College Student Suicide in the United States: 1990-1991 Through 2003-2004

Suggestions that there is a growing epidemic of suicide among college students in the United States are false. The National Survey of Counseling Center Directors reports 1,404 student suicides over a 14-year period and an adjusted suicide rate of 6.5, half the rate of the general US population (12.6 for all races) during this period when matched for gender and age. Counseling centers appear effective in treating suicidal students, for although the suicide rate for students who were currently or previously clients at campus counseling centers is 3 times the rate of other students, student clients have 18 times the risk of suicide compared to students in general. Identifying and referring students at elevated risk for suicide could further reduce the crude and relative rate of student suicide. However, even programs that do this only moderately well may require substantial increases in counseling staffing.     

Four eras of study of college student suicide in the United States: 1920-2004

Studies of college student suicide can be grouped into the following 4 eras: 1920-1960, 1960-1980, 1980-1990, and 1990-2004. The suicide rate for students has declined monotonically across these 4 eras, from 13.4 to 8.0 to 7.5 and, most recently, to 6.5. The decreasing proportion of men in the student populations studied largely accounts for this decline. Since 1960, the suicide rate for students has consistently been about half the rate of the general US population, matched for age and gender. This highly favorable relative suicide rate is the result of firearms having been effectively banned from campuses. Additional population-oriented approaches warrant implementation to further reduce student-suicide rates. Approaches focused on high-risk groups also hold promise. These findings are based upon and may be most valid for the 70% of all students who attend 4-year colleges and universities full time.     

College Counselors’ Perceptions and Practices Regarding Anticipatory Guidance on Firearms

Abstract

Objectives: This study assessed college counselors’ anticipatory guidance on firearms for student clients. Participants: The membership of the Association for University and College Counseling Center Directors was used to identify a national random sample of counseling centers (n = 361). One counselor from each center was selected to survey. Methods: In the winter of 2008, a 3-wave mailing procedure was used to maximize the response rate. Completed surveys served as consent (as approved by the University Human Subjects Committee). Results: A total of 213 counselors (59%) responded. They were unlikely to provide anticipatory guidance (6%), chart/keep records on client ownership/access to firearms (17%), or to counsel the majority of clients from various diagnostic categories on firearms. Conclusions: University personnel are likely to refer students with suspected mental health problems to university counseling centers. The findings indicate that few counseling centers will address firearm issues with students.     

Are college students more disturbed today? Stability in the acuity and qualitative character of psychopathology of college counseling center clients: 1992-1993 through 2001-2002

Are clients at college counseling centers more disturbed today than they were 5, 10, or 20 years ago? Since the mid-1980s, counseling center personnel have consistently perceived student clients as more distressed or reported acutely distressed clients as more prevalent than they did 1, 3, or 5 years ago. Only 3 studies employing a systematic, data-based methodology have addressed this question. Two researchers used different actuarial measures of the acuity or character of client pathology and concluded that current student clients are not more disturbed than were earlier ones. One researcher used clinical judgments rendered at the end of therapy and concluded that current students were more distressed. Using the Personality Assessment Inventory, the author found the actuarially determined quantitative and qualitative indices of pathology unchanged for 3,400 counseling center clients seen during 10 consecutive years. Over the same period, the use of medications increased fivefold. An actuarial measure of client distress appears crucial to both accurate diagnosis and treatment and to the adequate preparation of future counseling center professionals.     

Are College Students More Disturbed Today? Stability in the Acuity and Qualitative Character of Psychopathology of College Counseling Center Clients: 1992-1993 Through 2001-2002

Are clients at college counseling centers more disturbed today than they were 5, 10, or 20 years ago? Since the mid-1980s, counseling center personnel have consistently perceived student clients as more distressed or reported acutely distressed clients as more prevalent than they did 1, 3, or 5 years ago. Only 3 studies employing a systematic, data-based methodology have addressed this question. Two researchers used different actuarial measures of the acuity or character of client pathology and concluded that current student clients are not more disturbed than were earlier ones. One researcher used clinical judgments rendered at the end of therapy and concluded that current students were more distressed. Using the Personality Assessment Inventory, the author found the actuarially determined quantitative and qualitative indices of pathology unchanged for 3,400 counseling center clients seen during 10 consecutive years. Over the same period, the use of medications increased fivefold. An actuarial measure of client distress appears crucial to both accurate diagnosis and treatment and to the adequate preparation of future counseling center professionals.     

The Impact of Student Loan Debt and Student Loan Delinquency on Total,Sex‐, and Age‐specific Suicide Rates during the Great Recession

In 2012, the outstanding student loan balance in the United States surpassed $1 trillion, and between 2005 and 2012, the student loan delinquency rate increased by 77 percent. Simultaneously, by the end of the 2005–2012 time period, the total suicide rate in the United States reached the highest levels in more than a decade. To investigate the recent trends in student loans and suicide, this paper examined the association between state‐level student loan debt, student loan delinquency, and total, age‐, and sex‐specific suicide rates. The study used a hybrid (decompositional) longitudinal regression approach to examine the relationship between student loan debt, delinquency, and suicide rates during the 2005–2012 time period. The results showed student loan delinquency had a positive and significant effect on several of the suicide rates examined within states but had no effect on suicide rates between states net of controls. The results also showed student loan debt had a significant and negative association with suicide for people ages 20–24 and 25–34.     

Student assistance program: a new approach for student success in addressing behavioral health and life events

College health centers, whether large or small, often find it challenging to provide counseling and supportive services for all students (including remotely located students) 24 hours a day, 7 days a week. Student assistance programs (SAPs) are services provided to students through a contractual arrangement to the university or college as a part of student services. The goal is to address psychosocial concerns that may interfere with academic performance within the realm of short-term counseling. These services range from traditional behavioral health concerns about stress and depressive reactions to how to find child care with foreign-speaking services. In this article, the authors describe a method to provide such short-term counseling to a 2,200-student health-science campus. They present data from 1 year of service as well as the benefits and limitations.     

Student Assistance Program: A New Approach for Student Success in Addressing Behavioral Health and Life Events

College health centers, whether large or small, often find it challenging to provide counseling and supportive services for all students (including remotely located students) 24 hours a day, 7 days a week. Student assistance programs (SAPs) are services provided to students through a contractual arrangement to the university or college as a part of student services. The goal is to address psychosocial concerns that may interfere with academic performance within the realm of short-term counseling. These services range from traditional behavioral health concerns about stress and depressive reactions to how to find child care with foreign-speaking services. In this article, the authors describe a method to provide such short-term counseling to a 2,200-student health-science campus. They present data from 1 year of service as well as the benefits and limitations.     

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.     

“I Have No More to Write”: Writing as Trigger and Treatment for Suicidal Students

How can a concerned teacher spot suicidal tendencies in a student—before it is too late? I found a dramatic increase in a student’s output when the student wrote about tragic works by the poet Oscar Wilde, and found that certain themes and symbols were both linked to and distinct from their counterparts in the works of verbal art. I propose a noninvasive, sustainable set of guidelines that might be used to detect students at risk and interventions that I believe to be not only good suicide prevention, but also sound pedagogy.     

Book Review

The prevalence of suicide suggests social workers will encounter clients at risk for suicide, but research shows social workers receive little to no training on suicide and suicide prevention and feel unprepared to work effectively with clients at risk. Baseline results from a randomized intervention study of the Question, Persuade, and Refer suicide prevention gatekeeper training with 73 advanced master’s of social work student interns show suicide knowledge was average, attitudes about suicide prevention were generally neutral, and use of suicide prevention practice skills was low. These results indicate an opportunity for enhancing student outcomes through training and inform social work education regarding necessary preparation for student interns and new graduates to identify and respond effectively to client suicide risk.     

Assessing the risk factors for suicidal thoughts at a nontraditional commuter school

The sample of students completing the National College Health Assessment (NCHA) Survey at the University of Utah differs from the national reference group for the NCHA 2003 in age, employment, residence, and marital status. The purpose of this study is to determine if the defining characteristics of a commuter school increase the risk for suicidal thoughts. During the fall semester of 2004, the University of Utah implemented a randomized electronic survey assessing the student body's health status in several areas. The authors compared 88 respondents who endorsed seriously considered suicide in the previous 12 months were with the remaining 954 respondents to identify discriminating variables. Those students who seriously considered suicide more likely lived off campus, indicated they were emotionally abused, were in only fair health, experienced being assaulted, experienced unwanted sexual touching, or were not heterosexual. Students who were employed were significantly less likely to consider suicide.     

Responding to a Community Need: Oakland University's Adult Career Counseling Center

Rapid changes in the world of work coupled with changes in individuals' needs necessitate career counseling assistance. The Oakland University Adult Career Counseling Center uses the services of counseling students to offer career advising to community adults at no charge. The center and its approach are described, along with brief examples of typical clients.     

Knowledge and Attitudes of University Health Service Clients about Genital Herpes: Implications for Patient Education and Counseling

Abstract

Genital herpes virus infection is an important target for health education efforts because of its apparently rising incidence in the college student population and because it can have potentially serious psychological as well as medical consequences. In order to better understand the health education and counseling needs of students, the present study surveyed knowledge and attitudes about genital herpes of 190 university students using a gynecology clinic and of 161 students using a general medical clinic. The students were found to have a high degree of familiarity with the disease, its cause, and mode of transmission, but tended to view the consequences of the disease as more severe than is actually warranted by the common medical complications. There was some degree of misinformation about prevention and treatment of the disease and some negative attitudes about patients suffering from it, but the survey respondents endorsed a high level of responsible behavior with regard to the disease and expressed some optimism about the possibility of adapting to it. These findings suggest specific misconceptions about genital herpes that might be amenable to a mass education approach. They also suggest the need for a counseling program that centers around reasonable reassurance and appropriately positive psychological and medical management for newly diagnosed patients.     

Career‐Ready Students: A Goal of Comprehensive School Counseling Programs

This article opens with a rationale for and a definition of student career readiness. Next is a presentation of the qualities and attributes of career‐ready students. Then discussion follows about what students need to become career ready. Following this is a presentation of how comprehensive school counseling programs help students become career ready, including discussion of the delivery system for school counseling programs that provide the activities and services that contribute to student career readiness. The article closes with the critical point that helping all students become career ready requires a whole school–community approach.     

An interactive web-based method of outreach to college students at risk for suicide

OBJECTIVE AND PARTICIPANTS: From 2002 to 2005, the authors tested an interactive, Web-based method to encourage college students at risk for suicide to seek treatment. METHODS: The authors invited students at 2 universities to complete an online questionnaire that screened for depression and other suicide risk factors. Respondents received a personalized assessment and were able to communicate anonymously with a clinical counselor online. At-risk students were urged to attend in-person evaluation and treatment. RESULTS: A total of 1,162 students (8% of those invited) completed the screening questionnaire; 981 (84.4%) were designated as at high or moderate risk. Among this group, 190 (19.4%) attended an in-person evaluation session with the counselor, and 132 (13.5%) entered treatment. Students who engaged in online dialogues with the counselor were 3 times more likely than were those who did not to come for evaluation and enter treatment. CONCLUSIONS: The method has considerable promise for encouraging previously untreated, at-risk college students to get help.     

A qualitative analysis of suicide risk factors,preferred means,and means restriction feasibility within a homeless shelter environment

Suicide completion rates among homeless individuals are approximately nine times higher than the general population. The purpose of this study was to capture the state of social support among homeless individuals, understand how homeless community members support peers in crisis, examine the awareness of suicidal ideation, identify common methods for suicide, and generate strategies for means restriction within a shelter. Twenty individuals residing at an emergency shelter were interviewed. Participants were of diverse cultural identities overrepresented in the sample relative to the general population. Interviews revealed that 40% of participants lacked social support. However, the majority indicated that if they encountered someone at risk for suicide, they would provide support and encouragement to the at-risk individual. Almost half of participants reported knowing of an individual in the shelter who had previously attempted suicide and/or was currently or previously feeling suicidal. Overdose was identified as a primary method for suicide; however, the majority of participants were unable to generate strategies for means restriction. The present study offers a glimpse into the experience of homeless individuals and provides valuable information regarding risk factors for suicide within this highly marginalized and underserved population.     

The status of nutrition education in ACHA college and university health centers.

An assessment of the prevalence and scope of nutrition services offered through 208 randomly selected American College Health Association member student health centers revealed that 79% of the 160 respondents provided some type of nutrition education for students. One-to-one counseling, available at 96% of the institutions, was the most common approach. The larger the school's enrollment, the more likely it was to provide programs in nutrition. All of the institutions with student populations of more than 35,000 offered some type of nutrition service, as did 52% of the 19 schools with enrollments between 2,000 and 5,000. Health educators, nurses, doctors, dietitians, and trained peer educators provided the services, with registered dietitians the most common providers and often coordinators of the programs. Costs to students for nutrition interventions were nominal; weight-management programs were the most expensive and showed the greatest variation in content.     

Counseling Satisfaction of Gay,Lesbian, and Bisexual College Students

This paper investigates the satisfaction of gay male, lesbian, and bisexual college students with their counseling experiences. The sample of 31 research participants was interviewed using the Gay/Bisexual Counseling Satisfaction Survey, a demographic questionnaire, and the Beck Depression Inventory (BDI). Results indicated strong satisfaction with current counseling and counselors. Sexual orientation issues and loneliness were the most frequent presenting problems; these were positively associcated with counseling satisfaction, as was reporting barriers to counseling. BDI scores were copmarable to nonclinical samples, although there was frequent reporting of suicidal ideation. Implications for service delivery to this population are discussed.