Terapia Cognitivo-Conductual para Personas Sordas (CBT-TS) para Reducir el Riesgo de Suicidio

During study assessments, subjects will receive a suicide risk assessment, with actions commensurate with risk level, and a list of Deaf crisis intervention resources with instructions provided on how to use them. The list of resources contains crisis hotlines that are accessible for Deaf individuals including text-based options (e.g., Crisis Text line, 988 text number) and options to talk with counselors in ASL (e.g., 988 ASL services, DeafLEAd Crisis Line). The study coordinator will review each resource and explain their use. Subjects will be emailed this list of resources after their assessment. Other brief interventions that could be provided based on subject presentation include encouraging subjects to seek social support and share their thoughts with others; elicitation of coping strategies; and lethal means safety planning.

Intervention Group

Deaf CBT-TS is a two-session (90 minutes each) Zoom-based intervention designed to target a change in the beliefs that influence whether or not someone initiates mental health treatment. The intervention works by modifying problematic beliefs, providing accurate information about treatment, and problem-solving barriers. The first session is structured in four phases: (1) history of symptoms and current functioning, (2) coping strategies, (3) evaluation and modification of treatment beliefs using CBT strategies, and (4) action planning. Subjects are provided a list of resources for seeking treatment, as well as a personalized search of treatment options (conducted by the interventionist) in their area based on their insurance and language preference. The second session occurs within 3 weeks and is designed to check in with subjects regarding progress on their action plan, provide assistance in identifying treatment options, and problem-solve barriers

The Perceptions About Services Scale for the Deaf (PASS-D) will be used to assess participants' behavioral, normative, and control beliefs about treatment. The Behavioral Belief subscale has 10 items assessing advantages vs. disadvantages of seeking treatment, the Normative Belief subscale has 7 items assessing community support vs. opposition to seeking treatment, and the Control Beliefs subscale has 26 items assessing facilitators vs. barriers to seeking treatment. Each item is rated on a Likert scale ranging from 1 (Strongly Disagree) to 7 (Strongly Agree) with higher scores indicating more positive beliefs. Items for each subscale will be totaled.

The Perceptions About Services Scale for the Deaf (PASS-D) will be used to assess participants' behavioral, normative, and control beliefs about treatment. The Behavioral Belief subscale has 10 items assessing advantages vs. disadvantages of seeking treatment, the Normative Belief subscale has 7 items assessing community support vs. opposition to seeking treatment, and the Control Beliefs subscale has 26 items assessing facilitators vs. barriers to seeking treatment. Each item is rated on a Likert scale ranging from 1 (Strongly Disagree) to 7 (Strongly Agree) with higher scores indicating more positive beliefs. Items for each subscale will be totaled.

A Treatment Utilization Survey will assess use of 12 treatment services, number of sessions attended, current treatment status (active vs. completed), reasons for seeking/not seeking treatment, and any barriers experienced. Treatment Initiation will be measured with a binary variable. Subjects who have attended, scheduled, or contacted professional treatment services will be coded as 1 (initiated treatment) and those who have not attended or scheduled professional treatment services will be coded as 0 (not initiated).

A Treatment Utilization Survey will assess use of 12 treatment services, number of sessions attended, current treatment status (active vs. completed), reasons for seeking/not seeking treatment, and any barriers experienced. Treatment Initiation will be measured with a binary variable. Subjects who have attended, scheduled, or contacted professional treatment services will be coded as 1 (initiated treatment) and those who have not attended or scheduled professional treatment services will be coded as 0 (not initiated).

Hope will be assessed via the Beck Hopelessness Scale. The scale has 20 items scored as True or False. Scores of 1 or 0 are assigned to each item depending on the subject's response and the directionality of the item. The scores are summed with for a total score ranging from 0 - 20 and higher scores indicating more hopelessness.

Hope will be assessed via the Beck Hopelessness Scale. The scale has 20 items scored as True or False. Scores of 1 or 0 are assigned to each item depending on the subject's response and the directionality of the item. The scores are summed with for a total score ranging from 0 - 20 and higher scores indicating more hopelessness.

General mental health will be assessed via the PROMIS-29 V2.0. The scale has 29 items divided across 8 subscales. Three of the subscales are focused on general mental health: Anxiety, Depression, and Ability to Participate in Social Roles. These subscales each have four items rated on a Likert scale ranging from 1 (not at all) to 5 (very much) with higher scores indicating worse mental health functioning. Scores for each of the subscales will be summed and converted to T-scores. The T-scores for the three subscales will then be summed for a total score representing general mental health functioning.

General mental health will be assessed via the PROMIS-29 V2.0. The scale has 29 items divided across 8 subscales. Three of the subscales are focused on general mental health: Anxiety, Depression, and Ability to Participate in Social Roles. These subscales each have four items rated on a Likert scale ranging from 1 (not at all) to 5 (very much) with higher scores indicating worse mental health functioning. Scores for each of the subscales will be summed and converted to T-scores. The T-scores for the three subscales will then be summed for a total score representing general mental health functioning.

Physical functioning will be assessed via the PROMIS-29 V2.0. The scale has 29 items divided across 8 subscales. Five of the subscales are focused on physical functioning: Physical Function, Fatigue, Sleep Disturbance, Pain Interference, and Pain Intensity. The subscales Physical Function, Fatigue, Sleep Disturbance, Pain Interference each have four items rated on a Likert scale ranging from 1 (not at all) to 5 (very much) with higher scores indicating worse physical functioning. The Pain Interference subscale is a single item rated on a Likert scale ranging from 0 (no pain) to 10 (worst imaginable pain). Scores for each of the subscales will be summed and converted to T-scores. The T-scores for the five subscales will then be summed for a total score representing physical functioning.

Physical functioning will be assessed via the PROMIS-29 V2.0. The scale has 29 items divided across 8 subscales. Five of the subscales are focused on physical functioning: Physical Function, Fatigue, Sleep Disturbance, Pain Interference, and Pain Intensity. The subscales Physical Function, Fatigue, Sleep Disturbance, Pain Interference each have four items rated on a Likert scale ranging from 1 (not at all) to 5 (very much) with higher scores indicating worse physical functioning. The Pain Interference subscale is a single item rated on a Likert scale ranging from 0 (no pain) to 10 (worst imaginable pain). Scores for each of the subscales will be summed and converted to T-scores. The T-scores for the five subscales will then be summed for a total score representing physical functioning.

The National Survey on Drug Use and Health (NSDUH) 30-day alcohol consumption will be used to assess alcohol use including total number of drinking days, number of drinks per drinking day, and number of heavy episodes of drinking.

The National Survey on Drug Use and Health (NSDUH) 30-day alcohol consumption will be used to assess alcohol use including total number of drinking days, number of drinks per drinking day, and number of heavy episodes of drinking.

Suicide Ideation will be assessed via the Depressive Symptom Index Suicidality Scale. The scale has four items rated on a Likert scale from 0 - 3, with higher scores indicating a higher intensity of suicide ideation.

Suicide Ideation will be assessed via the Depressive Symptom Index Suicidality Scale. The scale has four items rated on a Likert scale from 0 - 3, with higher scores indicating a higher intensity of suicide ideation.