External locus of control, problem-focused coping and attempted suicide.
Abstract:
Twenty-five French men and women diagnosed with either suicidal ideation without a history of suicide attempts or suicidal ideation with a history of attempts participated in a study of the relationship between external locus of control, problem-focused coping, and attempted suicide. Results indicated that attempts are more prevalent among suicidal individuals who believe that their lives are controlled by chance and who rely less on problem-focused coping skills.

Article Type:
Report
Subject:
Suicidal behavior (Analysis)
Authors:
Lauer, Sophie
de Man, Anton F.
Marquez, Sonia
Ades, Jean
Pub Date:
12/01/2008
Publication:
Name: North American Journal of Psychology Publisher: North American Journal of Psychology Audience: Academic Format: Magazine/Journal Subject: Education; Psychology and mental health Copyright: COPYRIGHT 2008 North American Journal of Psychology ISSN: 1527-7143
Issue:
Date: Dec, 2008 Source Volume: 10 Source Issue: 3
Topic:
Canadian Subject Form: Suicidal behaviour
Accession Number:
191856974
Full Text:
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 thinking.

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 stress.

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 attempt suicide.

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).

METHOD

Participants

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 completing this work.

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Sophie Lauer & Anton F. de Man

Bishop's University

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. ademan@ubishops.ca
TABLE 1 Ideators vs. Attempters: Means, SD, F, and p-Values for
Potential Covariates and Main Variables

                 IDEATORS         ATTEMPTERS
               M        SD       M        SD       F        P

Potential
Covariates
  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.
Main
Variables
  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
Coping (PFC).

TABLE 2 Gender Means, SDs, F, and p-Values

             MEN              WOMEN
         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
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