UUnniivveerrssiittyy ooff DDeennvveerr DDiiggiittaall CCoommmmoonnss @@ DDUU Electronic Theses and Dissertations Graduate Studies 1-1-2013 DDeepprreessssiioonn aanndd SSuuiicciiddee BBeehhaavviioorr AAmmoonngg CCoolllleeggee SSttuuddeennttss:: UUnnddeerrssttaannddiinngg tthhee MMooddeerraattoorr EEffffeeccttss ooff SSeellff--EEsstteeeemm aanndd SSuuiicciiddee RReessiilliieennccee Canzi Wang University of Denver Follow this and additional works at: https://digitalcommons.du.edu/etd Part of the Experimental Analysis of Behavior Commons RReeccoommmmeennddeedd CCiittaattiioonn 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. https://digitalcommons.du.edu/etd/686 This Dissertation is brought to you for free and open access by the Graduate Studies at Digital Commons @ DU. 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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 i 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. ii 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. iii 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 iv 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 v 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 vi 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 vii