UnderstandingSuicideRiskswithDeafandHard-of-HearingPeopletoInformaSuicide

Preven>onInterven>onAdapta>on

MeghanFox,PsyD,LMHC

StevenBarne8,MDPeterWyman,PhD

Allspeakers,associatedwiththisconCnuingeducaConacCvity,haveindicatedthattheyhavenofinancialarrangementoraffiliaConwithanycommercialenCtywhoseproducts,research

orservicesmaybediscussedinthispresentaCon.

Agenda&AcknowledgementsAgenda

§  SuicideresearchwiththeDeaf,hard-of-hearing,(d/D/HH)&peoplewithhearingloss

§  Researchchallenges,strategies&methodologywithd/D/HH&peoplewithhearingloss

§  ResearchprojectExperiencesofDeafandHard-of-hearingCollegeStudentsAcknowledgements

§  URMCDepartmentofPsychiatry§  YeatesConwell,MD§  SourcesofStrengthteam§  RochesterPreven>onResearchCenter:Na>onalCenterforDeafHealthResearchteam§  RobertPollard,PhD–RIT/NTID§  NewYorkStateSuicidePreven>onConferenceCommiQee

Literatureond/D/HH&Suicide§  Turner,etal.(2007)iden>fied13studiesonsuicide&hearingloss

Samples Topics Designs

USAsamples-8 Deafness&suicide-4 Prevalencestudies-5

UKsamples-2 Othersensoryimpairments&suicide-1

Cross-sec>onalstudies-3

Survey-3

Australiasample-1 Tinnitus&suicide-4 Casestudy-1

Interna>onalsamples-2 Deafness&depression-4 Literaturereview-1

SuicideRisk§  Manyoftheriskfactorsthatinfluencesuicidebehaviorsratesinhearing

peoplewouldbeexpectedtodosoind/D/HHpeople§  Poorqualityoflife&mentaldistressareassociatedwithincreasedodds

ofcompletedsuicides&suicideaQemptsinhearingpeople[5,6]§  Factorsknowntocontributetothisrela>onshipinclude

§  LoweducaConala8ainment[7,8,9]§  Lackofstableemployment[7]§  SocioeconomicdeprivaCon[10]§  Presenceofpsychiatricdisorders[11-13]§  Substanceusedisorders[7,14,15]

§  Generallyd/D/HHpeoplereportlowerqualityoflife&increasedmentaldistresscomparedtohearingpeople[16,17]

§  Deaf&deaf-blindindividualsexperiencehigherratesofmentalhealthproblemsthanhearingindividuals[4,5]

PossibleSuicideRisksComparedwithhearingpeople,d/D/HHpeoplehaverelaAvely

§  LoweducaConala8ainment[18]§  Lowsocioeconomicstatus(SES)[19,20]§  Highratesofuntreatedpsychopathology[21]

§  Mul>plereasons

§  Highriskofsubstanceabusewithinsomesegmentsofthecommunity[22]§  Unstableemployment[16]

d/D/HHpeoplehavehighratesofcharacterisAcsassociatedwithsuicide§  EmoConaldistress[4]§  Unemployment[21]§  Childabusehistories[4]

d/D/HH-relatedSuicideRiskRiskfactorsthataremorespecifictod/D/HHpeople

§  Critchfield,etal.(1987)iden>fied§  Lackofrolemodels§  AlienaConfromfamily&peers§  Increasedriskofabuse§  SocialisolaCon§  Acceptanceofself;selfimage§  SeparaConofparentandchild§  PeerandrelaConshipproblems

§  Othershavesuggested§  FundofinformaCon(FOI)gaps§  Languagefluency&acquisiCon§  AcculturaConstress

§  Hearing-relatedproblems(e.g.medicalissuesrelatedtocauseofhearingloss,>nnitus,Ushersyndrome)‘majorcontribu>ngfactor’in29%ofsuicides[15]

§  Increaseddifficul>esford/D/HHpeopleinaccessingmentalhealth&socialservices[3,5]

Riskshearingpopula>on

d/D/HHspecificrisks

Limitedaccesstotreatment

SuicideriskAgeofonset

Perceivedburdensomeness

Thwartedbelongingness

Prevalence&IncidenceRates§  DeLeoetal(1999)found0.2%ofsuicidecasestohavesensoryimpairment§  Boyechko(1992)foundhighprevalenceratesofsuicidalbehavior&idea>on

amongd/D/HHcollegestudents§  Duringtheirlife>me

§  40%reportedhavingfeltthatlifewasnotworthliving§  44%hadexperiencedsuicidalthoughts§  30%reportedhavinga8emptedsuicide

§  18%hadaQemptedsuicideduringthepreviousyear§  Nocompletedsuicides

§  Critchfieldetal.(1987)examineddeafstudentsatdeaf-onlyanddeaf&hearingeduca>onalprograms

Deaf-onlyprograms Deaf&hearingprogram

SuicidalaQempts&gestures 2.2% 0.9%

Verbaliza>onofsuicide 4.6% 2.7%

Hospitaliza>onforsuicidalordepressiveepisode

1% 0.6%

Suicide&DeafPeople

Item NTIDdeaf2005(N=168)

RIThearing2005

(N=578)

NCHA†2005

Suicidalidea>onpast12months

12.0% 14.0% 10.7%

SuicideaQemptpast12months

8.3% 3.1%‡ 2.0%

†Undergraduatestudents(anyyear)‡NTIDvs.RITp<.05

NTID(deaf)vs.RIT(hearing)FreshmanSuicideSurveyResponsesvs.Na>onalCollegeHealthAssessment

Suicide&DeafPeople

Item RochesterDeafHealthSurveySample2008(N=339)

RochesterDeafHealthSurveyNTIDAlumniSample2008(N=162)

MonroeCty.BRFSS2006(N=2546)

Suicidalidea>onpast12months

9.6% 10.7% (notasked)

Suicideplanpast12months 2.5% 4.0% 0.7%

SuicideaQemptpast12months*

2.2% 1.3% 0.4%

EveraQemptedsuicide 14.6% 10.0% (notasked)

**MonroeCountysampleisweightedtoadjustforpossiblebiasesintroducedbytelephonesurveymethodology.

TwoDeafAdultSamples’SuicideSurveyResponsesvs.MonroeCounty(hearing)BRFSSResponses

ResearchStrategies&MethodologyCommunity-EngagedResearchApproach

§  Local&na>onaladvisoryboards§  Researchprojectspecificboards§  Townhallmee>ngs§  Transla>onteams

§  Included/D/HHcommunitymembers

§  Cogni>veinterviews§  Vitalstepindevelopingaculturally&linguisCcallyappropriateresearchmethodologieswithD/HHpopulaCons

§  ParCcipant’sthoughtprocesses,reacCons,&commentsaboutsurveyorothermethodologyisinterviewfocus-notactualanswers

§  IlluminatescogniCveprocessesthatrespondentsusetoanswersurveyquesCons§  Usetoevaluate&minimizesourcesofresponseerrorinthesurveyques>onnaire

[23]

§  Conceptuallystrengthensvalidity&reliability

SurveysinASL&SignedEnglish

Complex&intricateprocess§  Teamtransla>on&backtransla>on§  Cogni>veinterviews§  Scriptdevelopment§  Filming§  Computersorwaresurveybuilding§  Sorwaretes>ng

ResearchChallenges§  FewqualifiedresearchersfluentinASL&Deafculture§  Differentdefini>ons&waysofasking/capturing‘deaf’‘hard-of-hearing’

&othertermstoiden>fypopula>onindata§  Iden>fying&engaging&d/D/HHsub-groups(e.g.minimallanguageskill

d/D/HHpeople,DeafwithDisabili>es(DWD))§  Variabilityinmodesofcommunica>on&ASLskillsofd/D/HHpeople§  Linguis>c&culturalaccessibilityofexis>ngmeasures§  Fewdatacollec>onmeasuresinASL§  Complexlogis>cs&processinsurveyadapta>on§  Deaf&hard-of-hearingASLuserssmallpopula>on§  Nosinglesignfor‘suicide’–notalimita>onofASL§  UnderstandinghowDeafpeopleconceptualizeidea>ons&aQempts

§  Misunderstandingsinmediaregarding“accidents”

HowDeafResidenAalSchoolsApproachSuicideDudzinski(1998)surveyedd/D/HHresidenAalschools

§  Mostpar>cipa>ngschoolsconsideredsuicidalbehavioraproblem§  31%hadnoestablishedguidelinesforrespondingtosuchbehavior§  Fivemostcommonelementsofproceduresfordealingwithsuicidal

idea>onlistedweregeneric:§  (1)callparents§  (2)keepstudentunderobservaCon§  (3)completewri8endocumentaCon§  (4)callcounselor/psychologist§  (5)follow-up

§  Inschoolswithpoliciesfordealingwithsuicidalidea>on,themostcommonresponsetypewasadministra>ve

§  Insomeschoolsthepolicieswereexclusivelyadministra>veinnature§  Theleastcommoninterven>onwaspsychosocial

SourcesofStrengthDevelopedbyMarkLoMurray(1995-2004)

§  Upstreamsuicidepreven>onprogramwithadolescentPeerLeaders&AdultMentors§  2005:Na>onalFieldProjectAward–AmericanPublicHealthAssoc.(APHA)

KeyConcepts§  SocialConnectednessModel§  Change-Agents:KeyOpinionLeaders§  Ac>veTrainingandDiffusion

ObjecAves§  SpreadHealthyCopingtoReduceVulnerabilitytoSuicide§  StrengthenYouth-AdultConnec>ons§  IncreaseHelp-Seeking&Receiving

TesAng/programrefinement-2006§  NIMH&SAMSHAfundedRCTw/18schools;465PeerLeaders;2,700students[1

Semester](Wymanetal2010,AJPH)

§  FirstPeerLeaderprogramtochangeschool-widerisk&protec>vefactorsassociatedwithreducedsuicide

RaAonaleforSourcesofStrengthNeed

§  d/D/HHexperienceisola>on->mentalhealthimpact->suiciderisk§  College-impressionable>meford/D/HHstudentiden>tydevelopment&communityaffilia>on§  d/D/HHstudentreadinessforcollegestressors§  Lackofpreven>oneduca>oninmiddle&highschoolyears

SourcesofStrength§  ProgramPhilosophy

§  Developedthroughworkingwithunderservedpopula>ons§  Strengthsbased–notpathological§  Adaptabletomeetcommuni>eswheretheyare§  Communityownednotimposed

§  Style§  Hands-oninterac>velearning&applica>on§  Circlesea>ng§  Personalnarra>vesarevalued

§  NeedforAdaptaConofEvidencedBasedPracCceswithd/D/HH

 NetworkHealthDiffusionModel  ResearchAreastoInformAdapta>onofSourcesofStrength

§  Makeupofd/D/HHpeergroups

§  Iden>fica>onofpeerleaders

§  Rela>onshipswithpeers§  Iden>fica>onofmentors§  Rela>onshipswithmentors

§  Deafperspec>ve–wheel§  Adap>onforac>vi>es§  d/D/HHpeergroupsocial

norms§  Naturalcopingstrategies

§  Socialnetworkingind/D/HHcommuni>es

§  Impactofs>gmaonnetworking§  Howmessagesaresharedamong

networks

ResearchProjectAims

§  Iden>fyd/D/HHcollegestudents’socialnetworkcharacteris>csrelatedtoinfluen>alpeerleaders,>estomentors&affilia>ons

§  Iden>fyd/D/HHcollegestudents’perspec>vesonnaturalcopingresources

Methodology§  Qualita>veStudyusing25semi-structuredvideorecordedinterviewswithd/D/HH

RIT&NTIDstudentsintheirpreferredmodeofcommunica>on§  Ques>onsexploring:

§  On&offcampussocialnetworks§  Trustedgroups/clubs/officesoncampus§  Howlearnedaboutthesegroups/clubs/officesoncampus§  Howtheyaccessthesepeople&groups§  Stressors§  Whatgivesthemstrength

AnalysisPlans§  SignlanguagetranslatedintoEnglishthencodeEnglish§  Conductthema>canalysisusingandfrequencysta>s>csofdemographicinforma>on

§  MeghanL.Fox,PsyD,LMHCmeghan_fox@urmc.rochester.eduPostdoctoralFellowDepartmentofPsychiatryUniversityofRochesterMedicalCenter

§  StevenBarneN,MDsteven_barneQ@urmc.rochester.eduPrincipalInves>gator/ProgramDirectorRochesterPreven>onResearchCenter:Na>onalCenterforDeafHealthResearchAssociateProfessorDepartmentofFamilyMedicineandtheDepartmentofPublicHealthSciencesUniversityofRochesterMedicalCenter§  PeterWyman,PhDpeter_wyman@urmc.rochester.eduProfessorDirectoroftheSchoolandCommunity-BasedPreven>onLaboratoryDepartmentofPsychiatryUniversityofRochesterMedicalCenterFox,M.,BarneQ,S.,&Wyman,P.UnderstandingSuicideRiskswithDeafandHard-of-Hearing

PeopletoInformaSuicidePrevenConIntervenConAdaptaCon.September2017,Albany,NewYork,Paperpresentedatthemee>ngoftheNewYorkStateSuicidePreven>onConference.

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