Depression and lack of social support appear to precipitate suicidal thoughts and behavior in some college students, according to research from Johns Hopkins Children’s Center, the University of Maryland and other institutions.
The study, published in the Journal of Affective Disorders, followed more than a thousand students throughout their college years, identifying factors linked to suicidal thinking and highlighting the importance of spotting high-risk students early on and referring them for treatment.
Suicide is the second leading cause of death among college-age students in the United States, with some 1,100 deaths by suicide occurring in this age group each year.
The findings emanate from the NIH-funded College Life Study, in which researchers conducted in-depth face-to-face interviews with more than a thousand incoming freshmen at a large public university in the mid-Atlantic and annual follow-up interviews throughout their four years in college.
The researchers conducted in-depth face-to-face interviews with more than a thousand incoming college freshmen at the University of Maryland College Park and follow-up annual interviews throughout their four years in college.
Of the 1,085 students, 151 (12 percent) said they had pondered committing suicide at least once, 37 of whom (24.5 percent) said they did so repeatedly. Ten of the 151 said they made specific plans or carried out full-fledged attempts during college. Two of the 10 said they attempted suicide without ever planning to do so. Of the 151, 17 students reported attempting suicide before college, and 22 reported planning a suicide before college but not attempting it.
“Our findings are fairly grim, but there is a silver lining because we’ve identified risk factors that could be used to screen students and help us spot those at high risk and refer them for follow-up testing or treatment,” says lead investigator Holly C. Wilcox, Ph.D., a psychiatric epidemiologist at Hopkins Children’s.
Among these factors, Wilcox says, lack of social support — described as feeling unappreciated, unloved and uninvolved with family and friends — emerged as one of the most powerful predictors of persistent suicidal thoughts, even in the absence of other risk factors. Other risk factors included having depressive symptoms, exposure to domestic violence in childhood and having a mother suffering from depression, all of which made students more likely to ponder suicide.
Markers of familial risk, such as having a mother suffering from depression, also emerged as important factors not only in suicidal thinking but also in suicide plans and suicide attempts. Indeed, eight of the 10 students who planned or attempted a suicide reported having depressed mothers.
The risk for major psychiatric disorders peaks during late adolescence and early adulthood, especially during the transition from home to a life of partial independence, the investigators say. Being away from one’s family and friends coupled with the stress of new social and academic pressures can exacerbate depression and anxiety and, in some, could become the proverbial final straw that triggers suicidal behavior, the researchers say.
Somewhat to their surprise, the researchers say, they found that students who reported thinking repeatedly about suicide were no more likely to attempt it than those who did so only once. The finding suggests that mental health professionals cannot assume that those who think about suicide more often are at a higher risk, nor are those who have a single suicidal thought necessarily safer than those who ponder suicide repeatedly.
Ideally, all incoming freshmen should be screened for risk factors with a brief questionnaire during their first semester of college and during any subsequent visits to the university health center.
"College campuses are ideal for suicide prevention because the students are a captive audience, so universities should take advantage of this by creating easy access to mental health services during this critical period of young adult development," said senior investigator Amelia Arria, Ph.D., an epidemiologist at the University of Maryland Center on Young Adult Health and Development.
Co-investigators on the study included Kimberly Calderia and Kathryn Vincent of the University of Maryland School of Public Health; Gillian Pinchevsky, University of South Carolina; and Kevin O’Grady, University of Maryland-College Park.
The research was funded by the National Institutes of Health and the American Foundation for Suicide Prevention.