The Influence of Coping Skills on Psychological Distress and Suicide
Attitude among University Students in Malaysia
Norhayati Ibrahim
1,2
, A’isyah Mohd Safien
1
, Ching Sin Siau
1
1
Health Psychology Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
2
Research Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala
Lumpur, Malaysia
Keywords:
Psychological Distress, Coping Skills, Suicide, University Students.
Abstract:
Suicide is a leading cause of death among university students worldwide. The reduction of psychological
distress and suicidality is related to the adoption of effective coping strategies. This study sought to explore
the associations between psychological distress, coping style and suicide attitude among university students
in Malaysia. This study was conducted upon 178 students in two universities from public and private
settings. Participants completed four self-report questionnaires, namely the Kessler Psychological Distress
Scale (K10), Brief COPE and Yatt Suicide Attitude Scale (YSAS). Students from the private university
showed significantly higher levels of psychological distress compared to students from the public university,
but their suicide attitude did not differ significantly. There is a significant relationship between psychological
distress and suicide attitude participant (r= .263, p < .001) and the most commonly employed coping strategies
among them were the Religion and Positive Reframing domains. Behavioral Disengagement and Self-Blame
predicted higher psychological distress, whereas participant were Substance Use, Planning and Self-Blame
predicted higher suicide attitude. The suicide rate is rising and young adults need to adopt appropriate and
effective coping strategies, especially among university students. Both public and private university students
should be targeted for regular screening for psychological distress and suicidality as they are a psychologically
vulnerable population.
1 INTRODUCTION
Suicide is a public health issue globally, as there
are about about 800,000 suicide deaths annually
(Organization, 2 28). Up to 60% of the world’s deaths
from suicide occur among the Asian population
(Beautrais, 2006). Lower and middle- income
countries (LMICs) in southern and eastern regions in
Asia recorded the highest suicide rate in the world, at
17.7 per 100,000 population. The number of suicide
cases in Malaysia is rising, and a systematic review
revealed a rate of 6 to 8 per 100,000 population
(Armitage et al., 2015). However, suicide prevention
research in Asia is scarce (Chen et al., 2011).
Suicide is the second leading cause of death
among young people between the ages of 15 to 24
years old (Organization, 2 28). Notably, suicide
is a leading cause of death among college students
(Ross, 1969; Taub and Thompson, 2013), with rising
incidence and prevalence in Asian countries (Garlow
et al., 2008). Even in Muslim majority countries
where suicide is largely prohibited, suicide ideation
and attempt among university students from 12
nations, including Malaysia, was as high as 22% and
8.6% respectively (Eskin et al., 2018). In Malaysia,
suicide occurs more commonly among younger
Malaysians, as opposed to a higher prevalence among
older adults in the US (Maniam et al., 2014). A
study among adolescents in Malaysia reported that
12.6% of the participants indicated severe suicidal
ideation (Ibrahim et al., 2014). Another study among
Malaysian medical students reported about 7% were
suicidal (Tan et al., 2015). As suicide is a significant
problem among university students, it is imperative to
examine the factors leading to suicidal ideation and its
protective factors in Malaysia (Abdollahi et al., 2015).
There were a number of factors which predicted
suicidality among university students, among which
stress is a salient issue (MacKean, 1 06). Being
a university student involves an important transition
to living independently and facing challenges
academically (Shamsuddin et al., 2013). (MacKean, 1
Ibrahim, N., Safien, A. and Siau, C.
The Influence of Coping Skills on Psychological Distress and Suicide Attitude among University Students in Malaysia.
DOI: 10.5220/0009060201010108
In Proceedings of the Second International Conference on Social, Economy, Education and Humanity (ICoSEEH 2019) - Sustainable Development in Developing Country for Facing Industrial
Revolution 4.0, pages 101-108
ISBN: 978-989-758-464-0
Copyright
c
 2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
101

06) stated that university students are exposed to two
sources of stressors: stress related to the
transition from high school to university, and
stress related to the transition from adolescence to
adulthood. Stressors which originate from academic
(personal expectations, performance and homework)
and non-academic issues (body image, social issues,
relationships, violence and death) (Chao, ) could lead
to psychological distress.
In Malaysia, according to (Shamsuddin et al.,
2013) study on 506 university students across four
universities in the Klang Valley, 18.6% reported
moderate and 5.1% reported severe or extremely
severe stress. Another study among medical students
in Malaysia indicated that 29.6% reported suffering
from stress, of which the top 10 sources of
stress were related to academic problems (Yusoff
et al., 2010). Other stressors affecting facing
young people originate from relationship problems,
family problems, academic issues, and emotional
problems (?; Smith et al., 2015). The relationship
between psychological distress and suicide have been
well-established (Grover et al., 2009; Zhang et al.,
2012) and stressful life events are power predictors
of suicidality (Bantjes et al., 2016).
Coping refers to an individual’s cognitive and
behavioral efforts to master, reduce, or tolerate
internal and external stressors (Folkman and Lazarus,
1980). Folkman and Lazarus (1980) proposed
two methods an individual usually employs to
deal with negative situations: problem-focused
coping, where efforts, by any means, are made to
change the stressful situation, and emotion-focused
coping, in which an individual tries to reduce
the negative emotional state without changing
the actual circumstances. Problem-focused
coping includes Confrontative Coping, Seeking
Social Support and Plan Full Problem-Solving,
whereas emotion-focused coping includes
Self-Control, Seeking Social Support, Distancing,
Positive Appraisal, Accepting Responsibility, and
Escape/Avoidance. Another model of coping
proposed by (Carver et al., 1989) grouped Active
Coping, Planning, Restraint Coping, Seeking Social
Support for Instrumental Reasons, and Suppression
of Competing Activities into problem-focused
coping and Positive Reinterpretation and Growth,
Religion, Humor, Acceptance, and Seeking Social
Support into emotion-focused coping. They also
introduced a new domain of coping strategy, namely
Dysfunctional Coping which comprises of Venting
of Emotions, Denial, Behavioral Disengagement,
Mental Disengagement and Alcohol/Drug Use
(Carver et al., 1989).
Coping styles have been associated with
university students’ level of psychological distress
and suicidality. Therefore, it is important for
researchers to look into the types of coping skills
practiced by universities students. Recognition of
this factor will help in reducing the direct effect of
psychological distress as discussed above. This study
aims to examine the level of psychological distress,
suicide attitude and coping styles of university
students, and the interrelationship between these
variables.
2 METHODS
2.1 Research Design
This cross-sectional study using survey method was
carried out among university students from March to
April 2019.
2.2 Participants
A total of 178 Malaysian students from a public and a
private university were recruited.
2.3 Instruments
2.3.1 Psychological Distress
Students’ stress level was measured using the Kessler
Psychological Distress Scale (K10) which was
developed by (Kessler and Mroczek, 3 10) to screen
for psychological distress in the general population.
The scale consists of 10 questions addressing the
level of anxiety and depressive symptoms a person
may have experienced in the recent four-week period.
Each item was assessed with a 5-point Likert Scale
ranging from 1=“none of the time” to 5=“all of
the time”. The internal reliability of this scale is
high with Cronbach’s alpha value of .0.91 among a
student sample in Malaysia (Rajiah et al., 2014). The
reliability value of the K10 scale for schizophrenia
caregivers in Malaysia was 0.87 (Ong et al., 2016).
2.3.2 Suicide Attitude
The Yatt Suicide Attitude Scale (YSAS) was
developed in Malaysia to measure suicidal ideation
and suicide attempt (Ibrahim et al., ). This
questionnaire consisted of 10 items, of which five
items questioned the participants’ experiences with
suicidal ideation and suicide attempt respectively.
Participants answer on a 5- point Likert scale ranging
ICoSEEH 2019 - The Second International Conference on Social, Economy, Education, and Humanity
102

from 1=“Never” to 5=“Very Frequently”. The
questionnaire was validated among Malaysian youth
aged between 18 and 25 years old, confirming the
two-factor structure of suicidal ideation and suicide
attempt. The reliability of this scale was further
evaluated in a group of 219 Malaysian students from
a public university, with Cronbach’s alpha value of
.840.
2.3.3 Coping Skills
To measure the coping skills among the participant,
the researchers employed the brief form of COPE
scale (Carver, 1997). The COPE Inventory was
first developed to assess a broad range of coping
responses, several of which had an explicit basis
in theory. The Brief COPE inventory consisted of
28 items under 14 domains of coping strategies.
Participants answer on a 4-point Likert scale ranging
from 1=”I have not been doing this at all” to 4=“I
have been doing this a lot”. The questionnaire
subscales showed Cronbach’s alpha coefficients
ranging from 0.39 (Restraint Coping) to 0.92 (Humor)
in undergraduate students in Turkey (Bacanli et al.,
2013).
The total alpha value of the Malay version
of Brief COPE was validated by (Yusoff, 2011)
on secondary school students was 0.83. Some of
the coping skill showed high internal consistency
and some of them showed acceptable internal
consistency [self-distraction (0.58), Active Coping
(0.73), Denial (0.34), Substance Abuse, Emotional
Support (0.67), instrumental support (0.77),
Behavioral Disengagement (0.82),Venting (0.44),
Positive Reinterpretation (0.75), Planning (0.69),
Humor(0.51), Acceptance (0.02), Religion (0.84),
Self-blame (0.83)].
2.4 Procedures
The participants were approached before their
lectures. They completed the questionnaires in
about 5 to 10 minutes. This study was approved
by the Universiti Kebangsaan Malaysia Research
Ethics Committee (NN- 2018-060) and was funded by
Geran Galakan Penyelidikan Universiti Kebangsaan
Malaysia (GGP- 2017-059).
2.5 Data Analysis
This study used the Statistical Package of
Social Sciences (SPSS) version 22 software
for Windows to analyses the data. During data
analysis, descriptive and categorical variables were
summarized as frequencies and percentages. The
independent sample t-test was conducted to compare
psychological distress and suicide attitude according
to type of institution. The Pearson’s correlation test
was performed to test for significant relationships
between coping style with psychological distress and
suicide attitude. Significant variables were entered
into multiple linear regression models to test the
significance of the coping skills as predictors of
psychological distress and suicide attitude.
3 RESULTS
The participants of this study were Malaysian
students from a private (55.1%) and a public
university (44.9%). Female participants were
dominant in the sample, which constitutes up to
66.9% of them. Most of the participants were aged
between 20 to 21 years old (49.4%), Malay (78.7%).
In terms of monthly household income, the highest
number of them came from families with RM3001
to RM5000 (25.3%) and households with less than
RM1000 monthly income make up the smallest group
(5.6%). This study involved mostly first and second
year students (80.3%) and more than half of them
were scholarship recipients (50.6%) (Refer Table 1).
Private university students indicated significantly
higher levels of psychological distress (Mean=2.71,
SD=.73) in comparison with the public university
students, t (142.333) = 2.266, p = .025.
However, there were no significant differences in
suicide attitude between the two groups t (176) =
.065, p = .949 (Refer Table 2).
Based on mean, students from private and public
universities shared the highest coping skills in two
domains, namely Religion (Mean=3.64, SD = .53;
Mean=3.38, SD = .76) and Positive Reframing
(Mean=3.45, SD=.61; Mean=3.22, SD = .76).
Similar trends were also reported in coping skills
which were less used by the participants, i.e. the
Substance Use domain (Mean=1.23, SD=.60; Mean
= 1.12, SD = .47) and Behavioral Disengagement
domain (Mean=2.38, SD = .79; Mean=1.66, SD =
.70).
Psychological distress showed a significant
positive relationship with YSAS (r = .263, p < .001).
This means, the higher the psychological distress
level of a person, the more likely it is for him/her
to report suicidal ideation and suicide attempt. A
Pearson correlation was conducted between coping
styles with psychological distress and suicide attitude
in order to determine significant variables to be
inserted into the multiple regression models (refer
The Influence of Coping Skills on Psychological Distress and Suicide Attitude among University Students in Malaysia
103

Table 1: Demographic data of participants
Characteristics Frequency Percentage (%)
University
Private 98 55.1
Public 80 44.9
Gender
Male 59 33.1
Female 119 66.9
Age
18-19 years old 14 7.9
20-21 years old 88 49.4
22-25 years old 76 42.7
Race
Malay 140 78.7
Chinese 17 9.6
Indian 12 6.7
Others 9 5.1
Family Income
<RM1000 19 10.7
RM1001-3000 39 21.9
RM3001-5000 45 25.3
RM5001-7000 38 21.3
RM7001-10000 27 15.2
10001 and above 10 5.6
Year of Study
1-2 143 80.3
3-4 35 19.7
Source of Fee
Scholarship 90 50.6
Parents 44 24.7
Half Sponsored 44 24.7
Table 3).
A multiple linear regression was conducted to
test if Denial, Behavioral Disengagement, Humor,
Acceptance and Self-Blame significantly predicted
participants’ psychological distress. The results of
the regression indicated the predictors accounted
for 19.7% of the variance in psychological distress
(R
2
= 0.197, adjusted R
2
= 0.173, F (5, 177) =
8.42, p < .001. Only two domains in coping skills
significantly predicted psychological distress after
adjusting for other coping skills, namely Behavioral
Disengagement (β = 0.260, p < 0.01) and Self-Blame
(β = 0.372, p < .01) (refer Table 4).
Another multiple linear regression was conducted
to test if Substance Use, Positive Reframing,
Planning, and Self-Blame significantly predicted
participants’ suicide attitude. The results of the
regression indicated the predictors accounted for
13.7% of the variance in suicide attitude (R
2
=
0.137, adjusted R
2
= 0.117, F (4,177) = 6.89, p <
0.001. Suicide attitude was significantly predicted by
Substance Use (β = 0.270, p < .001), Planning (β =
0.024, p < .01) and Self-Blame (β = 0.189, p < 0.05).
4 DISCUSSION
This study aimed to examine the levels of,
and associations between psychological distress,
suicidality and coping style. There is an association
between psychological distress and suicidality. Those
who used behavioral disengagement and self-blame
were more likely to be psychologically distressed,
while those who had higher substance use, higher
self- blame and lower planning coping styles
indicated higher suicidality.
In the current study, the results indicated that
private university students were more psychologically
distressed compared to public university students.
This is similar to (Babar et al., 2015) study, where
the perceived stress level of dental students in private
universities in Malaysia were higher than that of
dental students from public universities. The same
trend was also observed in (Saravanan and Wilks,
2014) study. A possible explanation could be the
high tuition fees in private universities, as the fees
may cost 3 to 5 times higher than public institutions
(Digest, 2014). The higher fees may translate into
higher psychological distress experienced by private
students for fear of unemployment upon graduation
and as a consequence, being unable to repay student
loans (Babar et al., 2015).
Psychological distress is an independent factor
affecting suicidality among university students. This
is in congruent with the former findings by (Mitchell
et al., 2008), (Krysinska and Lester, 2010), (Lane
et al., 2012) and (Davis et al., 2014), who found
that psychological distress is a major risk factor for
suicidal ideation and suicide attempt. (Laurence
et al., 2009) found that academic factors (exams, fear
of falling, a shortage in clinical time) as well as
decrease in self-esteem were a source of stress among
their participants. (Cheng, 1999) reported that high
expectations of teachers, parents, and self were also
stress factors to be considered.
It is interesting to note that the risk factors
discussed above only affects a number of people. This
may due to the student’s coping strategies in dealing
with the stressful situations. (Compas et al., 2001)
suggest that coping is a means to resolve the stressful
situation and minimize emotional reaction. It is the
type of coping style that determines the psychological
health of a person (Seiffge-Krenke, 2004; Loukzadeh
and Bafrooi, 2013). As in the current study,
Behavioral Disengagement and Self-Blame domain
were significantly related to Psychological distress
ICoSEEH 2019 - The Second International Conference on Social, Economy, Education, and Humanity
104

Table 2: Independent t-test results comparing Psychological Distress and Yatt Suicide Attitude Scale according to type of
institution
Variable
Private Public p
M SD M SD
Psychological Distress 2.71 .73 2.41 .98 .025*
Yatt Suicide Attitude Scale 1.12 .24 1.12 .19 .949
Note. p < .05*
Table 3: Correlations between coping styles with the psychological distress and suicide attitude
Coping Styles Correlation coefficient
Psychological Distress Yatt Suicide Attitude Scale
Self-Distraction .143 .074
Active Coping .046 -.035
Denial .237** .039
Substance Use -.014 .287**
Emotional Support -.077 -.072
Instrumental Support -.126 -.087
Behavioral Disengagement .351** .113
Venting .127 .034
Positive Reframing -.028 -.161*
Planning -.087 -.236**
Humor .313** .102
Acceptance .190* -.067
Religion .090 -.126
Self-Blame .375** .147*
Note. ∗ p < .05, ∗ ∗ p < .0.01
Table 4: Multiple linear regression coping styles with psychological distress and suicide attitude
Coping Style
Psychological Distress Yatt Suicide Attitude Scale
B SE B β B SE B β
Denial .093 .402 .019
Substance Use .534 .143 .270***
Behavioral Disengagement 1.347 .447 .260**
Positive Reframing -.322 .116 -.204**
Planning -.009 .098 -.007
Humor -1.479 .939 -.194
Acceptance .504 .467 .079
Religion
Self-Blame 1.922 .609 .372** .245 .106 .189*
R
2
; adjusted R
2
.197; .173 .137; .117
F 8.42*** 6.89***
while suicide behavior was positively related to
different style of coping skills. (Horwitz et al., 2011),
(Fear et al., 2009) and (Ullman and Najdowski, 2009)
found that behavioral disengagement and self-blame
were predictive of higher levels of depression and
suicidal ideation. Although the directionality of the
associations is unknown, behavioral disengagement is
one of the symptoms of depression (Horwitz et al.,
2011). Self-Bame played both roles; it may stimulate
adaptive coping, on the other hand, it may lead to guilt
and, subsequently, depression (Blakely et al., 1991;
Karlsen and Bru, 2002). That may be the reason why
The Influence of Coping Skills on Psychological Distress and Suicide Attitude among University Students in Malaysia
105

the Self-Blame domain is correlated to both of the
instruments measuring suicidal behavior.
Another two coping skills, namely Substance
Use and Planning also correlated significantly with
the suicide attitude of the participants. (Wilcox
et al., 2004) described the suicide risk in substance
abusers in their meta-analysis study where individuals
with an alcohol use disorder increased their suicide
risk by approximately 9.8 times, 13.5 times for
opioid use disorder and 16.9 times among those with
polysubstance use. The disinhibition caused these
substances, such as alcohol, may lead to a higher
likelihood to carry out a more lethal suicide attempt.
Another study on university students in Malaysia
revealed that those who utilized an evasive coping
style were more likely to have higher suicidal ideation
(Din et al., 2018). This is in line with those who used
substance abuse to escape their problems rather than
resolve them.
The significant negative correlation between the
Planning domain of coping skills with suicide attitude
in this study is in agreement with (Pollock and
Williams, 2004; Konkan et al., 2014). (Pollock and
Williams, 2004) suggested that reducing the use of
problem-focused coping strategies such as planning
may increase the probability to a suicide attempt and
a tendency to ruminate on rather than proactively
resolve the problem. As a result, the individual may
not be able to see a way out of their problem, and
increase their likelihood of ideating and attempting
suicide.
This study may contribute to the benefit of
the society considering that some of the coping
skill are a strong risk factors for psychological
distress and suicidal especially among university
students. These findings should serve as a guide
for the improvement of psycho-education efforts
by improving students coping skill in all academic
settings as they will directly influence the mental
health and thus providing a knowledge on specific
cultural context of psychological distress and suicide
attitude in Malaysia.
This study has a few limitations. First of all,
this a cross-sectional study limited to students of two
universities, therefore the results need to be compared
with other studies obtained in Malaysia. However, the
results indicate that there is a need to conduct future
prevalence studies on students’ psychological distress
and suicidality in tandem with their coping skills. In
order for the data obtained to be generalized to the
Malaysian population, future studies should employ
cluster randomized sampling to involve both rural and
urban areas of Malaysia.
5 CONCLUSIONS
Stress and depression have been well-known
predisposing factors for increased suicidality among
university students globally. Effective programs
and professional help in fostering their active and
adaptive coping strategies must be established by
the university administration, generally, and adopted
by students specifically, so the negative emotions
can be managed well. This is turn will benefit for
psychological health of the students.
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