Previous literature has shown religion and spirituality to be protective factors for depressive symptoms and suicidal ideation, and that spiritual struggle is associated with increases in suicidal ideation. However, in some cases, positive religious coping may also 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 (CAMS). 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, perhaps in part because the number of interviews that met criteria were far fewer than expected. Several possible explanations are considered.