Elevated Risk For Suicidal Behavior Research Articles

How to survive the long night? Longitudinal relationship between sleep problems and suicidal behavior among adolescents: The serial mediating roles of negative emotion, self-control, and nonsuicidal self-injury.

Sleep problems are a significant risk factor for identifying and preventing suicidal involvement among adolescents. However, there is limited evidence to assess the underlying mechanisms between them. This study investigated the longitudinal relationship between sleep problems and suicidal behavior and examined whether this relationship was moderated by negative emotions, low self-control, and nonsuicidal self-injury (NSSI). From December 2020 onward, we assessed 1214 Chinese secondary school adolescents (60.7% were boys, aged 13-19 years) three times, 6 months apart. In the direct effects model, sleep problems were found to have a positive impact on adolescent suicidal behavior. In the indirect effects model, we observed that sleep problems were associated with an elevated risk of suicidal behavior through several pathways: one-mediator path of negative emotions, low self-control, and NSSI, respectively; two-mediator path of negative emotions via low self-control, negative emotions via NSSI, and low self-control via NSSI, and three-mediator path from negative emotions to NSSI via low self-control. This longitudinal study provides evidence that sleep problems in adolescents may increase suicidal behavior by exacerbating negative emotions, weakening self-control, and promoting NSSI. The findings suggest sleep problems should be addressed in suicide prevention and intervention efforts for adolescents.

Perinatal Depression and Risk of Suicidal Behavior

Suicidal ideation is common among women with perinatal depression (PND). However, prospective data are limited on the risk, particularly long-term risk, of suicidal behavior (suicide attempt and completed suicide) among women with perinatal depression. To examine the association between PND and risk of short- and long-term suicidal behavior. A nationwide population-matched cohort study was conducted in Sweden including 86 551 women with PND from 2001 to 2017 and 865 510 unaffected women individually matched on age and calendar year at delivery. Sibling comparison was used to account for familial confounding. Data were analyzed from January 2022 to November 2023. PND was identified through depression diagnosis or filled prescriptions of antidepressants from pregnancy to 1 year post partum in registers. All women were followed up for the first event of suicidal behavior recorded in registers. Hazard ratios (HR) of suicidal behavior were estimated using time-to-event analysis. Women with PND (86 551 participants) received a diagnosis at a mean (SD) age of 30.67 (5.23) years. During a median (IQR) follow-up of 6.91 (3.62-10.88) years, 3604 events of suicidal behavior (incidence rate [IR], 5.62 per 1000 person-years) were identified among women with PND and 6445 (IR, 1.01 per 1000 person-years) among population-unaffected women. Women with PND had an elevated risk of suicidal behavior when compared with matched unaffected women (HR, 3.15; 95% CI, 2.97-3.35). Comparable, albeit somewhat attenuated, associations were yielded when comparing PND women with their PND-free sisters (HR, 2.75; 95% CI, 2.10-3.61). In the population-matched cohort, the association was greater for postnatal depression and among women without a history of psychiatric disorders. The excess risk was pronounced during the first year after diagnosis (HR, 7.20; 95% CI, 6.07-8.54), yet remained statistically significant during 5 to 18 years of follow-up (HR, 2.34; 95% CI, 2.12-2.57). In this nationwide cohort study, women with PND were at an increased risk of suicidal behavior, particularly within the first year after diagnosis with persistent risk elevations throughout the 18 years of follow-up, highlighting the need for vigilant clinical monitoring of this vulnerable group.

Predictors of Suicide Behavior in Adolescents with Depression

The prevalence of teenage suicide has been progressively rising in recent years, posing a significant public health concern that jeopardizes the physical and psychological well-being of adolescents, and potentially their survival. Adolescents who experience depression are at an elevated risk for suicidal behavior. The present study provides a comprehensive overview of the distinct psychological, familial, and socio-environmental factors that contribute to suicidal tendencies among adolescents diagnosed with depression. The aim of this research is to establish a sound empirical foundation for the development of effective strategies to prevent adolescent suicide behavior.

Correlates for Suicidality Among At-risk Youth Receiving Community-Based Mental Health Services

“At-risk” adolescents are at high risk of unsuccessfully transitioning into adulthood and are also at elevated risk for suicidal behavior. Though much research has been conducted on risk factors for suicidality among the general adolescent population, research on suicidality among “at-risk” adolescents is lacking. This is a notable gap in the literature given that “at-risk” adolescents may be three times more likely to exhibit suicidality. The present study addressed this research gap by examining correlates for suicidality among “at-risk” adolescents receiving mental health services in the community. Using Electronic Health Record (EHR) data, risk factors for suicidality were analyzed at the bivariate and multivariate levels. Sexual abuse was a significant predictor of suicidality, as well as impulsivity for suicide attempt only. These findings may serve as useful adjuncts in the design of suicidality-screening tools and follow-up practices within the context of community-based mental health organizations which target at-risk adolescents.

Prevalence and correlates of suicidal behavior in primary care settings in Mozambique

BackgroundThis study assessed the prevalence of suicidal behavior and associated risk factors in public primary health care in Mozambique.MethodsThe Mini International Neuropsychiatric Interview was used to evaluate suicidal behavior among 502 adults attending three Primary Health Care (PHC) settings.ResultsIn the past month, 13% (n = 63) of PHC attendees expressed suicidal ideation, 8% (n = 40) had made a suicide plan, 4% (n = 20) had made a suicide attempt, and 5% (n = 25) reported a lifetime suicide attempt. Females had 2.8-fold increased odds of suicide plan (95% CI: 1.5, 5.5) and 3.3-fold increased odds of suicide attempt in the past month (95% CI: 1.2, 9.1). Each 10-year increase in age was associated with 0.61-fold the odds of suicide plan (95% CI: 0.38, 0.98) and 0.09-fold the odds of suicide attempt (95% CI: 0.01, 0.69) in the past month. People living with HIV (PLWHA) had 2.2-fold increased adjusted odds of past month suicide attempt (CI: 1.1, 4.1).ConclusionSuicidal behaviors are common among adults attending PHC clinics in Mozambique. Screening and linkage to effective preventive interventions are urgently needed in PHC settings. Females, younger individuals, and PLWHA are at elevated risk for suicidal behavior in PHC.

Workplace bullying and risk of suicide and suicide attempts: A register-based prospective cohort study of 98 330 participants in Denmark.

The aim of this study was to analyze whether individuals reporting exposure to workplace bullying had a higher risk of suicidal behavior, including both suicide attempt and death by suicide, than those not reporting such exposure. Using a prospective cohort study design, we linked data from nine Danish questionnaire-based surveys (2004-2014) to national registers up to 31 December 2016. Exposure to workplace bullying was measured by a single item. Suicide attempts were identified in hospital registers and death by suicide in the Cause of Death Register. Among participants with no previous suicide attempts, we estimated hazard ratios (HR) and 95% confidence intervals (CI), adjusting for sex, age, marital status, socioeconomic status, and history of psychiatric morbidity. The sample consisted of 98 330 participants (713 798 person-years), 63.6% were women, and the mean age was 44.5 years. Of these participants, 10 259 (10.4%) reported workplace bullying. During a mean follow-up of 7.3 years, we observed 184 cases of suicidal behavior, including 145 suicide attempts, 35 deaths by suicide and 4 cases that died by suicide after surviving a suicide attempt. The fully-adjusted HR for the association between workplace bullying and suicidal behavior was 1.65 (95% CI 1.06-2.58). The HR for suicide attempts and death by suicide were 1.65 (1.09-2.50) and 2.08 (0.82-5.27), respectively. Analyses stratified by sex showed a statistically significant association between workplace bullying and suicidal behavior among men but not women. The results suggest that exposure to workplace bullying is associated with an elevated risk of suicidal behavior among men.

Risk Factors for Suicide Attempt During Outpatient Care in Adolescents With Severe and Complex Depression.

Background: Young people receiving tertiary mental health care are at elevated risk for suicidal behavior, and understanding which individuals are at increased risk during care is important for treatment and suicide prevention. Aim: We aimed to retrospectively identify risk factors for attempted suicide during outpatient care and predict which young people did or did not attempt during care. Method: Penalized logistic regression analysis was performed in a small high-risk sample of 84 young people receiving care at Orygen's Youth Mood Clinic (age: 14-25 years, 51% female) to predict suicide attempt during care (N = 16). Results: Prediction of suicide attempt during care was only moderately accurate (Area Under the Receiver Operating Curve range 0.71; sensitivity 0.57) using a combination of sociodemographic, psychosocial, and clinical variables. The features that best discriminated both groups included suicidal ideation during care, history of suicide attempt prior to care, changes in appetite reported on the PHQ-9, history of parental separation, and parental mental illness. Limitation: Replication of findings in an independent validation sample is needed. Conclusion: While prediction of suicide attempt during care was only moderately successful, we were able to identify individual risk factors for suicidal behavior during care in a high-risk sample.

Initiation of Opioid Prescription and Risk of Suicidal Behavior Among Youth and Young Adults.

Opioids are involved in an increasing proportion of suicide deaths. This study examined the association between opioid analgesic prescription initiation and suicidal behavior among young people. We analyzed Swedish population-register data on 1 895 984 individuals ages 9 to 29 years without prior recorded opioid prescriptions. We identified prescriptions dispensed from January 2007 onward and diagnosed self-injurious behavior and death by suicide through December 2013. We first compared initiators with demographically matched noninitiators. To account for confounding, we applied an active comparator design, which examined suicidal behavior among opioid initiators relative to prescription nonsteroidal antiinflammatory drug (NSAID) initiators while inverse-probability-of-treatment weighting with individual and familial covariates. Among the cohort, 201 433 individuals initiated opioid prescription. Relative to demographically matched noninitiators, initiators (N = 180 808) had more than doubled risk of incident suicidal behavior (hazard ratio = 2.64; 95% confidence interval [CI], 2.47-2.81). However, in the active comparator design, opioid initiators (N = 86 635) had only 19% relatively greater risk of suicidal behavior compared with NSAID initiators (N = 255 096; hazard ratio = 1.19; 95% CI,: 1.11-1.28), corresponding to a weighted 5-year cumulative incidence of 2.2% (95% CI, 2.1-2.4) for opioid and 1.9% (95% CI, 1.9-2.0) for NSAID initiators. Most sensitivity analyses produced comparable results. Opioid initiation may make only a small contribution to the elevated risk of suicidal behavior among young people receiving pharmacologic pain management. In weighing benefits and harms of opioid initiation, our results suggest that increased risk of suicidal behavior may not be a major concern.

Depressive Symptoms Moderate the Association Between the Recent History of Alcohol Use Severity and Suicide Attempt History Among Adults in a Pretrial Jail Diversion Program.

Background: Justice-involved individuals are at elevated risk for suicidal behavior; however, research examining risk for suicidal behavior in pretrial jail diversion programs (pretrial diversion) is limited. Aims: We aimed to test (1) associations between depressive symptoms and alcohol and drug use, and suicide attempt history (SAH), and (2) interactions between depressive symptoms and alcohol and drug use in relation to SAH among adults in an urban pretrial jail diversion program. Method: The design was cross-sectional, including self-report assessments and file reviews of historical information. Adults (N = 274; Mage = 33.72; 73.7% men; 52.6% non-Hispanic Black) completed assessments within two weeks of beginning the pretrial program. Results: Depressive symptoms were positively associated with SAH after adjusting for other covariates. The significant depressive symptoms by alcohol use interaction indicated that adults with low to average depressive symptoms evidenced a similar likelihood of SAH to those with high depressive symptoms when they also had elevated alcohol use scores. Limitations: We used cross-sectional self-report data. Conclusion: It may be important to conduct suicide risk assessments for justice-involved people who use alcohol even when depressive symptoms are low.

Antidepressant Use and Risk of Suicidal Behavior in Older Persons With Depression: A Cohort Study in Hong Kong

Background: Depression is highly prevalent in older adults and requires treatment. However, debate persists on whether antidepressant use is associated with an elevated risk of suicidal behavior. This study aims to examine the short- and long-term risk of suicidal behavior by various classes of antidepressants in older persons with depression. Methods: Persons aged 40 years and above and received a clinical diagnosis of depression between January 1, 2001, and December 31, 2016 were identified from the Clinical Data Analysis and Reporting System in Hong Kong. The risk of suicidal behavior in persons who were prescribed antidepressants was compared with persons who were not prescribed any antidepressant drugs. Antidepressants were classified as tricyclic and related antidepressant drugs (TCAs), selective serotonin reuptake inhibitors (SSRIs), noradrenergic and specific serotonergic antidepressants (NaSSAs), serotonin–norepinephrine reuptake inhibitors (SNRIs) and others. Incidence and adjusted hazard ratio (aHR) of subsequent self-harm and suicide within one-year and the whole study period were estimated by age groups. Results: A total of 34,927 persons aged 40-64 years, and 19,300 persons aged 65+ years were included. In the younger age group, the highest short-term and long-term risks were found in others (aHR, 2.33; 1.02-5.34) and NaSSAs (2.88; 2.15-3.86), respectively. In the older age group, no significant association was observed between antidepressant use and suicidal behavior across all antidepressant classes. Conclusion: The self-harm and suicide associated risks vary across antidepressant classes and age groups. Cautions are always needed for antidepressant prescriptions.

Association between perceived public stigma and suicidal behaviors among college students of color in the U.S.

BackgroundSuicide is the 2nd leading cause of death among college students and 10 to 34-year-olds in the U.S. While rates of suicide among young people of color have increased, less is known about factors that contribute to suicidality among racial minority students who are sorely underrepresented within existing research. Thus, we sought to explore the association between perceived public stigma of receiving mental health treatment and suicidality among Black, Asian Domestic, Asian International, Latinx, Multiracial, Arab/Arab American, American Indian/Alaska Native, and White college students. MethodsWe analyzed cross-sectional survey responses from racially diverse sample of 153, 635 college students who participated in the Healthy Minds Study from years 2007–2018. Multivariable logistic regression was used to examine associations between perceived public stigma and suicide ideation, suicide planning, and suicide attempt. ResultsPerceived public stigma was significantly associated with greater odds of suicide ideation, planning, and attempt. Odds of having attempted suicide within the past year were significantly greater among Asian International and Black college students. Sexual minority students broadly, and bisexual students specifically, were also at elevated risk for suicidal behavior. LimitationsCross-sectional survey responses were assessed and causality cannot be determined. ConclusionsStudents who endorsed more perceived public stigma also reported significantly greater odds of having experienced suicide ideation, planning, and attempt within the past 12 months. Subsequent interventions should account for concerns surrounding public perceptions of stigma when working to prevent suicide among students of color.

T141. Suicidality and Emotional Inhibitory Control in Dually-Diagnosed Adolescents

Dually-diagnosed adolescents, presenting with a substance use disorder and at least one additional psychiatric diagnosis, are at elevated risk for suicidal behaviors. As impulsivity has been linked to suicidal behaviors, particularly in young people, the aim of this study was to examine the relationship inhibitory control and suicide attempt in dually-diagnosed adolescents.

Epidemiology of suicidal ideation, suicide attempts, and direct self-injurious behavior in adolescents with a migration background: a representative study

BackgroundData on the prevalence of suicidal ideation, suicide attempts, and direct self-injurious behavior in adolescents with a migration background are scarce. There are hints that this population is at risk. The aim of the study is to investigate the epidemiology of suicidal ideation, suicide attempts, and direct self-injurious behavior in adolescents with a migration background in Germany while taking gender-specific differences into consideration.MethodsA representative study with N = 10,638 students (mean age 14.91 years, SD = .73).) in the state of Lower Saxony in Germany was conducted. In the 2014–2015 school year, 672 classes were selected by randomly sampling different school types. The participation rate was 84.1%, excluding any classes for which the director refused to provide consent. A total of 49.8% were female adolescents, and 23.3% of the participants had a migration background. Target variables were assessed with items from the Ottawa Self-Injury Inventory, the Self-Harm Behavior Questionnaire and the Self-Harm Inventory, partly adapted.ResultsOf all students, 7.6% had a lifetime history of suicide attempts, and 36.6% answered with a rating of at least “rarely” when asked to rate the lifetime prevalence of suicidal ideation. The 12-month prevalence of direct self-injurious behavior was 17.8%. Adolescents with a migration background showed a significantly higher prevalence of all three constructs (p = .006; p < .001; p = .006). Male students with a migration background reported a significantly higher lifetime prevalence of suicide attempts (4.7% vs. 3.1%) than native males (p = .009). Female students with a migration background reported a significantly higher lifetime prevalence of suicide attempts (15.9% vs. 10.4%) and suicidal ideation (“often” 12.1% vs. 8.9%) than native female students (p < .001; p = .008).ConclusionOur assessment indicates an elevated risk for suicidal behaviors in adolescents with a migration background. From research on adults, it is known that the dominant motives for suicidal behavior in migrants are associated with their migration history/situation. As suggested by Cramer and Kapusta’s (Front Psychol 8:1756, 2017) theoretical model, the Social-Ecological Framework of Theory, Assessment, and Prevention, there is a need for culturally sensitive preventions that take into account the specific reasons for suicide attempts in migrants.

Risk Factors for Suicide in Older Inpatient Veterans with Schizophrenia

Patients with schizophrenia have an elevated risk of suicidal behavior. We explored whether there were age differences in inpatients with schizophrenia admitted for suicidal behavior. We compared demographic/clinical characteristics of 76 inpatients aged > 59 to those < 60. All patients had a score greater > 0 on items 4 (active suicidality) and/or 5 (passive suicidality) on the Beck Scale for Suicidal Ideation for inclusion. There were no significant group differences with respect to race, education, depressive symptoms or negative symptoms. There was evidence suggesting that hallucinations appear to be less prominent in the older group. Future studies will determine whether these age related differences are stable over time and could account for potential age differences in suicidal behavior in individuals with schizophrenia.

Are there sensitive periods when child maltreatment substantially elevates suicide risk? Results from a nationally representative sample of adolescents.

Although child maltreatment is a well documented risk factor for suicidal behavior, little is known about whether the timing of child maltreatment differentially associates with risk of suicidal ideation, suicide plans, or suicide attempts. The goal of this study was to examine whether a first exposure to physical or sexual abuse during specific developmental periods significantly elevated risk for suicidal behavior in adolescents. Data came from the National Comorbidity Survey Adolescent Supplement, a population-based sample of US adolescents aged 13-18 years old (n = 9,272). Using discrete time survival analysis, we assessed the association between timing of first abuse (early childhood: ages 0-5; middle childhood: ages 6-10; adolescence: ages 11-18) and suicidal ideation, plans, and attempts. Exposure to either physical or sexual abuse increased the odds of reporting suicidal ideation (odds ratio [OR] = 5.06 and OR = 3.56, respectively), plans (OR = 3.63 and OR = 3.58, respectively), and attempts (OR = 5.80 and OR = 4.21, respectively), even after controlling for sociodemographic covariates and psychiatric disorders. However, the timing of physical and sexual abuse exposure was unassociated with suicidal behavior (all p values >.05). Exposure to child maltreatment is strongly associated with risk for adolescent suicidal behaviors, though this association did not vary based on the developmental timing of first exposure. These findings suggest that prevention efforts should be implemented throughout early development and target all children, regardless of when they were first exposed.

Current Challenges in the Management of LGBT Suicide

Current Challenges in the Management of LGBT Suicide

Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial.

Suicide is a devastating public health problem and very few biological treatments have been found to be effective for quickly reducing the intensity of suicidal ideation (SI). We have previously shown that a single dose of ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, is associated with a rapid reduction in depressive symptom severity and SI in patients with treatment-resistant depression. We conducted a randomized, controlled trial of ketamine in patients with mood and anxiety spectrum disorders who presented with clinically significant SI (n = 24). Patients received a single infusion of ketamine or midazolam (as an active placebo) in addition to standard of care. SI measured using the Beck Scale for Suicidal Ideation (BSI) 24 h post-treatment represented the primary outcome. Secondary outcomes included the Montgomery-Asberg Depression Rating Scale--Suicidal Ideation (MADRS-SI) score at 24 h and additional measures beyond the 24-h time-point. The intervention was well tolerated and no dropouts occurred during the primary 7-day assessment period. BSI score was not different between the treatment groups at 24 h (p = 0.32); however, a significant difference emerged at 48 h (p = 0.047). MADRS-SI score was lower in the ketamine group compared to midazolam group at 24 h (p = 0.05). The treatment effect was no longer significant at the end of the 7-day assessment period. The current findings provide initial support for the safety and tolerability of ketamine as an intervention for SI in patients who are at elevated risk for suicidal behavior. Larger, well-powered studies are warranted.

Identifying adolescents at highly elevated risk for suicidal behavior in the emergency department.

The feasibility and concurrent validity of adolescent suicide risk screening in medical emergency departments (EDs) has been documented. The objectives of this short-term prospective study of adolescents who screened positive for suicide risk in the ED were: 1) to examine adolescents' rate of suicidal behavior during the 2 months following their ED visits and compare it with reported rates for psychiatric samples; and 2) to identify possible predictors of acute risk for suicidal behavior in this at-risk sample. Participants were 81 adolescents, ages 14-19 years, seeking services for psychiatric and nonpsychiatric chief complaints, who screened positive for suicide risk because of recent suicidal ideation, a suicide attempt, and/or depression plus alcohol or substance misuse. A comprehensive assessment of suicidal behavior, using the Columbia-Suicide Severity Rating Scale, was conducted at baseline and 2 month follow-up. Six adolescents (7.4%) reported a suicide attempt and 15 (18.5%) engaged in some type of suicidal behavior (actual, aborted, or interrupted suicide attempt; preparatory behavior) during the 2 months following their ED visit. These rates suggest that this screen identified a high-risk sample. Furthermore, adolescents who screened positive for suicidal ideation and/or attempt plus depression and alcohol/substance misuse were most likely to engage in future suicidal behavior (38.9%). In this study, use of a higher screen threshold (multiple suicide risk factors) showed promise for identifying highly elevated acute risk for suicidal behavior.

119 Primary Predictors of Suicide Outcomes One Year After Screening Positive for Suicide Risk in the Emergency Department

Although suicide is difficult to predict in the general population, emergency department (ED) patients presenting with suicide risk factors such as substance abuse or depression are a readily identifiable population at elevated risk for suicidal behavior. However, little is known about which factors have the strongest association with future suicide outcomes. This study aimed to determine the predictors associated with suicide outcomes documented during the 12 months following an ED visit where the patient screened positive for active suicidal ideation or behavior. Data were collected during the first two phases of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE), a quasi-experimental suicide intervention study involving eight EDs across the U.S. Sites enrolled adults with active suicidal ideation or an attempt in the last week. Data collection included baseline interview; 6- and 12-month chart reviews; and 6-, 12-, 24-, 36-, and 52-week telephone follow-up assessments. The suicide composite outcome included reporting a preparatory act (eg, buying pills), interrupted or aborted attempt, a suicide attempt, or a suicide in the 12 months following the initial ED visit. Variables with a univariable association with suicide outcomes at P<.10 were included in the multivariable logistic regression model. In the final model, P<.05 was considered statistically significant. Among the 874 subjects (phase 1=497; phase 2=377), the median age was 37 years (interquartile range 27-47) with 56% female, 74% white, and 87% non-Hispanic. At baseline, 577 (66%) had suicidal ideation only and 297 (34%) a suicide attempt in the last month. Twelve-month outcomes were available for 782 (90%), who completed at least one of the 5 telephone follow-up assessments or had documentation of a suicide attempt or suicide completion during the 6- or 12-month chart review. In the one year after the initial ED visit, 430 (55%) reported a preparatory act, interrupted or aborted attempt, a suicide attempt, or had committed suicide. Subjects were more likely to have suicidal behavior within one year after the initial ED visit if they reported at the initial ED visit that they had a high school education or less (OR 1.63; 95% CI, 1.18-2.26; P=.003), had a primary care provider (OR 1.43; 95% CI, 1.01-2.00; P=.04), were unemployed (OR 1.64; 95% CI, 1.16-2.32; P=.006), had active suicidal ideation with a plan and intent to act (OR 10.2; 95% CI, 1.13-91.56; P=.04), had a severe health issue (eg, stroke, HIV) (OR 1.49; 95% CI, 1.06-2.10; P=.02), had a history of mental health problem(s) (OR 1.99; 95% CI, 1.14-3.47; P=.02), or a had a history of suicide attempt(s) (OR 1.60; 95% CI, 1.11-2.30; P=.01). The strongest predictors of reporting suicidal behavior within one year after the initial ED visit were related to patient characteristics (demographics and medical history) and past suicidal ideation and behavior. This suggests that in addition to psychiatric history, individual characteristics such as education level and employment as well as severe medical conditions should be considered when assessing suicide risk in an adult ED population. Understanding the factors that predict future suicide behaviors for this population will help guide the design and implementation of improved suicide-related interventions in the ED.

Self-reported Barriers to Professional Help Seeking Among College Students at Elevated Risk for Suicide

Objectives: This study sought to describe self-reported barriers to professional help seeking among college students who are at elevated suicide risk and determine if these barriers vary by demographic and clinical characteristics. Participants: Participants were 165 non–treatment seekers recruited as part of a Web-based treatment linkage intervention for college students at elevated suicide risk (from September 2010 through December 2011). Methods: Data were collected using Web-based questionnaires. Two coders coded students’ responses to an open-ended question about reasons for not seeking professional help. Results: The most commonly reported barriers included perception that treatment is not needed (66%), lack of time (26.8%), and preference for self-management (18%). Stigma was mentioned by only 12% of students. There were notable differences based on gender, race, and severity of depression and alcohol abuse. Conclusions: Efforts aimed at reaching students at elevated risk for suicidal behavior should be particularly sensitive to these commonly described barriers.