Elsevier

Psychiatry Research

Volume 258, December 2017, Pages 189-193
Psychiatry Research

The construct and measurement of suicide-related coping

https://doi.org/10.1016/j.psychres.2017.08.008Get rights and content

Highlights

  • Studies of suicidal behavior are hampered by low base rates outcomes. Therefore, measures proximal to suicidal behavior are needed.

  • Suicide-related coping, a new construct, and a scale, the Suicide-Related Coping Scale, for its measurement, are described.

  • The scale is a promising measure with good reliability and validity. It can assess suicide-related coping in clinical practice and trials.

Abstract

Enhancing the ability to cope with suicidal thoughts, urges, and crises is a key component of therapeutic work with suicidal patients. Suicide-related coping can serve as a treatment target, can provide an additional component in the evaluation of suicidal patients, and can serve as an outcome in randomized controlled trials for the prevention of suicide. However, to date, psychometrically sound measures to assess suicide-related coping are lacking. The aim of this study was to examine the psychometric properties of a new measure, the Suicide-Related Coping Scale (SRCS). Adult patients who were either admitted to a psychiatric inpatient unit (n = 97) or an Emergency Department (n = 232) for suicide-related concerns were enrolled in this study. All were administered the SRCS at baseline and at one month. Factor analyses and internal consistency analyses were conducted. Additional measures were administered to assess convergent and divergent validity. Factor analysis of the SRCS revealed two factors, internal and external coping strategies. The SRCS had high internal consistency, good convergent validity and was sensitive to change. Suicide-related coping is a promising construct as measured by the SRCS to assess suicide-related coping in both clinical practice and trials.

Introduction

Over the past decade, suicide deaths in the United States have increased dramatically. In 2014, 42,773 individuals died by suicide (CDCP, 2016). While suicide-specific, evidence-based interventions (e.g., Cognitive Therapy for Suicide Prevention, Dialectical Behavior Therapy, and the Safety Planning Intervention) have been developed (CT-SP: Brown et al., 2005; DBT: Linehan et al., 2006; SPI: Stanley and Brown, 2012), only a few have a demonstrated impact on suicide deaths (Fleischmann et al., 2008, Motto and Bostrom, 2001). Trial results for suicidal ideation are mixed (Hawton et al., 2016). Suicidal ideation as an outcome is not highly correlated with suicidal behavior, in part, because it can fluctuate dramatically. For example, for some individuals, the time between contemplating suicide and making an attempt is quite brief while others consider it for a long time (Bagge et al., 2013, Simon et al., 2001, Spokas et al., 2012). Furthermore, most people who experience suicidal ideation never engage in suicidal behavior (Glenn and Nock, 2014). The urge to engage in suicidal behavior, a form of suicidal ideation that is proximal to acting on suicidal thoughts, is not typically considered as an intervention target but perhaps it should be. Not surprisingly, intervention studies that have used suicidal ideation as an outcome frequently find no differential effect of the active intervention (Linehan et al., 2006). This may, in part, be related to the fact that suicide-specific interventions often target increasing suicide-related coping behavior rather than decreasing suicidal ideation. In order to assess suicide risk in patients and effectiveness of interventions, we suggest that researchers should include suicide-related coping effectiveness, as an outcome, in addition to suicidal ideation and behaviors.

A productive (i.e. functional) coping style is protective against suicidal ideation while a nonproductive (i.e. nonfunctional) coping style is associated with suicidal ideation (Mirkovic et al., 2015). Additionally, individuals who engage in deliberate self-harm or repeated suicidal behavior are less likely to adopt a problem solving approach to coping more generally in their lives (Evans et al., 2005, Nrugham et al., 2012). In a study aimed at identifying strategies that suicidal individuals use to cope with suicidal thoughts, Simon et al. (2016) reported that suicidal individuals found clinician support as well as self-care activities such as distraction techniques and socialization to be helpful in managing suicidal crises. These findings are consistent with techniques used in efficacious interventions for reducing suicide risk (e.g., CT-SP, DBT, SPI). Such interventions are purported to enhance coping to prevent suicidal behavior while not specifically focusing on reducing suicidal ideation. However, while studies of these interventions typically include suicidal behavior and ideation outcomes, they do not typically assess suicide-related coping. Interestingly, such interventions have been found to reduce suicidal behavior but do not typically result in superior reductions in suicidal ideation.

We propose a construct, suicide-related coping, defined as knowledge of and perceived self-efficacy in engaging in the use of internal coping strategies and external resources to manage suicidal thoughts with the goal of decreasing imminent risk and averting suicidal crises. This construct may help to explain why some individuals have high levels of suicidal ideation but never act on it; their ability to cope with suicidal ideation and associated urges may be high even in the presence of severe ideation.

Psychometrically sound tools for measuring suicide-related coping have been lacking. We have developed a measure of suicide-related coping, the Suicide-Related Coping Scale (SRCS) to address this void. While no other scales measure suicide-related coping as proposed here, there are two related measures of this construct. First, the Suicide Resilience Inventory (SRI) evaluates protective and resilience factors for suicide (Osman et al., 2004, Rutter et al., 2008). The SRI differs from the SRCS in that several SRI items pertain to general resilience while the SRCS addresses suicide-specific coping. This distinction is important because what is effective for coping during a suicidal crisis (Simon et al., 2016) may differ from effective coping in non-crisis situations. Furthermore, most of the development testing for this scale was in adolescents and young adults while the SRCS was developed specifically in adults. Second, Czyz et al. (2016)tested a series of items designed to measure self-efficacy in relation to suicidal urges in children. Although the measure is described as a scale, no total scores are reported, with results analyzed item by item. Furthermore, more than 50% of the sample was under 18 years; suicide-related coping may differ in youth.

The purpose of the current study was to examine the psychometric properties of the SRCS. The specific aims were: (1) to describe the development of the SRCS; (2) to evaluate the factorial validity of the scale; and (3) to evaluate other psychometric properties including internal consistency, convergent validity, and sensitivity to change of the scale. It was expected that the SRCS would demonstrate good internal consistency and be sensitive to change over time. With regard to convergent validity, it was expected that the SRCS would be moderately related to measures of attitudes toward receiving mental healthcare and perceived barriers to care. It was expected that the SRCS would be moderately associated with suicidal ideation and lifetime suicide attempt history.

Section snippets

Description and development of the Suicide-Related Coping Scale

Several steps were followed to generate items for the SRCS. First, we developed a definition of the construct of suicide-related coping. Next, the literature was reviewed to determine whether similar scales existed of the construct we proposed to measure. The initial pool of items for the scale were generated by three authors (GKB, MGH, BS) who have extensive experience developing measures and assessing suicidal individuals. Items reflected: (1) overall self-efficacy and confidence in coping

Factorial validity

On the basis of interpretability and fit indices, two factors were ultimately selected for extraction; factor loadings for the two-factor solution are reported in Table 1. A total of 49% of the total variance was accounted for by both factors combined; factors 1 and 2 accounted for 41% and 8% of the variance, respectively. Model fit indices indicated that the two-factor solution was an acceptable fit to the data, CFI = 0.96, RMSEA = 0.07 (90% CI: 0.06–0.08). Fourteen of the 21 items loaded onto

Discussion

The purpose of this study was to describe the psychometric properties of a newly developed measure, the SRCS. This self-report measure assesses the construct of suicide-related coping, defined as knowledge of and perceived self-efficacy in using internal coping strategies and external resources to manage suicidal thoughts and urges with the goal of decreasing imminent risk and averting suicidal crises. We suggest that this measure differs from scales that focus on suicidal ideation generally

Disclosures

Drs. Brown and Stanley receive royalties from the Research Foundation for Mental Hygiene, Inc. for the Columbia Suicide Severity Rating Scale.

Acknowledgments

This research was supported in part by the Military Operational Medicine Research Program of the United States Department of Defense (W81XWH-09-2-0129) and Mental Health Services in the United States Department of Veterans Affairs (VA), the VA Healthcare Upstate New York (VISN 2) Center of Excellence for Suicide Prevention and Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC).

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