California State University, Fullerton

Research Study Consent Form

 

Study Title:    Parents’ and Peers’ Emotional and Physical Presence on Suicide Ideation

Protocol Number:   HSR-19-20-284

Researchers:    Peter Tan, Aaron Lukaszewski Ph.D

You are being asked to take part in a research study carried out by Peter Tan and Aaron Lukaszewski. This consent form explains the research study and your part in it if you decide to join the study.  Please read the form carefully, taking as much time as you need. Ask the researcher to explain anything you don’t understand by the email or the phone number provided below. You can decide not to participate in the study. If you decide to participate, you can stop taking the survey at any time.  There will be no penalty or loss of services or benefits if you decide to not take part in the study. 

What is this study about?

 

This research study is being conducted to understand the relationship between different people in people’s lives and suicide ideation.   

 

You are being asked to take part because you are age 51 or above.

 

Taking part in the study will take about 15 minutes.

 

You cannot take part in this study if you are not age 51 or above.

 

What will I be asked to do if I am in this study?

 

If you take part in the study, you will be asked to

·    Answer a series of questionnaires covering a variety of subjects.

·    The questions asked will assess relationships with parental figures and peers, psychological wellness, and demographics.

·    You may skip or leave blank any questions that you do not wish to answer.

 

Are there any benefits to me if I am in this study?

 

Participating in the study will give researchers and society a better understanding of the topic of suicide and can help improve future prevention and treatment efforts.

 

Are there any risks to me if I am in this study?

 

The potential risks from taking part in this study are as follows.  

·    You may feel uncomfortable to answer certain questions asked in the questionnaires that may be sensitive.

·    Some of the questions will cover the possibly sensitive and triggering topic of suicide.

 

You are free to skip any questions you do not wish to answer. If you experience any suicidal thoughts, please call the National Suicide Prevention Lifeline at +1 (800) 273-8255 immediately. You can also contact the Counseling and Psychological Services at Cal State, Fullerton at (657) 278-3040 to set up an appointment or speak to a therapist. You can also contact Orange County Mental Health Services at their 24-hour suicide prevention line a +1 (877) 727-4747 or at (855) 625-4657 from 8am to 6pm on Mondays to Fridays for information and referrals to Orange County Behavioral Health Services.

 

Will my information be kept anonymous or confidential?

 

The data for this study will be kept confidential to the extent allowed by law. No published results will identify you, and your name will not be associated with the findings. Under certain circumstances, information that identifies you may be released for internal and external reviews of this project. 

 

o   All data will be stored in a password protected computer.

o   Only members of the research staff will have access to your data.

 

The results of this study may be published or presented at professional meetings, but the identities of all research participants will remain confidential.

 

The data for this study will be kept for 10 years. The data will be used for future educational purposes, presentations, and publications.

 

There will be no costs to you for taking part in this study.

 

You will be entered into a raffle to win a $50 amazon gift card for taking part in this study.  If you decide to quit the study you will receive the same chance to win a $50 amazon gift card. You will be given the opportunity to provide an email. If selected, an amazon e-gift card will be sent to the email provided.

 

Who can I talk to if I have questions?

 

If you have questions about this study or the information in this form, please contact the researcher Peter Tan by email at ztan006@csu.fullerton.edu or by phone at (951) 236-2479 or advising professor Dr. Lukaszewski by email at alukaszewski@fullerton.edu or by phone at (925) 413-1633. If you have questions about your rights as a research participant, or would like to report a concern or complaint about this study, please contact the Institutional Review Board at (657) 278-7719, or e-mail irb@fullerton.edu

 

What are my rights as a research study volunteer?

 

Your participation in this research study is completely voluntary.  You may choose not to be a part of this study.  There will be no penalty to you if you choose not to take part.  You may choose not to answer specific questions or to stop participating at any time. 

 

What does my signature on this consent form mean?

Your signature on this form means that:

·    You understand the information given to you in this form

·    You have been able to ask the researcher questions and state any concerns

·    The researcher has responded to your questions and concerns

·    You believe you understand the research study and the potential benefits and risks that are involved.

Statement of Consent

I have carefully read and/or I have had the terms used in this consent form and their significance explained to me.  By signing below, I agree that I am at least 18 years of age and agree to participate in this project.