Suicide continues to be a leading cause of death around the globe (World Health Organization, 2012; Wu, Wang, Jia, & Mazza, 2015). Previous literature has shown religiosity as a protective factor for depressive symptoms and suicidal ideation (Dervic et al., 2004; Dew et al., 2010; Miller et al., 2012; Nonnemaker, McNeely, & Blum, 2003; Rasic et al., 2009; Rosmarin et al., 2012), and that spiritual struggle is associated with increases in suicidal ideation (Ahles, Mezulis, & Hudson, 2016; Henslee et al., 2014; Lee, Nezu, & Nezu, 2014; Rosmarin et al, 2013; Stratta et al., 2011; Trevino, Balboni, Zollfrank, Balboni, & Prigerson, 2014). However, studies by Huguelet et al. (2007) as well as Lawrence et al. (2016) indicated that in some cases, positive religious coping may be associated with risk factors for suicidality. The present study explored aspects of spiritual struggle or religious coping that were spontaneously offered and noted in a medical record during a standard emergency room risk assessment involving the Collaborative Assessment and Management of Suicidality. Among 839 archival records from emergency department settings in Yamhill County, Oregon in 2015 and 2016, only 36 interviews met criteria. It was hypothesized that those with expressed spiritual or religious struggle would indicate a higher risk for suicide through self-report, compared with those who express positive religious coping. The current study found no association between self-report of suicidal intent severity and style of spiritual or religious coping. The number of interviews that met criteria were far fewer than predicted. Several possible explanations are considered.