Doctor of Philosophy, The Ohio State University, 2024, Educational Studies

Suicide is a growing concern in the United States and around the world. Approximately 50,000 people die by suicide each year and more than 15 million additional people struggle with thoughts of suicide in the U.S. As a result, there are very few people who have not been affected by suicide. Much of the work that has been performed around suicide places a focus on awareness and interventions, which is necessary for understanding the issue and critical in directing people to help. In recent years, the increases in suicide have been met with increases in social awareness. There is one obvious gap, which has been a lack of implemented solutions. Unfortunately, little has been done to provide actual treatment models that have proven effective. This study explored the work conducted at an outpatient treatment center utilizing a novel treatment model specifically developed for individuals actively struggling with thoughts of suicide. This model merges two evidence-based models with over 50 randomized controlled trials between them to bring both access and treatment to the public. The sample included 58 participants with a mean age of 20 years and which was 57% female and 43% male. Importantly, 31% of those in the study had no prior history of mental health diagnosis. The study found that the treatment was effective in reducing suicidality scores in the sample from pre-treatment scores to post-treatment scores, with a very large effect size [t(57) = 8.1, p < .001, d = 1.02]. There were also a significant decreases in scores on hopelessness [t(56) = 9.875, p < .001, d = 1.630], psychological pain [ t(57) = 9.768, p<.001, d = 1.294], stress [t(57) = 9.560, p < .001, d = 1.266], and self-hate [t(57) = 8.118, p < .001, d = 1.075], all with large effect sizes. The treatment and dosage data shows that the participants were able to appropriately address the issue of suicide and achieve resolution in an average of 7.52 sessions over an average of 5.6 weeks, with a 93% succe (open full item for complete abstract)

Committee: Darcy Haag Granello (Advisor); Paul Granello (Committee Member); David Jobes (Committee Member); Kaprea Johnson (Committee Member) Subjects: Behavioral Psychology; Behavioral Sciences; Behaviorial Sciences; Clinical Psychology; Cognitive Psychology; Cognitive Therapy; Counseling Education; Counseling Psychology; Developmental Psychology; Ethics; Experimental Psychology; Health Care; Mental Health; Psychology; Psychotherapy; Public Health; Social Work; Sociology

Master of Arts, Case Western Reserve University, 0, Psychology

The current study examined the developmental pathways of conduct problems, depressive symptoms, and coping behaviors in adolescence and their influence on the risk of suicide in young adulthood. At ages 17, 22, and 23, participants from a control sample (N = 498) from a longitudinal prevention trial were administered a series of questionnaires, including the Brief Symptom Inventory, Life Events Coping Inventory, and a self-report survey on engagement in antisocial behaviors, and at ages 28-30, the Composite International Diagnostic Interview. Self-reports and the diagnostic interview were analyzed through a series of autoregressive paths. Gender differences were present. Across genders, depressive symptoms directly predicted suicide risk. For females, depressive symptoms predicted delinquent/aggressive coping, and delinquent/aggressive coping predicted future conduct problems. For males, two indirect paths to suicide risk were found: (1) positive distraction coping to depressive symptoms to suicide risk and (2) conduct problems to depressive symptoms to suicide risk. The results and their implications for future research and interventions targets are discussed.

Committee: Arin Connell (Advisor) Subjects: Psychology

Master of Arts (MA), Bowling Green State University, 2020, Psychology/Clinical

Lesbian, gay, bisexual, questioning/queer (LGBQ) individuals and those who are same-sex attracted (SSA) who are members of the Church of Jesus Christ of Latter-day Saints (LDS), often face unique challenges related to faith, family, and mental health. Of specific concern is the potential for LDS LGBTQ individuals to be at risk for suicide, due to the conflict between their religious/spirituality and their sexual identity. In the current study I sought to examine the ways in which religious/spiritual (r/s) struggles and one-upmanship might predict internalized homophobia and suicide risk in an online sample of 404 current/former LDS LGBTQ adults. Results indicated that in separate models, both r/s struggles and one-upmanship predicted suicide risk, but only r/s struggles predicted internalized homophobia. Additionally, mediation analysis demonstrated that internalized homophobia did not mediate the relationship between r/s struggles and suicide risk. Exploratory analysis revealed that r/s struggles fully mediated the relationship between one-upmanship and suicide risk. Clinicians working with current or former LDS LGBTQ individuals should consider the role that r/s struggles and one-upmanship might play in their clients' risk for suicide.

Committee: Annette Mahoney PhD (Advisor); Carolyn Tompsett PhD (Committee Member); Meagan Docherty PhD (Committee Member) Subjects: Clinical Psychology

Master of Science (MS), Ohio University, 2020, Clinical Psychology (Arts and Sciences)

Current rates of suicide are a growing global health concern. To best mitigate suicide risk, it is important that theoretically based interventions targeting empirically supported risk factors for suicide be developed and refined. Brief, accessible interventions could allow people to access these interventions when it is most necessary. A recent randomized control trial conducted by Schmidt et al. (2019) examined Building Stronger Alliances (BSA), a computer-based intervention based in the Interpersonal Theory of Suicide (IPTS), combined with cognitive bias modification targeting mood (CBM-I) along with two other suicide interventions. The current study is a secondary data analysis of the Schmidt et al. (2019) study focused on the BSA+CBM-I arm of the intervention in comparison to the control condition. Individuals in the BSA+CBM-I group were found to have reduced perceived burdensomeness, a key risk factor for suicide according to the IPTS, at the end of treatment compared to the control group. However, reduced perceived burdensomeness did not predict differences in suicidal ideation at 1-month follow-up. Distress tolerance at baseline predicted perceived burdensomeness at end of treatment but was not a significant moderator of the relationship between condition and perceived burdensomeness. No hypothesized mediation pathways from condition to suicidal ideation at 1-month follow-up, including through perceived burdensomeness, thwarted belongingness, or distress tolerance were significant. BSA+CBM-I appears to be an effective treatment in reducing a key risk factor for suicide in an at-risk sample. Future research is needed to examine efficacy in reducing suicide risk. Additional research also needs to address construct validity and malleability of thwarted belongingness.

Committee: Nicholas Allan PhD (Advisor); Julie Suhr PhD (Committee Member); Darcey Allan PhD (Committee Member) Subjects: Psychology

Specialist in Education (Ed.S.), University of Dayton, 2019, School Psychology

Recognizing the warning signs and risk factors for suicide is key in prevention efforts. The present study examined teacher knowledge of child and adolescent suicide risk factors and warning signs through the administration of a survey to 136 primary and secondary teachers. A quantitative survey design with paper surveys as the method of data collection was utilized for the present study. Participants were recruited through convenience sampling in school districts in which the primary researcher was completing a school psychology internship. Results indicated that teachers have limited knowledge of the risk factors and warning signs for suicide. Respondents listed an average of 2.39 out of 5 correct warning signs and an average of 2.22 out of 5 correct risk factors. Furthermore, the results of the Pearson product-moment correlation indicated no correlations between the grade level taught and correctly identified signs (r = 0.01) and between the number of years teaching and correctly identified signs (r = -.06). There was a correlation between the educational training program preparation and correctly identified signs (r = 0.22) and the number of professional development hours and correctly identified signs (r = 0.25). The results of the present study demonstrated the need for effective trainings for teachers to provide them with the knowledge of suicide risk factors and warning signs and resources to aide in the suicide prevention process.

Committee: Elana Bernstein Ph.D. (Committee Chair); Susan Davies Ed.D. (Committee Member); Jim Ayers Ed.S. (Committee Member) Subjects: Education; Psychology

PhD, University of Cincinnati, 2016, Education, Criminal Justice, and Human Services: Health Education

Adolescent alcohol use is a major public health problem in the United States. Few studies have examined the relationship between specific components of mental health (i.e. self-concept) and alcohol use, particularly across the varying developmental years. The primary aim of this study was to investigate the impact of self-concept on recent alcohol use (past 30 days) and recent binge drinking (five or more alcoholic beverages on one occasion) across three developmental ages. This study employed secondary data analysis using the National Longitudinal Study on Adolescent to Adult Health (Add Health). All participants were in grades 7-12 (N = 6,504) and completed the computer assisted in-home interview. A total of 17.3% of youth reported recent alcohol use and 11.3% reported recent binge drinking. Overall, recent alcohol use and recent binge drinking increased with increased grade levels. Youth who were male and white were also more likely than their counterparts for recent alcohol use and recent binge drinking. Youth with low self-concept were at increased odds for recent alcohol use. This held true regardless of sex, race and grade. Youth with low self-concept were at increased odds for recent binge drinking among male and female students, white students, and students in grades 7-8 and grades 11-12. Students in grades 7-8 with low self-concept had the highest odds ratios for recent alcohol use and recent binge drinking in comparison to students in grades 9-10 or 11-12 with low self-concept. Results of this study underscore the importance for health educators and preventionists to consider the impact of self-concept on youth substance use at differing grade levels when developing substance abuse prevention efforts. Youth suicide is in the top leading causes of death among adolescents and remains an important public health issue for health professionals today. Few have examined a more intrapersonal form of mental health, an individual's overall self-concept. The (open full item for complete abstract)

Committee: Keith King Ph.D. (Committee Chair); Ashley Merianos Ph.D. (Committee Member); Rebecca Vidourek Ph.D. (Committee Member) Subjects: Health Education

Doctor of Philosophy, University of Toledo, 2016, Psychology - Clinical

Research has linked childhood trauma to suicide risk, where certain forms of trauma, greater severity, and repeated exposure increase risk for suicide; however, the mechanisms underlying these relationships have not been systematically explored. The Interpersonal Theory of Suicide (IPT), which has three main components, including the better-researched thwarted belongingness and perceived burdensomeness, and a less-well studied component known as the acquired capability for suicide, has improved the understanding of suicide risk. Factors related to childhood trauma (e.g., complexity and forms of trauma, disrupted attachment, emotional and behavioral dysregulation) have not been directly assessed using the IPT. This study aimed to identify the mechanisms of childhood trauma that lead to suicide risk via the acquired capability for suicide. One hundred and thirty-nine college students enrolled in Introductory Psychology courses who endorsed prior trauma exposure, indicated being between the ages of 18 and 22 years old, and whose first language is English were recruited from Sona Systems to participate in a two part online survey of questionnaires. Bootstrapping techniques revealed that disrupted attachment, dual emotionally and physically painful trauma exposure, and emotion dysregulation are associated with acquired capability for suicide. There was a trend toward significance of the role of interpersonal trauma exposure being associated with an acquired capability for suicide. Results found no support for the role of behavioral dysregulation, physically painful forms of trauma, or emotionally painful forms of trauma being associated with acquired capability for suicide. Additionally, partial support was found for the interpersonal theory of suicide, specifically the role of perceived burdensomeness and an acquired capability for suicide were important predictors of suicide ideation and past attempts, while thwarted belongingness was not found to be a predictor. Findi (open full item for complete abstract)

Committee: Jon Elhai Ph.D. (Committee Chair); Joseph Hovey Ph.D. (Committee Member); Adrienne Fricker-Elhai Ph.D. (Committee Member); Jason Levine Ph.D. (Committee Member); Andrew Geers Ph.D. (Committee Member) Subjects: Clinical Psychology

Psy. D., Antioch University, 2015, Antioch Seattle: Clinical Psychology

This study evaluated suicide risk assessments in a correctional psychiatric setting. It considered whether clinicians' judgment of suicide risk predicted future suicidal behaviors in seriously mentally ill prisoners. Data analysis did not show that higher suicide risk scores predicted more suicidal behaviors, nor did it show that suicide risk scores differentiated multiple attempters, or those who went on to attempt suicide or self-harm two or more times in the three years following the assessment. Study data did, however show that suicide risk scores significantly differentiated those who went on to attempt suicide or self-harm at least once in the three years following the assessment. Low, moderate, and high suicide risk groups were characterized in terms of suicide assessments, suicidal behaviors, clinical factors, criminal factors, institutional behaviors, housing, and demographics. Multiple attempter and non-multiple attempter groups were similarly characterized. Observations about suicide risk assessment and housing were discussed. Notably, all but one infraction for suicide and self-harm took place in single-man housing. The electronic version of this dissertation is at OhioLink ETD Center, www.ohiolink.edu/etd

Committee: Alejandra Suarez Ph.D. (Committee Chair); Cynthia Goins Ph.D. (Committee Member); Jude Bergkamp Psy.D. (Committee Member) Subjects: Clinical Psychology; Criminology; Psychobiology

Master of Arts, The Ohio State University, 2015, Sociology

Prior research suggests that sexual minorities [e.g., lesbian, gay, and bisexual (LGB) identified individuals] are more susceptible than their heterosexual peers to behaviors such as substance use, criminality, and suicidality during both adolescence and young adulthood. Such scholarly work has examined the underpinnings of this association (Marshal et al. 2009; Fedewa & Ahn 2011; Safren & Steimberg 1999). Perhaps the most prominent explanation, minority stress theory suggests that due to discrimination and stigma, subjective age (i.e., one's sense of maturity) is increased by membership in the disadvantaged sexual minority group, while psychosocial maturity (i.e., the mental and emotional competence that accompanies genuine adult development) is stunted in sexual minority groups. Subjective age and psychosocial maturity, both aspects of adult identity, have been shown to influence adolescents' risk behavior and young adults' mental health (Galambos et al. 1999; Benson 2014). Yet no research links these two components of adult identity to risk behavior during the transition to young adulthood. Additionally, little work has been done to consider whether sexual minority youth's increased probability of risk behavior is due to differing levels of adult identity formation. Using the National Longitudinal Study of Adolescent Health (n=11,404; 53.6% female; ages 18 to 26 years), this study explores how two key components of adult identity, subjective age and psychosocial maturity, influence levels of substance abuse, criminality, and suicidality. This study further examines whether subjective age and psychosocial maturity differ between sexual minority young adults and their heterosexual peers, and additionally explores whether the relationships between subjective age and psychosocial maturity and risk behavior vary by sexual minority status. Results from ordinal and logistic regression analyses indicate that psychosocial maturity is significantly associated with reduced (open full item for complete abstract)

Committee: Corinne Reczek PhD (Advisor); Dana Haynie PhD (Committee Member); Chris Knoester PhD (Committee Member) Subjects: Sociology

Doctor of Philosophy, The Ohio State University, 2014, EDU Physical Activity and Educational Services

This study looks to evaluate the effectiveness of a suicide risk assessment tool, the Suicide Risk Assessment Matrix-Adult (S-RAM). The S-RAM is designed to incorporate risk and protective factors and the assumption is that the protective factors will help to influence the risk level of the clients. To answer the question of which variables have an effect on the Overall Suicide Risk Level (OSRL), four key subscales of the S-RAM were evaluated, these are Static, Risk, Protective, and Risk Formulation subscales. An Extreme Groups Design was used to sort the variables and cross tabulations were completed for each subscale to determine if there were any significant correlations and their strength. From this study, it was found that individually, the subscales had a “low” to “moderate” correlation with the “high” OSRL rating. Collectively, within the Risk Formulation subscale, the subscales appeared to correlate more significantly with the OSRL and key variables were highlighted. Further use of the S-RAM would require adjustments to the rating levels to provide consistency in ratings and add capability to score the items rather than using subjective information. The S-RAM does have potential to detect those at high risk for suicide however, the recommended changes would be very crucial to its continued use.

Committee: Paul Granello PhD (Advisor); Darcy Granello PhD (Committee Member); Joe Wheaton PhD (Committee Member) Subjects: Behavioral Sciences; Educational Psychology

Master of Arts, University of Toledo, 2007, Psychology

Suicide prevention can be accomplished only if clinicians can accurately identify suicidal individuals. In the realm of suicide research and clinical practice there has been an increasing recognition of the factors that elevate suicide risk. Moreover, attempts have been made to use personality assessment instruments to better understand suicide risk. The present study examined the usefulness of the Personality Assessment Inventory (PAI) in assessing suicide risk. As an archival study, clinical records of 85 referrals at the University of Toledo Psychology Clinic were utilized for the purposes of this study. As a measure of convergent validity and discriminant validity in suicide risk assessment, the results of all the Personality Assessment Inventory (PAI) scales and subscales were correlated with the two suicide risk scores as obtained from applying the two suicide assessment checklists – Suicide Assessment Checklist, Yufit (SAC-Y) and Suicide Assessment Checklist, Rogers (SAC-R) - to the intake interview reports and therapy process notes of the clients. Furthermore, a series of regression analyses were conducted in which the PAI-Depression scale (DEP), Suicide Ideation scale (SUI), and the Suicide Potential Index (SPI) served as the independent variables and the SAC-Y, SAC-R, and the presence or absence of a no-suicide contract served as dependent variables. The SAC-Y and SAC-R showed small to moderate correlations with the PAI scales and subscales. The SAC-Y showed the highest correlation with DEP, whereas the SAC-R showed the highest correlation with the SUI. The SUI and SPI displayed substantial incremental validity over DEP in predicting the SAC-R score; however DEP showed substantial incremental validity over SUI and SPI in predicting the SAC-Y score. Furthermore, SUI showed greater incremental validity than did the SPI. The findings of the present study suggest that DEP, SUI and SPI of the PAI make important contributions in suicide risk assessment and that (open full item for complete abstract)

Committee: Joseph Hovey (Advisor) Subjects: Psychology, Clinical

Master of Arts in Psychology, Cleveland State University, 2011, College of Sciences and Health Professions

Suicide is the third leading cause of death among adolescents in the United States. Given this, it is imperative that those who have regular contact with members of the youth population be able to recognize and identify those youth who are at risk for suicide. Part of the process of identifying suicidal adolescents requires having knowledge about adolescent suicide and about those factors that place certain adolescents at greater risk for completing suicide than others. One group of professionals who are in an optimal position to detect at-risk youth is schoolteachers. Fifty-four undergraduate students who were studying to obtain teaching licensure at a large public university completed the Adolescent Suicide Behavior Questionnaire (ASBQ), an instrument that measures knowledge about adolescent suicide across five content areas (Scouller & Smith, 2002; Smith & Scoullar, 2001).Undergraduate students also completed items from the eight clinical scales of the Suicide Opinion Questionnaire (SOQ), a measure that assesses attitudes toward suicide (Domino, 2005; Domino et al., 1982, 1988-89). On average, preservice teachers scored approximately 61% of ASBQ items correctly. Preservice teachers were the most informed about the warning signs of adolescent suicide and were the least informed about demographic and statistical information related to adolescent suicide. Preservice teachers in Middle Childhood and Secondary Education answered significantly more items correctly on the ASBQ than preservice teachers in Early Childhood Education. Preservice teachers with classroom teaching experience answered significantly more ASBQ items correctly than preservice teachers without this experience. Only 59.3% of all preservice teachers recognized that secondary school teachers are in a good position to detect the risk factors for suicide in their students. Responses to the SOQ indicated that preservice teachers were either conflicted or unsure about their attitudes toward suicide along (open full item for complete abstract)

Committee: Boaz Kahana PhD (Committee Chair); Amir Poreh PhD (Committee Member); John Wilson PhD (Committee Member) Subjects: Education; Educational Psychology; Mental Health; Middle School Education; Psychology; Secondary Education; Teacher Education