It may be argued that suicidal behavior comprises three major
manifestations: suicidal ideation, which is the process of thinking
about committing suicide; suicide attempt, which is the process where an
individual tries to commit suicide but is not successful; and completed
suicide, the process of successfully ending one's life. Although
these three processes can easily be viewed as a linear sequence, it must
be noted that they do not occur in an unbroken stream. Many people
entertain suicidal thoughts, but never reach the point where they feel
compelled to act on these thoughts, nor will all unsuccessful attempters
try again (and again) until they are successful, and not all completed
suicides have a history of attempts (Kessler, Borges & Walters,
1999; Pirkis, Burgess & Dunt, 2000). Because the three modes of
suicidal behavior do not form an automatic, inevitable chain of events,
it could be argued that individuals who attempt or complete suicide must
differ in some respect from those who do not move beyond suicidal
Investigating differences between suicidal ideators and completed
suicides is not easily accomplished unless there is sufficient
information available about the deceased to permit psychological
autopsies. However, studying differences between ideators and attempters
is feasible because members of both groups are available for
consultation. The present study compared suicidal ideators and
attempters in the context of Lazarus' (1966) theory of stress and
coping. More specifically, the investigation assessed the extent to
which the two groups differ in terms of their locus of control
orientation and level of problem-focused coping they use when faced with
In life there are many unusual, unpleasant, and threatening
experiences which put people under stress. If that stress is too severe
or if it is perceived as such, it can lead to damaging psychological
effects. Lazarus (1966) suggested that perception of threat is
influenced not only by characteristics of the stimulus but also by
characteristics of the perceiving individual. One of these personal
factors is the individual's locus of control orientation.
Individuals with internal locus of control perceive the outcomes of
their lives as resulting from their own behavior, whereas people with
external locus of control attribute control to chance, fate, or powerful
others (Levenson, 1981). Individuals who attribute control to external
factors perceive the world differently than those who believe that they
have personal control. Externals are more prone to perceive threat
because they believe that they lack control, whereas internals tend to
see situations as controllable and therefore perceive less threat.
When people are confronted with stress they face two challenges:
meeting the requirements of the stress situation and protecting the self
from psychological disorganization (Lazarus, 1993, 2000). When they feel
competent to handle the stress, they may opt for problem-focused coping;
when they doubt their own competencies, emotion-focused coping may
prevail. Those who use problem-focused coping likely approach stress as
a problem to be solved; they move from merely thinking and worrying
about their difficulties to actively taking steps to deal with them,
thereby reducing stress.
In the present study it was speculated that external locus of
control and limited problem-focused coping skills may tip the balance
between merely thinking about suicide and attempting suicide. Most
suicidal behavior occurs in the context of recent, often severe life
stress (Bonner & Rich, 1988; de Man, 1988a,b; de Man, Balkou &
Iglesias, 1987; de Man, Leduc & Labreche-Gauthier, 1993; Farmer
& Creed, 1989; Zimmerman, Pfohl, Stangle & Coryell, 1985) which
generates feelings of threat and requires a coping response. Individuals
with internal locus of control and good problem-focused coping skills
generally will feel that they can do something constructive, and as a
result appraise the situation as less threatening. They will not likely
develop suicidal ideation nor feel the need to act in a self-destructive
manner. People with external locus of control and limited
problem-focused coping abilities may be overwhelmed by the stress.
Unable to alleviate the pressure they may develop suicidal ideation
severe enough to trigger an attempt.
External locus of control has been found to be associated with
higher levels of suicidal risk (Evans, Owens, & Marsh, 2005) and a
tendency to Lauer, de Man, Marquez & Ades ATTEMPTED SUICIDE 627
endorse suicide as a normal act (Nelson & Singg, 1998). External
individuals use fewer problem-solving methods when dealing with stress
(Anderson, 1977; Hoffman & Levy-Shiff, 1994; Liu, Kurita, Uchiyama,
Okawa, Liu, & Ma, 2000), and problem solving deficits have been
found to be characteristics of suicidals (Curry, Miller, Waugh, &
Anderson, 1992; Josepho & Plutchik, 1994; Pollock & Williams,
2004; Schotte & Clum, 1987). In this context, the present study
tested the hypothesis that individuals with external locus of control
and those who rely less on problem-focused coping will be more prone to
Besides the main variables of locus of control, problem-focused
coping, and suicide attempt, the present study also included gender,
age, anxiety, and depression as potential covariates in its analysis
because these may account for variance in locus of control (Levenson,
1981), coping behavior (Vitaliano, Russo, Carr, Maiuro & Becker,
1985), and suicidal behavior (Berger, 1987; de Man, 1999; Girard, 1993;
Goldney, Winefield, Tiggeman, Winefield & Smith, 1989; Langlois
& Morrison, 2002).
Participants were 25 psychiatric inpatients who had been admitted
to the psychiatric service of a hospital in a suburb of Paris, France,
between January and May, 2007. There were 15 men and 10 women ranging in
age from 19 to 64 yrs (M = 47.6, SD = 11). These patients had been
hospitalized because they either suffered from suicidal ideation without
a history of suicide attempts ("ideators": n = 11) or from
suicidal ideation and at least one suicide attempt
("attempters": n = 14). The sample excluded suicidal
individuals with a diagnosis of severe cognitive or neurological
problems or schizophrenia.
Materials and Procedure
A questionnaire asked participants information about their age,
gender, and history of suicide attempts (if applicable). Locus of
control was measured with the French version (Jutras, 1987) of
Levenson's (1981) three-dimensional Locus of Control Scale. This
instrument comprises three 8-item subscales: Internal (I), Powerful
Others (P), and Chance (C). The I-scale measures internal locus of
control and indicates the degree to which respondents believe that they
have control over the outcomes of their lives. The two external scales
respectively reflect the extent to which respondents believe that
control is in the hands of powerful others (P) or determined by chance
or fate (C). Items are rated on 6-point Likert scales (strongly
disagrees to strongly agree) with higher scores indicating greater
internal (I) or external (P, C) beliefs. Jutras (1987) reported an alpha
of .57 for the I-scale, an alpha of .73 for the P-scale, and an alpha of
.70 for the C-scale.
Problem-focused coping was assessed with the 8-item Problem-Focused
subscale of the French version (Paulhan, Nuissier, Quintard, Cousson
& Bourgeois, 1994) of the Ways of Coping Checklist (Vitaliano,
Russo, Carr, Roland, Maiuro & Becker, 1985). The measure asks
participants to respond to the checklist with respect to a stressor they
encountered during the preceding month, and to indicate on 4-point
scales (no; more often no; more often yes; yes) the extent to which they
used the various coping strategies presented in the measure. Scores may
range from 8 to 32, with higher scores indicating greater use of
problem-focused coping. Vitaliano et al. (1985) reported coefficient
alphas for the problem-focused scale that ranged from .85 to .88.
Levels of anxiety and depression were assessed with the French
version (Lepine, 1996; Lepine, Godchau, Brun, Lemperiere, 1985) of the
Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith,
1983). This 14-item self-report measure comprises 7 anxiety items and 7
depression items from which separate anxiety and depression scores are
derived. Each item is rated on a 4-point scale (from 0 representing
absence of symptoms to 3 representing maximum symptomatology). Each
sub-scale has a maximum score of 21 with higher scores indicating higher
levels of disorder. Bjelland, Dahl, Haug, and Neckelmann (2002) upon
reviewing the relevant literature concluded that the HADS performs well
in screening for the separate dimensions of anxiety and depression.
Participants were approached within three days following their
admission to the hospital. They were given verbal and written
information about the project and the amount of time involved, and were
invited to participate. Upon signing an informed consent form they were
asked for information about their age, gender, and, if applicable, their
history (frequency) of suicide attempts. They were then given the
questionnaires with the request to complete these before the end of
their first week of hospitalization. Respondents were assured that they
could withdraw from participation at any time they wished to do so. All
the procedures took place in the hospital setting and psychological
support was available to the participants if needed.
RESULTS AND DISCUSSION
Eleven of the participants suffered from suicidal ideation but had
no history of suicide attempts. The other 14 had suicidal ideation but
in addition had made one or more suicide attempts, with number of
attempts ranging from 1 to 10 (M = 2.24). These ideators and attempters
were compared in terms of locus of control and problem-focused coping.
Before the main data analyses were conducted, the importance of the
potential covariates was assessed. One-way analyses of variance
indicated that the ideators and attempters did not differ in terms of
age, anxiety, and depression (see Table 1). These variables were
therefore excluded from subsequent analyses. Overall, the participants
were mainly middle-aged (M = 47.64; SD = 11.04) individuals who reported
psychiatrically significant (Lepine, 1996; Lepine, Godchau, Brun,
Lemperiere, 1985; Zigmond & Snaith, 1983) levels of anxiety (M =
14.52; SD = 4.44), and depression (M = 14.28; SD = 4.54).
The ideators and attempters differed significantly (Chi-Square =
3.90, p < .05) in gender distribution. A survey of the data showed
that there were more females then men among the attempters and more
males then females among the ideators. This is consistent with the
finding that women tend to make more attempts then men (Langlois &
Morrison, 2002). However, because the men and women did not differ
significantly with respect to the three locus of control measures and
problem-focused coping (see Table 2), there was no need to include
gender in subsequent analyses.
Significant differences were found between ideators and attempters
in terms of chance and problem-focused coping; no significant
differences were found with respect to internality and powerful others
(see Table 1). Attempters believed more strongly than ideators that the
outcomes of their lives were controlled by chance; they also used less
problem-focused coping than ideators did.
A stepwise logistic regression analysis performed on attempted
suicide as outcome and chance and problem-focused coping as the
respective predictors identified chance as best predictor (see Table 2).
Nagelkerke R2 was .24, and overall prediction success was 72%, with
63.6% of the ideators and 78.6% of the attempters correctly predicted.
The odds ratio of 1.13 showed that there was an increase in the
likelihood of attempting suicide on the basis of a one unit change in
belief in chance.
In summary, the results of this study provide support for the
hypotheses that individuals who have external locus of control (chance)
and who less often use problem-focused coping skills are more prone to
attempt suicide. Attempters tend to believe that the important events in
their lives are beyond their control and primarily determined by chance.
Under those circumstances it would not be surprising if they were to
develop feelings of powerlessness, helplessness, and hopelessness,
feelings which over time may lead to (increased) suicidal ideation.
Furthermore, attempters generally are less able to cope successfully
with stress because they tend not to opt for a problem-focused approach
to coping. Although ideators and attempters differed in terms of
problem-focused coping, the latter variable did not significantly
contribute to the logistic regression when chance was also included in
the equation. It seems that the relationship between (lack of)
problem-focused coping and suicide attempt was the result in part of the
association between chance and suicide attempt. This is consistent with
the observation that externals are less likely to use effective coping
strategies to handle stress than internals (Anderson, 1977; Hoffman
& Levy-Shiff, 1994; Liu, et al., 2000).
Note: The authors wish to thank Prof. Jean-Michel Petot of the
Universite Paris-X, Nanterre, for his invaluable assistance in
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Sophie Lauer & Anton F. de Man
Sonia Marquez & Jean Ades
Louis Mourier Hospital, Colombes
Author info: Correspondence should be sent to: A. F. de Man,
Department of Psychology, Bishop's University, Sherbrooke, Quebec,
J1M 1Z7, Canada. firstname.lastname@example.org
TABLE 1 Ideators vs. Attempters: Means, SD, F, and p-Values for
Potential Covariates and Main Variables
M SD M SD F P
AGE 50.64 8.91 45.29 12.25 1.47 ns.
ANX 14.09 5.19 14.86 3.92 .18 ns.
DEP 13.00 5.16 15.29 3.89 1.60 ns.
I 34.00 9.03 33.29 7.98 .04 .ns
PO 28.27 8.66 28.57 7.50 .01 ns.
C 26.45 8.47 33.29 6.47 5.24 .03
PFC 25.91 3.63 20.71 6.89 5.10 .03
Age (AGE), Anxiety (ANX), and Depression (DEP), Internality
(I), Powerful Others (P), Chance (C), and Problem-Focused
TABLE 2 Gender Means, SDs, F, and p-Values
M SD M SD F p
I 34.93 6.53 31.60 10.45 0.97 ns.
PO 27.53 8.64 29.80 6.71 0.48 ns.
C 28.53 8.06 32.90 6.47 1.83 ns.
PFC 23.17 6.53 22.75 5.94 0.03 ns.
Internality (I), Powerful Others (P), Chance (C), and
Problem-Focused Coping (PFC)
TABLE 3 Results of Stepwise Logistic Regression Analysis with
Suicide Attempts as DV and Chance and Problem-Focused
Coping as IVs.
B SE Wald df Sig. Exp(B)
Chance .12 .061 4.102 1 .043 1.131
Constant -3.45 1.863 3.430 1 .064 .032