Beruflich Dokumente
Kultur Dokumente
JENNIFER KYLE
Queens College, City University of New York, Flushing, New York, USA
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.
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
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.
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
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
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).
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).
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
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
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)
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.
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)
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.
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
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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