The results from the study showed that increased suicidal behaviour was related to increased avoidance coping, and reduced levels of accommodation and self-help coping. This suggests a generally protective effect of suicide via the use of self-help and
accommodation coping, and a risk effect via the use of avoidant coping. Modeling the data with regression analysis indicated that avoidance coping was the strongest predictor for increased level of suicide behaviour. This has strengthened the existing relationship that the study of avoidance may better help to understand how individuals proceed to further suicidality along the suicide path. Avoidance coping is considered to be a maladaptive coping strategy (John & Gross, 2004; Zuckerman & Gagne, 2003) and the
current findings support this. If individuals choose to use avoidance coping to avoid unwanted thoughts and negative emotions (rather than trying to alter them), these emotions may still be readily available despite the effort to keep them out of awareness. The negative thoughts and feelings they try to avoid may persist to a greater extent without being resolved (Najmi, Wegner, & Nock, 2007). As predicted by the Cry of Pain model (Williams 1997, Williams & Pollock, 2001), individuals who try to escape from an intolerable situation by trying not to think about the stressor are more likely to show increased suicide behaviour.
It is noteworthy that with the change of coping measure in this study, the present findings replicated the results of Study 1 whereby the use of avoidance coping was one of the most significant predictors of suicide behaviour. This again suggests that individuals who use high levels of avoidance coping may hold short-term goals instead of trying to resolve the problem. In the long term, the problem remains unresolved and may become more difficult and distressing in the future, and this can lead to greater engagement in suicide behaviour.The results also suggest that avoidance coping is an important factor in suicide behaviour even when a revised coping scale with fewer dimensions was used. This indicates that coping may be regarded as a stable trait that could be worth exploring from a neurological perspective in the proceeding studies.
In the current study, the increased use of accommodation and self-help coping was significantly associated with a reduced risk of suicidal behaviour. This suggests that individuals who more often seek support and express emotion (self-help coping) or accept a problem and positively reframe a situation (accommodation coping) are more likely to be protected against suicide behaviour. According to the arguments of the Cry of
Pain model (Williams, 1997; Williams & Pollock, 2001) and the SAMS (Johnson et al., 2008), individuals can feel trapped or defeated in a situation because they are unable to generate alternatives for an unbearable situation. In support of this, the current findings suggest that individuals who utilize different adaptive coping strategies in the form of accommodation and self-help can generate solutions to a stressful situation and may therefore be less likely to experience defeat and entrapment.
Whilst three of the coping strategies proposed by Zuckerman and Gagne (2003) were associated with a risk of suicide behaviour, self-punishment and approach coping showed no relationship with scores on the SBQ-R. This conflicts with previous research showing that suicide behaviour is best predicted by reduced use of approach coping (Pienaar, et al., 2007) and increased use of self-punishment coping (Pietrzak et al., 2011). Again, one reason for the disparity in the findings is that the samples used across the different studies vary quite substantially and participants may be exposed to different stressors. For example, the Pieenar et al. (2007) study recruited uniformed police officers from South Africa and Pietrzak et al. (2007) studied Veterans in the U.S. Coping
strategies and behaviour of individuals from those groups may not be applicable to university students who tend to be younger and have less experience in mastering their approach coping (this requires problem solving based on knowledge and past
experiences). The use of different coping strategies with regards to suicide behaviour has not been extensively investigated among university students and the present study has therefore shown that it is important to take account of the participant characteristics and the stressors they may experience before trying to encourage specific coping strategies.
The current findings have drawn attention to the appropriateness of categorizing coping as adaptive and maladaptive. It is suggested that the term maladaptive coping may not be consistent across all populations and all situations. For example, the use of
approach coping, that is considered to be effective in reducing suicidality in police officers (Pieenar et al., 2007), may not apply to other populations. Conversely, maladaptive coping strategies that are widely identified to have a negative affect on wellbeing may be beneficial in dealing with some situations (Clarke, 2006; Zuckerman & Gagne, 2003). As outlined in Chapter 2, the use of active coping (directly dealing with the stressor itself) was associated with healthy functioning only in the experience of a controllable event, but was related to unhealthy functioning when dealing with an uncontrollable event (Clarke, 2006). This suggests that there are no definite ways of defining a coping strategy as either adaptive or maladaptive because a coping strategy that is effective in one situation may not be effective in other situations. Further to the correlational findings of Study 1 and the present study, researchers in the future should explore the coping strategies individually rather than grouping them as adaptive or maladaptive.
The current study builds on and expands both theoretical work and past research findings examining coping, emotion regulation, and suicidal behaviour. Overall, the findings indicate that lower levels of avoidance coping, in combination with higher levels of cognitive reappraisal may explain the resilience of some individuals against suicidal behaviour. This may help to improve prevention of suicide in younger populations. A further important point raised by the research, in combination with past findings, is that the use of coping and emotional regulation may be influenced by cultural context and the
psychological processes that may be considered risk factors in some populations and situations may be beneficial in others. This supports the argument that emotion regulation strategies are similar to coping in that these strategies may be beneficial in certain
situations and harmful in others. Therefore, there is no absolute way of defining them as adaptive or maladaptive. The research therefore raises the importance of accounting for the background and situation of the individual when trying to identify risk factors to suicide.
Overall, the current findings complement the SAMS and provide support for the argument that cognitive reappraisal is considered as adaptive emotional regulation. There is convincing evidence that the use of appraisal serves as an important resilient factor for reducing suicidality. In terms of coping, the findings complement the proposal of the Cry of Pain model in that motivation to escape is one important reason for individual to commit suicide.
CHAPTER FOUR
Experimental investigations of executive functions and frontal asymmetry of suicide individuals