in this coming year. They used a caliber .38

revolver and a shotgun, respectively, in killing themselves. Then another

student is now on critical condition after she attempted to commit suicide

after getting depressed for failing to make it to the top honor list in her school

(Ozaeta, 2013).

Coping Responses

In dealing with the changes that happen in and around them, college

students may opt to make use of a coping strategy that will temporarily

alleviate their source of stress, or one that will help them cope successfully in

the long run. Coping consists of the thoughts and behaviors people use to

manage the demands of stressful experiences. Approaches to coping are

not intrinsically positive or negative; rather they are adaptive depending on

the situation and the stressful life event in which they are used (Daucet &

Letourneau, 2009). It may be further maintained by the duration, or can be

referred to as the dependence on the length of time he/she was willing to

cope, apart from the cognitive style dissimilarity, with which the individual

acts outside of the preferred behavior (Samms & Friedel, 2013). In addition,

it was further reported that if the student lacks the motivation, he or she may

return to his or her preferred behavior, which may not be effective in dealing



30

30

with the present situation. Furthermore, prior to the study of Haan and (as

cited in Samms & Friedel, 2013) coping was viewed as a defense

mechanism. However, due to their contribution, the view of coping shifted

from that of a defense mechanism, to a trait or a style. Also, although coping

was initially discussed in many different fields like economics, education;

politics, and business, it is more dominant in psychology and mental health

care, primarily because it revolved around how individuals dealt with stress,

pressure, and anxiety. In addition with this, Folkman and Lazarus (as cited in

Samms and Friedel, 2013) stated that behaviors and thoughts are where

coping stems from. These behavioral aspects and thoughts processes are

considered to be dynamic activities. This implied that it was almost

necessary for the individual to force himself or herself to respond to a burden

which surpassed his or her ability to handle this successfully. This explains

why coping is defined as “constantly changing cognitive and behavioral

efforts to manage specific external and/or internal demands that are

appraised as taxing or exceeding the resources of the person.

Generally, coping strategies can be divided into two major categories

namely, proactive and preventive coping. The concept and theory of

proactive coping and preventive coping comes from the theoretical tradition

of Lazarus (Lazarus, 1993). In this view, coping is defined as “the cognitive,

behavioral efforts to manage particular external and/or internal demands that

are appraised as taxing or exceeding resources of the person.” Although



31

31

anticipation of harm or loss is essential to this widely accepted definition,

traditional coping models emphasize the reactive nature of coping and focus

attention on how people cope with past or ongoing stressors (Lazarus,

1993). Therefore, it is also called reactive coping by Schwarzer and Taubert

(2002). In contrast, proactive and preventive coping deal with anticipated

stressful events that have not occurred. According to Greenglass (2002)

proactive coping theory is an emphasis on the time perspective distinguishes

reactive, preventive, and proactive coping. Proactive coping is defined as

efforts to strive actively to seek new challenges, create new opportunities,

and facilitate promotion toward challenging goals so that they will be less

negative, whereas preventive coping refers to the process by which a person

builds up resources and resistance “just in case” possible stressors occur in

the distant future.

Coping strategies, on the other hand can then also be categorized

into a more specific groups such as emotion-focused and problem-focused

(Daucet & Letourneau, 2009). Emotion-focused approaches regulate

emotional distress. Problem-focused approaches direct attention towards the

problem and look for ways to resolve it. Avero, Corace, Endler and Calvo

(2002) additionally suggest avoidance-focused coping as a category, which

entails person-oriented or task-oriented strategies to distract away from the

stressor at hand. Avoidant coping has also been examined as a coping

category and refers to coping responses that are oriented away from the



32

32

source of stress (e.g., withdrawal or denial; (Compas, Grant, & Orosan,

1993). In addition, Rosmarin, Bigda-Peyton, Ongur, and Bjorgvinsson (2013)

have described religious faith and spiritual beliefs as a means of coping also.

In the context of this study, college students are constantly adjusting

to be able to keep up with the daily demands of college life. In doing so, they

make use of different coping styles that can help them handle their

constantly changing situations.

Emotion-focused coping

Emotion-focused coping is defined as aiming to manage the

emotional distress that is associated with the situation (Lazarus & Folkman

as cited in Baker & Berenbaum, 2007). The said strategy of coping has a

broad range and may include substance abuse, use of emotional support,

positive reframing, humor, acceptance, religion, and self-blame. Carver,

Scheier, and Weintraub (as cited in Baker & Berenbaum, 2007). They also

reported that the effectiveness of this coping strategy is dependent on the

kind of approach used, but overall, this is considered to be maladaptive for a

variety of reasons. In addition, in using this coping strategy, it is possible that

it confounds coping efforts with distress, thereby making it ineffective and

makes the coping strategy maladaptive. However, it was reported that using

this coping strategy would be most effective for individuals who are less

attentive to their emotions, ambivalent about their emotions, who are not

clear about their emotions, and have a difficulty expressing their emotions.



33

33

Substance use

The most common forms of substance use are alcohol, tobacco, and

cannabis. Engaging in this type of behavior diverts the attention of the

individual from the source of stress and may help in alleviating it but only

temporarily. More often than not, turning to this kind of emotion-focused

coping only results in more problems in the future (Tavolacci et al., 2013).

Use of emotional support

The use of emotional support, in the form of social support, helps

facilitate coping by helping solve the problem, or through disclosure of

emotions (Snyder as cited in Nordin, Andersson & Nordin 2010). In addition,

it was reported that health outcomes are dependent on perceived, rather

than provided support (Barrera Cohen et al., 2000). This entails that the

individual’s perception of one’s support being present aids in coping, not

necessarily that it is actually the case. Also, support sources that were most

frequently used were in the forms of friends and spouses, followed by

professionals, children, other kin and spiritual advisors and, least frequently,

support groups and neighbours (Gibson et al. as cited in Nordin, Andersson,

& Nordin, 2010) .

Positive reframing

Given the many approaches of emotion-focused strategy in coping,

positive reframing had been reported as the most effective in dealing with

individuals who are considered to be perfectionists (Stoeber, 2011).



34

34

Perfectionism refers to a personality disposition characterized by

exceedingly high standards for performance accompanied by tendencies for

overly critical self-evaluations of one’s behavior. It was also said that

perfectionists are often dissatisfied with their achievements, selves, and

lives, simply because they never see themselves fully achieving their

standards. In university students, this is not an uncommon occurrence (Flett

& Hewitt; Frost, Marten, Lahart, & Rosenblate as cited in Stoeber, 2011). To

be able to effectively cope with this kind of behavior, individuals often resort

to the emotion-focused strategy of positive reframing. In the Brief Cope test

used in the same study by Stoeber (2011), positive reframing was found to

be the third most effective coping strategy, overall. The said study had

reported that positive reframing, along with two other coping strategies had

positive effects on satisfaction, most especially in dealing with failures and

disappointments (Stoeber, 2011).

Humor

In numerous research studies, the importance of humor has never

been undervalued, especially with regards to coping and dealing with life’s

stresses and challenges. In the same study conducted by Stoeber (2011),

humor, along with positive reframing and another coping strategy, was

considered to be one of the three positive ways of coping in that it helped the

individual feel satisfied at the end of the day. Although there are two

opposing views on the use of humor as a coping strategy, more researches



35

35

focusing on humor as an effective and positive form of coping have been

reported.

Acceptance

In a study conducted by Cook and Hayes (2010) acceptance-based

coping involves the deliberate taking in or actively contacting psychological

experiences without needless defense. This kind of coping strategy, is

indicative of more positive outcomes, than other coping strategies, because

there is no manipulation of stimuli, experiences, or events to be temporarily

forgotten, only to resurface again at a later time. In addition, the study

conducted by Stoeber (2011) affirmed that along with positive reframing and

humor, acceptance as an emotion-focused approach is a positive approach

to help individuals feel more adjusted and satisfied at the end of the day.

Religion

Religion as an emotion-focused approach is one that has been

proven by several studies as an approach that can help reduce suicidal

ideation. Individuals who use religion as a coping approach often have

prohibitions that concern suicide and non-suicidal self-harm (Kamal &

Loewenthal; Marion & Range; Morrison & Downey as cited in Borrill & Roger,

2011). In addition, using this coping approach has been reported to result in

lower anxiety (Koenig; Mueller, Plevak, & Rummans, 2001 as cited in Borrill

and Roger 2011) and lower depression (Daaleman & Kaufman; Randolph-

Seng, Nielsen, Bottoms, & Filipas, as cited in Borrill & Roger 2011).



36

36

Self-blame

In the study conducted by Stoeber (2011), self-blame was considered

to rank the lowest among all the other coping strategies in terms of

satisfaction it provided to the participants. In the same study, the amount of

satisfaction provided is inversely proportional to the frequency of use. In this

light, for individuals who are perfectionists, the coping strategy of self-blame

is most frequently used, although it is clearly maladaptive, as summarized by

Stoeber and Otto (2006).

Problem-focused coping

As opposed to emotion-focused coping, problem-focused coping

focuses on efforts to modify the problem at hand and typically includes

elements such as generating options to solve the problem, evaluating the

pros and cons of different options, and implementing steps to solve the

problem (Lazarus & Folkman as cited in Baker & Berenbaum, 2007). The

range of problem-focused coping includes active coping, use of instrumental

support, and planning. Given these approaches, Baker and Berenbaum

(2007) have reported that this strategy is most effective with individuals who

are attentive to their emotions, clear about them, and not having ambivalent

feelings.



37

37

Active coping

It is a coping response wherein the individual manages to solve their

problem by confronting it through direct action or increase of exertion on

effort (Crockett et al. 2007)

In a study conducted by Shimazu and Kosugi (2003), they had

hypothesized that active coping has a negative relation to psychological

distress and will be effective regardless of the type of chronic stressor

present. However, its effectiveness will be reduced when dealing with

situations that require more effort to cope with. That being said, they had

concluded their hypotheses with the idea that active coping must be assisted

by non-active coping methods to decrease psychological distress in

situations requiring more effort in coping. In addition, the study conducted by

Stoeber (2011) had predicted less frequent use of active coping in providing

satisfaction to individuals as a means of coping.

Use of instrumental support

Given that problem-focused coping aims to address and solve the

problems an individual has, the use of instrumental support as a coping

strategy is one that is effective and easily recognized. The topic of

discussion in this study is college students. Aside from the pressures and

stresses they experience academically, there are also instances that arise

from relational devaluation. In a study conducted by Cater, May, and Byrd

(2012), they had studied the kind of coping style used in terms of the kind of



38

38

hurt the individual experienced. In this study, they had identified two kinds of

hurt: introjective hurt and retaliatory hurt. It was reported that individuals who

had needed instrumental support from others were those who had

experienced introjective hurt. According to Cater et al. (2012) introjective hurt

reflects the tendency to internalize the hurt by engaging in self-blame;

whereas retaliatory hurt is when a person engages in aggressive retaliation

towards the perpetrator of the hurt. Thus, individuals who experience

introjective hurt are likely to intensify their hurt by internalizing it, which may

lead to maladaptive responses such as depression.

Planning

In the study conducted by Cater et al. (2012) the second type of hurt:

retaliatory hurt is more likely correlated to an individual making use of

planning as the problem-focused approach. This is believed to be so

because since the coping approach is active and problem-focused, the

individual may think of using planning to get back at the perpetrator of the

hurt, along with humor to offset the implication of the hurt experienced.

Avoidant Coping

It is a coping response wherein the individual refuses to confront the

problem by ignoring or repressing the problem. Individuals tend to avoid

facing their problems and would rather not deal with it (Crocket et al., 2007)

It is often characterized by a disengagement from problems, is

associated with distress (Dunkley & Blankstein, 2000). After controlling for



39

39

perceived social support, daily hassles, and other variables, Dunkley and

Blankstein (2000) found that avoidant coping mediated the relationship

between evaluative concerns perfectionism and distress.

In the study conducted by Ssenyonga, Owens and Olema (2013),

their findings revealed that adolescent refugees had a high prevalence of

PTSD, negative posttraumatic cognitions, use of avoidance coping

strategies, and a considerable high risk of suicide. The findings suggest that

for the adolescent refugees, negative appraisal and avoidance coping

strategies used subsequent to trauma exposure have implication for current

psychological well-being.

Distraction

According to Allen and Leary (2010) distraction involves using

behaviors such as watching television, exercising, reading, or engaging in

other pleasurable activities to distract oneself from the stressful event.

Distraction is a passive coping strategy in that the person copes without

directly confronting the situation or trying to solve the problem. Skinner and

Wellborn (1994) states that distraction is sometimes conceptualized as an

accommodative or secondary control coping tactic, which involve changing

one’s goals in order to accept failure, unpleasant circumstances, or other

problems. According to Allen and Leary (2010) whether distraction is

adaptive and effective depends on the situation. To the extent that the

situation cannot be changed, distraction may be helpful.



40

40

Denial

Denial is a strategy that means refusing to face reality and attempting

to rely on a view that is no longer relevant, whereas acceptance indicates

restructuring the experiences in order to cope with the reality of the situation

(Carver & Scheier, 2005)

Behavioral Disengagement

It is a coping response wherein the individual does not exert any more

effort in dealing with the problem, to the point of giving up their goals.

According to Carver and Connor-Smith (2010) when it comes to coping, it

was found that substance use, behavioral disengagement and self-blame

were related to poorer psychological well-being, whereas acceptance was

associated with better psychological well-being.

Uses of Coping

Students face social, emotional, physical and family problems which

might affect their learning ability and academic performance. As a result, it is

important that individuals develop different strategies in order to manage

stressful situations (Chew-Graham, Rogers, and Yassin, 2003).

In certain situations, certain coping strategies serve as protective

components by regulating the negative effects brought on by stressful

events, and creating alternatives to solve the problem, while others may

worsen the effects of stress and become risk factors themselves (Seiffge-



41

41

Krenke, 2000). Coping responses are highly predictive of psychological

wellness and act as buffers for disorders such as anxiety and depression

(Bisschop, Kriegsman, Beekman, & Deeg, 2004). They also predict low

levels of worker burnout (McCarthy, Lambert, O’Donnell, & Melendres,

2009). For example, the perception of having strong social support is related

to a greater likelihood of using one’s support network in coping with

workplace stress. Several studies show relationships between high social

support resourcefulness and task-focused or positive coping styles

(Ingledew, Hardy, & Cooper, 1997; Lewin & Sager, 2008; Snow, Swan,

Raghavan, Connell, & Klein, 2003).

A study by Lewis and Frydenberg (2002), revealed that adolescents

using problem-solving strategies, involving seeking help and advice, have

been reported to be associated with positive adjustment among adolescents

and tend to cope better (Schonert- Reichl, Offer, & Howard, 1995; Seiffge-

Krenke, 2000). In contrast, reliance on avoidant or disengaging coping styles

such as resignation or escape is generally associated with poor adjustment

and behavioral-emotional problems (Seiffge-Krenke, 2000; Lewis and

Frydenberg, 2002 ) It has been suggested that adolescents' wellbeing can

be improved if they were helped to minimize their use of negative avoidant

coping strategies and to increase their use of active coping (Frydenberg &

Lewis, 2009). These coping responses have been associated with resilience,

which can be defined as positive outcomes in the presence of adversity



42

42

(Campbell-Sills, Cohan, & Stein, 2006) and which involves a focus on

individuals’ strengths as well as deficits (Luthar, Cicchetti, & Becker, 2000)

this will help young people to reduce their risk of developing depressive

symptoms, which are strongly associated with suicidal thoughts and

behaviors (Sawyer, Pfeiffer, & Spence, 2009).

The function of coping may also lie in solving the actual problem, such

as increasing effort, enlisting help, or investing other resources Schwarzer as

cited in Schwarzer & Renner, 2000).

Another function may lie in feeling good in spite of the risk, for

example by redefining the situation as less threatening, by distraction, or by

gaining reassurance from others as the management of known risks, which

includes investing one’s resources to prevent or combat the stressor or to

maximize an anticipated benefit (Schwarzer & Renner, 2000). Coping can

also be used by minimizing the severity of the impact. Thus, the

consequences of stressful events, should they occur, would be less severe.

Coping may also be used to prepare for uncertain events in the long

run. The aim is to build up general resistance resources that result in less

strain in the future. In preventive coping, individuals consider a critical event

that may or may not occur in the distant future (Schwarzer, as cited in

Schwarzer & Renner, 2000 ).



43

43

Coping Response and Suicidal Ideation

When individuals experience pressure that exceeds their ability to

cope, this results in stress (Tavolacci, Ladner, Grigioni, Richard, Villet, &

Dechelotte, 2013). In dealing with stress, individuals seek their own way of

coping with the said stress. For university students, this kind of stress may

be related to studying, examinations, academic adjustments, and pressure

received from peers, teachers, or parents. This may result in negative

outcomes in the academic, emotional, and health aspects of their lives

(Tavolacci et al., 2013). Adjusting to university life is a major transition for

young adults, as they have to overcome the unfamiliarity of the university

environment. Therefore, entering college is by nature a stressful experience.

Considering the pivotal role of stress, a great amount of research has

been conducted to explore the factors contributing to the coping strategies

and suicide ideation of college students. Episodes of suicidal thoughts and

behaviors vary across many factors, including duration, intensity, frequency,

associated mood states, consideration of methods, communication of

distress, and help-seeking behaviors (Drum, Brownson, Burton Denmark, &

Smith, 2009). Coping, as another important predictor, has also been

extensively researched in understanding suicide behaviors.

According to the study done by Zhang, Wang, Xia, Liu, and Jung

(2012), results showed that the mediating role of active coping was

significant at trend, and passive coping was a significant mediator between



44

44

life stress and suicide ideation. Higher life stress increased use of passive

coping, in turn, passive coping increased suicide ideation.

Emotion-focused coping, avoidant coping, problem-focused coping,

and religious coping are important predictors of suicidal ideations among a

variety of populations. Several researchers (Daucet & Letourneau, 2009)

have reported the importance of avoidance-focused and emotion-focused

coping as predictors of suicidal ideations.

Avoidance coping as a risk factor for suicidal ideations was not

supported in a sample of adult medical inpatients, while higher levels of

emotion-focused coping were predictive of suicidal ideations (Avero et al.,

2002). Female undergraduates who used emotion-focused coping were also

more likely to experience suicidal ideations (Heckman, Kalichman, Kochman,

and Bergholte, 2000).

In his study Horwitz et al., (2011) found out that using substances and

coping by blaming one’s self were associated with greater serious suicidal

ideation. Other studies also support this relationship between the use of

substance and suicidality. According to Locke and Newcomb (as cited in

Galaif, Sussman, Newcomb, Locke, 2007) alcohol and other drug use has

been associated with suicidality among adolescents Locke and Newcomb

found that drug use had both a direct and indirect influence on suicidality.

Meanwhile, according to Sunnqvist, Bendz and Westrin (2013)

another adaptive coping strategy, i.e. seeking social support—instrumental,



45

45

was scored lower by the recent suicide attempters than suicide attempters at

follow up, or healthy controls. This means that the recent suicide attempters

were less prone to seek advice and information than the others. This is an

important finding, since social support can exert a protective influence

against stressors and buffer against the outcome of a stressful event. There

is evidence from comparative studies that socials support systems are

undermined among suicide attempters (Kumar, & George, 2013).

Avoidance-focused and emotion-focused coping are often reported to

be less effective strategies, primarily because these approaches do not

address the direct management of the problem at hand. (Daucet &

Letourneau, 2009). This exacerbates the stressful experience, and in turn

can lead to suicidal behaviors as a means to escape.

Miotto and Preti (2008) found the use of denial to be protective of

suicidal ideation in a school-aged population. It may be that denial serves as

a protective coping style in circumstances beyond adolescents’ control, such

as the death or illness of a family member, parental conflict, or poverty.

Given that an adolescent has little or no control over these situations,

problem focused coping may not realistically alleviate stress, and denial may

become a viable alternative.

Problem solving as a coping strategy, is thought to reduce the risk of

suicidal ideations. Problem-focused coping is recognized to be an effective



46

46

approach, as the individual takes active steps towards resolving the problem

that is causing their distress (Avero et al., 2002).

Religious coping appears to decrease the risk of suicidal ideations.

Among depressed adults with a history of child abuse, an inverse

relationship was demonstrated between the severity of suicidal ideations and

religious beliefs Rosmarin et al. (2013).

In addition, Khurana and Romer (2012) identified another category of

coping which is the support seeking strategy. According to their results, the

use of support seeking predicted reduction in suicidal ideation. However,

according to Lazarus (1993) the theory of coping as a process emphasizes

only problem-focused and emotion-focused as the two major functions of

coping. The function of problem-focused coping is to change the troubled

person-environment relationship by acting on the environment or oneself

while, on the other hand, emotion-focused coping’s function is to change

either the way stressful relationship with the environment is attended or the

relational meaning of what is happening which mitigates the stress even

though the actual conditions of the relationship have not changed (Lazarus,

1996).

Poor coping skills and deficits in problem-solving behaviors have been

known to increase the risk for suicidal behaviors, thus it can be assumed that

adequate or good coping skills and problem-solving behaviors, as well as a

range of other individual and adaptive skills, including positive beliefs and



47

47

high self-esteem may act as a buffer against suicidal behavior (Beautrais,

Joyce, and Mulder, 1997). The use of inappropriate coping skills by suicidal

adolescents might play a mediating role between the effects induced by life

events and the adolescent’s cognitive appraisals (Yang & Clum, 1996).

Adolescents tend to move toward suicidal behavior when they have

inadequate abilities to cope with stressors, thus using the chosen form of

suicidal behavior as a means to reach out to others (Horwits, Hill, and King,

2011). Studies have also found that adolescents with poor problem-solving

skills, specifically those who fail to perceive alternatives or solving difficulties

are more vulnerable to suicide and that a significant relationship between

coping and suicidality exists among adolescents (Kidd and Carroll, 2007).

According to Carver and Connor-Smith (2010) when it comes to coping, it

was found that substance use, behavioral disengagement and self-blame

were related to poorer psychological well-being, whereas acceptance was

associated with better psychological well-being.

Using emotion-focused coping alternatives, could mediate the effects

of stressful life events, and ultimately lead to hopelessness, and depressive

symptoms both of which are strong predictors of suicidality. In other words, a

reaction of walking away from a fight may be used both to calm down

(emotion-focused) and to change the setting of a conflict (problem-focused)

(Brunwasser, 2012).



48

48

The coping strategies that predicted poorer psychological well-being,

namely substance use, behavioral disengagement and self-blame, can be

classified as disengagement coping, whereas the coping strategy

acceptance, which predicted both psychological and physical well-being, can

be classified as engagement coping (Carver & Connor-Smith, 2010).

Cheng, Chen, Chen, and Jenkins (2000) found that adolescents with

suicidal ideation and depressive symptoms often make use of isolative

coping strategies, including thinking that people should be able to handle

their own problems. Also in the same study it was discovered that suicidal

adolescents with high levels of suicidal ideation would be less inclined to

using help-seeking as a coping strategy. Esposito, Johnson, Wolfsdorf, and

Spiritu (2003) also found social withdrawal to be the only difference in coping

strategies used between suicidal and non-suicidal adolescents, with both

groups reporting similar stressors but in varying degrees.

The present study seeks to enhance our understanding of the relation

of specific coping behaviors to suicidal ideation of adolescents specifically

college students. It improves upon previous research by addressing also the

specific coping behaviors within these categories that may account for

associations with suicidal ideation.

Synthesis of Reviewed Materials



49

49

After reviewing the literature and studies, the researchers were able to

understand better the factors that are related to suicidal ideation and coping

responses of college students. Namely, the literature review allowed the

researchers to trace the extent to which coping strategies as emotion-

focused, avoidant-focused and problem-focused affected the suicidal

ideation of these college students.

To understand the association of these coping strategies to suicidal

ideation, a thorough literature review was done. It helped the researchers

gain a deeper understanding of coping strategies and its implications to

college students’ suicidal ideation and behavior. Various literatures have

shown multiple results. Some studies have shown a positive relationship

between the specific dimensions of these coping strategies and suicidal

ideation, whereas others have shown none. A thorough understanding and

exploration of literature on this matter helped the researchers oversee the

changes to be made and limitations regarding this matter.

Over the past years, coping strategies used by students have been of

considerable interest to researchers. This is primarily due to the fact that

coping strategies and suicidal ideation has a significant relationship. Given

the steadily increasing cases of suicidal ideation among the youth today, it is

vital to look closely into this and study its relationship with coping strategies

to be able to detect it early and aid its prevention. A review on literatures on

this topic helped the researchers identify the coping strategies effects on



50

50

suicidal ideation and this is of great relevance not only in the field of

Behavioral Sciences but also in the field of Health Sciences as well, given

the negative implications of suicidal ideation to an individual’s life, health,

mentality, and environment.

The review materials provided comprehensive information about the

relationship of coping strategies to the suicidal ideation of second and third

year college students. This would prove to be useful in aiding the

researchers yield the best results, given the extensive knowledge gained

through the reviewed literatures and in helping them to be better prepared in

conducting their study, given their knowledge in its strengths and limitations.



51

51

Suicidal Ideation Coping Responses

Documents

Transcript of Suicidal Ideation Coping Responses