Depression and Suicide Behavior among College Students

129 Pages·2017·0.87 MB·English

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Canzi Wang
University of Denver
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Wang, Canzi, "Depression and Suicide Behavior Among College Students: Understanding the Moderator
Effects of Self-Esteem and Suicide Resilience" (2013). Electronic Theses and Dissertations. 686.
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DEPRESSION AND SUICIDE BEHAVIOR AMONG COLLEGE STUDENTS:
UNDERSTANDING THE MODERATOR EFFECTS OF SELF-ESTEEM AND
SUICIDE RESILIENCE

A Dissertation
Presented to
the Faculty of the Morgridge College of Education
University of Denver

In Partial Fulfillment
of the Requirements for the Degree
Doctor of Philosophy

by
Canzi Wang
August, 2013
Advisor: Ruth Chu-Lien Chao, Ph.D.
©Copyright by Canzi Wang 2013
All Rights Reserve
Author: Canzi Wang
Title: DEPRESSION AND SUICIDE BEHAVIOR AMONG
COLLEGE STUDENTS: UNDERSTANDING THE
MODERATOR EFFECTS OF SELF-ESTEEM AND
SUICIDE
Advisor: Ruth Chu-Lien Chao, Ph.D.
Degree Date: August 2013

ABSTRACT
As suicide-related incidents on college campuses increase and receive intense
media coverage and a growing percentage of college students experience suicide ideation
and attempts, there is a desperate need for a more profound understanding of suicidality
and its risk and protective factors among college populations. Recent years there has been
a growing interest in the buffering effect of resilience on suicidality (Johnson, Wood,
Gooding, Taylor, & Tarrier, 2011). This study adds to the suicide literature by exploring
the relationship among depression, self-esteem, suicide resilience, and suicidality.
Undergraduate students from a large university in the Western United States were asked
to assess their depressive symptoms, level of self-esteem, level of suicide resilience, and
thoughts and behaviors of suicide. Multiple regression analyses were used to explore the
relationships between these variables. The results indicate that depression was a
statistically significant predictor of suicide behavior. Results also suggest that high self-
esteem and high suicide resilience were buffers that protect college students who
experience depression from developing suicide behavior. A three-way interaction of
depression, self-esteem, and suicide resilience in predicting suicide behavior was also
found to be statistically significant. It suggests that when self-esteem and suicide
resilience were both high, the association between depression and suicide behavior was
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the weakest; when self-esteem and suicide resilience were both low, the association was
the strongest. Additional clinical implications, limitations of the study, and suggestions
for future research are addressed.

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ACKNOWLEDGEMENTS
I would like to greatly thank my dissertation committee for their encouragement
and support throughout this process- Dr. Ruth Chu-Lien Chao, Dr. Jennifer Erickson
Cornish (Outside Chair), Dr. Kathy Green, and Dr. Cynthia McRae. I want to particularly
thank my dissertation advisor, Dr. Ruth Chu-Lien Chao, for her persistent support and
guidance through the dissertation process as well as the course of my program. I would
also like to thank my supervisors, colleagues, and peers at my pre-doctoral internship site,
Colorado State University Health Network, for their support and kindness.
More importantly, I would like to thank my family and friends, especially my
husband, Jiancheng Liu, who has been giving me so much love, care, and support
throughout this process. I also feel extremely grateful to have my mother, Xin Chen, my
father, Jingjing Wang, and my grandmother, Dingzhi Zhou, for their unconditional love
and unquestioned encouragement in my pursuit of my dream professional field,
Counseling Psychology.

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TABLE OF CONTENTS
CHAPTER ONE ......................................................................................................... 1
Introduction ........................................................................................................... 1
Definition of Major Concepts ............................................................................. 12

CHAPTER TWO ...................................................................................................... 18
Literature Review ................................................................................................ 18
Overview ......................................................................................................... 18
Suicidality among US College Students ......................................................... 19
Suicide Theories.............................................................................................. 24
Depression and Suicide Behavior ................................................................... 28
Self-Esteem, Depression, and Suicide Behavior............................................. 32
Resilience, Depression, and Suicide Behavior ............................................... 38
Resilience, Self-esteem, Depression, and Suicide Behavior........................... 43

CHAPTER THREE .................................................................................................. 48
Methodology ....................................................................................................... 48
Participants ...................................................................................................... 48
Measures ......................................................................................................... 51
Procedure ........................................................................................................ 60
Expected Preliminary Analysis ....................................................................... 61

CHAPTER FOUR ..................................................................................................... 66
Results ................................................................................................................. 66
Preliminary Analysis and Descriptive Statistics ............................................. 66
Locating Outliers ............................................................................................ 68
Primary Analysis ............................................................................................. 68
Depression and Suicide Behavior ................................................................... 70
Self-Esteem as a Moderator ............................................................................ 70
Suicide Resilience as a Moderator .................................................................. 73
Three-way Interaction of Depression, Self-Esteem, and Suicide Resilience
......................................................................................................................... 76

CHAPTER FIVE ...................................................................................................... 83
Discussion ........................................................................................................... 83
Implication for Counseling ............................................................................. 86
Limitations ...................................................................................................... 89
Directions for Future Research ....................................................................... 90
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Conclusion ...................................................................................................... 91

REFERENCES ......................................................................................................... 93

APPENDICIES ....................................................................................................... 105
Appendix A The Moderation Model of This Study .................................... 105
Appendix B University of Denver IRB Approval ..................................... 107
Appendix C Target College‟s IRB Approval............................................. 109
Appendix D Project Information Sheet...................................................... 110
Appendix E Center for Epidemiologic Studies Depression Scale ............. 112
Appendix F Rosenberg Self-Esteem Scale ............................................... 114
Appendix G Suicide Resilience Inventory-25 ........................................... 115
Appendix H The Suicide Behaviors Questionnaire-Revised ..................... 117
Appendix I Demographic Questionnaire ................................................. 118

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LIST OF TABLES
Table 1 Overview of Demographic Variables ..................................................49
Table 2 Correlations, Means, Standard Deviations, and Alphas among
the Variables ........................................................................................66
Table 3 A Two-way Interaction of Depression × Self-Esteem on Suicidal
Ideation and Behavior ..........................................................................72
Table 4 A Two-way Interaction of Depression × Suicide Resilience on
Suicidal Ideation and Behavior ............................................................74
Table 5 A Three-way Interaction of Depression × Self-Esteem × Suicide
Resilience on Suicidal Ideation and Behavior .....................................77

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LIST OF FIGURES
Figure 1 Two-Way Interaction of Depression and Self-Esteem on Suicide
Behavior ...............................................................................................73
Figure 2 Two-Way Interaction of Depression and Suicide Resilience on
Suicide Behavior ..................................................................................75
Figure 3-1 Three-Way Interaction of Depression, Self-Esteem, and Suicide
Resilience on Suicide Behavior: High Self-Esteem.............................79
Figure 3-2 Three-Way Interaction of Depression, Self-Esteem, and Suicide
Resilience on Suicide Behavior: Low Self-Esteem .............................80
Figure 3-3 Three-Way Interaction of Depression, Self-Esteem, and Suicide
Resilience on Suicide Behavior: High Resilience ...............................81
Figure 3-4 Three-Way Interaction of Depression, Self-Esteem, and Suicide
Resilience on Suicide Behavior: Low Resilience ................................82

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