The Impact of Experiential Exercises on Communication and Relational Skills in a Suicide Prevention Gatekeeper-Training Program for College Resident Advisors

Abstract

Objective: In an effort to identify students at risk for suicide, many colleges are implementing suicide prevention training for campus gatekeepers. This study evaluated the efficacy of a 3-hour, experiential-based gatekeeper training that included an emphasis on enhancing communication skills and relational connection in addition to the didactic foci of standard gatekeeper training. Participants: Sixty-five college student resident advisors (RAs) were trained with Campus Connect. Methods: The training was dismantled to examine the specific contribution of experiential exercises on training outcomes. Results: Compared to didactic training alone, following participation in experiential exercises RAs’ training outcome scores exhibited additional improvement on the Suicide Intervention Response Inventory–2 and a 14-item self-report measure of self-efficacy for specific suicide- and crisis-related knowledge and skills. Conclusions: In gatekeeper training, experiential exercises emphasizing awareness and empathic responding and practice of these skills contribute to an improvement in crisis response skills above and beyond that of didactic training alone.     

Knowledge of Suicide Risk Factors,But Not Suicide Ideation Severity,Is Greater Among College Students Who Viewed 13 Reasons Why

Abstract

Objective: To test associations between viewing 13 Reasons Why, Season 1 and past week suicide ideation severity, behavior risk, stigma, and knowledge in college students. To explore whether personal exposure to suicide and depressive symptom severity moderated these associations. Participants: Eight-hundred and eighteen college students, 64% (n?=?522) of whom watched 13 Reasons Why. Methods: Students completed surveys online. Multivariate negative binomial regressions were used to test associations between watching 13 Reasons Why and suicide-related variables, and interaction terms. Results: Suicide ideation severity and suicide behavior risk were not significantly associated with viewing 13 Reasons Why; however, there was limited statistical power to detect associations. The association between watching 13 Reasons Why and greater suicide knowledge was stronger among those who did not have personal exposure to suicide. Conclusions: 13 Reasons Why may be a platform for psychoeducation on suicide, particularly among those who do not have personal exposure.     

Suicide prevention on college campuses: What works and what are the existing gaps? A systematic review and meta-analysis

Abstract

Objective: To examine the effects of universal and targeted suicide prevention programs on relevant outcomes in college campuses. Methods: College suicide prevention programs published from 2009 to 2018 were assessed on outcomes including knowledge, skills, self-efficacy, suicidal ideation, and suicidal behaviors. Effects of the interventions on outcome variables with sufficient studies to warrant meta-analysis (ie, knowledge, skills, and self-efficacy) were meta-analyzed. Studies reporting on the remaining outcomes (ie, suicidal ideation and behaviors) were systematically reviewed. Results: Significant increases in suicide prevention knowledge, skills, and self-efficacy were observed in universal prevention interventions that typically employed gatekeeper prevention strategies. Evidence of reductions in suicidal ideation and behaviors was observed across targeted suicide prevention programs for at-risk students. Conclusion: Prevention programs are beneficial for training those likely to come in contact with people endorsing suicidality, but further research is needed to show that suicide interventions can consistently have significant effects on suicidal students as well.     

Parent–Child Conflict and Suicide Rumination in College Students: The Mediating Roles of Depressive Symptoms and Anxiety Sensitivity

Abstract

Objective: Parent–child conflict, depressive symptoms, and anxiety sensitivity have each been identified as risk factors for suicide ideation in college students. This study examined the relations among these risk factors and suicide rumination utilizing transition theory to guide the hypothesized relations. Participants: Undergraduate college students participated in this study in the spring of 2012 (January to May). Methods: Participants completed self-report measures of parent–child conflict, depressive symptoms, anxiety sensitivity, and suicide rumination, among other measures. Hypothesized pathways and mediation were tested using path analysis. Results: Suicide rumination was positively and uniquely predicted by depressive symptoms, anxiety sensitivity, and parent–child conflict. The relation between parent–child conflict and suicide rumination was, in part, accounted for by depressive symptoms and anxiety sensitivity. Conclusions: Results suggest that it would be advisable for clinicians to assess for students’ conflicts with their parents in conjunction with their levels of depression and anxiety when assessing for suicide risk.     

Suicide Ideation Among US College Students Associations With Other Injury Risk Behaviors

Abstract

Suicide, the endpoint of a continuum that begins with suicide ideation, is the third leading cause of death among the US college-aged population. The first and second leading causes of death among this age group, unintentional injury and homicide, may also be linked to suicide ideation. We used data from the National College Health Risk Behavior Survey to examine the association between suicide ideation and injury-related behaviors among 18- to 24-year-old college students. Students who reported suicide ideation were significantly more likely than students who did not report considering suicide to carry a weapon, engage in a physical fight, boat or swim after drinking alcohol, ride with a driver who had been drinking alcohol, drive after drinking alcohol, and rarely or never used seat belts. Given this clustering of injury-related risk behaviors, college prevention programs should aim to reduce risks for injuries comprehensively, rather than addressing each risk behavior separately.     

The indirect effect of perceived burdensomeness on the relationship between indices of social support and suicide ideation in college students

Objective: Research has demonstrated that a lack of social support is related to suicide risk. This study examines perceived burdensomeness and thwarted belongingness, of the Interpersonal Theory of Suicide, as mechanisms of the social support–suicide relationship in college students. Method: The study consisted of 207 students from a Midwestern university. Data were collected from 2007 to 2008. Two multiple mediation analyses were conducted to examine whether perceived burdensomeness and thwarted belongingness mediated the relationship between indices of social support and suicide ideation. Results: Perceived burdensomeness mediated the relationships between perceived social support and suicide ideation (95% confidence interval [CI] ?.02 to ?.00, effect size = ?.01) and social connectedness and suicide ideation (95% CI ?.03 to ?.00, effect size = ?.03). Thwarted belongingness did not mediate either relationship. Conclusions: Results suggest that a lack of social support could lead to perceptions of being a burden on others, which could lead to suicide ideation.     

Evaluation of an avatar-based training program to promote suicide prevention awareness in a college setting

Objective: Training programs exist that prepare college students, faculty, and staff to identify and support students potentially at risk for suicide. Kognito is an online program that trains users through simulated interactions with virtual humans. This study evaluated Kognito's effectiveness in preparing users to intervene with at-risk students. Participants: Training was completed by 2,727 university students, faculty, and staff from April, 2014 through September, 2015. Methods: Voluntary and mandatory participants at a land-grant university completed Kognito modules designed for higher education, along with pre- and post-assessments. Results: All modules produced significant gains in reported Preparedness, Likelihood, and Self-Efficacy in intervening with troubled students. Despite initial disparities in reported abilities, after training participants reported being similarly capable of assisting at-risk students, including LGBTQ and veteran students. Conclusions: Kognito training appears to be effective, on a large scale, in educating users to act in a facilitative role for at-risk college students.     

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

Abstract

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.     

Young Adult Suicide and Sexual Orientation

ABSTRACT

The current project focused on the suicidal ideation and risk potential of young adults (N = 312) and explored scores on self-report measures of suicidal ideation inclusive of various sexual orientations. Results suggest that the Lesbian, Gay, and Bisexual (LGB) youth surveyed (N = 73) differ in their display of suicide risk with significantly higher Beck Hopelessness Scale (BHS) and Suicide Probability Scale (SPS) scores. Social support served as a mitigating factor relating significantly to lower levels of hopelessness and suicidal ideation, especially among those LGB participants. The SPS held a significant relationship to suicide attempt in the past year, while the BHS held a significant relationship to suicide attempt in the past six months. Implications for counselors serving young adults are addressed, including specific suggestions to enhance counselor education and supervision related to suicide assessment and LGB counselor competency.     

Positive Social Support,Negative Social Exchanges,and Suicidal Behavior in College Students

Abstract

Objective: Risk for suicide is often higher among college students, compared to same-age noncollegiate peers, and may be exacerbated by quality of social support and interactions. The authors examined the independent contributions of positive social support and negative social exchanges to suicide ideation and attempts in college students. Participants: Participants were 439 volunteer undergraduate students, who were primarily female (71%). Methods: Cross-sectional, survey design. Participants completed measures assessing positive social support, including emotional, informational, and tangible support; negative social exchanges; and suicidal behavior, including ideation and attempts. Results: Positive social support, particularly tangible support, and negative social exchanges were significantly predictive of greater suicidal behavior. Conclusions: Practical manifestations of support may buffer against suicide risk for college students, whereas conflict-based interactions may contribute to increased risk. At the institutional, parental, and peer levels, promotion of supportive relationships may be an important suicide prevention strategy.     

Implementing an Early Intervention Program for Residential Students Who Present With Suicide Risk: A Case Study

Abstract

Objective: This case study examined the effects of an early intervention program designed to respond to residential college students demonstrating risk for suicide. Participants: Participants were 108 undergraduates at a large northeastern public university referred to an early intervention program subsequent to presenting with risk factors for suicide between Fall 2004 and Spring 2011. Methods: Data were collected from archival records to examine quality of early intervention services, student retention, and grade point average (GPA) during the semesters prior to, during, and subsequent to the referral incident. Results: Program implementation was timely and responsive to student needs; students successfully completing the early intervention program remained in school and demonstrated small but significant rebounds in GPA the semester subsequent to the incident. Conclusions: There are benefits associated with the implementation of early intervention programs designed to respond to students manifesting risk for suicide, such as connecting the student to vital services and support networks.     

Crisis on campus: Eating disorder intervention from a developmental-ecological perspective

ABSTRACT

Objective: The purpose of this article is to review a crisis intervention using the developmental-ecological protocol (Collins and Collins, 2005) with a college student presenting with symptomatology of an active eating disorder. Participants: Participants included University Wellness Center employees responding to the crisis. Methods: Methods include an informal review of the crisis intervention response and application of the ABCDE developmental-ecological crisis model. Results: Results reported include insight into crisis intervention when university counseling and health center is not available as resources. Conclusions: ABCDE Developmental-ecological model recommendations for university faculty and staff are included.     

Factors associated with emotional distress and suicide ideation among international college students

Abstract

Objective: To identify risk and protective factors associated with greater emotional distress and suicide ideation among international college students. Participants: International students (n?=?435) from two Midwestern and two Southeastern universities in the US. Methods: Online surveys were administered that measured emotional distress, past-year suicide ideation, entrapment, cultural stress, family conflict, perfectionism, ethnic discrimination, interpersonal needs, ethnic identity, and cultural sanctions against suicide. Results: In final linear regression analyses, higher levels of entrapment, unmet interpersonal needs, and ethnic discrimination were significantly associated with increased emotional distress. Only unmet interpersonal needs remained significantly associated with greater past-year suicide ideation in a multivariate regression analysis. Conclusions: Clinicians working with international students and prevention programmers targeting this population should address students’ perceptions of entrapment, ethnic discrimination, and especially unmet interpersonal needs in efforts to decrease or prevent students’ feelings of emotional distress and suicide ideation.     

Perceived need for care and mental health service utilization among college students with suicidal ideation

ABSTRACT

Objective: This study aimed to identify correlates of service utilization and perceived need for care among college students with suicidal ideation. Participants: Respondents were recruited from introductory psychology courses at an undergraduate college during the Fall 2014 semester. Methods: Independent correlates of (1) mental health service utilization, (2) self-perceived need, and (3) other-perceived need for mental health services among college students (N = 190) with suicidal ideation were identified. Results: Service utilization was associated with need for care as perceived by others. Perceived need for care by others was associated with suicidal ideation intensity and suicide attempt history. Perceived need by the respondents themselves was correlated with depression severity, sex, and race but was not independently associated with actual service utilization. Conclusions: Perceived need by others was the sole significant correlate of service utilization, suggesting it is an important target for public health interventions aimed at facilitating pathways into mental health treatment.     

Breaking the silence: parentally suicide-bereaved youths’ self-disclosure on the internet and the social responses of others related to stigma

‘Suicide stigma’ contributes to the silencing of parental suicide within family and social networks. This article departs from a narrative theoretical framework on grief and identity to analyse suicide-bereaved youths ‘breaking the silence’ through self-disclosure in self-initiated chat threads on the Internet, which is their way of actively seeking social support, telling of their experiences and opening up space for a renegotiation of the meanings around suicide. The article investigates which narrative frameworks for the interpretation of suicide are operating in these contexts, and whether and, if so, how stigma is reproduced or counteracted. Two frameworks are identified: ‘Who is to blame for suicide?’; and ‘What caused the suicide?’. The former is utilized by the newly bereaved chat-initiators, who attribute blame for suicide to the parent and/or themselves in accordance with stigmatizing discourses. These are reproduced in the responses first and foremost of the non-suicide-bereaved, who construct a dichotomy between the deceased parent as ‘perpetrator’ and the child as ‘victim’ in order to relieve blame. A lack of contact with other suicide-bereaved youths can reinforce feelings of otherness. Identities, however, can potentially be de-stigmatized by the meanings drawn from the latter framework.     

Suicide Ideation Among College Students Evidencing Subclinical Depression

Abstract

Identifying elevated suicide ideation in college students is a critical step in preventing suicide attempts and deaths by suicide on college campuses. Although suicide ideation may be most prominent in students with severe depression, this should not suggest that only students with severe depression experience significant risk factors for suicide. Objective: The purpose of these 3 studies was to explore the relation between suicide ideation and severity of depressive symptoms in college students. Participants: In each study a sample of college students were recruited for participation. Methods: Participants completed self-report assessments of depressive symptoms and suicide ideation. Results: The results of these studies suggest that although the greatest elevation in suicide ideation occurs at the highest depressive symptoms, significant suicide ideation is also experienced by college students with mild and moderate depressive symptoms. Conclusions: The implications of these findings for the assessment of suicide ideation are discussed.     

The intersection of nonsuicidal self-injury and suicide-related behavior: Patterns of elevated risk and implications for college mental health

Objective: To analyze the overlap of nonsuicidal self-injury (NSSI) and suicide-related behaviors (SRB) among college students with regard to demographics, mental health, and coping styles. Participants: Respondents were 572 undergraduate students at a southwestern public university. Methods: Data were collected in 2015. Respondents completed a demographic survey and assessments of NSSI, SRB, internalizing symptoms (ie, anxiety, stress, and depression), aggression, and negative coping strategies. The survey was administered via a Web-based procedure. Results: Women reported more frequent cutting behaviors than men. Endorsement of NSSI was also associated with an increased likelihood of lifetime SRB. A subgroup of students endorsing both NSSI and SRB demonstrated poorer mental health, more negative coping, and self-reported female sex. Conclusions: College healthcare providers may benefit from competency-based training in techniques for the combination treatment of NSSI and SRB, as well as culturally based models of suicide.     

Self-compassion and suicidal behavior in college students: Serial indirect effects via depression and wellness behaviors

Objective: College students may be at heightened risk for suicide and suicidal behavior due to maladaptive cognitive-emotional factors and failure to practice basic health behaviors. However, self-compassion and wellness behaviors may protect against risk. The relation between self-compassion and suicidal behavior and the contributing roles of depressive symptoms and wellness behaviors was examined. Participants: Participants were 365 undergraduate students. Data were collected in April 2015. Methods: A cross-sectional, survey design was employed. Participants completed measures assessing self-compassion, depressive symptoms, wellness behaviors, and suicidal behavior. Serial mediation analyses were conducted covarying age, sex, and ethnicity. Results: Self-compassion was inversely related to suicidal behavior, and this relationship was serially mediated by depressive symptoms and wellness behaviors. Conclusions: Self-compassion may protect against suicidal behavior, in part, due to reduced depressive symptoms and heightened engagement in wellness behaviors. Individual and campus-wide strategies promoting self-compassion and wellness behaviors may reduce suicide risk on college campuses.     

Reducing Firearm-Related Violence on College Campuses—Police Chiefs' Perceptions and Practices

Abstract

Context: Firearms are used in the majority of college aged suicides and homicides. With recent efforts by various gun lobbying groups to have firearms more accessible to college students on campuses, there is the potential for more firearm-related morbidity and mortality. Objective: This study assessed university police chiefs’ perceptions and practices concerning selected issues of firearm violence and its reduction on college campuses. Participants: The Directory of the International Association for College Law Enforcement Administrators was used to identify a national random sample of campus police chiefs (n = 600). The respondents were predominantly males (89%), 40 to 59 years of age (71%), Caucasian (85%), and worked for 21or more years in law enforcement (75%). Methods: In the fall of 2008, a 2-wave mailing procedure was used to ensure an adequate response rate to a valid and reliable questionnaire. Results: A total of 417 (70%) questionnaires were returned. A firearm incident had occurred in the past year on 25% of campuses and on 35% of campuses within the past 5 years. The majority of campuses (57%) had a plan in place for longer than a year to deal with an “active shooter” on campus. Virtually all (97%) of the campuses had a policy in place that prohibited firearms on campus. The primary barrier (46%) to a highly visible campus plan for preventing firearms violence was the perception that firearms violence was not a problem on their campus. Conclusions: A greater awareness of the importance of a highly visible campus firearm policy and its potential for reducing firearm trauma on college campuses is needed.