Date of Award

2025

Degree Type

Dissertation

Degree Name

Doctor of Philosophy in Psychology

Specialization

Clinical Psychology

Department

Psychology

First Advisor

Nicole H. Weiss

Abstract

The ongoing opioid epidemic is among the worst public health crises in United States history, with over 200 people dying daily from opioid overdose. Opioid use and suicide co-occur at an alarmingly high rate, and despite large-scale efforts, this rate of co-occurrence continues to escalate. However, empirical examinations in this area lag behind, with no studies explicating the real-time longitudinal associations between opioid use and acute suicide risk; this information is needed to inform targeted intervention and policy. Furthermore, it remains unknown how an individualized trauma context - notably, proximal posttraumatic stress symptoms (PTSS) - may serve as a trigger for co-occurring opioid use and acute suicide risk. This study addressed a critical knowledge gap by using a multi-phase ecological momentary assessment (EMA) approach among 53 trauma-exposed adults who currently use opioids and are at elevated risk of suicide. Participants (Mage = 45.2 years; 81% white; 72% disabled; 57% men; 38% without stable housing) completed a baseline session and 14 consecutive days of daily surveys (twice per day) assessing PTSS, opioid cravings/use, and suicidal thoughts/behaviors. Community-based participatory research (CBPR) methods were applied to center individuals with lived experiences. Multilevel dynamic structural equation models (DSEM) were fit to daily data. Results showed that suicidal thoughts were significantly associated with next-survey PTSS (Standardized Fixed Effect Estimate = 0.53, 95% CI[0.25, 0.89]). Furthermore, there was a significant within-person moderation of opioid use - but not opioid cravings - on PTSS predicting next-survey suicidal thoughts (Standardized Fixed Effect Estimate = 0.40, 95% CI[0.02, 0.79]). A group iterative multiple model estimation (GIMME) approach was also applied. Findings indicated substantial heterogeneity in the daily associations among PTSS, opioid cravings, and suicidal thoughts across individuals. This study is the first, to our knowledge, to assess co-occurring PTSS, opioid use, and acute suicide risk using EMA. Findings offer initial insight into the nuances in the dynamic associations among PTSS, opioid use, and acute suicide risk among a high-risk sample. Importantly, findings call for future EMA work in this area to better inform clinical interventions for PTSS, opioid use, and suicide.

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