Research report
Prevalence and predictors of persistent suicide ideation, plans, and attempts during college

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Abstract

Background

Suicide is the second-leading cause of death among college students in the U.S. and is preventable. Approximately 1100 college students die by suicide each year. This study examined the prevalence and predictors of one-time and persistent suicide ideation, plans, and attempts reported during college.

Methods

Data were gathered prospectively over four years. Face-to-face interviews were conducted with 1253 first-year college students at one large mid-Atlantic university. Risk factors were measured in Year 1.

Results

An estimated 12%wt of individuals experienced suicide ideation at some point during college, and of those individuals, 25% had more than one episode of ideation (persistent ideation; 2.6%wt of the overall sample). Ten individuals had a plan or attempt during college (0.9%wt of the sample). Risk factors for persistent suicide ideation included low social support, childhood or adolescent exposure to domestic violence, maternal depression, and high self-reported depressive symptoms. Persistent ideators differed from one-time ideators only by higher levels of depression (p = .027). Persistent ideators were no more likely than one-time ideators to have made a suicide plan or attempt during college (8% vs. 9%, respectively).

Limitations

Although the sample size is large, only a small percentage of participants had persistent ideation, suicide plans or attempts during college.

Conclusion

These results have implications for programs aimed at identifying college students at risk for suicide. The accurate identification of college students at risk for suicide is an important step toward suicide prevention.

Introduction

Suicide is a major preventable public health problem in the U.S. and worldwide. Suicide accounted for 2381 deaths in 2006 among 18–22 year olds and is the second-leading cause of death among college-aged young adults in the U.S. with approximately 1100 suicides occurring each year among college students (Centers for Disease Control and Prevention, 2009). Several high-profile campus suicides have drawn attention to the psychological and social impact associated with suicide on individuals, families, and college campuses, potentially impacting hundreds or thousands of people. The 2008 American College Health Association (ACHA, 2009) assessment of 26,685 students in 40 postsecondary education institutions found that in the past 12 months, 1.3% of college students attempted suicide and 6.4% seriously considered suicide at least once.

Although suicide ideation can be considered a first step on the pathway to suicide (Kachur et al., 1995), it can vary from fleeting thoughts of being better off dead to persistent, ruminative thoughts about suicide. In the context of other risk factors such as plans, intent, or prior attempts, those with persistent ideation are often deemed by clinicians to be at high risk for suicidal behaviors. Borges et al. (2008), using data from the National Comorbidity Survey (NCS), found that in the absence of suicide plans or prior attempts, persistent suicide ideation may actually decrease the risk of future suicide plans and attempts. Witte et al. (2005) found, in a study of college students that assessed suicide ideation everyday for four consecutive weeks, that fluctuating levels of suicide ideation (“variability”) was associated with prior suicide attempts, especially among males. However, suicide ideation and attempts are difficult to predict due to the transient nature of suicide ideation (Nock and Banaji, 2007). More information on how to evaluate suicide risk among students is critically needed for health professionals working in campus mental health settings.

Suicidal behaviors are complex and a result of the interaction between psychosocial, psychological, environmental, and genetic risk factors. Many studies have provided solid evidence regarding the risk factors for adolescent suicide ideation and attempt but research is more limited on young adults, especially college students. Suicide ideation among college students may have a unique etiology because of the existing social and academic pressures that are distinct to this population. Several characteristics of this transitional developmental period, including leaving home and being away from family and peer support networks, increased opportunities for alcohol and drug use (Arria et al., 2009), and navigating through unfamiliar environments, make entry into college a particularly vulnerable time for young adults who might be predisposed to experiencing mental health problems. Moreover, college students are often subject to internal and external pressures to succeed academically, especially given the financial burden of college costs on families. Many psychiatric disorders first manifest during young adulthood and stress associated with the transition to college could exacerbate or heighten depression and anxiety. Studies of suicide ideation in college students have found that tobacco, alcohol, and drug use (Brener et al., 1999), negative life events, hopelessness, desperation, depressive symptoms (Garlow et al., 2008, Konick & Gutierrez, 2005), risky behaviors (Barrios et al., 2000), and a lack of social belongingness (Van Orden et al., 2008) are associated with suicide ideation.

Our research group recently reported that, depressive symptoms, low social support, affective dysregulation, father–child conflict, and alcohol use disorder were independently associated with suicide ideation among first-year college students. In that cross-sectional study, mother–child conflict increased the risk for suicide ideation, but only in the presence of high depressive symptoms. However, 60%wt of individuals with suicide ideation did not meet criteria for high depressive symptoms (Arria et al., 2009).

The present study extends our earlier findings by taking advantage of several waves of data from our longitudinal study. Specifically, we aimed to estimate the prevalence and identify predictors of persistent suicide ideation, suicide plans, and attempts among a cohort of students recruited during their first year of college and followed prospectively for four years. To the best of our knowledge, this is the first study of persistent suicide ideation in a college sample.

Section snippets

Study design

This study uses data from the College Life Study (CLS), a longitudinal prospective study of college students. Sample selection took place in two stages. First, a screening survey was administered to 3401 incoming first-time, first-year students ages 17 to 19, during new-student orientation in 2004 at one large, public university in the mid-Atlantic region of the U.S. The first stage response rate was 89%. Next, a stratified random sample of screener participants was selected to participate in a

Overall characteristics of the sample

Of the 1085 participants, 572 (52.7%) were female, 795 (73.3%) self-reported their race as White, and 82 (7.6%) reported homosexual, bisexual or unsure sexual orientation. Seventy-seven (7.7%) reported exposure to domestic violence during childhood or adolescence and 64 (6.6%) reported childhood or adolescence victimization. During Year 1 about one-quarter (n = 289; 27%) qualified for AUD and 151 (14.3%) qualified for CUD. More than one-quarter (n = 285; 28.6%) had a possible or definite history of

Discussion

The results from this study may have important implications for identifying university students at risk for suicide on the basis of several risk factors measurable at college entry. The profile of risk factors for persistent suicide ideation in this large university sample included childhood or adolescent exposure to domestic violence, and low social support and high depressive symptoms in the first year of college. Although maternal depression was not statistically associated with persistent

Role of funding source

The investigators acknowledge funding from the National Institute on Drug Abuse (R01DA14845, Dr. Arria, PI) and the American Foundation for Suicide Prevention. Neither organization had any further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of Interest

All authors declare that they have no conflicts of interest.

Acknowledgements

Special thanks are given to Laura Garnier-Dykstra, Sarah Kasperski, Lauren Stern, Emily Winick, Elizabeth Zarate, the interviewing team, and the participants.

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