Understanding Suicide Risks with Deaf and Hard-of-Hearing People to Inform a Suicide Preven>on Interven>on Adapta>on

Transcription

1 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.

2 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

3 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 & suicide - 1 Cross-sec>onal studies - 3 Survey - 3 Australia sample - 1 Tinnitus & suicide - 4 Case study - 1 Interna>onal samples - 2 Deafness & depression - 4 Literature review - 1

4 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]

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]

6 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]

7 Risks hearing popula>on Perceived burdensomeness d/d/hh specific risks Age of onset Thwarted belongingness Suicide risk Limited access to treatment

8 Prevalence & 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 depressive episode 1% 0.6%

9 Suicide & Deaf People NTID (deaf) vs. RIT (hearing) Freshman Suicide Survey Responses vs. Na>onal College Health Assessment Item NTID deaf 2005 (N=168) Suicidal idea>on past 12 months RIT hearing 2005 (N=578) NCHA % 14.0% 10.7% Suicide aqempt past 12 months 8.3% 3.1% 2.0% Undergraduate students (any year) NTID vs. RIT p<.05

10 Suicide & Deaf People Two Deaf Adult Samples Suicide Survey Responses vs. Monroe County (hearing) BRFSS Responses Item Suicidal idea>on past 12 months Rochester Deaf Health Survey Sample 2008 (N=339) Rochester Deaf Health Survey NTID Alumni Sample 2008 (N=162) Monroe Cty. BRFSS 2006 (N = 2546) 9.6% 10.7% (not asked) Suicide plan past 12 months 2.5% 4.0% 0.7% Suicide aqempt past 12 months* 2.2% 1.3% 0.4% Ever aqempted suicide 14.6% 10.0% (not asked) **Monroe County sample is weighted to adjust for possible biases introduced by telephone survey methodology.

11 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 & reliability

12 Surveys 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

13 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

14 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 psychosocial

15 Sources of Strength Developed by Mark LoMurray ( ) 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 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 suicide

16 RaAonale 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/hh

17 Network Health Diffusion Model Research Areas to Inform Adapta>on of Sources of Strength Makeup of d/d/hh peer groups Iden>fica>on of peer leaders Rela>onships with peers Iden>fica>on of mentors Rela>onships with mentors Deaf perspec>ve wheel Adap>on for ac>vi>es d/d/hh peer group social norms Natural coping strategies Social networking in d/d/hh communi>es Impact of s>gma on networking How messages are shared among networks

18 Research 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 Analysis Plans What gives them strength Sign language translated into English then code English Conduct thema>c analysis using and frequency sta>s>cs of demographic informa>on

19 Meghan L. Fox, PsyD, LMHC Postdoctoral Fellow Department of Psychiatry University of Rochester Medical Center Steven BarneN, MD 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 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.

20 References 1.hQp:// 2. hqp:// 3. Department of Health: A Sign of the Times London: Department of Health; 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): Deaf Connec>ons: Making Posi>ve Connec>ons Suicide and Deaf Communi>es in Glasgow Glasgow: Deaf Connec>ons; Royal Na>onal Ins>tute for the Deaf [hqp:// 7. Kapur N: Self harm in the general hospital. Psychiatry 2006, 5: 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;; US Government suicide sta>s>cs [hqp:// 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; Boyechko V: Suicidal behaviour and its correlates among hearing impaired college students. In PhD thesis University of South Dakota, Vermillion; 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:

21 References 13. Silverman M: The language of suicidology. Suicide Life Threat Behav 2006, 36: NHS Centre for Reviews and Dissemina>on: Deliberate self-harm. Effec>ve Health Care Bulle>n 1998, 4(6): De Leo D, Hickey AP, Meneghel G, Cantor CH: Blindness, fear of sight loss and suicide. Psychosoma>cs 1999, 40: Lewis J, Stephens D, Huws D: Suicide in >nnitus sufferers. J Audiologic Med 1992, 1: Lewis J, Stephens D: Parasuicide and >nnitus. J Audiologic Med 1995, 4: Lewis JE, Stephens SDG, McKenna L: Tinnitus and suicide. Clin Otolaryngol 1994, 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: Leigh IW, Robins CJ, Welkowitz J, Bond RN: Toward greater understanding of depression in deaf individuals. Am Ann Deaf 1989, 134: WaQ J, Davis FE: The prevalence of boredom proneness and depression among profoundly deaf residen>al school adolescents. Am Ann Deaf 1991, 136: Marcus AL: The prevalence of depression among deaf college students. In PhD thesis Temple University; 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://