Suicidal College Students Research Articles

The association between coping behaviors and the interpersonal theory of suicide in college students

High levels of stress are associated with suicide ideation among college students. The interpersonal theory of suicide provides a framework for conceptualizing the association between stress and suicide. This study will examine the associations between multiple types of stress (daily life hassles vs. negative life events) on suicidal ideation and the role of adaptive/maladaptive coping skills as potential moderators of the relationship between stress, thwarted belongingness, perceived burdensomeness, and suicidal ideation. The current study is a secondary analysis of data gathered from South-eastern university students in the U.S. College students (N = 218) with elevated depressive symptoms completed cross-sectional surveys. Participants were predominantly (78%) women and (72.8%) Hispanic, with a mean age of 20.81 years (SD = 3.96). Daily life hassles and negative life events were indirectly associated with suicidal ideation via perceived burdensomeness and thwarted belongingness. Only maladaptive coping behaviors significantly moderated the indirect effect of daily life hassles and negative life events on suicide ideation via perceived burdensomeness, but not thwarted belongingness. Thus, reliance on maladaptive coping behaviors increased the strength of the association between daily life hassles/negative life events and suicidal ideation. This study utilized cross-sectional data from a sample of college students with elevated depressive symptoms and may not generalize to other college student populations. Additionally, the use of cross-sectional data precludes causal interpretations of the findings. An improved understanding of potential buffers against the effects of stress can help identify opportunities for targeted prevention efforts to reduce rates of suicide-related behaviors in college students. Findings suggest that efforts to reduce student use of maladaptive coping behaviors may help to negate the negative impacts of stress on suicidal ideation.

Exploring psychological and psychosocial correlates of non-suicidal self-injury and suicide in college students using network analysis

BackgroundNon-suicidal self-injury (NSSI) and suicide are a serious health concern in young people. Remarkable progress has been made in understanding the correlates and risk factors for suicidality. However, it remains unclear the complex interplay between different factors and which factors are most saliently associated with NSSI and suicide risk and should be targeted for interventions. MethodsThis study utilized network analysis to examine the interrelationship between NSSI, suicide and a variety of psychological (e.g., depression, psychotic-like experiences) and psychosocial (e.g., childhood maltreatment, family dysfunction, being bullied and social support) correlates in a sample of Chinese first year college students (n = 2328). ResultsThe severity of depressive symptoms was the only factor connected to both NSSI and suicide. Other psychiatric factors like psychotic experiences could only act in an indirect way via the bridging effect of depression. Emotional abuse, compared with other forms of childhood adversities, was found to be the most influential maltreatment form associated with suicidal ideation and attempts. Finally, social support showed the potential to lower the risk of self-injury and suicide in young people. LimitationsOnly a subset of risk and resilience factors of NSSI and suicide were included. Causal inference was impossible due to the cross-sectional design. ConclusionsOur findings highlighted the importance of identifying risk groups with mental illnesses or negative childhood events, and providing additional support during the key time of transitioning into higher education.

Coping competence and hopelessness moderate the influence of perceived burdensomeness on suicidal ideation in undergraduate college students.

According to the interpersonal theory of suicide, the perception of imposing a burden on loved ones increases the risk for suicidal ideation. Little research, however, has examined the interaction of burdensomeness with cognitive variables in predicting suicidal ideation in college students even though the relationship between burdensomeness and ideation may be contingent on levels of cognitive risk factors. The present study thus examined the relationships between burdensomeness, hopelessness, coping competence, and suicidal ideation. Questionnaires were administered to 279 undergraduate students from a university in the Midwest United States. After controlling for depression, hopelessness, and coping competence, burdensomeness significantly predicted ideation and accounted for variance above and beyond the control variables. Moreover, the relationship between burdensomeness and suicidal ideation was significantly moderated by coping competence and hopelessness. The findings suggest that perceived burdensomeness plays a critical role in the risk for suicide in college students. More specifically, the findings suggest that coping competence and hopelessness can be ideal targets for interventions as changes in these variables may attenuate the association between perceived burdensomeness and suicidal ideation.

The relationship between anorexia nervosa and bulimia nervosa, attention deficit/hyperactivity disorder, and suicidality in college students.

This study aimed to assess the association between anorexia nervosa (AN), bulimia nervosa (BN), attention deficit/hyperactivity disorder (ADHD), and associated impairments (e.g., suicidality). A secondary data analysis of the American College Health Association-National College Health Assessment IIc (Fall 2015-Spring 2019) was conducted to assess the prevalence of comorbid anorexia or bulimia+ ADHD, symptoms, and impairments among college student (N=342,432; Mage =20.39, SD=1.88). Logistic regressions were used to compare eating disorder symptomology, treatment utilisation, and suicidality among college students. Compared to college students without ADHD, college students with ADHD were 18.30× more likely to be diagnosed with anorexia or bulimia and reported greater use of weight loss techniques (p's<0.001). College students with comorbid anorexia or bulimia+ADHD reported higher rates of dieting to lose weight (aOR=1.27, 95% CI: 1.12, 1.43, p<0.001) and treatment utilisation (aOR=1.30, 95% CI: 1.06, 1.50, p<0.001) compared to college students with AN or BN only. The highest level of suicidality was reported in college students with the comorbid AN or BN + ADHD. Elevated eating disorder symptoms and comorbidity is found among college students with ADHD. Increased screening and prevention for anorexia and bulimia is needed among young adults with ADHD to enhance care for those with these eating disorders.

The Association between Childhood Traumatic Experiences and Suicidality in College Students

The Association between Childhood Traumatic Experiences and Suicidality in College Students

Interaction between physical activity and problematic mobile phone use on suicidality in Chinese college students

BackgroundPrevious research has found a relationship between problematic mobile phone use (PMPU) and suicidality. However, few studies have examined the interaction effects between low physical activity (PA) and PMPU on suicidality among college students. This study aimed to examine the interactions of PA and PMPU and their impact on suicidality in a school-based sample among Chinese college students.MethodsAnalysis is based on date from two university in China, which recruited 4787 participants. Binomial logistic regression models were used to explore the associations of PA, PMPU with suicidal ideation and suicide attempt, as well as the interaction of PA and PMPU with suicidality.ResultsThe prevalence of suicide attempt and suicidal ideation were 3.5 and 7.2%, respectively. Low PA was significantly associated with suicide attempt (OR = 3.48, 95%CI: 2.52–4.81) and suicidal ideation (OR = 1.90, 95%CI: 1.46–2.46). PMPU was significantly associated with suicide attempt (OR = 3.65, 95%CI: 2.66–5.01) and suicidal ideation (OR = 2.83, 95%CI: 2.25–3.54). Interaction analysis indicated that low PA and PMPU were interactively associated with suicide attempt (OR = 9.51, 95%CI: 6.15–14.73, P < 0.001), RERI = 4.85(1.20–8.50), AP = 0.51(0.29–0.73), SI = 2.32(1.34–4.04). There was no additive interaction effects between PA and PMPU on suicidal ideation.ConclusionsThe findings reveals that the intervention programs of suicide attempt should consider the students PA levels and PMPU.

48.1 AN INTENSIVE OUTPATIENT PROGRAM FOR COLLEGE STUDENTS: COLLEGE-OPTION SERVICES FOR TEENS AT RISK AT UNIVERSITY OF PITTSBURGH MEDICAL CENTER

College Option Services for Teens at Risk (Co-STAR) is an intensive outpatient program (IOP) at Western Psychiatric Hospital at the University of Pittsburgh Medical Center that provides rapid and comprehensive assessment and treatment for depressed, anxious, and suicidal college students from local universities. It is designed for college students requiring a higher level of care than standard weekly outpatient treatment. The program meets 3 times/week and includes skills-based group psychotherapy, individual therapy, and medication management (both weekly).

Emotion Regulation and Depressive Symptoms Mediate the Association Between Schizotypal Personality Traits and Suicidality in Chinese College Students

Objective The psychological mechanisms underlying the relationship between schizotypal personality traits and suicidality are not understood. This study investigated the association of schizotypal personality traits with suicidality and explored the mediating role of cognitive appraisal and depression in the relationship between those two variables in a sample of Chinese college students. Method Participants (N = 2457) completed the Schizotypal Personality Questionnaire, the Emotional Regulation Questionnaire, the Zung Self-rating Depression Scale, and three questions related to suicidality. Results The cognitive reappraisal score was lower in the students with suicidality than the students without suicidality, whereas scores for depression and schizotypal personality traits were higher in the students with suicidality than the students without suicidality. Schizotypal personality traits and depression were risk factors for suicidality. Depression mediated the association between schizotypal personality traits and suicidality. Cognitive reappraisal negatively affected symptoms of depression and had a significant mediating effect on the association between schizotypal personality traits and suicidality. Conclusions Schizotypal personality traits and depression are risk factors for suicidality. Cognitive reappraisal and depression mediate the association between schizotypal personality traits and suicidality.

A Randomized Controlled Trial of the Collaborative Assessment and Management of Suicidality (CAMS) Versus Treatment as Usual (TAU) for Suicidal College Students

This randomized controlled trial compared the Collaborative Assessment and Management of Suicidality (CAMS) and Treatment as Usual (TAU) for suicidal college students within a feasibility trial. Sixty-two suicidal college students were randomized to CAMS (n = 33) or TAU (n = 29). We hypothesized that those receiving CAMS would show more improvement in suicide-related measures, and effects would be moderated by borderline personality disorder (BPD), prior suicide attempts, and age. Both treatment groups showed improvements in all outcome variables; CAMS had a significantly higher impact on depression and suicidal ideation when measured weekly during care and was more likely than TAU to decrease hopelessness among students with fewer BPD features, no suicide attempt history, and older age. Conversely, TAU did better for students with BPD features and history of multiple suicide attempts.

Coping and Suicide in College Students.

Background: Transitioning to college life in young adulthood can represent a challenging developmental period and college students are at heightened risk for engaging in suicidality. Aims: We aimed to investigate the roles dispositional optimism and coping strategies play in suicide risk (viz., suicidality) and suicide protection (viz., reasons for living) in college students. Method: A sample of 252 American college students were surveyed using anonymous questionnaires and hierarchical regression analyses were conducted to analyze the data. Results: Coping strategies, as a set, played an important role in both suicidality and reasons for living, after controlling for demographic factors (age and sex). When dispositional optimism was entered into the model, it was found to account for a significant amount of additional unique variance in both suicidality and reasons for living, even after accounting for coping. Limitations: It is unknown whether optimism remains meaningful in its association with suicide risk and protection beyond coping in other populations. Conclusion: Effective coping and optimism are associated with decreased suicide risk and increased suicide protection. Our findings point to the consistent role of dispositional optimism, over coping, in both suicide risk and protection.

Validation of a Chinese version of the Acquired Capability for Suicide Scale

This study aimed to revise and validate a Chinese Version of the Acquired Capability for Suicide Scale (ACSS-CV). In study 1 of 395 Chinese college students, a two-factor model comprising fearlessness about death and pain tolerance achieved satisfactory model fit. In study 2 of 491 different students, the ACSS-CV had good internal consistency, test–retest reliability, convergent validity, and discriminant validity. The ACSS-CV may be considered a useful instrument for measuring the acquired capability for suicide in Chinese college students.

A test of the interpersonal theory of suicide in college students

BackgroundThe interpersonal theory of suicide posits that perceived burdensomeness, thwarted belongingness, and acquired capability together interact to increase risk for lethal self-injury. Despite the prominence of this theoretical model, few studies have directly tested the three-way interaction central to the theory, with mixed findings reported in studies to date. The objective of this study was to test the theorized three-way interaction in relation to suicidal behaviors in a large sample of college students. MethodsUndergraduate students were recruited from two universities (N = 1,686; ages 18–29; 64.5% female). Participants completed measures of perceived burdensomeness and thwarted belongingness (Interpersonal Needs Questionnaire-25), fearlessness about death (Acquired Capability for Suicide Scale-Fearlessness About Death), and suicidal behaviors (Suicidal Behaviors Questionnaire-Revised). ResultsMultiple linear regression was used to test the three-way interaction among burdensomeness, belongingness, and fearlessness about death on suicidal behaviors. Controlling for sex and depressive symptoms, results indicated the presence of a significant three-way interaction. The interaction was probed by dichotomizing burdensomeness at high and low values. There was a significant two-way interaction at high burdensomeness such that low belongingness was only related to suicidal behavior at high levels of fearlessness about death. LimitationsThe study is cross-sectional and uses a composite measure of suicidal behaviors. ConclusionsThis study adds to a small but growing body of research testing the three-way interaction among perceived burdensomeness, thwarted belongingness, and capability for suicide in relation to suicidal behaviors. Longitudinal studies using measures that distinguish between suicidal ideation and suicide attempt within the ideation-to-action framework are needed.

The association between psychological strain and suicidal behaviors among college students: A mental health survey in Jilin Province, Northeast China

Suicide is a major global mental health problem among college students. The aim of the current study was to explore the association between the psychological strains of the strain theory of suicide and suicidal behaviors among college students. Participants comprised 1912 college students (16-28 years old, 47.2% female) from three universities in Jilin Province, China, who completed the self-report assessments of psychological strains (40 items Psychological Strains Scale) and suicidal behaviors (Suicidal Behaviors Questionnaire-Revised). The demographic characteristics included four variables: health status, psychological status, academic status and economic status. Approximately 15.0% (286/1912) of participants were classified as having suicide risk, based on the cut-off scores of the SBQ-R. The prevalence of suicidal behaviors among males and females was 11.9% (120/1009) and 18.4% (166/903), respectively. Value strain (OR = 1.075, 95%CI: 1.057-1.094), aspiration strain (OR = 1.082, 95%CI: 1.064-1.101), deprivation strain (OR = 1.073, 95%CI: 1.052-1.093), and coping strain (OR = 1.095, 95%CI: 1.075-1.116) were risk factors for suicidality in college students. Coping strain (OR = 1.050, 95%CI: 1.023-1.077) was still positively associated with suicide risk in multivariate logistic regression. Logistic regression analysis indicated that coping strain had the highest correlation with suicidal behaviors. The directionality of the relationships cannot be deduced because this study is cross-sectional. This study confirms a strong association between psychological strains and suicidal behaviors in college students. Some measures can be taken to reduce psychological strains to mitigate suicide risk among college students. More studies investigating coping strain among college students are warranted.

Predicting effects of borderline personality symptoms and self‐concept and identity disturbances on internet addiction, depression, and suicidality in college students: A prospective study

The aims of this study were to evaluate the predicting effects of borderline personality symptoms and self-concept and identity disturbances on internet addiction, significant depression, and suicidality among college students at follow-up assessments conducted 1 year later. A sample of 500 college students aged between 20 and 30 years participated in this study. Their levels of borderline personality symptoms, self-concept and identity disturbances, internet addiction, depression, and suicidality at baseline and at follow-up interviews were assessed through the Borderline Symptoms List, Self-concept and Identity Measure, Chen Internet Addiction Scale, Beck Depression Inventory-II, and questions related to suicidality from the Epidemiological version of the Kiddie Schedule for Affective Disorders and Schizophrenia, respectively. A total of 324 college students received follow-up assessments 1 year later. Among them, 15.4%, 27.5%, and 17% had internet addiction, significant depression, and suicidality, respectively. Our result revealed the severity of borderline symptoms, disturbed identity, unconsolidated identity, and lack of identity at initial assessment increased the occurrence of internet addiction, significant depression, and suicidality at follow-up assessment except for the predictive effect of unconsolidated identity on internet addiction. The results indicated that self-concept and identity and borderline symptoms may have a significant role in the risk of mental health problems in college students.

Attentional bias and the Suicide Status Form: Behavioral perseveration of written responses

Given the vast public health problem of suicide, the need for more effective assessment of suicidal risk is clear. The major approaches applied to this challenge include various direct approaches (e.g., suicide-focused interviews) and indirect approaches (e.g., implicit methodologies or “occult” assessments) that tend to assess an attentional bias for suicidal risk, the latter of which the present investigation sought to study. Using the Suicide Status Form (SSF)—the central multi-purpose tool that is used within a collaborative assessment process with suicidal patients who are engaged in the “Collaborative Assessment and Management of Suicidality” (CAMS; Jobes, 2016)—we aimed to investigate the influence of perseverative, hand-written content responses pertaining to potential suicidal risk. Specifically, we explored whether repeating certain topic content might reflect a perseverative response style; we thus compared written content results of first session SSFs taken from a sample of suicidal U.S. Army Soldiers (Study 1) and a sample of suicidal college students (Study 2). Across the two studies, patients who repeated the same content (“1-Topic Repeaters”) had significantly higher ratings related to suicidal ideation in comparison to those with more heterogeneous response styles. This replicated finding perhaps reveals a form of behavioral perseveration that is potentially related to increased suicidal risk with possible implications for successful treatment.

Multiplicative Effects of Social and Psychological Risk Factors on College Students' Suicidal Behaviors.

Less is known about the multiplicative effects of social and psychological risk and protective factors of suicidality on college campuses. The current study aimed to investigate the multiplicative effects of social (identifying oneself as gay/lesbian, financial difficulty, violence victimization, and religiosity) and psychological (anxiety, depression, problem alcohol use, drug use) and risk/protective factors on suicidal behaviors among college students in the United States. Using a cross-sectional design, the Healthy Mind Study (HMS; 2016–2017), is a national online survey of college students in the United States. Social (identifying oneself as gay/lesbian, violence victimization, financial difficulty, and religiosity) and psychological (anxiety, depression, problem alcohol use, and drug use) risk/protective factors were assessed among 27,961 individuals. Three aspects of suicidality, including ideation, plan, and attempt, were also assessed. Logistic regression models were used for data analysis. Financial difficulty, violence victimization, identifying oneself as gay/lesbian, anxiety, depression, and drug use increased, while religiosity reduced the odds of suicidal behaviors. Multiplicative effects were found between the following social and psychological risk factors: (1) financial difficulty and anxiety; (2) financial difficulty and depression; (3) depression and drug use; (4) problem alcohol use and drug use; and (5) depression and problem alcohol use. There is a considerable overlap in the social and psychological processes, such as financial stress, mood disorders, and substance use problems, on risk of suicide in college students. As social and psychological risk factors do not operate independently, comprehensive suicidal risk evaluations that simultaneously address multiple social and psychological risk factors may be superior to programs that only address a single risk factor.

Predicting Effects of Psychological Inflexibility/Experiential Avoidance and Stress Coping Strategies for Internet Addiction, Significant Depression, and Suicidality in College Students: A Prospective Study.

The aims of this study were to evaluate the predicting effects of psychological inflexibility/experiential avoidance (PI/EA) and stress coping strategies for Internet addiction, significant depression and suicidality among college students during the follow-up period of one year. A total of 500 college students participated in this study. The level of PI/EA and stress coping strategies were evaluated initially. One year later, 324 participants were invited to complete the Chen Internet Addiction Scale, Beck Depression Inventory-II and the questionnaire for suicidality to evaluate depression symptoms and internet addiction and suicidality. The predicting effects of PI/EA and stress coping strategies were examined by using logistic regression analysis controlling for the effects of gender and age. The results indicated that PI/EA at the initial assessment increased the risk of Internet addiction (OR = 1.087, 95% CI: 1.042–1.135), significant depression (OR = 1.125, 95% CI: 1.081–1.170), and suicidality (OR = 1.099, 95% CI: 1.053–1.147) at the follow-up assessment. Less effective coping at the initial assessment also increased the risk of Internet addiction (OR = 1.074, 95% CI: 1.011–1.140), significant depression (OR = 1.091, 95% CI: 1.037–1.147), and suicidality (OR = 1.074, 95% CI: 1.014–1.138) at the follow-up assessment. Problem focused and emotion-focus coping at the initial assessment was not significantly associated with the risks of Internet addiction, significant depression, and suicidality at the follow-up assessment. College students who have high PI/EA or are accustomed to using less effective stress coping strategies should be the target of prevention programs for IA (internet addiction), depression, and suicidality.

Developing Adaptive Treatment Strategies to Address Suicidal Risk in College Students: A Pilot Sequential, Multiple Assignment, Randomized Trial (SMART)

This pilot study investigated the potential to utilize adaptive treatment strategies for treating moderate to severe suicidal risk among college students. This article will describe the unique study design and report on feasibility and acceptability findings. A 2-stage Sequential Multiple Assignment Randomized Trial (SMART) was conducted: In Stage 1, 62 suicidal college students were randomized to either a suicide-focused or a treatment-as-usual condition (4–8 weeks). Those deemed insufficient responders were re-randomized to one of two Stage 2 interventions—both suicide-focused but one comprehensive and multimodal and the other flexible and theoretically agnostic (4–16 additional weeks). Recruitment rates were high, treatment dropout levels were lower than expected for the setting, study dropouts were rare, and counselors were able to deliver suicide-focused approaches with fidelity. Treatment satisfaction was high among clients and moderately high among counselors. Findings from this pilot show that a SMART is highly feasible and acceptable to suicidal college students, counselors, and campuses.

Sleep problems and suicidal behaviors in college students

Using a large sample of college students, objectives were to examine (1) the overlap between poor sleep and suicide risk status, (2) whether poor sleep was associated with suicide behaviors above and beyond depression, (3) whether sleep problems and depression interacted to predict increased suicidal behaviors or risk, and (4) which specific components of sleep were uniquely associated with suicidal behaviors. Participants were 1700 college students (ages 18-29 years; 65% female) from two universities who completed measures assessing sleep, depressive symptoms, and suicidal behaviors (Suicidal Behaviors Questionnaire–Revised [SBQ-R], a composite measure including ideation, past attempt, disclosure to others, and future likelihood of suicide that includes a cutoff for determining participants with suicide risk). Approximately one-quarter (24%) of participants were classified with suicide risk. Four-fifths (82.7%) of participants classified with suicide risk also met cutoff criteria for sleep problems; conversely, almost one-third (31.3%) of the participants classified with sleep problems were also classified with suicide risk. Total sleep problems remained significantly associated with suicidal behaviors above and beyond depressive symptoms, though sleep and depression did not interact to predict suicidal behaviors or risk. When considered together and controlling for sex, the odds of being classified with suicide risk were 6.54 times greater for participants with elevated depressive symptoms and 2.70 times greater for participants with sleep problems. Analyses examining specific sleep domains found shorter sleep duration, having bad dreams, feeling too cold while sleeping, and sleep medication use to each be independently associated with suicidal behaviors. Findings add to a growing body of literature linking sleep and suicide in college students.

Family history of suicide and high motor impulsivity distinguish suicide attempters from suicide ideators among college students

Suicide in college students has become an important public health issue in China. The aim of this study was to identify the differences between suicide attempters and suicide ideators based on a cross-sectional survey. Our results indicate that although female gender, positive screening for psychiatric illness, positive family history of suicide, elevated overall impulsivity, and elevated motor impulsivity were correlated with suicidal ideation, only positive family history of suicide and high motor impulsivity could differentiate suicide attempters from suicidal ideators. Future research with a longitudinal and prospective study design should be conducted to confirm these findings.