Examination of the Coping Flexibility Hypothesis Using the Coping Flexibility Scale-Revised

Coping flexibility and associated factors after gastrectomy in patients with gastric cancer: A cross-sectional multisite study

Objective

To elucidate the current state of coping flexibility and associated factors in gastric cancer patients after gastrectomy.

Methods

A cross-sectional multisite study was conducted with 142 patients with gastric cancer who completed questionnaires on coping flexibility, postgastrectomy dysfunction, health literacy, and perceived social support. Coping flexibility was measured using the Coping Flexibility Scale-Revised, which includes three subscales: Abandonment Coping (i.e., abandoning ineffective coping strategies), Re-Coping (i.e., assessing the process of developing and implementing alternative coping strategies), and Meta-Coping (i.e., monitoring coping flexibility process). Higher scores indicate greater coping flexibility. Descriptive statistics and univariable and multivariable logistic analyses were conducted to examine factors associated with coping flexibility.

Results

The mean age of the participants was 72.6 (± 10.5) years. Limited activity due to decreased food consumption was associated with lower scores for Abandonment Coping (odds ratio [OR]: 0.4; P ​= ​0.03; 95% confidence interval [CI], 0.2-0.9) and Re-Coping (OR: 0.3; P ​= ​0.003; 95% CI, 0.1-0.6). Higher levels of communicative health literacy were associated with higher Abandonment Coping scores (OR: 1.1; P ​= ​0.04; 95% CI, 1.0-1.3), and higher levels of critical health literacy were associated with higher Re-Coping scores (OR: 1.2; P ​= ​0.03; 95% CI, 1.0-1.3).

Conclusions

Limited activity due to decreased food consumption and limited coping flexibility were significantly associated. Health literacy had an important role in facilitating coping flexibility. Nursing support may be crucial in evaluating coping strategies and developing alternatives based on new information.

Estudio De La Vida Bajo Estres: Methodological Overview and Baseline Data Analysis of a Case-Control Investigation of Risk and Resiliency Factors for Traumatic Stress in Colombia

The Estudio de la Vida Bajo Estres (My Life Under Stress [MI-VIDA] Study) aims to investigate risk and resilience factors associated with the development of PTSD in a trauma-exposed sample of more than 500 Colombian residents exposed to this country's armed conflict. The study utilised a longitudinal case-control design capturing psychosocial data over 18 months, in addition to baseline DNA samples for a parallel genomic analysis. This paper specifically provides an overview of the design and methodology of the wider investigation, and reports baseline characteristics including sociodemographic information and mental health outcome prevalences from this hard-to-reach and under-researched population. Results of baseline analysis suggested that one third (34.88%) of this trauma-exposed sample screened positively for PTSD. Participants endorsed high numbers of potentially traumatic experiences including Forced Displacement (88.61%), Exposure to Severe Human Suffering (53.91%), Combat Exposure (53.02%), and Physical Assault (51.78%). Participants also reported relatively high levels of mental ill-health including depression (29.90%) and anxiety (27.56%). The number of traumas experienced, and the reported comorbid difficulties were generally higher among those who screened positive for PTSD. These preliminary analyses detail the baseline characteristics, and the relative burden of mental ill-health in this trauma-exposed sample. The wider study comprising longitudinal measurement of these conditions has the potential to make a significant contribution to the understanding of risk and resiliency factors for posttraumatic stress in this unique Latin American context.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10862-025-10203-1.

Translating theoretical insights into an emotion regulation flexibility intervention: assessing effectiveness

ABSTRACTObjective: Traditional research often categorizes emotion regulation strategies as adaptive or maladaptive, overlooking crucial situational and individual differences that dictate their efficacy. The literature highlights the need for a more nuanced approach, like the role of emotion regulation flexibility. Despite its importance, research on developing and testing interventions that promote this flexibility is scarce. Addressing this gap, our study designed and tested an "Emotion Regulation Flexibility Booster Program" (ERFBP). We aimed to assess its efficacy in improving emotion regulation flexibility (ERF) and its impact on various mental health indicators. Method: We recruited 153 participants with low emotion regulation flexibility, randomly assigning them to experimental, control, and no-treatment groups. The experimental group was provided with an intervention based on an ERF model. The control group received sessions on study habits, whereas no-treatment group received no training. Results: The analysis indicated that participants in the ERFBP group exhibited significant changes in ERF, subjective wellbeing, and emotion regulation goals and psychological distress compared to baseline measurements and post-intervention scores of other two groups. Conclusion: These findings support the effectiveness of the ERFBP in enhancing ERF and wellbeing. However, further research must confirm these findings across diverse contexts and populations.

Profiles of parental coping with paediatric cancer and their associations with parental illness adaptation

AIMS

To identify profiles of coping in parents of children with cancer and their underlying factors and to examine which profile(s) are associated with illness adaptation.

DESIGN

A cross-sectional study utilizing surveys among parents of children with cancer (n = 89).

METHODS

Questionnaires included socio-demographics, ways of coping, parenting stress, depression, post-traumatic symptoms, illness adjustment and quality of life. Parental coping profiles were identified via latent profile analysis. Logistic multinomial regression was used to identify predictors of coping profiles. Adaptation outcomes were compared across the coping profiles via multivariable analyses of variance with Bonferroni adjustments.

RESULTS

Five profiles were identified: The 'Strong Repertoire' used coping strategies moderate to high degree, with a positive-active orientation; The 'Moderate-Activist' used a similar pattern, rather more moderately; The 'Self-Regulator' used self-content strategies; The 'Mild-Engager' used active-engaging strategies; The 'Avoidant Coper' used avoidant-passive strategies. Parental stress predicted coping profiles, so that parents experiencing greater stress utilized the 'Avoidant Coper' to a greater degree. Group comparisons revealed that 'Avoidant-Copers' had more depressive and post-traumatic symptoms, worse illness adjustment and lower quality of life.

CONCLUSIONS

Passive-avoidant mechanisms of coping may be maladaptive in terms of parental cancer adaptation and indicative of lower resilience.

IMPACT

Findings can direct clinicians to promote familial resilience by adapting policy and practice to meet familial needs.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

Gender Differences in Coping Strategies and Life Satisfaction Following Cognitive-Behavioral and Mindfulness-Based Intervention for Crohn's Disease: A Randomized Controlled Trial

Background and Objective: Crohn's Disease (CD) is a chronic inflammatory condition with significant physical and psychological impacts, often requiring comprehensive self-management. This study examines the effects of COBMINDEX (Cognitive-Behavioral and Mindfulness Intervention with Daily Exercise) on coping strategies and life satisfaction in CD patients, focusing on gender-specific responses. Study objectives were to assess the impact of COBMINDEX on adaptive and maladaptive coping strategies and life satisfaction in CD patients, and to examine gender differences in these outcomes. Materials and Methods: A pre-planned secondary analysis of a randomized controlled trial, conducted from 2018 to 2021, at two public tertiary hospitals in Israel. A total of 120 CD patients (45 men and 75 women) were randomly assigned to either theCOBMINDEX group or a wait-list control group. Participants were assessed at baseline and post-intervention for coping strategies, mindfulness, psychological symptoms, and life satisfaction using validated scales. Quantile regression explored the gender-specific predictors of life satisfaction. This study was registered at ClinicalTrials.gov (NCT05085925) and Israel Ministry of Health (MOH_2020- 02- 24_008721. asp). Results: Both genders showed significant improvements in mindfulness, emotion-focused coping, and active coping (p < 0.05). Women exhibited reduced dysfunctional coping and greater emotional support use. For men, emotion-focused coping and mindfulness positively predicted life satisfaction, while for women, reductions in psychological symptoms and dysfunctional coping were significant predictors (p < 0.01). Conclusions: COBMINDEX enhances coping strategies and life satisfaction in CD patients, with notable gender differences. These findings highlight the importance of gender-tailored psychological interventions to improve overall patient well-being.

Exploring the Effects of Coping Flexibility on Sleep Quality via Subjective Distress: A Longitudinal Study of Young Adults

BACKGROUND

Coping flexibility is one's ability to modify their coping strategies and adapt to the demands of stressful situations. However, limited studies have demonstrated that coping flexibility directly influenced sleep quality. This study examined the relationships between coping flexibility, subjective distress, and sleep quality. We hypothesized that coping flexibility would enhance sleep quality via subjective distress.

METHODS

In total 99 male and 151 female college students completed questionnaires on coping flexibility, subjective distress, and sleep quality. Subsequently, they completed the questionnaire on sleep quality six months later.

RESULTS

Structural equation modeling showed a significant indirect effect of coping flexibility, which indicated that higher coping flexibility was associated with higher sleep quality via reduced subjective distress.

CONCLUSIONS

Our findings suggested that subjective distress and lower coping flexibility were risk factors for poor sleep quality.

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.

Emotion regulation flexibility and psychosis: A longitudinal study disentangling components of flexibility in psychosis-proneness

OBJECTIVES

Flexibility in self-regulation has emerged as an important component of mental health. Previous findings found that deficits in two components of regulatory flexibility were linked cross-sectionally to psychosis-proneness. We aimed to replicate and extend these findings longitudinally.

METHODS

We measured psychosis-proneness and components of emotion regulation flexibility (i.e. context sensitivity, repertoire and feedback) at two time points with three months in between.

RESULTS

Two flexibility components predicted psychotic-like experiences. The ability to detect the absence of contextual cues was implicated in both positive and negative dimensions but through opposite pathways. Expressive suppression ability-a subcomponent of repertoire-predicted positive symptoms. None of the flexibility components predicted distress related to the symptoms.

CONCLUSIONS

The current study provides further evidence on the implication of emotion regulation flexibility in the longer-term maintenance of psychotic-like experiences. Future studies can advance this work further by evaluating possible bidirectional relationships between psychotic-like experiences and deficits in emotion regulation flexibility.

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.

Multilevel Risk and Protective Factors for Frequent and Nonfrequent Past-30-Day Marijuana Use: Findings From a Representative Sample of High School Youth

OBJECTIVE

Research has identified many factors associated with past-30-day (P30D) marijuana use among youth but has not assessed factors that may differentiate youth who use frequently from youth who do not. We took a multilevel approach to identify and compare risk and protective factors associated with frequent and nonfrequent P30D marijuana use among high school students.

METHOD

Individual-level data were obtained from the 2019 Nevada Youth Risk Behavior Survey (completed by 4,980 high school youth from 99 schools); school-level data were obtained from the state's Department of Education. A multinomial, multilevel model was used to estimate the association between risk and protective factors at the individual and school levels and a three-level frequency of use outcome: no P30D use (0 times), nonfrequent P30D use (1-19 times), and frequent P30D use (≥20 times).

RESULTS

At the individual level, other P30D substance use, exposure to adverse childhood experiences (ACEs), perceived ease of access, and perceived risk were associated with both frequent and nonfrequent use, but the relationships were generally stronger for frequent use. P30D nonprescription drug use and school connectedness were associated with frequent use only. At the school level, number of students with individualized education programs, number of incidents involving possession of controlled substances, and school type were associated with frequent use only.

CONCLUSIONS

Individual and school-based interventions designed to address the factors uniquely or strongly associated with frequent marijuana use may prevent escalation from occasional use to more frequent use among high school youth.

The development of career planning scale for junior high school students based on cognitive information processing theory

Based on the career theory of Cognitive Information Processing (CIP), we selected scale items from literature reviews and expert guidance. The scale consisted of 28 items with 4 factors (interests, abilities, values, personality). To test the scale's factor structure, we used confirmatory factor analysis (CFA), and the model was modified according to CFA results. The second-order confirmatory factor analysis was applied to the model of the scale to prove the rationality of the total score. The internal consistency were evaluated using Cronbach's alpha coefficients. In addition, the composite reliability (CR) and average variance extraction (AVE) of the scale were also calculated to test the convergent validity. After related analyses, the scale was proved to have good psychometric properties, which can be used to measure junior high school students' career planning level in information technology course from the aspects of interest, ability, values, and personality. The effect of the first-order confirmatory factor analysis model constructed in this study is not ideal. Therefore, on this basis, a second-order confirmatory factor analysis model is constructed in combination with existing literatures, and the rationality of the model is verified through data, which highlights the novelty of this study.

Psychometric Validation of the Brief-COPE Scale in a Sample of Individuals with Multiple Sclerosis: A Brief Report

People with multiple sclerosis (MS) must often cope with high levels of stress, especially during the ongoing COVID-19 pandemic. The Brief-COPE is commonly used to assess how individuals use different coping strategies to deal with stressful life situations, but its application with people who have MS has not been validated. The purpose of this study was to assess the measurement structure and psychometric properties of the Brief-COPE in a sample of community-dwelling adults with multiple sclerosis, using exploratory factor analysis. Results revealed a three-factor measurement structure: (a) flexible coping, (b) succumbing coping, and (c) substance use coping. Correlations among these three factors and external measures of related concepts provided evidence of the validity of these factors. The Brief-COPE can be incorporated in rehabilitation counseling, mental health, and health care settings to assess coping strategies, assisting people with MS with managing stressful life events during and after the pandemic. Rehabilitation and health researchers can use it to assess the effectiveness of psychosocial interventions aimed to improve coping abilities and mental health of people with MS.

Coping with COVID Stress: Maladaptive and Adaptive Response Styles Predicting College Student Internalizing Symptom Dimensions

The COVID-19 pandemic significantly disrupted daily life for undergraduates and introduced new stressors (e.g., campus closures). How individuals respond to stressors can interact with stress to increase disorder risk in both unique and transdiagnostic ways. The current study examined how maladaptive and adaptive stress response styles moderated the perceived severity of COVID-related stressors effect on general and specific internalizing dimensions at the beginning of the COVID-19 pandemic in a combined undergraduate sample across two universities (N = 451) using latent bifactor modeling and LASSO modeling to identify optimal predictors. Results showed that perceived stress severity and maladaptive response styles (not adaptive response styles or interactions between stress and response styles) were associated with both common and specific internalizing dimensions. Results suggest additive associations of stress severity and maladaptive coping with internalizing symptoms during the pandemic’s beginning, and provide important insights for screening, prevention, and intervention during future public health crises.

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.

A Preliminary Validation of the Chinese Version of the Information Technology Identity Scale

Background

Information technology has become an irreplaceable part of people’s lives, and the interaction between information technology and self-identity has produced a new type of information technology (IT) identity. However, there is no measurement tool for this concept in China. The main aim of the study was to revise Carter’s IT Identity Scale in the context of Chinese cultural background and to determine whether the Chinese version is congruent with the English version.

Methods

In this study, we revised the scale on the basis of the information technology identity scale developed by Carter, translated the scale according to the Chinese cultural environment. Our sample size was 408, and all of them were junior middle school students. After testing this sample, we carried out item analysis, validity analysis, and reliability analysis.

Results

(1) The correlation coefficients between each item and the total score were significant (0.775–0.885). (2) The three-factor structure (relatedness, dependence, emotional energy) of the Chinese version of the IT identity scale was consistent with the original scale. The values of the factor loadings of each item in the three factors of confirmatory factor analysis (CFA) were all greater than 0.700, and the model fit indexes (CFI, NFI, NNFI, TLI and IFI) were all greater than 0.900, indicating a good model fit. (3) Average variance extraction (AVE), composite reliability (CR), Pearson correlation, and the square root of AVE indicated good convergence and discriminant validity. (4) The ɑ coefficients and CR of the three dimensions (ie, relatedness, dependence, emotional energy) were all greater than 0.800, and the split coefficients were all greater than 0.800, indicating high reliability.

Conclusion

The Chinese version of the information technology identity scale presented satisfactory psychometric properties and shared many similarities with the original version. Ultimately, we revised an information technology identity scale suitable for Chinese culture.

Coping Flexibility and Alcohol-Related Outcomes: Examining Coping Motives as Mediators

Background: Coping has been implicated in the etiology and treatment of problem drinking. Traditional, static measurement of coping styles (e.g., approach, avoidance, social support) may fail to capture how adaptive a given coping style may be. Coping flexibility is an emerging construct, associated with psychological health, and one that may shed light on coping's role in drinking risk. Coping flexibility includes (1) discontinuation of an ineffective coping strategy ("Discontinuation") and (2) production of an alternative strategy ("Implementation"). This study is the first to our knowledge to examine its association to drinking outcomes. Further, because coping deficits are theorized to lead to drinking through coping motives, we also examined mediated pathways from coping flexibility to alcohol outcomes via coping motives. Methods: College students (N = 528) completed an online assessment. Data were analyzed using path analysis. Control variables included sex and coping styles. Results: In path analytic models, Implementation was negatively associated with alcohol use and, indirectly via coping motives, negatively associated with alcohol consequences. The direct effect on alcohol use remained when controlling for coping styles and sex, but the mediational pathway was no longer significant. Conclusions: This study provides some evidence for the protective role of coping flexibility in alcohol use behavior, which may have implications for how best to address coping skills in alcohol interventions. The direct effect of Implementation on drinking suggests that there may be utility in teaching clients a flexible approach to coping in treatment. Replication, particularly with longitudinal designs, is needed.

Self-Control Dynamics in Daily Life: The Importance of Variability Between Self-Regulatory Strategies and Strategy Differentiation

Research on self-control has increasingly acknowledged the importance of self-regulatory strategies, with strategies in earlier stages of the developing tempting impulse thought to be more effective than strategies in later stages. However, recent research on emotion regulation has moved away from assuming that some strategies are per se and across situations more adaptive than others. Instead, strategy use that is variable to fit situational demands is considered more adaptive. In the present research, we transfer this dynamic process perspective to self-regulatory strategies in the context of persistence conflicts. We investigated eight indicators of strategy use (i.e., strategy intensity, instability, inertia, predictability, differentiation, diversity, and within- and between-strategy variability) in an experience sampling study ( N = 264 participants with 1,923 observations). We found that variability between strategies was significantly associated with self-regulatory success above and beyond mean levels of self-regulatory strategy use. Moreover, the association between trait self-control on one hand and everyday self-regulatory success and affective well-being on the other hand was partially mediated by between-strategy variability. Our results do not only show the benefits of variable strategy use for individual’s self-regulatory success but also the benefits of more strongly connecting the fields of emotion regulation and self-control research.

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.

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

Background: This study focused on poor coping flexibility, which involves the perseveration of a failed coping strategy, as a moderator of the association between depression and suicidal risk; no study has previously examined the association between coping flexibility and suicidal risk. Aims: This study examined whether individuals with lower coping flexibility would have a stronger suicidal risk when experiencing depression above a certain level. Method: Participants, who were 682 college students, answered questionnaires regarding coping flexibility, depressive symptoms, and suicidal risk. Results: Hierarchical multiple regression analyses showed that in individuals with greater depressive symptoms, lower coping flexibility was associated with higher suicidal risk, but this was not the case in individuals without depressive symptoms. Our hypothesis was supported. Limitations: Our findings cannot indicate the causal direction of the association between coping flexibility and depressive symptoms and suicidal risk. Conclusion: Our findings may be useful in understanding the association between depression and suicidal risk through coping flexibility and contribute to reductions in suicidal risk, as coping flexibility can be improved through training.