2022 Undergraduate Research Symposium: Mary Tooma Graduate co-author: Emily Graham LeRose This research was conducted to investigate the underlying etiological cause(s) and/or psychosocial contributions to suicidal ideation as highly self-reported among individuals with a developmental stutter. A comprehensive literature review was completed to explore two of the hypothesized components thought to increase risk for suicidal ideation in this population; genetic heritability of suicidal ideation and the presence of co-morbid mental health disorders arising as a result of having a stutter (i.e., depression, anxiety, etc.). Additionally, an empirical review was completed for recommendations to improve overall outcomes in therapy for individuals who stutter. Results from this investigation of the literature found the most empirical support for a connection between high rates of co-morbid mental health disorders and suicidal ideation in individuals who stutter. Additionally, a therapeutic approach titled "Attachment-Based Family Therapy" has been shown to be highly effective in treating individuals, particularly adolescents, who experience suicidal ideation and depression.

2. Investigating High Rates of Suicidal
Ideation in Individuals who Stutter
Mary Tooma, Emily Graham LeRose, MA, CCC-SLP, Shelly Jo Kraft, PhD, CCC-SLP*
Department of Communication Sciences and Disorders
Wayne State University

3. This research was conducted to investigate the underlying etiological
cause(s) and/or psychosocial contributions to suicidal ideation as
highly self-reported among individuals with a developmental stutter.
A comprehensive literature review was completed to explore two of
the hypothesized components thought to increase risk for suicidal
ideation in this population; genetic heritability of suicidal ideation
and the presence of co-morbid mental health disorders arising as a
result of having a stutter (i.e., depression, anxiety, etc.). Additionally,
an empirical review was completed for recommendations to improve
overall outcomes in therapy for individuals who stutter. Results from
this investigation of the literature found the most empirical support
for a connection between high rates of co-morbid mental health
disorders and suicidal ideation in individuals who stutter.
Additionally, a therapeutic approach titled "Attachment-Based
Family Therapy" has been shown to be highly effective in treating
individuals, particularly adolescents, who experience suicidal
ideation and depression.
Abstract (limit to 250 max)

4. Research Purpose and Hypothesis
Purpose
1. Is suicidal ideation in individuals with a developmental stutter related to genetic co-
morbid heritability of suicidal tendencies?
2. Is suicidal ideation in individuals with a developmental stutter related to the significant
sequela of mental health disorders (i.e., depression, anxiety, etc.) that can result as a
consequence of having a stutter?
3. What are the clinical implications and recommendations based on this significant
finding of high rates of self-reported suicidal ideation in individuals with a
developmental stutter?
Hypothesis
Although there is thought to be some correspondence between genetic heritability and
suicidal ideation, the correlation between depression and suicidal ideation is thought to be
the strongest link in this population. Given the previously established high rates of co-
morbid mood disorders with developmental stuttering, this appears to be the most likely
cause of the high rates of suicidal ideation in individuals with a developmental stutter. In
terms of clinical implications, it is thought to be likely that including counseling into
traditional speech therapy and co-treatment with a mental health professional may yield best
overall life satisfaction outcomes.

5. • Developmental Stuttering
• Developmental stuttering is a disorder of verbal speech fluency characterized by abnormal rhythm,
atypical prolongations and repetitions of sounds, syllables, words, and phrases (American Speech-
Language Hearing Association, 1993).
• Stuttering behaviors typically emerge during early childhood with an incidence of up to 8% (Yairi &
Ambrose, 2013)
• Although spontaneous recovery often occurs during childhood, approximately 1% of the adult
population continues to have a persistent developmental stutter (Bloodstein & Bernstein-Ratner,
2008).
• Traditional speech therapy conducted by speech-language pathologists (SLPs) seeks to reduce
stuttering behaviors and increase fluent speech through a variety of different therapeutic approaches
• Suicidal Ideation
• Broad term describes
• Contemplation and consideration
• Wishes of suicide
• Concentration on death and suicide
• The “Other Health Inventory for Individuals who Stutter” (OHI)
• Developed at Wayne State University in the Kraft Lab
• Used to examine comorbid conditions in people with a stutter
• Examines a broad spectrum of health conditions which may occur over a lifetime
• Characterizes a broader phenotype for stuttering in an attempt to begin association between genes and
the risk for other health problems in individuals who stutter
Introduction
What is stuttering, suicidal ideation, and the OHI?

6. Introduction
How was the OHI conducted?
Qualtrics Survey
• Y/N format to ask if there was ever an occurrence of disorders
• Posted on stuttering community pages on Facebook and Reddit
• Must be 18 years or older to participate in the survey
Survey Content
• Gathered information on the self-reported presence of neurological,
psychological, general health, speech & language, and stuttering
throughout the lifespan (e.g., have you ever experienced or been
diagnosed with gout?)
Analysis of Results
• P-value <0.05 was used to identify statistically significant disorders
• Compare OHI reported rate of disorder to empirical prevalence data
• Suicidal ideation: 39% OHI prevalence compared to 9.2%
expected prevalence according to the literature (Nock et al.,
2021)
Chi Square
• Assessed for any significant difference based on gender (p-value
<0.05) across the health conditions

7. Methodology/Experimental
Comprehensive Literature Review
• Interpretation of literature review
• Obtained information based on research from scholarly
articles
• Searched major key words such as stuttering and suicidal
ideation, stuttering and depression, stuttering and mental
health disorders, mental health disorders and suicidal
ideation, genetic heritability and stuttering, genetic
heritability and suicidal ideation
• Used the Wayne State University Database to find articles as
well as Google Scholar and ScienceDirect

8. Suicide in Swedish Twins
• Information was collected from monozygotic (MZ) and dizygotic (DZ)
twins using questionnaires, telephone interviews, health examinations
and register linkage
• Twins born any time between 1886-1958 with established zygosity
were used for this study since the world’s highest population-based
number of twin was between the years 1886-2000. (Lichtenstein et al.,
2006)
• Any suicides through December 31, 2003 were found by the linkage
with the Swedish Death Register
• Found MZ twins were more likely to experience suicidal ideation if the
other twin had the same experience than in DZ twins
Results and Discussion
Twin Studies of Suicidal Ideation
Suicide in Australian Twins
• Information was collected from monozygotic (MZ) and dizygotic (DZ) twins
born between the years 1964 and 1971 who were enrolled in the Australian Twin
Registry
• Mailed a Health and Lifestyle Questionnaire in 1989-1990.
• Those who self-identified on the Health and Lifestyle Questionnaire with a
stutter had an interview phase for a further study
• Found MZ twins were more likely to experience suicidal ideation if the other
twin had the same experience than in DZ twins

9. • A twin study demonstrated that 70% of stuttering can be attributed to genetics
while the remaining 30% can be attributed to environmental influences
(Felsenfeld et al., 2000)
• People who stutter are more likely to have a family member who has a history of
stuttering than those who do not stutter (Perez & Stoeckle, 2016)
• Male relatives have a higher risk to develop a stutter than female relatives (Kidd
& Perkins, 1984)
• The quality of life of individual who stutter can be negatively impacted not only
by the impairment of stuttering itself, but also through imitation and restrictions
imposed by society (ICF; World Health Organization, 2007)
• Males and females who stutter are both very likely to experience an increase in
depressive symptoms however only males who stutter are found to significantly
report suicidal ideation more than females who stutter (Briley et al., 2021)
• Studies that focus on molecular genetics based on suicidality have failed to
identify a reoccurring finding of genome-wide significance (Mirkovic et al.,
2016)
• Those living in high-income countries suggest that suicidal ideation is at least
partly genetically heritable and independent from psychiatric disorders (Brent &
Melhem, 2008)
Results and Discussion

10. Results and Discussion
Findings from the OHI
Statistically
Significant
OHI Prevalence Expected
Prevalence
Literature
Anxiety Disorder 0.64 0.10 Baxter et al., 2021
Mood Disorder 0.39 0.29 Kessler et al.,
2012
Trauma and Stress
Related Disorder
0.32 0.07 Gradus, 2017
Major Depressive
Disorder
0.22 0.13 Sullivan et al.,
2000
Suicidal Ideation 0.39 0.092 Nock et al., 2013
LeRose et al., 2022

11. Results and Discussion
0
2
4
6
8
10
12
14
16
Standard
Deviation
Types of Disorders
Standard Deviation of Disorders
Children who Stutter Fluent Controls
Rocha et al., 2019

12. Results and Discussion
Clinical Implications and Recommendations
• Attachment-Based Family Therapy (ABFT) was found to have
greater rates of reduced self-reported suicidal ideation that was
maintained after several months compare to Enhanced Usual
Care (EUC) (Diamond et al., 2010)
0
20
40
60
80
100
120
140
160
Post-treatment Follow-up
Percent
of
reduced
Suicidal
Ideation
Treatment Used
Treatment Used Vs Percent of Reduced Suicidal
Ideation
ABFT EUC

13. Results and Discussion
• One of the strongest diagnostic risk factors for suicidal ideation is the presence
of a mood disorder (Nock et al., 2021).
•Given the high rates of mood, anxiety, and trauma and stress-related
disorders reported on the OHI and supported in the literature, a clear
connection becomes apparent between stuttering and mental health-related
sequela, including suicidal ideation
• A recent study found significance between presence of depressive
symptoms and stuttering
• People who stutter were found to have statistically significantly more
depressive symptoms (t= 7.39) and prevalence of suicidal ideation (x2 =
9.72) than fluent controls (Briley et al., 2021)
• An increase in severity of depression among individuals who stutter was
significantly higher than fluent controls
• Males who stutter are found to report higher suicidal ideation
• Could be a result of more negative view of males who stutter than
females who stutter (Klein & Hood, 2004)

14. Conclusions
• There is empirical support, particularly in twin studies, for a genetically
heritable risk for suicidal ideation, yet there have been to date no
findings of genome-wide significance
• Genetic risk of suicidal ideation cannot be ruled out as a
contributing factor in this population
• More significant support, however, exists in the literature for a
connection between suicidal ideation and the high reported presence of
depression in individuals who stutter, both found on the OHI and
research by Briley and colleagues (2021)
• Additional research is needed to clarify the genetic contributions and
risk factors for both developmental stuttering and comorbid health
conditions

15. Conclusions
• The scope of speech-language pathologists (SLPs) to include basic
competency in counseling, and inclusion of goals in therapy that target
reducing anxiety around stuttering itself in addition to learning adaptive
coping strategies that may help to improve overall outcomes
(Tomisato et al., 2022)
• When concern for mental health disorders becomes apparent and beyond
the scope of the speech-language pathologist, referral to a mental health
professional for collaborative treatment should be strongly considered
• Particularly for adolescents, "Attachment-Based Family Therapy" has
demonstrated positive outcomes for individuals experiencing suicidal
ideation and depression in psychotherapy (Diamond et al., 2010)

16. References
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