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 ideation in the original multinomial regression model, it was significant once non-significant variables were removed to estimate a final model. Moreover, the level of depressive symptoms during Year 1 of college was the only variable that independently predicted persistent suicide ideation during college among ideators.
Although suicide plans and attempts in our sample were rare, a history of possible or definite maternal depression was the variable most strongly linked with a suicide attempt/plan during college. Eighty percent (8 of 10) of those with a plan or suicide attempt reported a definite maternal history of depression. Female gender, low social support, high affective dysregulation, and high depressive symptoms were also associated with increased risk of a suicide plan or attempt. However, we did not find any evidence that the risk for suicide plan or attempt differed based on the number of episodes of ideation. Thus, it appears doubtful that individuals with persistent suicide ideation represent a group at any higher risk for suicide in this population as compared to individuals who reported ideation only once. This finding agrees with prior studies showing that persistent ideation does not appear to confer greater risk for attempt (Borges et al., 2008
; Witte et al., 2005
), but may be an indicator of elevated depressive symptoms.
Several study limitations merit attention. Although the entire sample size was large, the subsets of individuals with persistent suicide ideation, suicide plan and attempt were fairly small. Persistent suicide ideation was not directly assessed and no data were collected on age at ideation, plan and attempt. The BDI was administered annually but only assessed suicide ideation in the past week. However, lifetime suicide ideation, plan and attempt questions were assessed in Year 4 with emphasis on the past year. Those who reported these outcomes more than one year ago were grouped together. Data were not used when we did not know when the events occurred (during college or prior to college), which lowered the power to detect associations and may have biased our results. These data are based upon self-report and is thus subject to bias. Moreover, it is possible that individuals with depression were more likely to be aware of a parental history of depression than those who were not depressed. Unfortunately, no measure of parental suicide attempts was gathered, primarily because this level of detailed information might not have been disclosed by parents to their young adult children. Our measure of social support, and possible maternal and paternal depression, were subjective and reflected the participant’s perceptions; thus it is possible that suicidal thoughts might be related to negative views of their social support structures rather than actual deficits in social support. Moreover, in some cases, mental health problems might cause conflict in the participant’s relationships.
Because our sample is limited to individuals from a single, public university, the results may not be generalizable to students at institutions in other areas of the country, or to students attending smaller, private universities. Suicide rates differ by geographic location (Centers for Disease Control and Prevention, 1997
), and it is possible that rates of suicide ideation might vary similarly.
Despite such limitations, the present study also possesses a number of counterbalanced strengths. The longitudinal study design, following a large cohort through the college years, helps to constrain sources of bias and error that otherwise can complicate cross-sectional research. The sample is large with low attrition and temporality was constrained for most independent variables. The assessment battery was extensive covering a broad range of important variables.
The prevalence of suicide attempt in our sample over the course of four years (0.09%wt
) is lower than the annual prevalence reported by the 2008 ACHA assessment (1.3% reported attempted suicide in the past 12 months; ACHA, 2009
). One possible explanation for this discrepancy is that this study had a very comprehensive plan for addressing suicidality and getting help for participants in crisis. For example, interviewers were trained to score the BDI prior to concluding the interview and, depending on the severity of the responses, to either assist the participant in making an appointment at the campus health center or escort the participant to the health center for immediate attention, according to IRB-approved procedures. The research team repeatedly received positive feedback from participants in response to these actions, which we believe resulted in timely and needed intervention in several cases. Thus, perhaps those who continued to have plans and attempts, despite the assistance provided, had higher familial risk.
This research extends our knowledge regarding factors to identify college students at risk for ideation, plan, and attempt. As college is a time of transition from the family home to partial independence, it can be stressful, especially for students who are more psychologically vulnerable with inadequate support. Peak risk for suicide attempt is in late adolescence and young adulthood. Young adults are also entering the period of risk for disorders closely linked with suicide such as unipolar and bipolar depression, schizophrenia, and drug and alcohol dependence. Our results imply that markers of familial risk such as parental depression, exposure to domestic violence and low social support are influential risk factors for suicide ideation, persistent suicide ideation, and a suicide plan or attempt.
The present findings, if replicated, have important implications for prevention. College campuses are an ideal setting for prevention as students are a “captive audience” and ideally, campuses should place a greater emphasis on ensuring easy access to quality mental health services at this critical period of young adult development. The present findings point to a number of risk factors that college health providers could consider when screening for suicide risk. Moreover, the finding that low social support predicted suicide ideation, independent of depressive symptoms and other factors, suggests that health promotion activities on college campuses should strive to promote social support as a key protective factor.
Although this project aimed to identify specific risk factors for suicidal thoughts and behaviors, the complexity of these associations must be acknowledged; risk and protection are processes that interact with each other to increase or decrease risk (Goldsmith et al., 2002
). Future studies with larger samples should aim to identify interaction of risk and protective factors. The findings reported by Witte and colleagues (2005)
are in agreement with the present findings, and with our prior findings (Arria et al., 2009
) showing an association of affective dysregulation with suicide ideation and attempt. We did not have power herein to study if affective dysregulation was an independent predictor of suicide attempt but future studies are warranted that could sort out the potential unique role of mood lability on suicide attempt.