Socio-demographic, mental health and childhood adversity risk factors for self-harm and suicidal behaviour in College students in Northern Ireland

Exploring the prevalence of childhood adversity among university students in the United Kingdom: A systematic review and meta-analysis

OBJECTIVES

The focus of this review was to systematically review and meta-analyse the prevalence of ACEs among university students in the UK.

METHOD

The systematic searching of six electronic databases (conducted February 2024) identified ten relevant articles (peer-reviewed articles of a quantitative nature that included ACE prevalence). PROSPERO reference: CRD42022364799.

RESULTS

Pooled prevalence for number of ACEs endured was 55.4% (95% CI: 32.4% - 78.4%; I2 > 99.5%) for one or more, and 31.6% (7.5% - 55.6%; I2 > 99.5%) for three or more. Pooled prevalence was: 15.9% (7.0% - 24.7%; I2 > 94.5%) for physical abuse; 27.0% (18.1% - 35.9%; I2 > 94.5%) for emotional abuse; 12.1% (5.2% - 19.0%; I2 > 94.5%) for sexual abuse; 8.4% (1.7% - 15.1%; I2 > 95.4%) for physical neglect, and 30.0% (21.5% - 38.5%; I2 > 95.4%) for emotional neglect. Pooled prevalence for household dysfunction categories were: 34.4% (22.8% - 46.0%) for parental separation; 18.4% (10.1% - 26.8%) for domestic violence; 35.2% (23.6% - 46.8%) for mental health difficulties; 21.4% (12.9% - 29.9%) for substance use; and 5.7% (2.3% - 9.1%) for incarceration (I2 > 88.8% for all household dysfunction items). Significant heterogeneity was observed between studies for most categories of adversity, and it was not possible to explain/reduce this variance by removing small numbers of influential/discrepant studies. Further analyses suggested potential influences of measurement tool used, country of data collection, and age and sex of participants.

CONCLUSION

Results demonstrate considerable, largely unaccounted-for, heterogeneity in estimates of the prevalence of ACEs, impeding confidence in any summary statistics. Conclusions must be tentative due to analyses being underpowered given small numbers of papers, as well as potential confounds, meaning results may not be truly representative. However, results do suggest high prevalence rates which warrant further investigation, with appropriate support offered to students.

Potential suicide risk among the college student population: machine learning approaches for identifying predictors and different students' risk profiles

BACKGROUND

Suicide is one of the leading causes of death among young people and university students. Research has identified numerous socio-demographic, relational, and clinical factors as potential predictors of suicide risk, and machine learning techniques have emerged as promising ways to improve risk assessment.

OBJECTIVE

This cross-sectional observational study aimed at identifying predictors and college student profiles associated with suicide risk through a machine learning approach.

METHODS

A total of 3102 students were surveyed regarding potential suicide risk, socio-demographic characteristics, academic career, and physical/mental health and well-being. The classification tree technique and the multiple correspondence analysis were applied to define students' profiles in terms of suicide risk and to detect the main predictors of such a risk.

RESULTS

Among the participating students, 7% showed high potential suicide risk and 3.8% had a history of suicide attempts. Psychological distress and use of alcohol/substance were prominent predictors of suicide risk contributing to define the profile of high risk of suicide: students with significant psychological distress, and with medium/high-risk use of alcohol and psychoactive substances. Conversely, low psychological distress and low-risk use of alcohol and substances, together with religious practice, represented the profile of students with low risk of suicide.

CONCLUSIONS

Machine learning techniques could hold promise for assessing suicide risk in college students, potentially leading to the development of more effective prevention programs. These programs should address both risk and protective factors and be tailored to students' needs and to the different categories of risk.

Suicidal ideation risk among LGB Spanish university students: The role of childhood and adolescence adversities and mental disorders

BACKGROUND

Childhood/adolescence adversities and mental disorders are higher among LGB youths.

AIMS

To evaluate the role of childhood maltreatment, bullying, and mental disorders on the association between sexual orientation and suicidal ideation (SI); and the role of mental disorders on the association between sexual orientation discrimination and SI.

METHODS

Baseline and 12-month follow-up online surveys of Spanish first-year university students (18-24-year-olds). Multivariable logistic regression models assessed the effects of childhood/adolescence adversities and mental disorders in the relationship between sexual orientation, discrimination and SI.

RESULTS

A total of 1224 students were included (16.4 % LGBs). Risk factors of lifetime SI were sexual orientation (OR 2.4), any bullying (OR 2.4), any childhood maltreatment (OR 4.0), and any mental disorders (OR 3.8). Final model Area Under the Curve (AUC) 0.78. Among homosexual and bisexual students, discrimination showed increased risk of 12-month SI (OR 2.2), but this effect was no longer statistically significant when any 12-month mental disorder was added (OR 7.8). Final model AUC 0.72.

LIMITATIONS

Sample of interest was relatively small. But it was similar to comparable studies and statistical adjustments have been performed. Assessment of mental disorders and SI was not based on clinical assessment. However, validated scales showing good diagnostic agreement with clinical judgement were used.

CONCLUSIONS

Childhood/adolescence adversities and mental disorders interact in the association between sexual orientation and SI. Mental disorders may mediate the association between sexual orientation discrimination and SI. Further research using larger samples and causal modelling approach assessing the mediators of SI risk among LGBs is needed.

Suicidal behaviour among the university students in the UK: A systematic review

Introduction

Identifying risk factors would help consider suicide prevention in any specific population. We aimed to assess suicidal behaviour among university students in the UK.

Methods

An extensive keyword search was conducted through PubMed, Cochrane, CINHAL Plus, PubMed Central, Web of Science, Trip database, and Science Direct, following the PRISMA guidelines to identify different publications. The search strategy for the literature review was based on the Population Exposure Outcome framework. Critical appraisal utilised the CASP tool for cohort studies and the AXIS tool for cross-sectional studies, resulting in 14 included studies. A narrative synthesis was performed.

Results

Postgraduate and undergraduate students used different suicidal methods such as poisoning, jumping, hanging, drowning, and suffocating, with jumping most preferred by male students. The predisposing factors of suicide among university students included: mental health problems (depression, psychological stress, psychosis, mania, neuroticism, financial anxiety, imperfect parents' connection with students), sexual orientation with risk of suicide among non-heterosexual students due to lowered self-esteem from feeling disregarded, disrespected and insufficient attention from the surrounding. Suicidal behaviour was high among unmarried students, male and unemployed female students, and students with childhood experiences such as physical abuse, family violence, emotional abuse, neglect, and physical punishment-gender, with females seeking more services from general hospitals with more suicide attempts in older females. High risk was also noted in males, with increased risk in white students compared to black students.

Conclusion

The review highlighted that students with previous mental health problems, a history of experiencing sexual abuse in childhood, bad relationships with their mother, disrespect and disregard in the community due to sexual identity are the major contributing factors for suicide among university students in the UK.

Prevalence of anxiety, depression, mania, insomnia, stress, suicidal ideation, psychotic experiences, & loneliness in UK university students

Despite existing wellbeing services, university students remain particularly vulnerable to mental health difficulties. Therefore, this study was designed to provide a comprehensive assessment of the prevalence of psychiatric symptoms by using well validated scales with robust psychometric properties. More specifically, the current data provides crucial information concerning the prevalence of anxiety, depression, mania, insomnia, stress, suicidal ideation, psychotic experiences and loneliness amongst a sample of N = 1408 UK university students. A cross-sectional online questionnaire-based study was implemented. Online recruitment for this dataset began on September 17th, 2018, and ended on the 30th July 2019. Eight validated measures were used: Generalized Anxiety Disorder Scale; Patient Health Questionnaire; The Mood Disorder Questionnaire; The Sleep Condition Indicator; The Perceived Stress Scale; Suicidal Behaviours Questionnaire-Revised; The Prodromal Questionnaire 16 (PQ-16); and the University of California Loneliness Scale. The dataset is available to other researchers and is provided on figshare. Information concerning the data records, usage notes, code availability and technical validation are presented. Finally, we present demographic information concerning psychiatric symptom prevalence.

The effect of childhood trauma and resilience on psychopathology in adulthood: Does bullying moderate the associations?

BACKGROUND

Exposure to traumatic events in childhood, including bullying, can negatively affect physical and mental health in adulthood. The aim of the present study was to determine the prevalence of bullying in different sociodemographic groups of the Slovak Republic and to assess the moderating effect of bullying on the associations between childhood trauma, resilience, and the later occurrence of psychopathology.

METHODS

For the analyses, a representative sample of the population of the Slovak Republic was used (N = 1018, mean age 46.24 years, 48.7% of men). Multivariate linear regression models were used to investigate the predictive ability of childhood trauma (The Childhood Trauma Questionnaire, CTQ) and resilience (The Brief Resilience Scale, BRS) to explain psychopathology (The Brief Symptom Inventory, BSI-53). Bullying (The Adverse Childhood Experiences - International Questionnaire, ACE-IQ) was used as a moderator.

RESULTS

In total, 13.5% of respondents have experienced bullying. The most common form of bullying was making fun of someone because of how their body or face looked (46.7%) and excluding someone from activities or ignoring them (36.5%). Higher scores in all types of psychopathology and the Global Severity Index (GSI) were significantly associated with higher scores of emotional and sexual abuse, and some of them with physical neglect. The protective effect of resilience was moderated by bullying in several types of psychopathology, specifically in somatization, obsessive-compulsive, interpersonal sensitivity, depression, psychoticism, and the GSI.

CONCLUSION

Understanding the links between childhood trauma, bullying, and later psychopathology can help professionals target policies, resources, and interventions to support children and families at risk. Every child should feel accepted and safe at home and school.

Adverse childhood experiences, unhealthy lifestyle, and nonsuicidal self-injury: findings from six universities in Shaanxi province, China

Background

Nonsuicidal self-injury (NSSI) is a serious public health problem. The role of adverse childhood experiences (ACEs) and lifestyle on the risk for NSSI is still underexplored, especially among college students. We aimed to investigate the association of ACEs with the risk of NSSI, and effect modifications by lifestyle among college students.

Methods

A total of 18,723 college students from six universities were recruited through a multistage, random cluster sampling method in Shaanxi province, China. The Adverse Childhood Experiences International Questionnaire was used to assess ACEs for each participant, and the Chinese version of the Ottawa Self-injury Inventory was used to assess the presence or absence of NSSI behaviors. Information about lifestyle was collected by a self-designed questionnaire. The associations of NSSI with ACEs and lifestyle were analyzed using logistic regression models. Furthermore, we constructed a combination score of multiple lifestyles and evaluated whether lifestyle modified the effect of ACEs on the risk of NSSI.

Results

The prevalence of NSSI for the past 1 month, 6 months, and 12 months was 3.8, 5.3, and 6.5%, respectively. 82.6% of participants have reported experiencing at least one type of ACEs, and participants with higher levels of ACEs (≥4) were more likely to have higher odds of developing NSSI during the past 1 month (OR, 4.10; 95%CI, 3.38-4.97), 6 months (OR, 4.76; 95%CI, 4.03-5.62), and 12 months (OR, 5.62; 95%CI, 4.83-6.55), as compared with participants with low levels of ACEs (0-1). There were additive interactions between ACEs and lifestyle. Compared with participants with low levels of ACEs and healthy lifestyle, participants with high levels of ACEs and unhealthy lifestyle had the highest odds of NSSI during the past 1 month (OR, 5.56; 95%CI, 3.80-8.31), 6 months (OR, 6.62; 95%CI, 4.73-9.42), and 12 months (OR, 7.62; 95%CI, 5.59-10.52).

Conclusion

These results suggest that ACEs play an important role in the occurrence of NSSI among college students, especially in those with unhealthy lifestyle. Our findings may help develop targeted intervention strategies for the prevention of NSSI.

Exploring psychological and psychosocial correlates of non-suicidal self-injury and suicide in college students using network analysis

BACKGROUND

Non-suicidal self-injury (NSSI) and suicide are a serious health concern in young people. Remarkable progress has been made in understanding the correlates and risk factors for suicidality. However, it remains unclear the complex interplay between different factors and which factors are most saliently associated with NSSI and suicide risk and should be targeted for interventions.

METHODS

This study utilized network analysis to examine the interrelationship between NSSI, suicide and a variety of psychological (e.g., depression, psychotic-like experiences) and psychosocial (e.g., childhood maltreatment, family dysfunction, being bullied and social support) correlates in a sample of Chinese first year college students (n = 2328).

RESULTS

The severity of depressive symptoms was the only factor connected to both NSSI and suicide. Other psychiatric factors like psychotic experiences could only act in an indirect way via the bridging effect of depression. Emotional abuse, compared with other forms of childhood adversities, was found to be the most influential maltreatment form associated with suicidal ideation and attempts. Finally, social support showed the potential to lower the risk of self-injury and suicide in young people.

LIMITATIONS

Only a subset of risk and resilience factors of NSSI and suicide were included. Causal inference was impossible due to the cross-sectional design.

CONCLUSIONS

Our findings highlighted the importance of identifying risk groups with mental illnesses or negative childhood events, and providing additional support during the key time of transitioning into higher education.

A latent class analysis using the integrated motivational-volitional model of suicidal behaviour: Understanding suicide risk over 36 months

BACKGROUND

The use of latent class analysis (LCA) to understand suicide risk is often not guided by theoretical frameworks. This study used the Integrated Motivational-Volitional (IMV) Model of Suicidal Behaviour to inform the classification of subtypes of young adults with a suicidal history.

METHODS

Data from young adults in Scotland (n = 3508) were used in this study including a subgroup of participants (n = 845) with a history of suicidality. LCA using risk factors from the IMV model was conducted on this subgroup, and the subgroups and non-suicidal control group were compared. Trajectories of suicidal behaviour over 36 months was compared between the classes.

RESULTS

Three classes were identified. Class 1 (62 %) had low scores on all risk factors, Class 2 (23 %) had moderate scores, and Class 3 (14 %) had high scores on all risk factors. Those in Class 1 had a stable low risk of suicidal behaviour, while those in Class 2 and 3 showed marked variation over time, although Class 3 had the highest risk across all timepoints.

LIMITATIONS

The rate of suicidal behaviour in the sample was low, and differential dropout may have impacted the findings.

CONCLUSIONS

These findings suggest that young adults can be classified into different profiles based on suicide risk variables derived from the IMV model, which still distinguishes them 36 months later. Such profiling may help determining who is most at risk for suicidal behaviour over time.

Joint Contributions of Depression and Insufficient Sleep to Self-Harm Behaviors in Chinese College Students: A Population-Based Study in Jiangsu, China

Self-harm in young people is common, and previous studies have shown that insufficient sleep or depression was associated with self-harm. However, the joint association of insufficient sleep and depression with self-harm is unknown. We employed representative population-based data from the "Surveillance for Common Disease and Health Risk Factors Among Students in Jiangsu Province 2019" project. College students reported their self-harm behavior over the past year. Rate ratios (RRs) and corresponding 95% confidence intervals (CIs) for self-harm in relation to sleep and depression were modeled using negative binomial regression with a sample population as an offset, adjusting for age, gender, and region. The instrumental variable approach was used for the sensitivity analyses. Of the study population, approximately 3.8% reported self-harm behaviors. Students with sufficient sleep experienced a lower risk of self-harm than those with insufficient sleep. Compared with students with sufficient sleep and the absence of depression, the adjusted risk of self-harm was elevated 3-fold (1.46-4.51) in those reporting insufficient sleep in the absence of depression, 11-fold (6.26-17.77) in those with sufficient sleep and definite depression, and 15-fold (8.54-25.17) in those with both insufficient sleep and definite depression. The sensitivity analyses indicate that insufficient sleep remained a contributing risk factor for self-harm. Lack of sleep in young people is significantly associated with self-harm, particularly in the presence of depression. The provision of mental health care and attention to sleep deprivation are particularly important for college students.

Familial and Bullying Victimisation: The Impact of Early Adversity Within the Home and Peer Settings on Late Adolescence and Adult Psychopathology

BACKGROUND

Awareness of adverse childhood experiences and their impact on adult psychopathology primarily focuses on adversities within the home. There is limited insight into the impact of adversities across peer environments.

OBJECTIVE

This study investigates 19 items related to adverse experiences across the home, school and peer environments and their relationship to 12-month and lifetime psychopathology.

DATA

Secondary analysis of the Ulster University Student Well-being Study. The dataset included completed responses across all selected variables for 729 participants.

METHOD AND RESULTS

Latent profile analysis identified a low adversity profile, bullying adversity profile and higher prevalence adversity profile. Regression analysis of the three profiles and demographics variables indicated their impact on adult psychopathology lifetime and 12-month prevalence rates.

CONCLUSION

Schools and HE institutions should acknowledge the impact of childhood adversities. In doing so, it is important to consider the deeper impact of bullying due to its links with psychopathology across the lifespan. Educational institutions should take appropriate steps to mitigate continued exposure as students' progress through the education system.

Prevalence and Psychiatric Correlates of Illicit Substance Use in UK Undergraduate Students

This study examined the prevalence of illegal drug use in UK students and motivators behind such behavior. Additionally, we explored possible relationships between substance use, psychosocial motivators, and psychiatric distress. A group (n = 543) of students completed online measures of substance use, anxiety, depression, perceived stress, and insomnia. A series of reasons behind their use were ranked based on importance. Reported cannabis, cocaine, nitrous oxide, ketamine, and MDMA use were most prevalent based on lifetime, past year, and month assessments. The experience of anxiety, depression, perceived stress, and insomnia were related to increased reports of substance use. Poor self-confidence and self-medication were key motivators of illicit drug use in those presenting greater psychiatric distress. These outcomes add to the sparse body of literature concerning illicit substance use in relation to psychiatric distress amongst UK students. Furthermore, we provided novel insight into the psychosocial motivators of such use.

Variations in psychological disorders, suicidality, and help-seeking behaviour among college students from different academic disciplines

BACKGROUND

Elevated levels of suicidality, ADHD, mental ill-health and substance disorders are reported among college students globally, yet few receive treatment. Some faculties and courses appear to have more at-risk students than others. The current study aimed to determine if students commencing college in different academic disciplines were at a heightened risk for psychopathology, substance use disorders and suicidal behaviour, and examined variations in help-seeking behaviour.

MATERIALS AND METHODS

The study utilised data collected from 1,829 first-year undergraduate students as part of the Student Psychological Intervention Trial (SPIT) which commenced in September 2019 across four Ulster University campuses in Northern Ireland and an Institute of Technology, in the North-West of Ireland. The SPIT study is part of the World Mental Health International College Student Initiative (WMH-ICS) which uses the WMH-CIDI to identify 12-month and lifetime disorders.

RESULTS

Students from Life and Health Sciences reported the lowest rates of a range of psychological problems in the year prior to commencing college, while participants studying Arts and Humanities displayed the highest levels (e.g. depression 20.6%; social anxiety 38.8%). However, within faculty variations were found. For example, psychology students reported high rates, while nursing students reported low rates. Variations in help seeking behaviour were also revealed, with male students less likely to seek help.

CONCLUSIONS

Detecting specific cohorts at risk of psychological disorders and suicidality is challenging. This study revealed that some academic disciplines have more vulnerable students than others, with many reluctant to seek help for their problems. It is important for educators to be aware of such issues and for colleges to provide information and support to students at risk. Tailored interventions and prevention strategies may be beneficial to address the needs of students from different disciplines.

Factors that influence mental health of university and college students in the UK: a systematic review

Background

Worsening mental health of students in higher education is a public policy concern and the impact of measures to reduce transmission of COVID-19 has heightened awareness of this issue. Preventing poor mental health and supporting positive mental wellbeing needs to be based on an evidence informed understanding what factors influence the mental health of students.

Objectives

To identify factors associated with mental health of students in higher education.

Methods

We undertook a systematic review of observational studies that measured factors associated with student mental wellbeing and poor mental health. Extensive searches were undertaken across five databases. We included studies undertaken in the UK and published within the last decade (2010–2020). Due to heterogeneity of factors, and diversity of outcomes used to measure wellbeing and poor mental health the findings were analysed and described narratively.

Findings

We included 31 studies, most of which were cross sectional in design. Those factors most strongly and consistently associated with increased risk of developing poor mental health included students with experiences of trauma in childhood, those that identify as LGBTQ and students with autism. Factors that promote wellbeing include developing strong and supportive social networks. Students who are prepared and able to adjust to the changes that moving into higher education presents also experience better mental health. Some behaviours that are associated with poor mental health include lack of engagement both with learning and leisure activities and poor mental health literacy.

Conclusion

Improved knowledge of factors associated with poor mental health and also those that increase mental wellbeing can provide a foundation for designing strategies and specific interventions that can prevent poor mental health and ensuring targeted support is available for students at increased risk.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13943-x.

The Mediating Roles of Mental Health and Substance Use on Suicidal Behavior Among Undergraduate Students With ADHD

OBJECTIVE

To evaluate the prevalence of suicidal ideation (SI), plans and attempts, and non-suicidal self-injury (NSSI) among students with attention deficit hyperactivity disorder (ADHD). Furthermore, we explored the mediating effects of depression, anxiety, alcohol and substance use on the association between ADHD and suicidal behaviors and NSSI.

METHOD

Participants were first-year undergraduate students (n = 1,829) recruited as part of the World Mental Health International College Student Initiative. Participants completed validated clinical measures online.

RESULTS

The prevalence of suicide behaviors and NSSI were significantly higher among students with ADHD than those without. Mediation analyses indicated that ADHD directly and indirectly increased suicidal behaviors and NSSI. While ADHD increased suicidal behaviors and NSSI through depression, ADHD and the co-variates age and gender also had indirect effects on suicidal behaviors via substance use.

CONCLUSIONS

Specific predictors of risk were identified for students with ADHD which may inform the development of more targeted mental health and suicide prevention strategies across campuses.

A positive mental imagery intervention for targeting suicidal ideation in university students: A pilot study

Objectives

Suicide is a major public health concern and is now considered to be the leading cause of death in young people. Suicidal ideation within student populations has recently increased. The Broad‐Minded Affective Coping (BMAC) offers a brief psychological intervention targeting suicidal ideation by enabling access to competing positive emotions and thoughts using guided imagery. Its acceptability and feasibility in student populations are unclear.

Design

A single arm pilot study investigated the feasibility and acceptability of a six‐session BMAC intervention for university students experiencing suicidal ideation.

Method

Recruitment took place from university counselling services. Suicidal ideation and emotional states were assessed at baseline and after 6 and 12 weeks. Participants also completed corresponding sessional measures.

Results

Twelve eligible participants consented to take part with 11 receiving the intervention. Ten participants completed post treatment and follow up assessments. Retention to treatment was high with participants attending an average of 5.2 (87%; SD = 1.54) out of six intervention sessions. There were also good completion rates of the BMAC technique between sessions. Participants reported high levels of satisfaction with the intervention. There was an associated reduction across a range of clinical outcomes, including suicidal ideation, with large effect sizes.

Discussion

This pilot study showed promising results on the feasibility and acceptability of the BMAC intervention in students experiencing suicidal ideation. However, the study had a small sample size and no comparator control group. Further exploration of the BMAC intervention is warranted.

Self-disgust as a potential mechanism underlying the association between body image disturbance and suicidal thoughts and behaviours

This study examined whether self-disgust added incremental variance to and mediated the multivariate association between measures of body image disturbance and suicidal thoughts and behaviours. We hypothesized that self-disgust would be associated with suicidal ideation above the effects of body image disturbance, and that self-disgust would mediate the relationship between body image disturbance and suicidal ideation. A total of N=728 participants completed The Body Image Disturbance Questionnaire, The Self-Disgust Scale, and the Suicidal Behaviours Questionnaire-Revised. Suicidality was significantly related to increased levels of self-disgust and body image disturbance, whereas self-disgust was associated with greater body image disturbance. Linear regression analysis showed that self-disgust was associated with suicidal thoughts and behaviours, over and above the effects of body image disturbance. Multiple mediation modelling further showed that self-disgust mediated the relationship between body image disturbance and suicidal thoughts and behaviours. Our findings highlight the role of self-disgust in the context of body image disturbance and support the notion that body image disturbance is associated with aversive self-conscious emotions. Interventions aiming to reduce the risk of suicidality in people with body image disturbance may address self-disgust and negative self-conscious emotions.

Factors associated with suicide ideation of healthcare university students

ABSTRACT Objectives: to analyze the factors associated with suicidal ideation in students from healthcare graduation courses. Methods: quantitative, cross-sectional study, with 251 students from the courses of radiology, speech-language therapy, medicine, nutrition, health service management, and nursing, from a federal higher education institution in the Southeast of Brazil. Data were collected from August to October 2019, using an electronic questionnaire. Results: the prevalence of suicidal ideation among participants was 26.33%. In the final logistic regression model, only depressive symptoms were associated with suicidal ideation. Having symptoms of depression increased the chances of suicidal ideation 2.6 times. Conclusion: the high prevalence of suicidal ideation and its associated factors constitutes a situational diagnosis that demands the elaboration of public and institutional policies, focused on the promotion and attention to the mental health of the students.

Suicidal behaviours and mental health disorders among students commencing college

The increase in psychological disorders and suicidal behaviour in students is a reason for growing concern. Some may start university with pre-existing problems, while others develop problems during this time. It is important to evaluate mental health and wellbeing early, identifying those at risk. The aim of this study was to compare mental health problems and help-seeking behaviour between students in Northern Ireland (NI) and the Republic of Ireland (ROI). Whilst geographically proximate, the institutions span a cross-border region with distinct education and healthcare systems. First-year undergraduate students (n = 1828) were recruited in September 2019 as part of the World Mental Health International College Student Initiative. Suicidal behaviour, mental health and substance disorders were investigated using the World Mental Health- Composite International Diagnostic Interview. Prevalence of disorders was high, with more ROI students experiencing problems than NI students. Students were significantly more likely to experience mental health problems if they were female (p<0.001), non-heterosexual (p<0.0001), and over the age of 21 (p<0.0001). These findings show that many students are starting university with high levels of psychopathology and suicidal behaviour, highlighting the importance of early intervention which may need to be tailored to different student populations.

Factors associated with suicide ideation of healthcare university students

OBJECTIVES

to analyze the factors associated with suicidal ideation in students from healthcare graduation courses.

METHODS

quantitative, cross-sectional study, with 251 students from the courses of radiology, speech-language therapy, medicine, nutrition, health service management, and nursing, from a federal higher education institution in the Southeast of Brazil. Data were collected from August to October 2019, using an electronic questionnaire.

RESULTS

the prevalence of suicidal ideation among participants was 26.33%. In the final logistic regression model, only depressive symptoms were associated with suicidal ideation. Having symptoms of depression increased the chances of suicidal ideation 2.6 times.

CONCLUSION

the high prevalence of suicidal ideation and its associated factors constitutes a situational diagnosis that demands the elaboration of public and institutional policies, focused on the promotion and attention to the mental health of the students.

Depression, anxiety and suicidal behaviour among college students: Comparisons pre-COVID-19 and during the pandemic

Background

Many students struggle with psychological problems during their college years. These problems may be even more apparent during the COVID-19 pandemic with the accompanying restrictions and transition to an online learning environment, but few longitudinal studies have been conducted to date. The aim of this study was to compare symptoms of depression, anxiety and suicidality prior to and during the pandemic, and identify stressors.

Methods

This study was conducted among students attending Ulster University, Northern Ireland (NI) and LYIT, Republic of Ireland (ROI), as part of the World Mental Health International College Student Initiative (WMH-ICS). Data was collected from first year students in September 2019. The completed response rate was 25.22% (NI) and 41.9% (ROI) in relation to the number of first-year students registered. A follow up study was conducted in Autumn 2020, with 884 students fully completing the online survey in both years, equating to just under half of those who completed initially.

Results

High levels of mental health problems were found in year 1, especially in the ROI. Levels of depression increased significantly in year 2, particularly among students in NI, however, levels of anxiety decreased. No significant variations were found for suicidal behaviour. Several stressors were revealed, including increased social isolation, and worrying about loved ones.

Limitations

The findings may not be generalised to other student populations.

Conclusions

This study reveals variation in symptoms of depression and anxiety since the onset of the pandemic. In particular, the large increase in students with depression is of concern.

The interaction between suicidal ideation, insomnia symptoms, and student status

Evidence demonstrates increased vulnerability to thoughts and behaviors related to suicide (i.e., suicidal ideation) in students. This study examined the interaction between insomnia-symptoms and student-status (students vs. non-students) on reports of suicidal thoughts of behaviors. A total of 363 (N = 363) university students and 300 (N = 300) members of the general population provided complete data on measures of insomnia-symptoms and suicidal ideation. Students indicated greater reports of both total and lifetime ideation while also considering suicidal behavior within the past year. However, no differences were observed in reports of possible future attempt(s) and the disclosure of suicidal thoughts and behaviors to another person. Moreover, students presenting concurrent symptoms of insomnia reported significantly elevated levels of suicidal ideation relative to nonstudents. These outcomes highlight the possible role of insomnia symptoms in accentuating suicidal thoughts and behaviors in the student population.

A systematic review and meta-analysis of poor sleep, insomnia symptoms and stress in undergraduate students

University students experience high prevalence of mental health problems and exacerbation of mental health difficulties, including sleep disturbances and stress during their studies. Stress and poor sleep quality and/or insomnia are interlinked outcomes for this population. The aim was to conduct a systematic review, and meta-analyses, of the relationships between sleep quality and/or insomnia with stress in students. Full-text articles of studies exploring the associations of stress with poor sleep quality and/or insomnia in undergraduate students using validated tools and published in peer-reviewed journals were eligible for inclusion. Thirty-four studies, resulting in 37 effect sizes, included and all were suitable for meta-analysis. The weighted pooled effect size between sleep quality and stress was for 0.39 (25 studies, n = 10,065), whereas a slightly higher pooled association of 0.41 was demonstrated for insomnia and stress (12 studies, n = 5564.5). Pooled associations show moderate effects for associations between sleep quality, insomnia and stress in undergraduate students. High heterogeneity in meta-analyses was found, suggesting the findings should be considered cautiously. Future research should focus on longitudinal studies exploring sleep difficulties across the academic year, whilst university services should consider psychoeducation for stress and sleep in university students, especially during transition to university.

Sexual Orientation and the Integrated Motivational-Volitional Model of Suicidal Behavior: Results from a Cross-Sectional Study of Young Adults in the United Kingdom

Sexual orientation minority (i.e., lesbian, gay, bisexual, queer, and other; LGBQ+) persons represent a vulnerable population with respect to suicide-related behavior. An emerging theory of suicide, the Integrated Motivational-Volitional Model of Suicide (IMV), is utilized in the present study to examine sexual orientation, as well as a number of other IMV-defined pre-motivational factors (i.e., demographics, psychological distress and personality), as they impact the IMV motivational factors of defeat, entrapment, and suicidal ideation/intent. The present investigation featured a cross-sectional online survey of young adults (ages 18-34 years; n = 418; 27% identified as LGBTQ+) across the United Kingdom. The key findings included: (1) high rates of 12-month suicidal ideation prevalence (54.5%) and willingness to enact a future suicide attempt (60.8%); (2) bisexual and other (e.g., pansexual)-identifying sexual minority persons reported higher levels of IMV-related outcomes (e.g., internal entrapment, defeat); (3) sexual orientation accounted for significant variance in predicting motivational constructs controlling for a number of other pre-motivational factors; (4) other sexual minority status, compared to heterosexual identity, predic all motivational outcomes, and; (5) extraversion, agreeableness, and emotional stability emerged as pre-motivational protective factors for varying motivational outcomes. Findings are discussed with respect to the suicide and sexual minority theories, as well as tailored suicide prevention efforts and future research.

The mortality rate from self-harm in Iran

BACKGROUND

Self-harm-related death is one of the most unfortunate, tragic, and regrettable types of death owing to injuries with a variety of socio-economic and cultural causes. The study aimed to determine the trend in the mortality of self-harm by sex and age at national and provincial levels in Iran over a period of 26 years.

METHODS

The Iran Death Registration System (DRS), cemetery databanks in Tehran and Esfahan, and the national population and housing censuses of Iran were used for this study. Using a growth model, the population was estimated in the age groups. Incompleteness, misalignment, and misclassification in the DRS were all considered and addressed accordingly. We used a spatio-temporal and Gaussian process regression model to estimate mortality rates in children and adults.

RESULTS

Over the study period, 67,670 deaths were estimated owing to self-harm across the country. The overall age-standardized mortality rate decreased from 4.32 per 100,000 (95% unit interface (UI): 3.25-5.75) to 2.78 (2.15-3.59) per 100,000 between 1990 and 2015, a reduction of approximately 35.65%. The M/F ratio was 2.03:1 with an annual percent change of -2.38% and -1.37% for women and men, respectively. The annual self-harm mortality rate was higher among individuals aged 15-24 years, as well as it was more in men during the study period.

CONCLUSION

Mortality from self-harm has declined over the study period in Iran. Higher rates in men and in population aged 15-24 years, with considerable variation by province, were the distinguishing features of self-harm. Iran needs to improve monitoring through a comprehensive multisectoral strategy; and most importantly, provide timely, effective and low-cost preventive interventions.

What do undergraduates with high levels of childhood adversity want to cope with stress?

OBJECTIVES

We aimed to determine how universities can tailor delivery of stress-related interventions and intervention-related messages for students with adverse childhood experiences (ACEs).

METHOD

We assessed 762 undergraduates (76% female; average age = 20.3) on an expanded ACEs measure, stress, health, and past use of interventions and what types of interventions they would like to cope with stress. We also experimentally manipulated websites advertising mental health services to test whether certain message frames and types of intervention delivery would appeal differentially to students with more ACEs.

RESULTS

ACEs were associated with worse health, more stress, and a greater likelihood of having used health-related interventions. Students with more ACEs were more willing to try the interventions on the websites, regardless of messaging and type of delivery. They also expressed a greater desire for face-to-face interactions centered on mental health.

CONCLUSIONS

School-wide adoption of ACE-informed policies can change lifelong trajectories of students with ACEs.

Prevalence and psychiatric correlates of suicidal ideation in UK university students

BACKGROUND

Evidence highlights increased susceptibility to thoughts and behaviors related to suicide (i.e. suicidal ideation) in the student population, often in co-occurrence with mental health difficulties. Typically, studies focus on specific symptoms, with few providing comprehensive examination of risk factors. In this study we examined the prevalence of suicidal ideation among UK university students and assessed the association with multiple psychiatric risk factors.

METHODS

A total of N = 1273 students completed online measures of suicidal ideation, anxiety, depression, insomnia, mania, psychosis, and perceived stress.

RESULTS

37.3% students were classified as high-risk for suicidal behaviour. Moreover, 42.2% of students contemplated suicide at least once within the past twelve months, and 25.1% reported telling someone about these thoughts at least once. Logistic regression analysis showed that suicidal ideation was significantly associated with symptoms of depression, mania, psychosis, and stress.

LIMITATIONS

The cross-sectional nature of ours study does not allow us to infer causality in the observed associations.

CONCLUSIONS

Our results indicate the prevalence of suicidal ideation in a large sample of university students in the UK, and highlight associated mental health risk factors associated with it. Our findings have implications for mental health practitioners working with University students.

Methylome profiling of young adults with depression supports a link with immune response and psoriasis

BACKGROUND

Currently the leading cause of global disability, clinical depression is a heterogeneous condition characterised by low mood, anhedonia and cognitive impairments. Its growing incidence among young people, often co-occurring with self-harm, is of particular concern. We recently reported very high rates of depression among first year university students in Northern Ireland, with over 25% meeting the clinical criteria, based on DSM IV. However, the causes of depression in such groups remain unclear, and diagnosis is hampered by a lack of biological markers. The aim of this exploratory study was to examine DNA methylation patterns in saliva samples from individuals with a history of depression and matched healthy controls.

RESULTS

From our student subjects who showed evidence of a total lifetime major depressive event (MDE, n = 186) we identified a small but distinct subgroup (n = 30) with higher risk scores on the basis of co-occurrence of self-harm and attempted suicide. Factors conferring elevated risk included being female or non-heterosexual, and intrinsic factors such as emotional suppression and impulsiveness. Saliva samples were collected and a closely matched set of high-risk cases (n = 16) and healthy controls (n = 16) similar in age, gender and smoking status were compared. These showed substantial differences in DNA methylation marks across the genome, specifically in the late cornified envelope (LCE) gene cluster. Gene ontology analysis showed highly significant enrichment for immune response, and in particular genes associated with the inflammatory skin condition psoriasis, which we confirmed using a second bioinformatics approach. We then verified methylation gains at the LCE gene cluster at the epidermal differentiation complex and at MIR4520A/B in our cases in the laboratory, using pyrosequencing. Additionally, we found loss of methylation at the PSORSC13 locus on chromosome 6 by array and pyrosequencing, validating recent findings in brain tissue from people who had died by suicide. Finally, we could show that similar changes in immune gene methylation preceded the onset of depression in an independent cohort of adolescent females.

CONCLUSIONS

Our data suggests an immune component to the aetiology of depression in at least a small subgroup of cases, consistent with the accumulating evidence supporting a relationship between inflammation and depression. Additionally, DNA methylation changes at key loci, detected in saliva, may represent a valuable tool for identifying at-risk subjects.

Suicide in Northern Ireland: epidemiology, risk factors, and prevention

The rates of suicide and self-harm in Northern Ireland are high, and have increased from 143 registered suicides in 1996 to 313 in 2010 and 318 in 2015. This Review summarises the epidemiology of suicidal behaviour, as well as the evidence from a small number of studies that have identified risk factors associated with high suicide rates in Northern Ireland. These risk factors were mental illness, trauma, exposure to the conflict known as the Troubles, deprivation, relationship problems, employment difficulties, financial difficulties, being LGBT, childhood adversities, and alcohol or drug use. We highlight the key challenges and opportunities for suicide prevention, emphasising a so-called lifespan approach. More needs to be done to address the relationship between substance misuse and suicide. Future research and prevention efforts should also focus on the transgenerational effect of the conflict, youth suicide, suicide prevention in minority groups, and the criminal justice context. The provision of and access to suicide-specific psychosocial interventions need to be prioritised, more support for people in crisis is required, as well as interventions for mental illness. Protect Life 2, the national suicide prevention strategy, needs to be implemented in full. Given the legacy of conflict in Northern Ireland, all suicide prevention efforts should be trauma informed.

Lesbian, gay or bisexual identity as a risk factor for trauma and mental health problems in Northern Irish students and the protective role of social support

Background: People identifying as lesbian, gay or bisexual (LGB) have been shown to experience more trauma and poorer mental health than their heterosexual counterparts, particularly in countries with discriminatory laws and policies. Northern Ireland is a post-conflict region with high rates of trauma and mental health problems, as well as significant levels of prejudice against the LGB community. To date, no studies in Northern Ireland have compared trauma exposure, social support and mental health status of LGB students to their heterosexual peers. Objective: The present study aimed to assess whether LGB status was associated with more trauma exposure and poorer mental health, and whether social support mediated these associations. Method: The sample was comprised of 1,116 university students. Eighty-nine percent (n = 993) identified as heterosexual and 11% (n = 123) identified as LGB. Path analysis was used to test the hypotheses. Results: LGB status was significantly associated with increased trauma exposure and with symptoms of PTSD, depression and anxiety, but not with problematic alcohol use. These associations were mediated by social support from family only. Conclusions: These results evidence vulnerabilities among Northern Irish students identifying as LGB in relation to trauma and mental health compared with their heterosexual peers. However, social support from family has the potential to mitigate risk. Educational initiatives should raise awareness of the importance of familial support for LGB youth, and those young people who lack family support should be considered an at-risk group, warranting particularly intensive targeting by relevant supports.

Gender commonalities and differences in risk and protective factors of suicidal thoughts and behaviors: A cross-sectional study of Spanish university students

AIM

To assess gender differences in the association between risk/protective factors and suicidal thoughts and behaviors (STB); and whether there is any gender-interaction with those factors and STB; among Spanish university students.

METHODS

Data from baseline online survey of UNIVERSAL project, a multicenter, observational study of first-year Spanish university students (18-24 years). We assessed STB; lifetime and 12-month negative life-events and family adversities; mental disorders; personal and community factors. Gender-specific regression models and gender-interactions were also analyzed.

RESULTS

We included 2,105 students, 55.4% women. Twelve-month prevalence of suicidal ideation (SI) was 10%, plans 5.7%, attempts 0.6%. Statistically significant gender-interactions were found for lifetime anxiety disorder, hopelessness, violence between parents, chronic health conditions and family support. Lifetime mood disorder was a common risk factor of SI for both genders (Females: OR= 5.5; 95%CI 3.3-9.3; Males: OR= 4.4; 95%CI 2.0-9.7). For females, exposure to violence between parents (OR= 3.5; 95%CI 1.7-7.2), anxiety disorder (OR= 2.7; 95%CI 1.6-4.6), and alcohol/substance disorder (OR= 2.1; 95%CI 1.1-4.3); and for males, physical childhood maltreatment (OR= 3.6; 95%CI 1.4-9.2), deceased parents (OR= 4.6; 95%CI 1.2-17.7), and hopelessness (OR= 7.7; 95%CI 2.8-21.2), increased SI risk. Family support (OR= 0.5; 95%CI 0.2-0.9) and peers/others support (OR= 0.4; 95%CI 0.2-0.8) were associated to a lower SI risk only among females.

CONCLUSIONS

Only mood disorder was a common risk factor of SI for both genders, whereas important gender-differences were observed regarding the other factors assessed. The protective effect from family and peers/others support was observed only among females. Further research assessing underlying mechanisms and pathways of gender-differences is needed.

Research on Relationships between Sexual Identity, Adverse Childhood Experiences and Non-Suicidal Self-Injury among Rural High School Students in Less Developed Areas of China

Purpose: The objective of this study was to examine the influence of sexual identity and adverse childhood experiences (ACEs) on non-suicidal self-injury (NSSI) among rural high school students in less developed areas of China. Methods: Behavior risk factors data collected from 1810 students from a high school in Jiangxi province, China. Five measures of childhood abuse and household dysfunction were summarized, and ACE was divided into 0, 1, 2, 3–5 ACEs. Logistic regression analysis was used to explore the influence of sexual identity, adverse childhood experiences, and their interaction with non-suicidal self-injury. Results: Compared with heterosexual students, high school students who identify as lesbian, gay, or bisexual (LGB) have a higher tendency of non-suicidal self-injury (AOR = 3.250, 95% CI = 1.69–6.28, p < 0.01). There was also a graded relationship between cumulative ACEs exposure and non-suicidal self-injury behaviors (AOR = 1.627, 95% CI = 1.02–2.60, p < 0.05). Odds for NSSI are higher among students with both experienced ACEs and identified as LGB (AOR = 2.821, 95% CI = 1.51–5.29, p < 0.05). Conclusions: Non-suicidal self-injury is associated with ACEs exposure and with those who identify as LGB, and the NSSI odds are greater when students identify as LGB and have experienced ACEs. More interventions to reduce non-suicidal self-injury should focus on LGB and ACEs and more attention needs to be paid to those who identify as LGB and have been exposed to ACEs.

Readiness to change and barriers to treatment seeking in college students with a mental disorder

BACKGROUND

College students have high prevalence of mental disorders and suicidal thoughts and behaviours, and low rates of treatment uptake. This study assesses treatment access, intentions to seek help, and perceived barriers to help-seeking, considering gender and suicidal thoughts or behaviours (STBs) as predictors.

METHODS

Data is from the Ulster University Student Wellbeing study (2015) conducted in Northern Ireland (NI), as part of the WHO World Mental Health Surveys International College Student Project. Participants are 392 new college entrants (162 males (41.3%)/230 females (58.7%)), who all reported some lifetime mental disorder or STBs.

RESULTS

Receipt of treatment was low (37.8%), particularly among males and those with no STBs. Males were less likely to intend to access external professional services and were less likely than females to rate embarrassment (OR = 0.60) or worry about being treated differently (OR = 0.63) as important reasons for not seeking treatment. Those with STBs rated wanting to handle things on their own as a more important barrier those with no STBs (OR = 0.55 for non STBs group) and rated being unsure where to go as a less important barrier than those with no STBs (OR = 1.80 for non STBs group).

LIMITATIONS

Data is correlational and concerns lifetime criteria for mental disorder, with no consideration of current mental status nor disorder type.

CONCLUSIONS

These findings have implications for the active screening and intervention for vulnerable college students, particularly males and those with mental disorders but no STBs.

The role of seasonality and photoperiod on the lethality of suicide attempts: A case-control study

BACKGROUND

The risk factors related to suicidal behaviors are complex and not yet fully known. Several studies underline how suicide results from the combination of psycho-social, biological, cultural, and environmental factors. The aim of this study was to investigate the potential role of seasonality and photoperiod on high-lethality suicide attempts (HLSA) compared with low-lethality suicide attempts (LLSA) in a sample of psychiatric inpatients.

METHODS

After attempting suicide, subjects were admitted in the emergency/psychiatric ward of the IRCCS Ospedale Policlinico San Martino from 1st August 2013 to 31st July 2018. Socio-demographic and clinical characteristics were collected.

RESULTS

The sample consisted of four hundred thirty-two individuals admitted for suicide attempt. One hundred thirty-three subjects (30.8%) of the sample committed a HLSA. The HLSA group peaked in the months with a higher sunlight exposure (June and July). Bivariate correlation analyses between seasonality/photoperiod in the whole sample and HLSA were positively associated with summer and highest solar intensity period.

LIMITATIONS

Data were limited to a single hospital, patients' seasonal environment, meteorological variables and psychological factors. In addition, the presence of acute life-events fostering the suicidal crisis has not been investigated.

CONCLUSIONS

The current study provides a novel perspective on the questions surrounding the impact of seasonality and daylight exposure on lethality of suicide attempts. further studies are needed to provide deeper understandings on the delicate molecular network that links suicide behaviors, seasonality and daylight in order to develop more effective prevention and treatment strategies in the future.

Sleep problem, suicide and self-harm in university students: A systematic review

Suicide and self-harm behaviours represent public health concerns, and university students are a particularly high risk group. Identifying modifiable risk factors for the development and maintenance of suicidal thoughts and behaviours is a research priority, as prevention is crucial. Research examining the relationship between poor sleep and self-harm/suicidality within university students is, for the first time, systematically evaluated, critically appraised, and synthesised. This literature consistently demonstrates that insomnia and nightmares are associated with elevated suicide risk of suicidal thoughts and behaviours within this subpopulation of young adults. However, as findings are predominantly derived from cross-sectional investigations, the directionality of this relationship is not yet clear. While research investigating the psychological processes driving these relationships is in its infancy, preliminary findings suggest that thwarted belongingness, socio-cognitive factors and emotional dysregulation could be partly responsible. Methodological limitations are highlighted and a research agenda suggesting the key directions for future research is proposed. Continued research in this area - employing longitudinal designs, and testing novel theoretically derived hypotheses - will be crucial to the development of suicide prevention and intervention efforts.