Prospective Associations of Specific Coping Behaviors with Depression and Suicide Risk among Psychiatric Emergency Patients

Abstract

Suicide is currently the second leading cause of death for adolescents and young adults ages 13-25 in the United States. Many risk factors for suicide have been identified in community and clinical samples, and there are many potential pathways and combinations of risk factors that may result in suicidal thoughts or behaviors. Although risk factors for suicide are often moderated by demographic factors such as age and sex, interventions with suicidal populations are not typically tailored to account for these differences. Coping refers to cognitive and behavioral efforts to manage stress and has been examined in relation to suicide risk. However, research on longitudinal relationships between coping and suicide risk is limited and has not included high risk clinical samples. The aims of this dissertation project are to 1) identify the cross-sectional and longitudinal associations of coping styles with suicide risk in a high risk sample of adolescents and young adults, and 2) examine how these associations may be moderated by sex and age. Participants were 286 adolescents and emerging adults, ages 13-25, recruited from a psychiatric emergency department in the Midwestern United States and completed measures of depression, suicidal ideation/behaviors, and coping. Participants were 77% Caucasian and 59% female. 4-month telephone follow-ups were completed by 79% of participants, and included an assessment of interim suicidal thoughts and behaviors. Linear and logistic regressions examined the relationships between coping styles with depression, suicidal thoughts, and suicidal behaviors. Positive reframing was the coping style most consistently associated with positive outcomes, whereas self-blame and disengagement were the coping styles most consistently associated with negative outcomes. In moderator analyses, problem-solving coping styles (i.e., active coping, planning) were protective of suicide attempts and behaviors for males, but conveyed risk for females. Additionally, planning was protective of suicidal behaviors for younger participants, but conveyed risk for older participants. Findings suggest an intervention focused on increasing positive reframing and subsequently reducing self-blame may be particularly beneficial for suicidal patients. These findings also highlight the need to tailor interventions, particularly those with a coping emphasis, to account for developmental and sex-related differences in coping.