Moderation Effects of Coping Flexibility on the Association Between Depressive Symptoms and Suicidal Risk

A Moderation Model for Bolstering Resilience to Suicidal Psychopathology: Positive Sociopsychological Constructs and Coping Flexibilities Buffering the Impact of Daily Life Stress Among Medical Students

ABSTRACT

Positive sociopsychological constructs and coping flexibility may be helpful for alleviating suicidal psychopathology, although relatively little research has examined this possibility among medical students. This survey aimed to investigate whether positive sociopsychological constructs and coping flexibility could buffer the negative impact of daily life stress and bolster the resilience to suicidal ideations and attempts among medical students. This cross-sectional model was based on a study of 787 Indian medical students (725 women and 62 men; mean age, 21.08 years; SD = 2.78; range, 19-37 years) who were asked to complete a battery of self-administered questionnaires. For the purpose of determining the independent and interaction impacts of potential variables of influence, hierarchical multiple linear regression models were used. The moderation analysis investigated that the association between daily life stress and suicidal ideation was buffered among the students having higher levels of positive mental health and coping flexibility, whereas this association was no longer significant at the highest level of positive mental health. Furthermore, the relationship between daily life stress and suicidal attempts continued to be buffered by above-average levels of coping flexibility, emotional stability (ES), and optimism. These findings represent that promoting positive mental health, coping flexibility, ES, and optimism may be a promising approach to mitigate suicidal thoughts and attempts in interventions for medical students at high risk. These modifiable moderating factors can be enhanced by empirically supported treatment and prevention efforts to bolster suicidal resilience.

Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW)

Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.

Moderating effect of coping flexibility over waiting patiently as a coping strategy for interpersonal stressors and depressive symptoms

Objective: The present study examined the moderating effect of coping flexibility on the association between the coping waiting patiently for interpersonal stressors and depression. Coping flexibility refers to devising and implementing suitable coping strategies according to the situation, coping was defined in this study as holding oneself back and not acting prematurely to address a stressful relationship. Participants: A total of 481 Japanese college students. Methods: Participants completed questionnaires to measure coping, coping flexibility, perceived stress, and depression using a longitudinal design. Results: Multiple regression analysis showed that an interaction between coping and coping flexibility was associated with depression. This result indicated that higher levels of coping was associated with lower depression 16 weeks later when coping flexibility was higher, but the association was not observed when coping flexibility was lower. Conclusions: Our findings contribute to elucidating the condition or process whereby the strategy of waiting patiently as a coping mechanism for interpersonal stressor reduces depression.

Resilience to suicidal behavior in young adults: a cross-sectional study

Despite decades of research on suicide risk factors in young people, there has been no significant improvement in our understanding of this phenomenon. This study adopts a positive deviance approach to identify individuals with suicide resilience and to describe their associated psychological and sociodemographic profiles. Australian young adults aged 18–25 years with suicidal thoughts (N = 557) completed an online survey covering sociodemographic, mental health status, emotion regulatory and suicide-related domains. Latent class analysis was used to identify the individuals with suicide resilience. The predictors of suicide resilience were assessed using logistic regression models. The results suggested that one in ten (n = 55) met the criteria for suicide resilience. Factors that had a significant association with suicide resilience included greater cognitive flexibility, greater self-efficacy in expressing positive affect, reduced use of digital technology and less self-harm and substance use as a response to emotional distress. This study identified the factors that may protect young adults with suicidal thoughts from progressing to suicide attempts. Suicide prevention programs might be optimised by shifting from a deficit-based to a strength-based approach through promoting cognitive flexibility, self-efficacy and reducing maladaptive coping.

Pathways Linking the Big Five to Psychological Distress: Exploring the Mediating Roles of Stress Mindset and Coping Flexibility

Personality affects the vulnerability to the emotional symptoms of depression and anxiety. This study investigated whether stress mindset (general belief about the nature of stress) and coping flexibility (the ability to terminate ineffective coping strategies and adopt alternative ones) mediate the relations of the Big Five personality traits to psychological distress. A total of 260 undergraduate students (60.4% female) in Singapore completed self-reported questionnaires. A series of path analyses was performed. Firstly, a dual-pathway model of stress coping was established, which consisted of (a) a stress-threat-distress pathway where a stress-is-a-threat mindset mediated the association between stressful experiences and psychological distress and (b) a challenge-flexibility-enhancement pathway where coping flexibility mediated the relation of a stress-is-a-challenge mindset to a lower level of psychological distress, without being influenced by stressful experiences. Furthermore, Neuroticism was associated with the stress-threat-distress pathway, with stressful experiences and a stress-is-a-treat mindset mediating the relation of Neuroticism to psychological distress. Conscientiousness was associated with the challenge-flexibility-enhancement pathway, with a stress-is-a-challenge mindset and coping flexibility mediating the relation of Conscientiousness to less psychological distress. Extraversion, Agreeableness, and Openness were directly associated with greater coping flexibility. The findings enrich the literature on personality and stress coping and inform future interventions to promote mental health.

Coping with Stress, Executive Functions, and Depressive Symptoms: Focusing on Flexible Responses to Stress

Coping flexibility is conceptually similar to both inhibition and set-shifting. Though they serve different functions, all three are robustly associated with depression. Coping flexibility is the ability to relinquish a coping strategy regarded as ineffective and to devise and implement an alternative one; the concept is based on stress and coping theory. Inhibition is the ability to suppress responses selectively according to a change in the situation, while set-shifting is the process of switching flexibly between task sets, mental sets, or response rules. Inhibition and set-shifting are both executive functions in cognitive mechanisms. We hypothesized that coping flexibility was associated with a lower risk of depression, even when the effects of inhibition and set-shifting were controlled for. In total, 200 Japanese university students (100 women and 100 men) completed questionnaires that measured coping flexibility and depression and performed the Stroop Color and Word Test and the Wisconsin Card Sorting Test, which measured inhibition and set-shifting. We found that greater coping flexibility was associated with a lower risk of depression, even when the effects of inhibition and set-shifting were controlled for. Our findings suggest that, although coping flexibility is conceptually similar to inhibition and set-shifting, its association with depression differs from theirs.