Understanding Suicide Risks with Deaf and Hard-of-Hearing People to Inform a Suicide Preven on Interven on Adapta on
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Understanding Suicide Risks with Deaf and
Hard-of-Hearing People to Inform a Suicide
Preven>on Interven>on Adapta>on
Meghan Fox, PsyD, LMHC
Steven Barne8, MD
Peter Wyman, PhD
All speakers, associated with this conCnuing educaCon acCvity, have indicated that they have
no financial arrangement or affiliaCon with any commercial enCty whose products, research
or services may be discussed in this presentaCon.
Agenda & Acknowledgements
Agenda
§ Suicide research with the Deaf, hard-of-hearing, (d/D/HH) & people with
hearing loss
§ Research challenges, strategies & methodology with d/D/HH & people
with hearing loss
§ Research project Experiences of Deaf and Hard-of-hearing College Students
Acknowledgements
§ URMC Department of Psychiatry
§ Yeates Conwell, MD
§ Sources of Strength team
§ Rochester Preven>on Research Center: Na>onal Center for Deaf Health Research team
§ Robert Pollard, PhD – RIT/NTID
§ New York State Suicide Preven>on Conference CommiQee
Literature on d/D/HH & Suicide
§ Turner, et al. (2007) iden>fied 13 studies on suicide & hearing loss
Samples Topics Designs
USA samples - 8 Deafness & suicide - 4 Prevalence studies - 5
UK samples - 2 Other sensory impairments & Cross-sec>onal studies - 3
suicide - 1
Survey - 3
Australia sample - 1 Tinnitus & suicide - 4 Case study - 1
Interna>onal samples - 2 Deafness & depression - 4 Literature review - 1
Suicide Risk
§ Many of the risk factors that influence suicide behaviors rates in hearing
people would be expected to do so in d/D/HH people
§ Poor quality of life & mental distress are associated with increased odds
of completed suicides & suicide aQempts in hearing people [5, 6]
§ Factors known to contribute to this rela>onship include
§ Low educaConal a8ainment [7,8,9]
§ Lack of stable employment [7]
§ Socioeconomic deprivaCon [10]
§ Presence of psychiatric disorders [11-13]
§ Substance use disorders [7,14,15]
§ Generally d/D/HH people report lower quality of life & increased mental
distress compared to hearing people [16, 17]
§ Deaf & deaf-blind individuals experience higher rates of mental health
problems than hearing individuals [4,5]
Possible Suicide Risks
Compared with hearing people, d/D/HH people have relaAvely
§ Low educaConal a8ainment [18]
§ Low socioeconomic status (SES) [19, 20]
§ High rates of untreated psychopathology [21]
§ Mul>ple reasons
§ High risk of substance abuse within some segments of the community [22]
§ Unstable employment [16]
d/D/HH people have high rates of characterisAcs associated with suicide
§ EmoConal distress [4]
§ Unemployment [21]
§ Child abuse histories [4]d/D/HH-related Suicide Risk
Risk factors that are more specific to d/D/HH people
§ Critchfield, et al. (1987) iden>fied
§ Lack of role models
§ AlienaCon from family & peers
§ Increased risk of abuse
§ Social isolaCon
§ Acceptance of self; self image
§ SeparaCon of parent and child
§ Peer and relaConship problems
§ Others have suggested
§ Fund of informaCon (FOI) gaps
§ Language fluency & acquisiCon
§ AcculturaCon stress
§ Hearing-related problems (e.g. medical issues related to cause of hearing
loss, >nnitus, Usher syndrome) ‘major contribu>ng factor’ in 29% of suicides
[15]
§ Increased difficul>es for d/D/HH people in accessing mental health & social
services [3,5]Risks hearing
popula>on
Perceived
burdensomeness
d/D/HH Age of Suicide risk
specific risks onset Thwarted
belongingness
Limited access
to treatmentPrevalence & Incidence Rates
§ De Leo et al (1999) found 0.2% of suicide cases to have sensory impairment
§ Boyechko (1992) found high prevalence rates of suicidal behavior & idea>on
among d/D/HH college students
§ During their life>me
§ 40% reported having felt that life was not worth living
§ 44% had experienced suicidal thoughts
§ 30% reported having a8empted suicide
§ 18% had aQempted suicide during the previous year
§ No completed suicides
§ Critchfield et al. (1987) examined deaf students at deaf-only and deaf & hearing
educa>onal programs
Deaf-only programs Deaf & hearing program
Suicidal aQempts & gestures 2.2% 0.9%
Verbaliza>on of suicide 4.6% 2.7%
Hospitaliza>on for suicidal or 1% 0.6%
depressive episodeSuicide & Deaf People
NTID (deaf) vs. RIT (hearing) Freshman Suicide Survey Responses vs. Na>onal College Health Assessment
Item NTID deaf 2005 RIT hearing NCHA† 2005
(N=168) 2005
(N=578)
Suicidal idea>on past 12 12.0% 14.0% 10.7%
months
Suicide aQempt past 12 8.3% 3.1% ‡ 2.0%
months
† Undergraduate students (any year)
‡ NTID vs. RIT pSuicide & Deaf People
Two Deaf Adult Samples’ Suicide Survey Responses vs. Monroe County (hearing) BRFSS Responses
Item Rochester Deaf Rochester Deaf Monroe Cty.
Health Survey Health Survey BRFSS 2006
Sample 2008 NTID Alumni
(N=339) Sample 2008 (N = 2546)
(N=162)
Suicidal idea>on past 12 9.6% 10.7% (not asked)
months
Suicide plan past 12 months 2.5% 4.0% 0.7%
Suicide aQempt past 12 2.2% 1.3% 0.4%
months*
Ever aQempted suicide 14.6% 10.0% (not asked)
**Monroe County sample is weighted to adjust for possible biases introduced by
telephone survey methodology.Research Strategies & Methodology
Community-Engaged Research Approach
§ Local & na>onal advisory boards
§ Research project specific boards
§ Town hall mee>ngs
§ Transla>on teams
§ Include d/D/HH community members
§ Cogni>ve interviews
§ Vital step in developing a culturally & linguisCcally appropriate research
methodologies with D/HH populaCons
§ ParCcipant’s thought processes, reacCons, & comments about survey or other
methodology is interview focus - not actual answers
§ Illuminates cogniCve processes that respondents use to answer survey quesCons
§ Use to evaluate & minimize sources of response error in the survey ques>onnaire
[23]
§ Conceptually strengthens validity & reliabilitySurveys in ASL & Signed English Complex & intricate process § Team transla>on & back transla>on § Cogni>ve interviews § Script development § Filming § Computer sorware survey building § Sorware tes>ng
Research Challenges
§ Few qualified researchers fluent in ASL & Deaf culture
§ Different defini>ons & ways of asking/capturing ‘deaf’ ‘hard-of-hearing’
& other terms to iden>fy popula>on in data
§ Iden>fying & engaging & d/D/HH sub-groups (e.g. minimal language skill
d/D/HH people, Deaf with Disabili>es (DWD))
§ Variability in modes of communica>on & ASL skills of d/D/HH people
§ Linguis>c & cultural accessibility of exis>ng measures
§ Few data collec>on measures in ASL
§ Complex logis>cs & process in survey adapta>on
§ Deaf & hard-of-hearing ASL users small popula>on
§ No single sign for ‘suicide’ – not a limita>on of ASL
§ Understanding how Deaf people conceptualize idea>ons & aQempts
§ Misunderstandings in media regarding “accidents”How Deaf ResidenAal Schools Approach Suicide
Dudzinski (1998) surveyed d/D/HH residenAal schools
§ Most par>cipa>ng schools considered suicidal behavior a problem
§ 31% had no established guidelines for responding to such behavior
§ Five most common elements of procedures for dealing with suicidal
idea>on listed were generic:
§ (1) call parents
§ (2) keep student under observaCon
§ (3) complete wri8en documentaCon
§ (4) call counselor/psychologist
§ (5) follow-up
§ In schools with policies for dealing with suicidal idea>on, the most
common response type was administra>ve
§ In some schools the policies were exclusively administra>ve in nature
§ The least common interven>on was psychosocialSources of Strength
Developed by Mark LoMurray (1995-2004)
§ Upstream suicide preven>on program with adolescent Peer Leaders & Adult Mentors
§ 2005: Na>onal Field Project Award – American Public Health Assoc. (APHA)
Key Concepts
§ Social Connectedness Model
§ Change-Agents: Key Opinion Leaders
§ Ac>ve Training and Diffusion
ObjecAves
§ Spread Healthy Coping to Reduce Vulnerability to Suicide
§ Strengthen Youth-Adult Connec>ons
§ Increase Help-Seeking & Receiving
TesAng/program refinement - 2006
§ NIMH & SAMSHA funded RCT w/ 18 schools; 465 Peer Leaders; 2,700 students [1
Semester] (Wyman et al 2010, AJPH)
§ First Peer Leader program to change school-wide risk & protec>ve factors associated
with reduced suicideRaAonale for Sources of Strength
Need
§ d/D/HH experience isola>on -> mental health impact -> suicide risk
§ College - impressionable >me for d/D/HH student iden>ty development & community affilia>on
§ d/D/HH student readiness for college stressors
§ Lack of preven>on educa>on in middle & high school years
Sources of Strength
§ Program Philosophy
§ Developed through working with underserved popula>ons
§ Strengths based – not pathological
§ Adaptable to meet communi>es where they are
§ Community owned not imposed
§ Style
§ Hands-on interac>ve learning & applica>on
§ Circle sea>ng
§ Personal narra>ves are valued
§ Need for AdaptaCon of Evidenced Based PracCces with d/D/HHNetwork Health Diffusion Model
Research Areas to Inform Adapta>on of Sources of Strength
§ Makeup of d/D/HH peer § Deaf perspec>ve – wheel § Social networking in d/D/HH
groups § Adap>on for ac>vi>es communi>es
§ Iden>fica>on of peer § d/D/HH peer group social § Impact of s>gma on networking
leaders norms § How messages are shared among
§ Rela>onships with peers § Natural coping strategies networks
§ Iden>fica>on of mentors
§ Rela>onships with mentorsResearch Project
Aims
§ Iden>fy d/D/HH college students’ social network characteris>cs related to influen>al
peer leaders, >es to mentors & affilia>ons
§ Iden>fy d/D/HH college students’ perspec>ves on natural coping resources
Methodology
§ Qualita>ve Study using 25 semi-structured video recorded interviews with d/D/HH
RIT & NTID students in their preferred mode of communica>on
§ Ques>ons exploring:
§ On & off campus social networks
§ Trusted groups/clubs/offices on campus
§ How learned about these groups/clubs/offices on campus
§ How they access these people & groups
§ Stressors
§ What gives them strength
Analysis Plans
§ Sign language translated into English then code English
§ Conduct thema>c analysis using and frequency sta>s>cs of demographic informa>on§ Meghan L. Fox, PsyD, LMHC meghan_fox@urmc.rochester.edu
Postdoctoral Fellow
Department of Psychiatry
University of Rochester Medical Center
§ Steven BarneN, MD steven_barneQ@urmc.rochester.edu
Principal Inves>gator/Program Director
Rochester Preven>on Research Center: Na>onal Center for Deaf Health Research
Associate Professor
Department of Family Medicine and the Department of Public Health Sciences
University of Rochester Medical Center
§ Peter Wyman, PhD peter_wyman@urmc.rochester.edu
Professor
Director of the School and Community-Based Preven>on Laboratory
Department of Psychiatry
University of Rochester Medical Center
Fox, M., BarneQ, S., & Wyman, P. Understanding Suicide Risks with Deaf and Hard-of-Hearing
People to Inform a Suicide PrevenCon IntervenCon AdaptaCon. September 2017, Albany,
New York, Paper presented at the mee>ng of the New York State Suicide Preven>on
Conference.References 1.hQp://www.denvergov.org/signlanguageresources/DeafCulture/tabid/436089/Default.aspx 2. hQp://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&dID=152694 3. Department of Health: A Sign of the Times London: Department of Health; 2003. 4. Kvam MH, Loeb M, Tambs K: Mental health in deaf adults: symptoms of anxiety and depression among hearing and deaf individuals. J Deaf Stud Deaf Educ 2006, 12(1):1-7. 5. Deaf Connec>ons: Making Posi>ve Connec>ons – Suicide and Deaf Communi>es in Glasgow Glasgow: Deaf Connec>ons; 2006. 6. Royal Na>onal Ins>tute for the Deaf [hQp://www.rnid.org.uk] 7. Kapur N: Self harm in the general hospital. Psychiatry 2006, 5:76-80. 8. Holt J, HoQo S, Cole K: Demographic Aspects of Hearing Impairment: Ques>ons and Answers 3rd edi>on. Washington, DC: Center for Assessment and Demographic Studies, Gallaudet University;; 1994. 9. US Government suicide sta>s>cs [hQp://www.nimh.nih.gov/publicat/harmsway.cfm] 10. Dudzinski EF: An analysis of administra>ve response paQerns to suicide idea>on among deaf young adults. In PhD thesis Gallaudet University, Washington DC; 1998. 11. Boyechko V: Suicidal behaviour and its correlates among hearing impaired college students. In PhD thesis University of South Dakota, Vermillion; 1992 12. Critchfield AB, Morrison F, Quinn WM: Suicide interven>on with hearing impaired adolescents. In Innova>ons in the habilita>on and rehabilita>on of Deaf adolescents. Selected proceedings of the second na>onal conference on the habilita>on and rehabilita>on of Deaf Adolescents Edited by: Anderson GB, Watson D. Arkansas: American Deafness and Rehabilita>on Associa>on; 1987:187-203.
References 13. Silverman M: The language of suicidology. Suicide Life Threat Behav 2006, 36:519-532. 14. NHS Centre for Reviews and Dissemina>on: Deliberate self-harm. Effec>ve Health Care Bulle>n 1998, 4(6):1-12. 15. De Leo D, Hickey AP, Meneghel G, Cantor CH: Blindness, fear of sight loss and suicide. Psychosoma>cs 1999, 40:339-344. 16. Lewis J, Stephens D, Huws D: Suicide in >nnitus sufferers. J Audiologic Med 1992, 1:30-37. 17. Lewis J, Stephens D: Parasuicide and >nnitus. J Audiologic Med 1995, 4:34-39. 18. Lewis JE, Stephens SDG, McKenna L: Tinnitus and suicide. Clin Otolaryngol 1994, 19:50-54. 19. Leigh IW, Robins CJ, Welkowitz J: Modifica>on of the Beck Depression Inventory for use with a deaf popula>on. J Clin Psychol 1988, 44:728-732. 20. Leigh IW, Robins CJ, Welkowitz J, Bond RN: Toward greater understanding of depression in deaf individuals. Am Ann Deaf 1989, 134:249-254. 21. WaQ J, Davis FE: The prevalence of boredom proneness and depression among profoundly deaf residen>al school adolescents. Am Ann Deaf 1991, 136:409-413. 22. Marcus AL: The prevalence of depression among deaf college students. In PhD thesis Temple University; 1991. 23. Willis, G. B. (1999). Cogni>ve interviewing: A “how to” guide. Guide provided for the short course, “Reducing Survey Error through Research on the Cogni>ve and Decision Processes in Surveys” offered at the mee>ng of the American Sta>s>cal Associa>on. Retrieved from hQp://www.hkr.se/pagefiles/35002/gordonwillis.pdf
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