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Journal of Spirituality in Mental Health, 15:4767, 2013

Copyright Taylor & Francis Group, LLC


ISSN: 1934-9637 print/1934-9645 online
DOI: 10.1080/19349637.2012.744620

Spirituality: Its Role as a Mediating Protective


Factor in Youth at Risk for Suicide

JENNIFER KYLE
Queens College, City University of New York, Flushing, New York, USA

The aim of this study is to examine the role of spiritual well-being


as a predictor of suicide risk, specifically the role of spiritual beliefs
as a mediating variable in predicting risk in a diverse sample of
college-aged youth. Participants (N = 243) completed self-report
instruments to assess suicidality, social support, spiritual well-
being, and reasons for living. Logistic regression analyses were per-
formed using the independent variables to predict suicide-related
behaviors. Spiritual beliefs may function as a mediating variable
by assisting the negotiation of social support where increased levels
promote higher levels of coping.

KEYWORDS spiritual beliefs, religiosity, protective factors, sui-


cide, multicultural youth

Research examining youth suicide has underscored youths vulnerability to


suicide and suicide-related behaviors (Wilcox et al., 2010). Young adults, age
1825 years old, report higher rates of suicidal ideation and attempts than
older adults (Substance Abuse and Mental Health Services, 2009) leading
some to suggest that the lower rates of suicidal ideation and attempts among
older adults may be attributed to their reliance on faith-based protective fac-
tors, such as religiosity (June, Segal, Coolidge, & Klebe, 2009). Consistent
with a recent Pew Center report (Pew Forum On Religion & Public Life,
2010), American youth are less religious than previous generations, reporting
lower levels of religious affiliation and church attendance. However, these
data further indicate that young adults under age 30 are as likely as older
adults to believe in miracles, heaven and hell, life after death and absolute
standards of right and wrong for all; and young adults who attend tradition-
ally Black churches have reported attendance rates of almost 85%. Faith and

Address correspondence to Jennifer Kyle, Queens College, 65-30 Kissena Blvd., PH032,
City University of New York, Flushing, NY 11367. E-mail: jkyle3@gmail.com

47
48 J. Kyle

its use as a protective factor for suicide by youth including youth of color
remain unclear. Therefore, the aim of this current study is to examine the
role of spiritual faith as a predictor of suicide risk, paying particular attention
to the role of spiritual well being as a mediating variable in assessing suicide
risk in a diverse sample of young adults.

Protective Factors Related to Suicide Risk


Suicide is the second leading cause of death for young adults nationally
(Centers for Disease Control, 2009). Risk factors for suicide and attempts
in young adults include mood disorders (Esposito, Spirito, Boergers, &
Donaldson, 2003), substance use disorders (Lamis, Ellis, Chumney, & Dula,
2009), poor social support (Wilcox et al., 2010), family conflict (Evans,
Hawton, & Rodham, 2004), and feelings of hopelessness (Drum, Brownson,
Burton-Denmark, & Smith, 2009); and multiple risk factors appears in higher
proportions among those with past attempts (Pena, Matthieu, Zayas, Masyn,
& Caine, 2010). Highlighting the dynamic relations among risk factors,
Moscicki (2001) suggested suicide risk results from complex interactions
risk factors and the lack of, or limited access to, protective factors such as
enhanced coping skills, family cohesion, adequate social support and access
to mental health services. Further, Hatala (2011) suggested that resilience
or protective factors are based upon a dynamic interaction of factors from
biological to social support to spiritual capacity. In young adults, protective
factors associated with reduced risk include solid family and social support
(Compton, Thompson, & Kaslow, 2005), spiritual faith (Richardson-Vejlgaard,
Sher, Oquendo, Lizardi, & Stanley, 2009), gender (McLaren, 2011), and adap-
tive coping styles (Grosz, Zimmerman, & Asnis, 1995). Further, Compton
et al. (2005) found that depression mediated the effect of protective factors
such as family and social support. Although spiritual faith is associated with
reduced likelihood of suicide behaviors, having spiritual beliefs and its ability
to mediate the effects of protective factors (e.g., coping and social support),
remains unclear.

Spiritual Faith
In general, faith provides individuals with the ability to find personal mean-
ing in life events allowing individuals to persevere in the face of daily hassles
and life stressors. Faith intersects with individual psychology in three key
domains as it provides a framework for (a) understanding life events (i.e.,
attributional), (b) handling these life events (i.e., coping strategies), and (c)
developing in complexity and becoming continuously internalized over the
course of the lifespan (i.e., religions basic tenets/spiritual beliefs become
woven into the fabric of ones personal value system). In other words, faith
Spirituality as a Mediating Protective Factor 49

becomes part of ones orienting system, partially informed by early experi-


ences, but also changing and shaping how individuals will interpret current
events and responds to those events (Hood, Hill, & Spilka, 2009; Pargament,
1997).
Research indicates that adults tend to search for meaning, particularly
during times of uncertainty. Through prayer and church activities, adults
often reduce negative affect such as fear and guilt by using faith-based cop-
ing strategies (Pargament, 1997). The strength of faith-based coping is its
ability to find meaning and purpose within ones suffering that allows them
to overcome adversity and maintain greater psychological and physical well
being (Wachholtz & Sambamoorthi, 2011). Resilient people tend to have a
strong sense of purpose, having set important goals in their lives and are
actively involved in attaining them (Jackson & Bergeman, 2011; Collucci &
Martin, 2008). So beginning to gather empirical data on how spiritual youth
create meaning in daily events and cope with stress or negative life events is
key to understanding faiths role in suicide risk for youth.
Along with meaning making and coping, the church is the place
where worship and ritualized practice occurs. The church becomes a symbol
imbued with deeper meanings such as a place of belonging, of shared affect,
and traditions. Faith-based institutions allow people to believe in large, coop-
erative groups suggesting that part of religions power stems from the human
motivational need to connect to others. The human need to belong and have
positive affective interactions with others is fundamental to psychological
well-being and development (Baumeister & Leary, 1995).
Faith with its shared search for personal meaning can serve as a means
of connection among its members. For example, the powerful need to belong
serves as the foundation for the black church tradition, allowing its members
to persevere in the face of adversity (Matlin, Molock, & Tebes, 2011; Mattis,
2000). Faith plays a role across cultures by maintaining cultural traditions,
furthering cultural identity and serving as informal places for help-seeking at
time of stress (Goldston et al., 2008). However, should the need to belong go
unsatisfied, feelings of loneliness may surface, stemming from either insuffi-
cient social interactions or poor intimate relationships (Baumeister & Leary,
1995). Hopelessness, isolation, poor coping, lack of purpose and sadness are
noted risk factors for suicidal ideation (Wang, Richard Lightsey, Pietruszka,
Uruk, & Wells, 2007; Edwards & Holden, 2003).
For the purpose of this study, religiosity and spirituality are distinct but
overlapping domains of spiritual faith (Griffin-Fennel, 2006). Conceptually,
religiosity is associated with organized worship, and the adherence to the
beliefs, doctrines and practices of a given religion (Slater, Hall, & Edwards,
2003) with an emphasis on ones relationship with God (Ellison, Burr, &
McCall, 1997). Spirituality, on the other hand, has been defined as the
internalization of positive values of faith-based beliefs and a reverence for
50 J. Kyle

the divine (Griffin-Fennell, 2006; Mattis, 2000; Zinnbauer, Pargament, &


Cole, 1997).

Spiritual Faith Related to Suicide Risk


Each domain, religiosity versus spirituality, may provide its own means of
assuaging risk. For example, Ellison et al. (1997) suggested that religions
buffering effect is due to social connectedness and group relatedness that
are reflected in religious practice but also in ones connection to God; so
that, what might be protective is the daily connection to a shared reli-
gious practice and religious doctrine. In another study of religiousness and
suicidality, Greening and Stoppelbein (2002) found that religions with higher
levels of orthodoxy were related to lower incidents of suicidality in an ado-
lescent sample. Higher levels of orthodoxy may be comforting for youth as
they provide structure and may be relied upon as youth navigate troubling
developmental milestones (e.g., attending college, working) while moving
toward personal autonomy and adulthood. Further, Kirkpatrick (1998) has
suggested that ones relationship with God is reminiscent of early attachment
relationships with the caregiver, in particular the mother-child relationship.
Therefore, ones relationship with God becomes imbued with the idealized
elements of the mother-child relationship such as security and safety, which,
can be called upon during times of stress (Pickard & Nelson-Becker, 2011).
Spirituality or existential well-being, on the other hand, is the internalized
aspects of positive faith based values, relating to positive coping styles.
Spiritualitys value as a protective factor may be its ability to mediate the
affect between religiousness and depression (Dew et al., 2008).
Previous research on suicide and spirituality suggest that reduced
suicide risk is related to increased moral objections to suicide (Richardson-
Vejlgaard et al., 2009), high levels of social support (Compton et al., 2005),
and being a religious person (Sisask et al., 2010). After an extensive review
of the literature on suicide and spirituality, Collucci and Martin (2008) con-
cluded that the research is confusing, highlighting the lack of clarity in terms
of defining the conceptual aspects of spiritual faith (e.g., spirituality versus
religiosity) that are protective citing the use of a limited number of cohort
variables related to religion and faith as an indicator of religious beliefs (e.g.,
church attendance; Collucci & Martin, 2008) and thereby failing to clearly
illustrate the specific faith-based factors that are protective.
Further, the moral objections subscale of the Reasons for Living
Inventory has been shown to be a robust protective factor against risk in
youth and adults (Dervic et al., 2011; Malone, Oquendo, Haas, Ellis, &
Mann, 2000); however, the subscale uses language that reflects the faith-
based reasons why one might not commit suicide (Ellis & Smith, 1991).
Although appropriate during a suicidal crisis, moral objections to suicide
Spirituality as a Mediating Protective Factor 51

may not access the other untapped aspects of spiritual faith that may also
be protective. Moral objections to suicide enlightens how spiritual faith func-
tions during a suicide crisis but the strong language of prohibitions may
obscure the subtle aspects of faith that serve to buoy individuals during peri-
ods of stress. People of faith have internalized their beliefs not based on
its prohibitions but the benefits, such as connections to church members or
clergy, coping, and religious tradition comingled with family gatherings and
rituals (Collucci & Martin, 2008). Additionally, there is lack of consensus on
how to operationally define spiritual faith as well as a lack of clarity regard-
ing the difference between religion and spirituality that may have further
complicated the matter (Kapucinski & Masters, 2010). This lack of concep-
tual specificity obscures the subtle functional differences of both religiosity
and spirituality as protective factors. Additionally, this lack of clarity may
further obscure the dynamic relations among spiritual faith and other protec-
tive factors, such as social support, where spiritual faitheither religiosity or
spiritualitymay mediate the effects of youths ability to use their support
networks or reflect a developmental process at work.

Purpose of the Present Study


Faith and its use as a protective factor by youth remain unclear. Therefore,
the aim of this current study is to examine the role of spiritual well-being in
predicting suicide risk, paying particular attention to the role of spiritual well-
being as a potentially mediating variable in suicide risk in a diverse sample
of college students. More specifically, the following research question and
hypotheses guided the design of the current study: Does spirituality along
with social support add to the reasons for living (i.e., serve as a mediating
protective factors) in a diverse sample of college youth, by assisting to predict
a history of suicidal ideation, past attempts, and current ideation?

H1: Participants who report spiritual beliefs will be significantly differ-


ent from those who do not have spiritual beliefs on their scores
for each of the independent variables (i.e., College Student Reasons
for Living Inventory [RFL-CS], Spiritual Well-Being Scale [SWBS], and
Young Adult Social Support Inventory [YA-SSI] and will be significantly
different on the independent variables as predictors of risk.
H2: Participants who report spiritual beliefs will be significantly different
from those who do not have spiritual beliefs on their scores for each
of the independent variables as predictors of risk.
H3: Participants who report spiritual beliefs will be significantly different
from those who do not have spiritual beliefs on their scores for all
spiritually related subscales of the independent variables as predictors
of risk.
52 J. Kyle

METHOD
Participants
Participants (N = 243) were recruited from an online subject pool for intro-
ductory psychology undergraduate students at an urban university and were
offered course credit for participation. Participants had the option of selecting
this study among several being offered via the online subject pool. In order
to provide consent, all participants were 18 years or older. Complete demo-
graphic information on participants can be found in Table 1. Participants
age ranged from 18 to 56 (M = 21.14, SD = 6.001). In terms of gender,
61% or participants were female (n = 148) and 39% were male (n = 95).
In terms of race, approximately 33% of participants identified themselves as
White (n = 81), 27% self-identified as Asian (n = 66), 19% self-identified
as Hispanic (n = 47), and about 8% self-identified as Black (n = 19).
Approximately 81% of participants reported that they had spiritual beliefs
(n = 196); and half reported that they belonged to a church, synagogue, or
mosque (n = 122).

Procedure
After insuring that potential participants were at least 18 years old and then
receiving informed consent, participants completed a comprehensive battery

TABLE 1 Demographic Information of Participating University Students (N = 243)

Demographic variables % N

Gender
Female 60.9 148
Male 39.1 95
Race
White 33.3 81
Asian 27.2 66
Latinos 19.3 47
Black 7.8 19
Marital status
Single 96.3 234
Married or divorced 3.7 9
Place of birth
U.S. mainland 60.5 147
International 39.5 96
Religious identification
Catholic 30.0 74
Jewish 17.0 42
Muslim 6.1 15
Protestant 4.9 12
Christian 4.5 11
Hindu/Buddhist 4.0 10
Have spiritual beliefs 80.7 196
Belong to a church, synagogue, or mosque 50.2 122
Spirituality as a Mediating Protective Factor 53

of self-report instruments chosen to assess the following variables: suicidality,


social support, spiritual well-being, and reasons for living. The survey instru-
ments were administered in a group setting, with up to four participants in a
given time slot. The paper-and-pencil surveys were administered in a small
clinic room within a graduate counselor education program that was set
up to provide semiprivate participation. Once the survey instruments were
completed (approximately 45 minutes; range 3060 minutes), the researcher
briefly reviewed each package to assure participant well-being. Participants
were then given a copy of their consent form and an informational resource
sheet that listed local and online resources and supports. At the comple-
tion of the data collection portion of this study, only four participants were
referred directly to the campus-based counseling center.

Instruments
SUICIDALITY MEASURE

The Harkavy Asnis Suicide Scale (HASS) was designed to collect informa-
tion on current and past suicidal behavior (Harkavy Friedman, & Asnis,
1989). For the purpose of this study, participants completed the first section
(HASS-DEMO) capturing demographic information, current suicidal ideation
and plans, and suicide attempts. Regarding internal consistency, the coeffi-
cient alpha was obtained from clinical and nonclinical samples ranging from
0.897 to 0.915 (Harkavy et al., 1989).

SOCIAL SUPPORT MEASURE

The YA-SSI was created to assess social support in college-age youth assess-
ing the different types of social support (e.g., emotional, esteem, network,
appraisal, and altruistic) as well as noting the sources of support i.e., fam-
ily, friends, church groups or social organizations and the amount received
(McCubbin & Thompson, 1989). The YA-SSI measure contains 11 subscales
or factors. However, for the purpose of this study, participants completed
the following factors: Parents, Siblings, College Friends, Spiritual Faith, and
Church. For each of the subscales, the reliability data (Cronbach alpha)
are as follows: Parent = .95, Sibling = .95, Spiritual Faith = 91, College
Friends = 91, Church/Synagogue Groups = .90. The overall internal reli-
ability was .89 (Cronbachs alpha) and the testretest reliability was .90
(McCubbin & Thompson, 1989).

SPIRITUAL WELL - BEING MEASURE

The SWBS provides an overall measure of ones perception of their spir-


itual life, and has subscale scores for Religious and Existential Well-Being
dimensions (Paloutzian & Ellison, 1982). The Religious Well-Being (RWB)
54 J. Kyle

subscale provides an assessment of ones relationship with God, while the


Existential Well-Being Subscale (EWB) gives an assessment of ones sense
of life purpose and life satisfaction. The SWBS is composed of 20 items,
10 items assess religious well-being and the other ten items assess existential
well-being. A total score for the scale is obtained by summing responses for
each subscale. For each of the subscales, the testretest reliability data are
as follows: SWBS = .93, RWB = .96, EWB = .86. For each of the sub-scales,
the internal consistency data (Cronbach alpha) are as follows: SWBS = .89,
RWB = .87, EWB = .78 (Paloutzian & Ellison, 1982).

REASONS FOR LIVING MEASURE

In order to capture specific age-related variables, the College Student-


Reasons for Living scale (CS-RFL) was created in order to attain the reasons a
college student may have for choosing life over suicide (Osman et al., 1998;
Westefeld, Cardin, & Deaton, 1992). Responsibility to Family and Friends
(including peer relationships) and College/Future Concerns were added to
obtain additional age-related concerns. The internal consistency of the scale
is robust at .91 (Westefeld et al., 1992). For each of the subscales, the reliabil-
ity data (Cronbach alpha) are as follows: Survival and Coping Beliefs = 0.88;
College and Future-Related Concerns = 0.88; Moral Objections = 0.86;
Responsibility to Friends and Family = 0.80; Fear of Suicide = 0.71; Fear
of Social Disapproval = 0.69 (Westefeld, Badura, Kiel, & Scheel, 1996).

Research Design and Statistical Analysis


Descriptive statistics were computed for all variables, including correlations
among all predictor variables (Table 2). Logistic regression is a statistical
model that is used to determine whether a number of independent vari-
ables can be used to predict a dichotomous dependent variable (Cohen,
Cohen, West, & Aiken, 2003). For this study, the logistic regression analyses
were performed using participants totals scores on the predictor variables,
social support, spiritual well-being, and reasons for living (i.e., continuous
variables) to predict participants history of suicidal ideation, current suicidal
ideation and attempted suicides (i.e., dichotomous variables). Total scores on
each of the predictor variables were converted to Z scores to ease compar-
isons in units of change among the predictor variables and the associations
with the criterion variables.

RESULTS

Descriptive analyses of the HASS demographics scale indicate that over 32%
of the sample reported a history of suicidal ideation beginning at age 8; and
TABLE 2 Intercorrelations for Predictor Variables: YA-SSI, CS-RFLI, and SWBS

Total College
YA-SSI: RFL: Student SWBS: SWBS:
YA-SSI: Spiritual YA-SSI: Survival RFL: Moral Reasons for Existential Religious SWBS:
Church Beliefs Total & Coping Objections Living Well-Being Well-Being Total

YA-SSI: Church 1
YA-SSI: Spiritual Beliefs .546 1
YA-SSI: Total .671 .710 1

55
CS-RFL: Survival & Coping .235 .251 .494 1
CS-RFL: Moral Objections .428 .520 .529 .463 1
CS-RFL: Total .246 .307 .447 .791 .703 1
SWBS: Existential Well-Being .092 .144 .077 .037 .013 .064 1
SWBS: Religious Well-Being .370 .352 .318 .162 .382 .284 .390 1
SWBS: Total .297 .312 .255 .129 .265 .224 .784 .878 1
Note. YA-SSI = Young Adult Social Support Inventory; CS-RFL = College Student Reasons for Living Inventory; SWBS = Spiritual Well-Being Scale.

Correlation is significant at the .05 level (two-tailed). Correlation is significant at the .01 level (two-tailed).
56 J. Kyle

28% of those reporting a history of suicidal ideation also reported having a


plan. Only 3% of the sample reported a history of suicide attempts and most
participants reported only one attempt; however two participants reported
five or more attempts. Analysis of the HASS demographic indicated that four
participants reported current suicidal ideation in the past week and of those
participants, three participants denied plan or intent on direct examination
by the researchers, the remaining participant was brought to the campus-
counseling center. Independent t tests on demographic data such as gender,
religion, race, birthplace, and having sought mental health treatment within
the past year, there were no significant group differences between those who
reported a history of suicidal behavior (ideation and attempts) and those who
did not.

Hypothesis 1
The t-test comparisons on participants total scores for each of the predictor
variables (RFL-CS, SWBS) and YA-SSI were all significant (p < .001). There
was a significant difference for the Total Social Support scores for those
with spiritual beliefs (M = 27. 51, SD = 9.485) and without (M = 17.93,
SD = 7.258; t(85.141) = 7.556, p < .0001). The magnitude of the differences
in means on Social Support (mean difference = 9.570, 95% confidence
interval 12.089 to 7.052) was large (ETA squared = .19). Next, there was
a significant difference for the Reasons for living Inventory scores for those
with spiritual beliefs (M = 196.16, SD = 29.685) and without (M = 181.93,
SD = 30.631; t(240) = 2.908, p < .004). The magnitude of the differences
in means on the Reasons for Living Inventory (mean difference = 14.228,
95% confidence interval 23.867 to 4.590) was small (ETA squared = .03).
Lastly, there was a significant difference for the Spiritual Well-Being scale
scores for those with spiritual beliefs (M = 68.51, SD = 8.053) and without
(M = 71.87, SD = 6.969; t(240) = 2.608, p < .05). The magnitude of
the differences in means (mean difference = 3.359, 95% confidence interval
0.822 to 5.896) was small (ETA squared = .03).

Hypotheses 2 and 3
Logistic regression was used for the analyses addressing the studys key
aims, to investigate protective factors (e.g., spiritual well-being, reasons for
living, and social support), and related cohort variables (e.g., gender, race
and religious affiliation) both (a) in relation to those with current ideation
and a history of past suicidal behaviors as well as (b) investigating the role
of spirituality and social support for those with and without spiritual beliefs
as a predictor of suicidal behaviors.
Spirituality as a Mediating Protective Factor 57

Direct logistic regression was performed on both groups, those reporting


spiritual beliefs and those who do not, to assess the impact of a number
of factors on the likelihood that respondents would also report a history of
suicidal behaviors. For respondents who reported having spiritual beliefs, the
model contained three independent variables (RFL-CS, SWBS, and YA-SSI)
that were converted to Z scores, as a method of comparing units of change
on the dependent variable and three cohort variables (i.e., race, gender, and
religious identification).
Table 3 presents the model containing cohort variables (race, gender,
and religious affiliation) were entered in Block 1 and predictor variables
(RFL-CS, SWBS, and YA-SSI) that were entered in Block 2. As illustrated
in Table 3, for Block 1, the model was not statistically significant, X 2 (12,
N = 243) = 16.827, p > .05. However, the full model containing all pre-
dictors and three cohort variables, race, gender and religious affiliation was
statistically significant, X 2 (15, N = 243) = 59.305, p < .0001, indicating that
for individuals who reported having spiritual beliefs, the model was able
to distinguish between respondents who reported a past history of suicidal
ideation and those who did not. The model as a whole explained between
26.1% (Cox and Snell R 2 ) and 37% (Nagelkirke R 2 ) of suicidal behaviors and
correctly classified 78.1% of the cases.
Only four of the independent variables made a unique statistically sig-
nificant contribution to the model, including male gender, protestant religion,
total social support and total spiritual well-being. The strongest predictor of
reporting a history of suicidal ideation was being male, recording an odds
ratio of 2.261. This indicated that male respondents who had spiritual beliefs
were more likely to report a history of suicidal ideation, controlling for all

TABLE 3 Summary of Logistical Regression Analysis for Those With and Without with
Spiritual Beliefs Using Social Support, Spiritual Well-being, Reasons for Living, Race, Gender,
and Religious Affiliation Variables as Predictors of Past Suicidal Ideation (N = 243)

With spiritual beliefsa Without spiritual beliefsb

Variable B SE B B SE B

Block 1
Gender .516 .362 1.675 .449 .719 1.567
Religious affiliation Protestant 1.367 .610 .255 .797 1.872 2.219
Block 2
Gender .816 .413 2.261 .554 .861 1.739
Religious affiliation Protestant 1.408 .703 .245 .469 2.057 1.599
YA-SSI 1.115 .249 .328 .308 .634 .735
CS-RFLI .436 .227 .647 .735 .588 .479
SWBS .864 .261 .421 2.323 .963 .098
a
Block 1: X 2 (12, N = 243) = 16.827, NS. Block 2: X 2 (15, N = 243) = 59.305, p < .000. b Block 1: X 2
(11, N = 243) = 6.542, NS. Block 2: X 2 (14, N = 243) = 17.627, NS.

p < .05. p < .01. p < .000.


58 J. Kyle

other factors in the model and therefore were almost 2 times more likely to
report suicidal ideation in the past. All other predictors were associated with
a decrease in past ideations, total spiritual well-being reported a higher beta
value (.421) than total social support (.328) and protestant religion (.245).
Table 3 also presents the model for those respondents who reported not
having spiritual beliefs. Again, logistic regression was performed to assess
the impact of three independent variables on the likelihood that respon-
dents would also report a history of suicidal behaviors. The model contained
three independent variables (total social support, total spiritual well-being,
and total reasons for living) and three cohort variables (race, gender and
religious identification). The model containing cohort variables, race, gender
and religious affiliation were entered in Block 1 and predictor variables (total
social support, total spiritual well-being, and total reasons for living) were
entered in Block 2. For Block 1, the model was not statistically significant,
X 2 (11, N = 243) = 6.542, p > .05. And the full model containing all pre-
dictors and three cohort variables, race, gender and religious affiliation was
not statistically significant, X 2 (14, N = 243) = 17.627, p > .05 indicating
that for individuals who reported not having spiritual beliefs, the model was
unable to distinguish between respondents who reported a past history of
suicidal ideation and those who did not. Examining the impact of the inde-
pendent variables (i.e., RFL-CS, SWBS, and YA-SSI) on suicide attempts and
current ideation was not statistically significant in its ability to predict current
ideation and past history of attempts for those with and without spiritual
beliefs.
Table 4 presents the results of additional logistic regression analysis that
were performed to assess the likelihood that respondents, who report having
spiritual beliefs would also report that they had thought about suicide in the
past using the subfactors of each scale that were conceptually related to spir-
itual faith. The model containing cohort variables, race, gender and religious
affiliation were entered in Block 1 and predictor variables (YA-SSI: Church,
YA-SSI: Spiritual Beliefs, RFL: Survival & Coping, RFL: Moral Objections, RFL:
Responsibility to Family & SWBS: Religious Wellbeing, SWBS: Existential
Well-Being) were entered in Block 2. For Block 1, the model was not sta-
tistically significant, X 2 (12, N = 243) = 16.827, p > .05. However, the full
model containing all predictors and three cohort variables, race, gender and
religious affiliation was statistically significant, X 2 (19, N = 243) = 62.926,
p < .0001 indicating that the model was able to distinguish between respon-
dents who report having spiritual beliefs and a past history of suicidal
ideation and those who did not. The model as a whole explained between
27.5% (Cox and Snell R 2 ) and 38.9% (Nagelkirke R 2 ) of suicidal behaviors
and correctly classified 78.6% of the cases.
Only four of the independent variables made a unique statistically signif-
icant contribution to the model, including male gender, RFLI: Coping, RFLI:
Moral Objections and SWBS: Religious Wellbeing. The strongest predictor of
Spirituality as a Mediating Protective Factor 59

TABLE 4 Summary of Logistical Regression Analysis for Those With and Without with
Spiritual Beliefs Using Spiritually-Related Variables, Race, Gender, and Religious Affiliation
Variables as Predictors of Past Suicidal Ideation (N = 243)

With spiritual beliefsa Without spiritual beliefsb

Variable B SE B B SE B

Block 1
Gender .516 .362 1.675 .449 .719 1.567
Religious affiliation 1.367 .610 .255 21.541 40192.969
Protestant
Block 2
Gender .889 .435 2.433 .900 1.680 2.460
Religious affiliation 1.223 .741 .294 11.722 40192.969 123200.018
Protestant
YA-SSI: Church .428 .269 .652 46.262 37684.559 .000
YA-SSI: Spiritual Beliefs .330 .263 .719 3.271 3.017 26.346
CS-RFLI: Survival & Coping .836 .260 .434 5.346 2.591 .005
CS-RFLI: Moral Objections .776 .317 .460 1.429 1.419 4.176
SWBS: Religious 1.044 .292 .352 2.520 1.834 .080
Well-Being
a
Block 1: X 2 (12, N = 243) = 16.827, NS. Block 2: X 2 (19, N = 243) = 62.926, p < .000. b Block 1: X 2
(11, N = 243) = 6.542, NS. Block 2: X 2 (18, N = 243) = 38.287, p < .01.

p < .05. p < .01. p < .000.

reporting a history of suicidal ideation was being male, recording an odds


ratio of 2.433. This indicated that male respondents who had spiritual beliefs
were more likely to report a history of suicidal ideation, controlling for all
other factors in the model and therefore were almost 2 times more likely to
report suicidal ideation in the past. All other predictors were associated with
a decrease in past ideation, RFLI: Moral Objections reported a higher beta
value (.460) than RFLI: Coping (.434) and SWBS: Religious Wellbeing (.352).
Table 4 also presents the results of the logistic regression analysis assess-
ing the likelihood that respondents, who report not having spiritual beliefs
and would also report that they had thought about suicide in the past using
the subfactors of each scale that were conceptually related to spiritual faith.
Initially, the model contained religious affiliation but this was ultimately
dropped because it was not correlated to the other variables in the model.
Therefore the model containing cohort variables, race, and gender were
entered in Block 1 and predictor variables (YA-SSI: Church, YA-SSI: Spiritual
Beliefs, RFL: Survival & Coping, RFL: Moral Objections, RFL: Responsibility
to Family & SWBS: Religious Wellbeing, SWBS: Existential Well-being) were
entered in Block 2. For Block 1, the model was not statistically significant,
X 2 (5, N = 243) = 1.773, p > .05. However, the full model containing all
predictors and three cohort variables, race, gender and religious affiliation
was statistically significant, X 2 (19, N = 243) = 28.9817, p < .004 indicating
that the model was able to distinguish between respondents who report not
having spiritual beliefs and a past history of suicidal ideation and those who
60 J. Kyle

did not. The model as a whole explained between 46.6% (Cox and Snell
R 2 ) and 62.7% (Nagelkirke R 2 ) of suicidal behaviors and correctly classified
82.6% of the cases.
Only the RFLI: Coping made a unique statistically significant contribu-
tion to the model, predicting the likelihood of reporting a history of suicidal
ideation and recording an odds ratio of .060. While controlling for all other
factors in the model, this indicates that respondents who reported not having
spiritual beliefs and a history of suicidal ideation were more likely to report
low levels of coping. Examining the impact of the independent variables con-
ceptually related to spiritual faith on suicide attempts and current ideation
was not statistically significant in its ability to predict current ideation and
past history of attempts for those with and without spiritual beliefs.

DISCUSSION

This study sought to examine the role of spiritual beliefs as a mediating


variable between suicide risk and protective factors in youth. There were
significant group differences between those with and without spiritual beliefs
on all independent measures including the CS-RFLI, YA-SSI, and SWBS scales,
suggesting that those with spiritual beliefs have lower levels of risk and that
they may use protective factors differently.
When comparing the magnitude of mean differences on each of the
predictor variables between those who report having spiritual beliefs and
those who do not, social support had the larger effect size, suggesting that
those with spiritual beliefs were more likely to favorably evaluate the type
and quality of social support received from a variety of sources (e.g., parents,
siblings, friends, and church groups). The dimensions on the social support
scale contain affective themes that may have particular relevance to spiri-
tual youth such as emotional support, self-esteem, connection to ones social
network and positive appraisal of the support provided. These themes may
resonate with those who have spiritual beliefs as they tend toward a posi-
tive, pro-social perspective and thereby by have higher levels of self-worth,
esteem and belonging. Further, social support where a sense of belonging
or group connection is fostered, is inversely related hopelessness, isolation
and ultimately suicide risk (Joiner, Hollar, & Van Orden, 2006); and therefore
may explain the robust effect size for social support.
Interestingly, the effect size for both the CS-RFLI and SWBS was small,
suggests that appropriate use of this measure may be in at-risk samples
as the CS-RFLI was initially designed as a crisis intervention tool (Linehan,
Goodstein, Nielsen, & Chiles, 1983). The small effect size for SWBS may be
due to the EWB subscale, as this subscale was weakly related with the other
subscales and subsequently did not load on any of the models.
Spirituality as a Mediating Protective Factor 61

Comparing the two groups, those with and without spiritual beliefs on
the each of the independent variables and their ability to predict suicide
further highlight the difference between these two groups. For each model,
either the total independent variables or the spiritually related variables, the
independent variables were able to predict past history of risk and classify
approximately 80% of the cases. As reported by earlier studies, the CS-RFLI
was found inversely related to risk. However, in this sample of youth, the
total CS-RFLI did not factor into the model and this may simply stem from
using a nonclinical sample that were not currently in crisis. However, for
youths who report spiritual beliefs, the subscales of the CS-RFLI, Survival and
Coping as well as Moral Objections to Suicide were most salient; while the
others, such as Responsibility to Family and Friends, Future-Related Concerns
and Fear of Suicide were not and may have canceled out the robust effect
of Survival and Coping and Moral Objections to Suicide.
In the current study, among the predictors, CS-RFLI and YA-SSI were
inversely correlated to SWBS. Previous research using the SWBS and the
CS-RFLI found positive correlation between RWB subscale and the CS-RFLI
as well as the Moral Objections subscales (Ellis & Smith, 1991), which was
not found in this study. However there are key differences between the cur-
rent study and the previous research. The earlier sample was mostly white
females from a southern college and there were regional, gender, religious,
and ethnic differences affecting each cohort. Additionally the previous study
used the RFLI and not the college student version, which may have missed
particular issues relevant to college students. However, in this present study
once all the predictors were loaded into the model, all predictors were
inversely related to suicide risk therefore each scale might be capturing a
facet of the psychological experience of youth as related to suicide risk.
Spiritual beliefs may function as a mediating variable between risk and
protective factors due to the basic tenants of spiritual faith (e.g., coping,
meaning making, moral objections to suicide, and fostering connections to
family and friends), which resonate with resiliency factors that assuage risk.
For those youth with spiritual beliefs, the models suggest that higher levels
of protective factors such as Social Support, Moral Objections to Suicide,
Survival and Coping, and Religious Well-Being are related to reduce risk.
Further, spiritual beliefs may function as a mediating variable by assisting the
negotiation of social support and meaning making where increased levels
of both promote higher levels of coping and thereby reduce risk. Therefore,
spiritual youth may have added confidence in their ability to handle adversity
and stress that may trigger a crisis.
Although, moral objections are positively correlated with factors of spir-
itual faith (Dervic et al., 2011) and therefore prohibiting self harm (Malone
et al., 2000). Interestingly, for those who report spiritual beliefs, the only reli-
gious group affiliation associated with reduced risk was the Protestant faith.
Its significance in the overall model may suggest a difference in religious
62 J. Kyle

doctrine, where an emphasis on guilt and sin may resonate with prohibitions
to suicide and ultimately higher moral objections to suicide as measured by
the CS-RFLI. However, no conclusions can be drawn by the failure of other
religious groups to load into either model. Both the SWBS and CS-RFLI were
created and normed on western samples that have had few participants from
Muslim, Hindu or Buddhist faiths and therefore may not have captured the
subtle differences of Eastern-based faiths.
In this youth sample, spiritual beliefs may also rest upon the salience
of parental and family-based values that are protective as the robust find-
ings on social support suggest. For youth, their spiritual beliefs develop from
values learned within familial and religious traditions, where ritualized prac-
tice and spiritual milestones overtime becomes part of their personal identity
(Pargament, 1997). For this sample, RWB, as assed by SWBS, had particular
relevance to youth, as it captures ritualized practice and directly assess ones
relationship to God versus EWB subscale assesses internalized positive, life
values (Paloutzian & Ellison, 1982); and may explain the low correlations
within this sample that youth are still developing young adults. Existential
well-being reflects an internalize life values that may not resonate with this
sample developmentally. RWB had an increased salience to this group of
spiritual youth as they may be leaning on religious supports either through
concrete practice or their relationship with God. Ellison et al. (1997) found
that religiositys effect is primarily associated with its ability to maintain social
bonds, encourage social interactions and facilitate social identification with
others who have similar values morals and values. As a resiliency factor,
spiritual faiths robust nature may vary by intensity across the lifespan and
therefore, may not be an artifact of age per se but reflects an underlying
developmental process. Therefore, spiritual faith may be an individual devel-
opmental variable and its use as a resilience or protective factor during crisis
may require closer examination rather than a brief inquiry.
The only significant cohort variable to increase risk was male gender.
Although this is not surprising based on epidemiological research that has
often cited male gender as a risk for suicide; however, in this sample, males
with spiritual beliefs had reduced protective factors and therefore were at
increased risk of suicidal ideation. This finding suggests that young men
with spiritual beliefs may be least able to utilize social support that may
assuage risk; and that spiritual beliefs did not increase their overall spiri-
tual well-being placing them at increased risk. A possible explanation may
be acculturative stress as forty percent of the sample were born abroad
and these young men may be undergoing additional stress as they attempt
to navigate college and career pressures. Additionally, male participants
immigrated to the United States from a variety of countries that are high
on patriarchy (e.g., Pakistan, Uzbekistan) and therefore may been influ-
enced by traditional masculine roles that reinforce the need to be strong
provider leaving little room for garnering social support at times of need;
Spirituality as a Mediating Protective Factor 63

And religious traditionalism may further reinforce these traditional male roles
as stoic providers.
A serendipitous finding came via debriefings conducted by the principal
investigator with all participants to assess risk. Anecdotally many of the males
who endorsed a history of suicidal ideation in past reported it as a weakness
and were ashamed. Further, they reported fears of contaminating their family
and friends with their sadness or depressive thoughts and therefore chose
to isolate themselves by going on long secluded walks or retiring to a quiet
isolated space. The theme of contamination leading to isolation was shared
by many of the male subjects, who were unaware of mental health services
designed to offset such suffering.
In contrast, young women also reported that thoughts of self-harm were
related to acculturative stress, however, their lack of personal freedom and
their familys insistence on arrange marriages were their stressors. One young
woman, who was facing an arranged marriage upon the completion of her
college degree, reported that the only control she had in her life was the
time and the means of her death. For her and other women in her position,
spiritual faith was not protective or a source of resilience but served as a
means of control.
Spiritual faith provides one the ability to make meaning out of adverse
situations. However in this sample, individuals without spiritual beliefs
scored high on Survival and Coping. And, the language of these statements
on the CS-RFLI resonates with youth who do not report spiritual beliefs,
reflecting a sense of determinism and individualism while voicing a resis-
tance to adhere to religious doctrine. A possible explanation for this contrary
finding may stem from earlier religious teaching. Pargament (1997) suggested
that spiritual beliefs and religious doctrine experienced early in life may
make a reassertion in later life when individual has come to an emotional or
developmental crisis and thus seek to find an answer via their faith. Here,
coping learned earlier in life supports individualism and determinism.
Interestingly, race as a cohort variable did not load into any of the
models for predicting suicide risk. This lack of significance may be related to
subtle factors affecting between group variances that may have been masked
by larger within group variances that are related to spiritual beliefs.

Future Directions
The findings of this study stress the importance of spiritual faith in the lives
of youth and have clinical implications for those engaged in their treatment.
By inviting clinicians to allow spiritual issues in treatment acknowledges its
impact in their lives and promotes greater growth and well-being. However,
several questions remain regarding the role of spiritual faith and suicide risk.
The nature of suicide risk in college students is quickly sparked, intense but
brief (Drum et al., 2009); but how might spiritual faith function during this
64 J. Kyle

suicidal crisis? Dew et al. (2008) have suggested that the relationship between
risk factors and spiritual faith in youth samples may be more complex, sug-
gesting that the relation of depression to religiousness are bi-directional each
having an effect on the other. As an example, is the youth depressed and
then less likely to engage in religious practice or is the youth, who is less
engaged in religious practice, and therefore becomes depressed?
Lastly, the RFLI and the CS-RFLI are widely used assessment tools that
have been reported to have utility in predicting those who are at risk (Osman
et al., 1998). Most individuals who describe themselves faithful have inter-
nalized their faith not based on its prohibitions but benefits. The items on
Moral Objections to Suicide scale by definition are prohibitions. The fact that
they are highly associated with those with a history may reflect a concrete
attribution style verses those whose faith is an intrinsic source of support
that is drawn upon during stressful events.
In conclusion, there were significant group differences between those
with and without spiritual beliefs on all independent measures suggesting
that those with spiritual beliefs have lower levels of risk and use protec-
tive factors differently. Further, spiritual beliefs may function as a mediating
variable by assisting the negotiation of social support and meaning mak-
ing where increased levels of both promote higher levels of coping and
thereby reduce risk. Young men with spiritual beliefs may be least able
to utilize social support that may assuage risk; and that spiritual beliefs
did not increase their overall spiritual well being placing them at increased
risk.

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