Doctor of Philosophy, The Ohio State University, 2013, Psychology

Research has shown young children do contemplate and attempt suicide and are considered an under-studied population. Studies have identified risk factors for suicide-related behaviors among children across several domains; however, few studies have examined how risk factors from disparate domains interact to increase or decrease risk for suicide attempt in children. The Longitudinal Assessment of Manic Symptoms (LAMS) study (Findling et al., 2010; Horwitz et al., 2010) has collected a wealth of data on a child (ages 6 to 12) community mental health sample enriched for elevated symptoms of mania. Current or past suicidal acts were present for 57 (8.4%) of the 678 participants in the LAMS study for whom SRB status could be determined. For the current project, data from the LAMS study were analyzed in a multiple logistic regression model-building procedure. First, five independent domain-specific models (i.e., demographic variables, psychiatric family history, child psychopathology, psychosocial factors, and stressful life events) were constructed to better understand correlates of suicide-related behaviors among children in the sample. Subsequently, an integrated model of the combined influence of these factors was developed. Covariates that were highly associated with SRB in the domain-specific models were as follows: Demographic variables--age at baseline (OR=1.31) and having both biological parents as primary and secondary caregiver (OR=.51); Family history variables--having a parent attempt suicide (OR=2.71); Child psychopathology variables--suicidal ideation (OR=20.41), tobacco use (OR=3.98), and anhedonia (OR=2.01); Psychosocial variables--changing schools for reasons other than normal progression (OR=2.06), quality of parent-child relationship (OR=1.36), and ever having an academic tutor (OR=.30); Stressful life events--knowing someone who had recently tried to hurt him/herself (OR=3.24), mother or father recently remarrying (OR=3.23), ending a close fr (open full item for complete abstract)

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)

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

This investigation aimed to evaluate the impact of the implementation of the Columbia Suicide Severity Rating Scale tool in the Emergency Department. The setting of the study focused on a non-profit community-based hospital that serves the Hispanic-dominant population in a Suburban area. The utilization of secondary data from 2022 and 2023 was analyzed statistically to evaluate the success of the implementation of the Columbia Suicide Severity Rating Scale tool pre- and post-implementation. The study focused on the impact on risk level assignment, arrival to provider assessment times, and discharge disposition, pre-and post-implementation. The analysis aims to bring awareness and aid in necessary changes to the delivery of care for patients who seek care with suicide ideation or suicide attempts. The statistical analysis utilized a Mann-Whitney U test, Chi-square test, and two sample t-tests to determine the statistical impact pre- and post-implementation of the Columbia Suicide Severity Rating Scale tool. The results showed no statistically significant differences between pre- and post-implementations. Though the outcome shared no statistically significant difference, clinical significance was observed as minor shifts in data were noted. Future studies suggest integrating theoretical themes into the patient's plan of care to accommodate the population being served. The analysis and findings of this study identified vital prospective areas of focus that brought awareness to the psychiatric population, enhance care plans for high-risk patients, and expand on post-discharge education.

PHD, Kent State University, 2023, College of Education, Health and Human Services / School of Lifespan Development and Educational Sciences

This qualitative phenomenological study explored the experiences of counselor supervisors who had a supervisee's client die by suicide while under their supervision. As this was a phenomenological study to do an initial exploration of a new phenomenon of study, Interpretative Phenomenological Analysis, or IPA, was utilized (Smith et al., 2009). The analysis process allowed the researcher to identify emergent themes from the participants and find meaning in those themes (Smith et al., 2009). The research question was: “How do counselor supervisors experience the suicide death of a supervisee's client?” Participants were recruited from states that identify counselor supervisors with an “S” based on the counselor board rules and regulations for supervisor designation, license, and endorsement. Participants engaged in one 2-hour interview and one follow-up email to explore their experiences after a client of a supervisee had died by suicide. The resulting data were analyzed using guidelines for IPA. The emergent themes of participant experiences are presented from the study. Implication and recommendations from the themes are discussed, including a model for supervision after the suicide death of a supervisee's client. Recommendations for future research and limitations of the study are also presented.

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2023, Nursing

Suicide bereavement results in distinct coping challenges, such as suicidal ideation and extreme grief. This scholarly project examined systematic reviews of modalities of care and the impact those modalities of care had in improving mental wellness following suicide bereavement. Local and online providers of the modalities of care examined, in those systematic reviews, were identified. Training, incorporating potential negative outcomes of suicide bereavement, trauma-informed care/communicating to offer information, and familiarization with a suicide bereavement referral reference pamphlet, was provided to the coroner and deputy coroners of a local county (N = 5). The findings reflect learning was achieved. As a result, the coroner and deputy coroners modified their approach to suicide bereavement.

Master of Arts, University of Toledo, 2021, Psychology - Clinical

Suicide-related behaviors and opioid misuse are co-occurring major public health problems that are responsible for decreased life expectancy. Despite advances using public health data on understanding the prevalence of both behaviors' co-occurrence, there is a lack of research explicating why opioid use is associated with heightened suicide and suicide attempt risk. Contemporary models of self-injurious behavior suggest several variables predictive of suicidal behavior that may have relevance for opioid misuse: increased negative self-appraisal, decreased social norm espousal, fearlessness about death, pain habituation, and practical capability, or knowledge and familiarity with lethal means. Given that prior research has associated opioid misuse with elevated levels of these risk factors, they may explain the association between opioid misuse and suicide-related behavior. Further, to distinguish if any observed association is unique to opioid misuse, it is important to compare associations with other substances robustly associated with suicide risk, such as alcohol. To address this research gap, a community sample of participants with lifetime suicide ideation (N=283) was recruited across three groups: those with opioid misuse (n=99; Opioid group), alcohol misuse (n=80; Alcohol Group) and no problematic substance use (n=104; No Substance Misuse group). Participants completed self-report measures assessing characteristics of suicide risk (e.g., suicide ideation, planning and attempt) and assessing the above risk factors hypothesized to account for the link between opioid misuse and suicidal thoughts and behaviors. All examined factors except pain tolerance were associated with suicide risk characteristics. Only increased negative self-appraisal (measured by self-criticism and self-hate), and practical capability were statistically different across groups, such that Opioid group participants reported: (1) significantly less self-criticism than Alcohol group pa (open full item for complete abstract)

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.

Master of Arts, Case Western Reserve University, 2016, Psychology

Trait impulsivity is an important risk factor for suicide. New measures of trait impulsivity were developed. Psychological autopsy was used to evaluate 4 groups of deceased adults: suicide completers with prior attempts, suicide completers with no past attempts, individuals who died by natural causes who had previously attempted suicide, and individuals who had died by natural causes with no past attempts. Elevated rates of emotional impulsivity were seen in individuals who died by natural causes that had previously attempted suicide. Behavioral impulsivity was elevated in individuals with prior non-fatal suicide attempts who died by suicide or natural causes. Suicide completers who died by hanging had elevated rates of behavioral impulsivity. Higher levels of life stress were experienced by suicide completers and individuals with non-fatal suicide attempts. No relationship between suicidal planning and trait impulsivity was observed. Trait impulsivity may indirectly elevate suicide risk by increasing stressors.

Doctor of Philosophy (PhD), Ohio University, 2014, Counselor Education (Education)

The purpose of this cross-sectional study was to evaluate the role of five dimensions of death attitudes (fear of death, death avoidance, approach acceptance, neutral acceptance, and escape acceptance) in the prediction of three dimensions of suicide attitude (acceptance of suicide, condemnation of suicide, and preventability of suicide) among a cross-section of counseling students' after controlling for the effects of six personal variables: (1) age, (2) gender, (3) religious beliefs, (4) suicide potential, (5) exposure to others' suicidal behaviors, and (6) personal suicidal behaviors, and six professional variables: (1) professional exposure to suicidal behaviors, (2) exposure to suicidal behaviors as a student, (3) academic standing, (4) prior professional experience, (5) death education, and (6) suicide training. A stratified random cluster sample of 183 counseling students enrolled in programs accredited by the Council for the Accreditation of Counseling and Related Programs (CACREP) and the Council for Rehabilitation Education (CORE) completed a 97-item survey online. Death attitudes were measured using the Death Attitude Profile-Revised (DAP-R; Wong, Reker, & Gesser, 1994) and suicide attitudes were measured using the Attitudes Towards Suicide Scale (ATTS; Renberg & Jacobsson, 2003). Results from hierarchical multiple regression analyses indicated that participants' death attitude scores accounted for statistically significant variance in participants' acceptance of suicide scores and condemnation of suicide scores above and beyond the effects of the twelve covariates; however, counseling students' death attitude scores did not account for statistically significant variance in participants' attitudes towards the preventability of suicide scores. Escape acceptance was the only dimension of death attitudes that had no statistically significant effect in the prediction of counseling students' suicide attitude scores. Several covariates, including su (open full item for complete abstract)

Doctor of Psychology (PsyD), Wright State University, 2013, School of Professional Psychology

Schneidman (1957) wrote that acts of suicide were attempts to escape from unbearable and intense psychological pain, or “psychache.” In this study, we analyzed suicides wherein we determined that the primary motivation for the suicidal act was escape from physical or psychological pain. The analysis incorporated information regarding the content of suicide notes, investigators' reports, and databases from an urban Midwestern metropolitan area coroner's office. The analysis contained demographics, expressed life problems of the decedents, characteristics of the suicide, suicide note contents and suicide note themes. We found that the samples in which escape was determined as the primary motivation for suicide were similar to the overall samples, suggesting that escape from psychological or physical pain may be a unifying characteristic of suicidal thought and action. We presented implications from the findings for loved ones of suicide victims and helping professionals. Limitations of the study and suggestions for future research were also discussed.

Master of Arts, University of Toledo, 2011, College of Arts and Sciences

Research has shown that there are various predictors of suicide ideation. Moreover, people's attitudes toward suicide are also associated with suicide ideation, and suicide attitudes have been associated with predictors of suicide ideation. This research examines four different variables as predictors of suicide ideation in a college sample: depression, hopelessness, perceived stress, and religiosity. Young adult suicide attitudes were also investigated to determine the extent to which they moderate the relationships between the aforementioned predictors and suicide ideation. Correlational analyses and stepwise, hierarchical multiple regressions revealed that depression, hopelessness, and perceived stress are significant predictors of suicide ideation, but only the relationship between perceived stress and suicide ideation was moderated by suicide attitudes. These results have important implications for the prevention of suicide, suggesting that suicide prevention programs, counseling centers, and psychology clinics on college campuses should include suicide attitudes as well as depression, hopelessness, and perceived stress in their assessment and identification of individuals who may be at risk for engaging in suicide ideation.

Doctor of Philosophy, University of Akron, 2011, Counseling Psychology

Research exploring the experiences of bereavement by suicide is relatively new. Until very recently, research has been mostly qualitative in nature and has focused primarily on the negative outcomes of those bereaved by suicide (Jobes, Luoma, Hustead,& Mann, 2000). The present study explored the experience of individuals bereaved by the loss of a loved one to suicide by framing the experience with Tedeschi and Calhoun's (1995) theory of Posttraumatic Growth, which fully acknowledges both distress and growth as results of trauma. Utilizing an online data collection method, 325 participants completed measures of posttraumatic growth, depression, impact of event, changes in outlook, and emotional closeness. Results indicate that persons bereaved by suicide do report growth following the trauma of loss of a loved one to suicide. However, the experience of posttraumatic growth may not follow the theorized pattern that Tedeschi and Calhoun have offered. Specifically, results do not support that the experience of posttraumatic growth is related to the length of time since the loss occurred (r = .047, p =.39). However, the current research does support the prediction that distress is negatively related to time since bereavement (r = -.25, p < .01). Potential explanations for these unexpected results are considered for each hypothesis. Implications for both research and practice are also discussed.

Doctor of Philosophy, University of Akron, 2007, Counselor Education and Supervision

This study explored the psychometric properties of the Suicide Opinion Questionnaire (SOQ) to investigate its value for assessing attitudes toward suicide. Despite several limitations, the SOQ continues to be the most prominent measure of attitudes toward suicide. The 568 participants (> 18 years of age) were predominantly female (72.9%) and Caucasian (87.9%). Participants were obtained primarily through networking within various mental health facilities and a large university in the Midwest. The most frequently reported education level was graduate (Masters; 33.5%) followed by undergraduate (28.9%). Most of the participants knew someone who had attempted suicide (63.4%) and who had died by suicide (59%). Research instruments included a demographic questionnaire, the Suicide Behavior Questionnaire-Revised (SBQ-R), the SOQ, the Satisfaction With Life Scale (SWLS), the Spiritual Meaning Scale (SMS), the Religious Commitment Inventory-10 (RCI-10), and a service referral list. Participation was voluntary, anonymous, and confidential. Prior SOQ models from the literature were subjected to confirmatory factor analyses (CFA). The CFA fit indices failed to reach the recommended cutoffs; therefore, the continued use of prior SOQ models was not supported. The SOQ items were then subjected to an exploratory principal axis factor analysis resulting in two factors accounting for 8.73% and 6.6% of the total variance, respectively. Next, an oblique rotation resulted in 17 items loading on Factor 1, Perceived Suicide Knowledge, and 12 items loading on Factor 2, Acceptability. Adequate (> .70) internal consistency reliability was exhibited for the factors and the additional measures. Meaningful and statistically significant relationships identified in the correlation matrix included an inverse relationship between Acceptability and spiritual meaningfulness and religiosity, an inverse relationship between participants' history of suicidal ideation/behaviors and perceptions of satisfa (open full item for complete abstract)

Doctor of Psychology (Psy.D.), Xavier University, 2024, Psychology

There is long-standing evidence that acquired capability and emotion regulation are key to understanding the progression from self-harm to suicide (Law et al., 2015; Turton et al., 2021; Van Orden et al., 2010). However, recent literature suggests that emotion dysregulation alone is not a sufficient explanation for non-suicidal self-injury (NSSI) and suicidality. Research has demonstrated that emotion-regulation self-efficacy (ERSE), or the belief in one's ability to regulate one's emotions (e.g., Gratz et al., 2020), is a factor in predicting the pathway between NSSI and suicidal behavior (Gratz et al., 2020). The purpose of this project was to examine the relationship between emotion reactivity, ERSE, NSSI, acquired capability, and suicidal thoughts and behaviors. Participants were asked to complete a screener and those who endorsed self-harm history were eligible to complete the follow-up questionnaire (N = 174). Findings indicated that ERSE is lower among people with history of NSSI and either suicidal ideation or suicide attempt history, as compared to those with only a history of NSSI. In addition, ERSE is negatively associated with emotion reactivity such that those with greater emotion reactivity have lower ERSE. ERSE predicted suicidal risk over and above emotion reactivity, acquired capability, and number of NSSI methods. Last, ERSE for positive affect predicted suicidal risk over and above emotion reactivity and acquired capability, such that those with lower ERSE have higher suicidal risk. Implications of these findings point to ERSE as a predictor for suicidal risk.

PHD, Kent State University, 2023, College of Public Health

Adolescent suicide is a critical and growing public health concern. This three-manuscript dissertation aimed to better understand adolescent suicide by: 1) Exploring adolescent perceptions of suicide, including mental health stressors and help-seeking barriers and facilitators; 2) Determining the effectiveness of the LifeAct High School Program, a school- based suicide prevention program, on knowledge and help-seeking intentions; and 3) Examining the research that has been conducted on completed suicides and suicidality among collegiate student-athletes. For study 1, focus groups were conducted among ninth grade students following a semi-structured interview guide. Key themes from these sessions included the challenge of determining when peers are at risk for suicide, the desire to engage in more conversations about mental health and suicide, and help-seeking strategies that present as favorable and unfavorable. For study 2, ten schools in northeast Ohio participated in a two-group quasi-experimental design with pre-, post, and follow-up tests. Exposure to the LifeAct program was associated with an increase in knowledge but not help-seeking intentions. For study 3, a scoping review was conducted to map prior research on collegiate student-athletes and suicidal behavior. Main findings include a paucity of research on this topic, especially on interventions aimed to address unique risk factors among this population. Overall, findings from these three studies highlight help-seeking barriers as a large obstacle in adolescent suicide prevention and emphasize the importance of continuously monitoring trends and the need to develop more precise measures of suicidality. Implications for policy and practice are discussed.

Specialist in Education (Ed.S.), University of Dayton, 2021, School Psychology

Evidence-based research suggests that schools offer the most extensive intervention opportunities for students at-risk for suicide (Evans & Hurrell, 2016). An important aspect of this system is the implementation and evaluation of school-based suicide prevention programs, such as Hope Squad. Current literature on this program is limited, as this program is relatively new and is being implemented in a growing number of schools across the country. Thus, the present study investigated the perspectives of school personnel on the suicide prevention program, Hope Squad. Following a qualitative method of research, eight participants, who are directly involved with Hope Squad, were interviewed using a semi-structured interview protocol. Through a thematic analysis, categories and themes emerged, including: need for Hope Squad (mental health concerns, being proactive, and social-emotional supports), benefits of Hope Squad (trained and trusted peers, suicide training, mental health awareness, and change in the culture of the school), challenges within Hope Squad (time for training members and stigma), and pandemic response (social media platforms, dramatic decrease in referrals, and delay in training). Schools can facilitate trainings through programs such as Hope Squad, to better equip staff and students to help students at-risk for suicide and create a more positive school environment. The findings from this study can be used to increase awareness of Hope Squad and the perspectives of school personnel towards this suicide prevention program.

Doctor of Philosophy, The Ohio State University, 2021, Human Ecology: Human Development and Family Science

Bi+ individuals—those who are attracted to more than one gender—are at the highest risk of suicidal thoughts and behaviors when compared to heterosexual, gay, and lesbian individuals. According to minority stress theory, this is partially due to minority stress—a unique, additive form of stress experienced by those who identify as any sexual orientation other than heterosexual—based in heterosexism—values that encourage different-gender relationships—and monosexism—beliefs that delegitimize those who are attracted to more than one gender. However, minority stress theory does not account for the underlying mechanisms that contribute to suicidal thoughts and behaviors of this population. The purpose of this study was to test hypotheses at the intersection of minority stress theory and the interpersonal theory of suicide to (a) investigate whether sources of minority stress contribute to suicide risk factors either directly or indirectly, (b) examine whether social support and connectedness to the LGBQ+ community contribute, weaken, or eliminate these associations, and (c) evaluate if characteristics of romantic relationships contribute to these factors. A subsample of Bi+ participants was analyzed from the Generations Study, a population-based sample of sexual minority adults to examine well-being among three age cohorts. Many analyses were conducted to test hypotheses including mediation analyses, moderation analyses, latent variable testing, hierarchical and logistic regression, and multiple group comparison procedures using MPlus, SPSS Amos, and SPSS Statistics. Results suggest that certain sources of minority stress associate with suicide risk factors, and characteristics of romantic relationships may contribute to loneliness and self-worth. Implications for future research and suicide prevention are discussed throughout.

Specialist in Education, Miami University, 2020, School Psychology

The factors influencing school psychologists' ability to appropriately and adequately prevent and intervene in suicide crisis situations were investigated in the current study. Suicide preparedness was defined as: self-efficacy, formalized training, and prior experiences. Surveys were sent via state LISTSERVs, School Psyched Facebook group, and directly at the Ohio School Psychologists Association annual training. Participants (n = 44) responded to demographic questions, a self-efficacy scale, and experiential preparedness questions. Responses indicated that more than half (59%) of participants had attended a formalized suicide training within two years. Over half (55%) of participants spent at least 45% of their time in a secondary setting, and almost two-thirds (61%) of participants have a written suicide protocol in their district. We failed to find that formalized training recency and presence of a protocol have significant impact on respondent self-efficacy composite scores. Implications for future research are reviewed.

Doctor of Philosophy, University of Akron, 2019, Counseling Psychology

Suicide is the tenth leading cause of death in the United States (McIntosh & Drapeau, 2018). Mental illness is prevalent among suicide deaths (Cavanaugh et al., 2003) and psychologists can expect to have clients with increased suicide risk during their training or career (Dexter-Mazza & Freeman, 2003; Kleespies, Penk, & Forsyth, 1993), it is vital that students training to be health service psychologists, including clinical psychology, counseling psychology, and school psychology (APA, 2018), be competent in providing clinical care to individuals with increased suicide risk. Competency incorporates “knowledge, skills, attitudes, and personal qualities” essential to clinical practice (Albanese et al., 2008). Although suicide is an important topic, only two studies have directly examined clinical skill with suicidal clients by graduate students (Mackelprang et al., 2014; Neimeyer & Bonnelle, 1997). There have been many calls to further emphasize clinical preparation related to suicide assessment and management (SAM; Neimeyer, 2000; Rudd et al., 2008; Westefeld et al., 2000), particularly because many students receive little training related to suicide at the internship level or beyond (Schmitz et al., 2012). The current study examined the experience, training, and competency of 140 health service psychology graduate students prior to internship, using a measure of skill (Suicide Intervention Response Inventory [SIRI-2]; Neimeyer & Bonnelle, 1997), attitudes, knowledge (Attitudes Towards Suicide Scale [ATTS]; Salander Renberg & Jacobsson, 2003), and a self-rating of clinical suicide competency (Suicide Competency Assessment Form [SCAF]; Cramer et al., 2013). These measures were compared examining a number of personal qualities identified in previous research as potentially affecting skill, attitudes, or knowledge related to suicide. Findings indicate nearly all graduate students were providing clinical services to clients with suicidal thoughts or attempts prior to (open full item for complete abstract)

Master of Arts, Case Western Reserve University, 2019, Psychology

Dual diagnosis is the presence co-occurring disorders. Individuals with a dual diagnosis are more likely to have a pronounced psychiatric history, past traumatic events, and a decreased quality of life when compared to individuals who have one or no disorders The purpose of the present study was to evaluate how dual diagnosis is associated with individuals who experience clinically significant symptomatology in two different samples: Veteran (VA) psychiatric outpatient participants and medical examiner's (ME) subjects who died by suicide. Groups were compared on several dependent measures, using chi-square to examine categorical variables and independent t-tests to examine continuous variables. The VA dual diagnosis group was found to have higher rates of stressful life events when compared to the VA depression group. However, there were no significant differences between the VA groups in regards to symptom severity and previous suicide attempts. The ME dual diagnosis group was found to have higher rates of stressful life events when compared to the ME depression group. There were no significant differences between the ME groups in regard to violence of suicide method.