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.     

Spiritual Well-Being and Suicidal Ideation Among College Students

Objective: This study explored whether specific dimensions of spiritual well-being (religious well-being and existential well-being) relate to reduced suicidal ideation, and whether associations persisted after controlling for religiosity and psychosocial variables associated with suicide. Participants: Participants were 457 college students who completed measures that assessed spiritual well-being, religiosity, hopelessness, depression, social support, and suicidal ideation. Methods: The authors used linear regression modeling to assess religious and spiritual correlates of suicidal ideation. Results: After controlling for demographic variables and psychosocial factors, neither involvement in organized religion nor religious well-being significantly contributed to suicidal ideation. However, even after controlling for significant correlates, existential well-being remained a significant predictor of suicidal ideation. Conclusions: This investigation highlighted existential well-being as an important factor associated with lower levels of suicidal ideation among college students. Findings from this study focusing on the association between spiritual well-being and suicidality may prove especially beneficial to suicide prevention efforts.     

Childhood trauma and risk for suicidal distress in justice-involved children

Justice-involved children (JIC) have higher rates of trauma exposure and suicidality than the general population. The Childhood Trauma Model predicts that children can accumulate multiple traumatic experiences that can be more harmful than a single traumatic event. The purpose of this study is to investigate the individual and cumulative effects of childhood trauma on suicidal distress among JIC. The study employs logistic regression to analyze panel data on 2367 12–16 year-olds from the Florida Department of Juvenile Justice (FLDJJ). The study shows that 9 types of individual traumatic experiences increased risk for suicidal ideation from 22 to 180%. For one unit increase in the trauma score, the risk for suicidal distress increased 25%, so that JIC who experienced 5 types of traumas were 2.4 times more likely to experience suicidal distress as JIC who experienced a single trauma. These findings illustrate the need to invest mental health services and suicide prevention resources in populations in the juvenile justice system. Intervention must be tailored to serve children who suffered specific traumatic events, as well as those who experience multiple types of trauma. Further, policies that manage JIC as kid criminals rather than as traumatized children may exacerbate their suicidality and problematic behavior.     

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.     

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.     

Suicidal Ideation and Comorbid Disorders in Adolescents and Young Adults Diagnosed with Asperger's Syndrome: A Population at Risk

ABSTRACT

The purpose of this study was to examine the level of suicidal ideation and comorbid disorders (major depressive disorder, generalized anxiety disorder) among adolescents and young adults with diagnosed Asperger's syndrome (AS). A cross-sectional study using a self-administrated mail questionnaire and a Web-based questionnaire were used. Two samples were selected for this study. The first sample used snowball sampling, starting with parents of adolescents and young adults with diagnosed AS who participated in a qualitative study conducted in 2002. The second sample consisted of a volunteer sample of parents who visited Web sites for parents and individuals with diagnosed autism spectrum disorder. The sample included 10 adolescents and young adults with diagnosed AS. Fifty percent of the sample had a clinically significant level of suicidal ideation, 20% met criteria for a diagnosis of major depressive disorder, and 30% met criteria for generalized anxiety disorder.     

An Evidence-Based Approach to Managing Suicidal Behavior in Patients with BPD

SUMMARY

This review will suggest an evidence-based approach to managing suicidal patients with borderline personality disorder (BPD). Many principles currently used in practice have little basis in empirical data. And some approaches used to manage chronic suicidality, particularly the emphasis on “safety,” may actually be counter-productive.     

Suicidal Thoughts/Behaviors in Sexually Abused Children

This study examined the frequency of suicidality based on self-report and parent report in 430 sexually abused outpatient youth ages 3 to 17. Thirty-four percent of youth experienced suicidal ideation or behavior. However, when both parent and child completed measures, the rate of suicidality increased to 45.3%. The prevalence of suicidal thoughts and behavior was not higher based on relationship to the perpetrator, race, or previous placement outside the home. Suicidal youth rated themselves as more depressed, anxious, and angry on self-reports. Child self-reports of post-traumatic stress disorder were greater among the suicidal youth. Parent reports of depression and post-traumatic stress disorder were greater among suicidal youth. A logistic regression model including Trauma Symptom Checklist for Children Depression and Anger scores correctly classified 74.2% of suicidal and nonsuicidal children and adolescents, but not self-criticism, was predicted by depression and anger. These findings support the need for formal multi-informant evaluations of suicidality in sexually abused youth.     

Suicidality among homeless people: Testing the mediating effects of self-efficacy and depression

ABSTRACT

This cross-sectional study examined the mediating effect of PTSD on suicide ideation and suicide attempt through two mediators, self-efficacy and depression, among homeless adults. We recruited a non-random, purposive sample of 156 homeless adults from seven homeless people shelters in Kansas. SEM results suggest that self-efficacy and depression were significant mediators between PTSD and suicide ideation, but not between PTSD and suicide attempt. This study’s findings can be used to identify risk factors associated with suicidal behaviors that can be used to design service programs aimed at preventing suicidal ideation and attempt among people who are homeless.     

Exposure to Community Violence,Suicidality, and Psychological Distress Among African American and Latino Youths: Findings From the CDC Youth Violence Survey

The present investigation explored risk and protective factors for suicidal ideation and behavior in a sub-sample of African American and Latino adolescents (n = 2,626) who participated in the 2004 Centers for Disease Control Youth Violence Survey. Structural equation modeling was used to explore exposure to violence at the community level as a contextual factor that could potentially influence depressive symptomatology, substance abuse, parental support, social support, and suicidality among study participants. Findings indicated that exposure to violence at the community level was not directly related to suicidality among this population of urban adolescents. However, it was directly related with several other variables under study in the model, which in turn were directly related with suicidality. Tests of invariance revealed several across-group differences, particularly by race and gender, in how the identified risk and protective factors in the model related to suicidality. Implications for research and practice with urban, ethnic minority, adolescent populations are discussed.     

An mHealth Approach to Extend a Brief Intervention for Adolescent Alcohol Use and Suicidal Behavior: Qualitative Analyses of Adolescent and Parent Feedback

Abstract

Mobile health (mHealth) tools that supplement inpatient psychiatric care can maintain and enhance intervention effects following hospitalization. Adolescents hospitalized following a suicidal event represent a vulnerable population who could greatly benefit from such an mHealth intervention. In specific, suicidal adolescents who drink alcohol are in need of robust interventions that address the bidirectional relationship between alcohol use and suicidal thoughts and behaviors, because it puts them at especially high risk for suicide upon discharge. The purpose of this study was to conduct qualitative interviews to gather feedback to improve a brief alcohol intervention provided to suicidal adolescents during psychiatric hospitalization, and to develop a mHealth tool to extend care after discharge. Participants, eight adolescents and their parents, identified the need for a smartphone application to deliver intervention content to adolescents and parents during the posthospitalization period. Adolescents sought support in meeting alcohol- and mood-related goals, while parents desired general resources as well as tips for conversations with their adolescent about mood and alcohol use.     

A Survey of Wellness/Healthy Lifestyling on College and University Campuses

Abstract

Mental health providers at university counseling and health centers should be alert to the possibility that college students with previously unrecognized attention deficit hyperactivity disorder (ADHD) may present for initial evaluation at their centers. This study was a systematic chart review of 42 students at an Upper Midwest university who were diagnosed with ADHD during calendar year 1993. Diagnoses were made by the treating psychiatrist, who reviewed records for presenting problems; recent associated problems; previous evaluations as a child, adolescent, or adult; and associated problems in childhood. Presenting problems included ADHD symptoms, mood symptoms, nonspecific learning disability, and academic underachievement. Associated problems were depressive disorders, anxiety disorders, drug and alcohol abuse or both, dependency, legal problems, learning disabilities, and eating disorders. Thirty-three percent had been evaluated for academic or behavior problems as children, and 36% had sought previous psychological care for non-ADHD symptoms as adults. Thirty-one percent were presenting at the university health center for their first evaluation. Childhood histories showed educational underachievement, learning disabilities, and behavior problems.     

The relationship between childhood abuse and suicidality in adult bipolar disorder

This study evaluates the effect of childhood sexual and physical abuse on suicidality in adults with bipolar disorder. We conducted a retrospective chart review of adult outpatients (N= 381) with DSM-IV-TR-defined bipolar disorder seeking evaluation and treatment at an academic specialty research program (i.e., Mood Disorders Pharmacology Unit, University Health Network, University of Toronto) between October 2002 and November 2005. Eighteen percent (n = 68) of adult patients with bipolar disorder had a recorded history of childhood abuse (p = 0.009). Sixty-three percent (n = 43) of bipolar patients with a history of childhood abuse reported lifetime suicidality (chi2 = 6.885, df= 1, p = 0.009). Logistic regression analysis indicated that Childhood abuse was a significant predictor of lifetime suicidality in adult bipolar patients (OR = 2.05, CI = 1.19-3.510). Childhood abuse is associated with suicidal ideation and suicide attempts in adults with bipolar disorder. Anamnestic inquiry regarding childhood maltreatment is salient to risk assessment, illness management planning, preventative strategies, and treatment interventions in bipolar disorder.     

Health attitudes and suicidal ideation among university students

ABSTRACT

Objective: The purpose of this study was to examine whether positive health attitudes are associated with suicidal ideation among university students after accounting for other health risk factors linked to suicidal ideation. Participants: Participants were 690 undergraduates from a large midwestern university during fall semester 2011. Methods: Participants reported demographics and health characteristics. Regression models compared individuals who reported suicidal ideation and those who did not. Results: In unadjusted models, suicidal ideation was significantly negatively associated with positive health attitudes, and positively associated with depression, drug use problems, sleep problems, and being overweight. In adjusted models, more positive health attitudes continued to be significantly negatively associated with suicidal ideation. Conclusions: This study suggests a link between positive health attitudes and lower probability of suicidal ideation. Additional research is needed to assess enhancing general health attitudes as a suicide prevention effort.     

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.     

Prevalence and predictors of suicidal ideation,plan, and attempts,in first-year college students with ADHD

Abstract

Objective. The present study evaluated the prevalence of past suicidal ideation (SI), plan, and attempt in college students with ADHD (N?=?102) compared to a matched control (N?=?102). Predictors of SI, plan, and attempts, were examined. Participants. Study participants were first year college students at a large Southeastern university who completed measures during August or September of 2014 or January of 2015. Methods. Measures were completed by first year students via an online survey. Results. Prevalence rates for SI and related behaviors were higher among the ADHD group than the matched control, with suicide attempts rates four times higher in the ADHD group (13.7% vs. 2.9%). Results showed that ADHD predicted rates of SI and suicide attempt accounting for depression and key demographic variables. Conclusions. Findings have implications for suicide risk assessments conducted with college students with ADHD.     

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.     

The effects of familial acculturative stress and hopelessness on suicidal ideation by immigration status among college students

Objectives: Based on acculturative family distancing theory, we examined whether familial acculturative stress interacted with hopelessness to predict suicidal ideation differentially among emerging adult immigrant versus nonimmigrant college students. Participants: We recruited 152 generationally and racially/ethnically diverse college students (42 immigrants) from 2012 to 2013. Methods: Participants completed measures of hopelessness, depressive symptoms, ethnic identity, familial acculturative stress, and suicidal ideation. Results: Immigrant status interacted with hopelessness and familial acculturative stress. Hopelessness was associated with less suicidal ideation among immigrants than among nonimmigrants at a familial acculturative stress score below the 11th percentile, but greater suicidal ideation among immigrants than among nonimmigrants at a familial acculturative stress score above the 72nd percentile. Conclusions: Familial acculturative stress may exacerbate the effect of hopelessness on suicidal ideation among immigrant college students, and should be monitored during suicide risk assessment and treatment.     

Gambling disorder and suicidality within the UK: an analysis investigating mental health and gambling severity as risk factors to suicidality

Greater severities of gambling behaviour and poorer mental health have been identified in the literature as risk factors for suicidality within gambling disorder (GD) populations. This is the first known study within the UK to use empirical data, taken from a UK treatment clinic for GD (National Problem Gambling Clinic, UK) to explore the associations between current suicidality (thoughts and plans) and measures assessing gambling severity and mental health. Self-report data from 122 participants were collected during the intake process at the clinic through a variety of methods including the use of questionnaires and a standardized 90-minute interview with a psychologist. Reported suicidality was high (current suicidal thoughts [28.7%] and plans [6.6%]), yet only one measure of gambling severity (estimated total losses) was found to be inversely associated with suicidality. Indices of poorer mental health were found to have a greater association with suicidality than measures of gambling severity, and a logistic regression analysis identified depressive symptomology and a history of psychiatric disorder in the participants’ family as significant factors associated with suicidality. Overall, within GD populations, factors associated with poorer mental health rather than gambling severity are seemingly a greater risk factor in patients with suicidality.     

Risk for Preadolescent Suicidal Behavior: An Ecological Model

The relationship between preadolescent suicidality (ideation, threats, attempts) and subsequent adolescent suicidal behavior is well documented. We tested a six domain, ecological suicide risk model in a sample of 69 preadolescent outpatients (ages 5 to 12 years). We correlated items from each domain with Suicidality as measured by the Pfeffer Spectrum of Suicide Potential Scale. Three domains (Child Risk Factors, Childhood Traumas, Family Stressors) had a total of 19 items that were significantly correlated with Suicidality (alpha < .05 level); one item in the fourth dimension, Social Supports, was included (alpha = .06). We show that children who demonstrate anxiety/depression, aggressive and antisocial behavior in a climate of parental hostility are at risk for suicidal behavior.