Journal List > J Korean Neuropsychiatr Assoc > v.56(2) > 1017861

Park, Lim, Choi, Park, and Joe: The Effect of Depression, Stress, Coping Strategies on the Suicidal Ideation in Healthy Controls and Psychiatric Patients



The aim of this study was to compare the coping strategies among healthy controls, psychotic and neurotic patients and to evaluate the predictors of suicidal ideation.


The study population consisted of 115 outpatients in Ulsan University Hospital and 160 healthy controls. They filled out self-report questionnaires including demographics and validated psychiatric scales for depression, perceived stress, coping strategies, and suicide ideation. An analysis of the covariance was used to compare the clinical data among the groups. Stepwise multiple regression analysis was performed to estimate the effects of coping strategies and depression on the risk for suicidal ideation.


Compared to the controls, the psychosis group used less active coping, and the neurosis group used more self-blame coping strategies. In healthy controls, suicidal ideation was predicted by depression, female gender, and using more self-blame coping. Although planning in psychosis was a protective factor, acceptance and self-blame in psychosis and behavioral disengagement in neurosis was a risk factor for suicidal ideation.


Patients with psychotic and neurotic disorders use different coping strategies to deal with their distress and some of those are risk factors for suicidal ideation. Therefore, improving coping skills will be helpful for preventing suicide by alleviating the levels of stress and providing more effective emotion regulation.

Figures and Tables

Table 1

ICD-10 diagnosis code of clinical group


ICD : International Classification of Diseases, GAD : Generalized anxiety disorder, MADD : Mixed anxiety and depressive disorder, PTSD : Post-traumatic stress disorder

Table 2

Sociodemographic characteristics of study subjects

Table 3

Clinical characteristics of participants


* : p<0.05, † : p<0.001. SSI : Scale for Suicide Ideation, PSS : Scale for Perceived Stress, BDI : Beck Depression Inventory, SD : Standard deviation, F : F value, η2 : Partial eta squared, HC : Healthy control, P : Psychosis, N : Neurosis

Table 4

Stepwise multiple regression analysis for variables predicting suicidal ideation


* : p<0.05, † : p<0.001. SE : Standard error, VIF : Variance inflation factors, BDI : Beck Depression Inventory


Conflicts of Interest The authors have no financial conflicts of interest.


1. Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry. 1999; 156:181–189.
2. Jung SH. Korean workers are most stressed in the OECD. Korea Joonang Daily. 2010. 08. 27.
3. Chang SJ, Koh SB, Kang MG, Cha BS, Park JK, Hyun SJ, et al. [Epidemiology of psychosocial distress in Korean employees]. J Prev Med Public Health. 2005; 38:25–37.
4. Yoon MS. Korean students suffer from all work and no play. The Korea Herald. 2015. 03. 11.
5. Jung MK, Lee KM. A path analysis of stress, depression, optimism, and resilience in the elderly. J Korean Gerontol Soc. 2010; 30:629–642.
6. Eun KS. Socioeconomic determinants of suicide rate in Korea. Korea J Popul Stud. 2005; 28:97–129.
7. OCED. Health Data 2014. cited 2016 Jun 15. Available from:
8. Hawton K, van Heeringen K. Suicide. Lancet. 2009; 373:1372–1381.
9. Bentley KH, Franklin JC, Ribeiro JD, Kleiman EM, Fox KR, Nock MK. Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: a meta-analytic review. Clin Psychol Rev. 2016; 43:30–46.
10. Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. Philadelphia: Wolters Kluwer;2014. p. 763.
11. Pemberton R, Fuller Tyszkiewicz MD. Factors contributing to depressive mood states in everyday life: a systematic review. J Affect Disord. 2016; 200:103–110.
12. Myin-Germeys I, van Os J. Stress-reactivity in psychosis: evidence for an affective pathway to psychosis. Clin Psychol Rev. 2007; 27:409–424.
13. Lincoln TM, Köther U, Hartmann M, Kempkensteffen J, Moritz S. Responses to stress in patients with psychotic disorders compared to persons with varying levels of vulnerability to psychosis, persons with depression and healthy controls. J Behav Ther Exp Psychiatry. 2015; 47:92–101.
14. Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer Publishing Company;1984.
15. Marty MA, Segal DL, Coolidge FL. Relationships among dispositional coping strategies, suicidal ideation, and protective factors against suicide in older adults. Aging Ment Health. 2010; 14:1015–1023.
16. Horwitz AG, Hill RM, King CA. Specific coping behaviors in relation to adolescent depression and suicidal ideation. J Adolesc. 2011; 34:1077–1085.
17. Woodhead EL, Cronkite RC, Moos RH, Timko C. Coping strategies predictive of adverse outcomes among community adults. J Clin Psychol. 2014; 70:1183–1195.
18. Moritz S, Jahns AK, Schröder J, Berger T, Lincoln TM, Klein JP, et al. More adaptive versus less maladaptive coping: what is more predictive of symptom severity? Development of a new scale to investigate coping profiles across different psychopathological syndromes. J Affect Disord. 2016; 191:300–307.
19. Moritz S, Lüdtke T, Westermann S, Hermeneit J, Watroba J, Lincoln TM. Dysfunctional coping with stress in psychosis. An investigation with the Maladaptive and Adaptive Coping Styles (MAX) questionnaire. Schizophr Res. 2016; 175:129–135.
20. Lysaker PH, Bryson GJ, Marks K, Greig TC, Bell MD. Coping style in schizophrenia: associations with neurocognitive deficits and personality. Schizophr Bull. 2004; 30:113–121.
21. Hori H, Teraishi T, Ota M, Hattori K, Matsuo J, Kinoshita Y, et al. Psychological coping in depressed outpatients: association with cortisol response to the combined dexamethasone/CRH test. J Affect Disord. 2014; 152-154:441–447.
22. McNeill SA, Galovski TE. Coping styles among individuals with severe mental illness and comorbid PTSD. Community Ment Health J. 2015; 51:663–673.
23. Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the Scale for Suicide Ideation. J Consult Clin Psychol. 1979; 47:343–352.
24. Shin MS, Park KB, Oh KJ, Kim ZS. A study of suicidal ideation among high school students: the structural relation among depression, hopelessness, and suicidal ideation. Korean J Clin Psychol. 1990; 9:1–19.
25. You SM, Lee SY. Relationship of perceived stress, maladaptive perfectionism, suicidal ideation: focusing on the moderating effects of social problem solving and attachment styles. Korean J Sch Psychol. 2008; 5:119–136.
26. Beck AT, Steer RA, Brown GK. Beck Depression Inventory: Manual. 2nd ed. San Antonio: Psychological Corporation;1996.
27. Lee YH, Song JY. A study of the reliability and the validity of the BDI, SDS, and MMPI-D Scales. Korean J Clin Psychol. 1990; 10:98–113.
28. Hahn H, Yum T, Shin Y, Kim K, Yoon D, Chung K. A standardization study of Beck Depression Inventory in Korea. J Korean Neuropsychiatr Assoc. 1986; 25:487–500.
29. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983; 24:385–396.
30. Park JH, Seo YS. Validation of the Perceived Stress Scale (PSS) on samples of Korean university students. Korean J Psychol. 2010; 29:611–629.
31. Carver CS. You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med. 1997; 4:92–100.
32. Joo SA. A study of PTSD of the subway operators with the experience of “person under train” incidents [dissertation]. Seoul: Ewha Woman's University;2009.
33. Betensky JD, Robinson DG, Gunduz-Bruce H, Sevy S, Lencz T, Kane JM, et al. Patterns of stress in schizophrenia. Psychiatry Res. 2008; 160:38–46.
34. Phillips LJ, Edwards J, McMurray N, Francey S. Comparison of experiences of stress and coping between young people at risk of psychosis and a non-clinical cohort. Behav Cogn Psychother. 2012; 40:69–88.
35. Lee DG, Park HJ. Clusters of coping styles and their differences in procrastination and psychological distress. Korean J Soc Pers Psychol. 2009; 23:43–57.
36. Taylor SE, Brown JD. Positive illusions and well-being revisited: separating fact from fiction. Psychol Bull. 1994; 116:21–27. discussion 28.
37. Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol. 1989; 56:267–283.
38. Koo SJ, Bae SM, Hyun MH. Effect of stress, copying strategies and forgiveness on Hwa-byung symptoms. Korean J Health Psychol. 2011; 16:691–707.
39. Park EH. The structural relationship among ego-resiliency, stress coping and adaptive cognitive emotion regulation that influence posttraumatic growth [dissertation]. Jinju: Gyeongsang National University;2016.
40. Lee SY, Kim KR, Park JY, Park JS, Kim B, Kang JI, et al. Coping strategies and their relationship to psychopathologies in people at ultra high-risk for psychosis and with schizophrenia. J Nerv Ment Dis. 2011; 199:106–110.
41. Holubova M, Prasko J, Hruby R, Kamaradova D, Ociskova M, Latalova K, et al. Coping strategies and quality of life in schizophrenia: cross-sectional study. Neuropsychiatr Dis Treat. 2015; 11:3041–3048.
42. Holubova M, Prasko J, Hruby R, Latalova K, Kamaradova D, Marackova M, et al. Coping strategies and self-stigma in patients with schizophrenia-spectrum disorders. Patient Prefer Adherence. 2016; 10:1151–1158.
43. Nielsen MB, Knardahl S. Coping strategies: a prospective study of patterns, stability, and relationships with psychological distress. Scand J Psychol. 2014; 55:142–150.
44. Ito M, Matsushima E. Presentation of coping strategies associated with physical and mental health during health check-ups. Community Ment Health J. 2017; 53:297–305.
45. Kitano A, Yamauchi H, Hosaka T, Yagata H, Hosokawa K, Ohde S, et al. Psychological impact of breast cancer screening in Japan. Int J Clin Oncol. 2015; 20:1110–1116.
46. El Sheshtawy EA. Coping with stress and quality of life in schizophrenic patients. Asian J Psychiatr. 2011; 4:51–54.
47. Ponizovsky AM, Finkelstein I, Poliakova I, Mostovoy D, Goldberger N, Rosca P. Interpersonal distances, coping strategies and psychopathology in patients with depression and schizophrenia. World J Psychiatry. 2013; 3:74–84.
48. Allen AB, Leary MR. Self-compassion, stress, and coping. Soc Personal Psychol Compass. 2010; 4:107–118.
49. Raut NB, Singh S, Subramanyam AA, Pinto C, Kamath RM, Shanker S. Study of loneliness, depression and coping mechanisms in elderly. J Geriatr Ment Health. 2014; 1:20–27.
50. Tuncay T, Musabak I, Gok DE, Kutlu M. The relationship between anxiety, coping strategies and characteristics of patients with diabetes. Health Qual Life Outcomes. 2008; 6:79.
51. Feng J, Li S, Chen H. Impacts of stress, self-efficacy, and optimism on suicide ideation among rehabilitation patients with acute pesticide poisoning. PLoS One. 2015; 10:e0118011.
52. Keilp JG, Grunebaum MF, Gorlyn M, LeBlanc S, Burke AK, Galfalvy H, et al. Suicidal ideation and the subjective aspects of depression. J Affect Disord. 2012; 140:75–81.
53. Svensson T, Inoue M, Charvat H, Sawada N, Iwasaki M, Sasazuki S, et al. Coping behaviors and suicide in the middle-aged and older Japanese general population: the Japan Public Health Center-based Prospective Study. Ann Epidemiol. 2014; 24:199–205.
54. Aldridge AA, Roesch SC. Developing coping typologies of minority adolescents: a latent profile analysis. J Adolesc. 2008; 31:499–517.
55. Rowland JE, Hamilton MK, Lino BJ, Ly P, Denny K, Hwang EJ, et al. Cognitive regulation of negative affect in schizophrenia and bipolar disorder. Psychiatry Res. 2013; 208:21–28.
56. Jalbrzikowski M, Sugar CA, Zinberg J, Bachman P, Cannon TD, Bearden CE. Coping styles of individuals at clinical high risk for developing psychosis. Early Interv Psychiatry. 2014; 8:68–76.
57. Kasckow J, Felmet K, Zisook S. Managing suicide risk in patients with schizophrenia. CNS Drugs. 2011; 25:129–143.
58. Cooke M, Peters E, Fannon D, Anilkumar AP, Aasen I, Kuipers E, et al. Insight, distress and coping styles in schizophrenia. Schizophr Res. 2007; 94:12–22.
59. Lewis L. Mourning, insight, and reduction of suicide risk in schizophrenia. Bull Menninger Clin. 2004; 68:231–244.
60. Pompili M, Ruberto A, Kotzalidis GD, Girardi P, Tatarelli R. Suicide and awareness of illness in schizophrenia: an overview. Bull Menninger Clin. 2004; 68:297–318.
61. Aldebot S, de Mamani AG. Denial and acceptance coping styles and medication adherence in schizophrenia. J Nerv Ment Dis. 2009; 197:580–584.
62. Saarinen PI, Lehtonen J, Lönnqvist J. Suicide risk in schizophrenia: an analysis of 17 consecutive suicides. Schizophr Bull. 1999; 25:533–542.
63. Evans LD, Kouros C, Frankel SA, McCauley E, Diamond GS, Schloredt KA, et al. Longitudinal relations between stress and depressive symptoms in youth: coping as a mediator. J Abnorm Child Psychol. 2015; 43:355–368.
64. Brytek A. [Self-esteem, strategies of coping and feeling of anger in french patients with anorexia nervosa]. Psychiatr Pol. 2006; 40:743–750.
65. Khazem LR, Law KC, Green BA, Anestis MD. Examining the relationship between coping strategies and suicidal desire in a sample of United States military personnel. Compr Psychiatry. 2015; 57:2–9.
66. Maciejewski PK, Phelps AC, Kacel EL, Balboni TA, Balboni M, Wright AA, et al. Religious coping and behavioral disengagement: opposing influences on advance care planning and receipt of intensive care near death. Psychooncology. 2012; 21:714–723.
67. Park CL, Edmondson D, Fenster JR, Blank TO. Positive and negative health behavior changes in cancer survivors: a stress and coping perspective. J Health Psychol. 2008; 13:1198–1206.
68. Carver CS, Pozo C, Harris SD, Noriega V, Scheier MF, Robinson DS, et al. How coping mediates the effect of optimism on distress: a study of women with early stage breast cancer. J Pers Soc Psychol. 1993; 65:375–390.
69. Aldwin CM, Sutton KJ, Chiara G, Spiro A 3rd. Age differences in stress, coping, and appraisal: findings from the Normative Aging Study. J Gerontol B Psychol Sci Soc Sci. 1996; 51:P179–P188.
70. Campos RC, Holden RR, Costa F, Oliveira AR, Abreu M, Fresca N. The moderating effect of gender on the relationship between coping and suicide risk in a Portuguese community sample of adults. J Ment Health. 2017; 26:66–73.
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