The PhD Program is pleased to announce the upcoming Dissertation Defense for Christel Joel Tajouoh Daghuie on Friday, 4/24 at 1pm in 5E11. Christel’s project, titled " The Silent Risk: Sociodemographic and Mental Health Correlates of Indeterminate Suicidality Status Among U.S. Adolescents " is summarized below. If you are interested in attending the public presentation, please contact Jen Canapp.
Special thanks to Christel’s Chair Dr. Jodi Frey and committee members Drs. Bruce DeForge, Fernando Wagner, Paul Sacco, and Kiara Alvarez(Johns Hopkins).
Best wishes, Christel!
Title: The Silent Risk: Sociodemographic and Mental Health Correlates of Indeterminate Suicidality Status Among U.S. Adolescents
Suicide remains one of the leading causes of death among adolescents in the United States. In 2023, suicide was the second leading cause of death among individuals aged 10–14 and 15–24, highlighting the severity of youth suicide risk nationwide. Recent national surveillance data also indicate that approximately 20% of U.S. high school students seriously considered attempting suicide and nearly 10% reported a suicide attempt in the past year, underscoring the widespread burden of suicidal distress among adolescents. Despite these alarming trends, the measurement of suicide-related behaviors in large national surveys remains complex. Adolescent suicide surveillance in the United States relies heavily on large scale surveys that typically recode suicidality as a binary construct, “yes” or “no”. However, the National Survey on Drug Use and Health (NSDUH) includes response options such as “I’m not sure,” “Don’t know,” or “I do not want to answer,” yet these responses are typically excluded from statistical analyses and treated as missing data or measurement error. This assumption may obscure meaningful patterns related to psychological distress, disclosure barriers, or survey response processes. This dissertation reframes such responses as meaningful indicators rather than missing data and examines their structure and correlates among U.S. adolescents using the 2021–2023 NSDUH.
The purpose of this study was to examine the prevalence, structure, and correlates of indeterminate responses to suicidality questions among adolescents using nationally representative data from the 2021–2023 NSDUH. Three research questions guided the study: (1) What is the latent structure of item-level indeterminate responding among adolescents in the NSDUH? (2) Is indeterminate responding to suicidality questions associated with indeterminate responding to other sensitive and non-sensitive survey items? (3) To what extent are psychiatric, psychosocial, and demographic characteristics associated with indeterminate suicide risk status among adolescents?
Tetrachoric correlations and exploratory factor analysis (EFA) were used to examine the structure of item-level indeterminate responding, and multinomial logistic regression models were used to examine predictors of adolescents’ responses to suicidal thoughts and suicide planning questions, including indeterminate response categories.
Results indicated that indeterminate responding was domain-specific rather than random and that suicidality items formed a distinct factor separate from other sensitive domains, demonstrating that indeterminate suicidality responses reflect a unique underlying process. Importantly, adolescents who selected indeterminate responses to suicidality questions exhibited many of the same demographic, psychiatric, and psychosocial risk factors associated with endorsement of suicidal thoughts and planning, suggesting that indeterminate responses may reflect levels of vulnerability similar to those observed among adolescents who explicitly report suicidality.
These findings challenge the longstanding practice of treating indeterminate suicidality responses as non informative. Instead, they function as meaningful signals of vulnerability, influenced by demographic characteristics, psychiatric factors, and psychosocial barriers. Public health surveillance, screening tools, and clinical practice must recognize, retain, and model these responses to avoid underestimating suicide risk, and to advance more equitable and responsive prevention strategies, and improve surveillance efforts.
- Committee Chair: Jodi Frey
- Committee Member: Fernando Wagner
- Committee Member: Paul Sacco
- Committee Member: Bruce DeForge
- Committee Member: Kiara Alvarez