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Suicidal thoughts and behaviors among college students and same-aged peers: results from the World Health Organization World Mental Health Surveys

  • Philippe Mortier
  • Randy P. Auerbach
  • Jordi Alonso
  • William G. Axinn
  • Pim Cuijpers
  • David D. Ebert
  • Jennifer G. Green
  • Irving Hwang
  • Ronald C. Kessler
  • Howard Liu
  • Matthew K. Nock
  • Stephanie Pinder-Amaker
  • Nancy A. Sampson
  • Alan M. Zaslavsky
  • Jibril Abdulmalik
  • Sergio Aguilar-Gaxiola
  • Ali Al-Hamzawi
  • Corina Benjet
  • Koen Demyttenaere
  • Silvia Florescu
  • Giovanni De Girolamo
  • Oye Gureje
  • Josep Maria Haro
  • Chiyi Hu
  • Yueqin Huang
  • Peter De Jonge
  • Elie G. Karam
  • Andrzej Kiejna
  • Viviane Kovess-Masfety
  • Sing Lee
  • John J. Mcgrath
  • Siobhan O’neill
  • Vladimir Nakov
  • Beth-Ellen Pennell
  • Marina Piazza
  • José Posada-Villa
  • Charlene Rapsey
  • Maria Carmen Viana
  • Miguel Xavier
  • Ronny Bruffaerts
Original Paper

Abstract

Purpose

The primary aims are to (1) obtain representative prevalence estimates of suicidal thoughts and behaviors (STB) among college students worldwide and (2) investigate whether STB is related to matriculation to and attrition from college.

Methods

Data from the WHO World Mental Health Surveys were analyzed, which include face-to-face interviews with 5750 young adults aged 18–22 spanning 21 countries (weighted mean response rate = 71.4%). Standardized STB prevalence estimates were calculated for four well-defined groups of same-aged peers: college students, college attriters (i.e., dropouts), secondary school graduates who never entered college, and secondary school non-graduates. Logistic regression assessed the association between STB and college entrance as well as attrition from college.

Results

Twelve-month STB in college students was 1.9%, a rate significantly lower than same-aged peers not in college (3.4%; OR 0.5; p < 0.01). Lifetime prevalence of STB with onset prior to age 18 among college entrants (i.e., college students or attriters) was 7.2%, a rate significantly lower than among non-college attenders (i.e., secondary school graduates or non-graduates; 8.2%; OR 0.7; p = 0.03). Pre-matriculation onset STB (but not post-matriculation onset STB) increased the odds of college attrition (OR 1.7; p < 0.01).

Conclusion

STB with onset prior to age 18 is associated with reduced likelihood of college entrance as well as greater attrition from college. Future prospective research should investigate the causality of these associations and determine whether targeting onset and persistence of childhood–adolescent onset STB leads to improved educational attainment.

Keywords

Suicidal thoughts and behaviors Young adult College student Academic performance Epidemiology 

Notes

Acknowledgements

We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis. A complete list of all within-country and cross-national WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.

Funding

The World Health Organization World Mental Health (WMH) Survey Initiative is supported by the National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline, and Bristol-Myers Squibb. None of the funders had any role in the design, analysis, interpretation of results, or preparation of this paper. The 2007 Australian National Survey of Mental Health and Wellbeing is funded by the Australian Government Department of Health and Ageing. The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00204-3. The Bulgarian Epidemiological Study of common mental disorders EPIBUL is supported by the Ministry of Health and the National Center for Public Health Protection. The Chinese World Mental Health Survey Initiative is supported by the Pfizer Foundation. The Shenzhen Mental Health Survey is supported by the Shenzhen Bureau of Health and the Shenzhen Bureau of Science, Technology, and Information. The Colombian National Study of Mental Health (NSMH) is supported by the Ministry of Social Protection. The Mental Health Study Medellín – Colombia was carried out and supported jointly by the Center for Excellence on Research in Mental Health (CES University) and the Secretary of Health of Medellín. The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123, and EAHC 20081308), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. Implementation of the Iraq Mental Health Survey (IMHS) and data entry were carried out by the staff of the Iraqi MOH and MOP with direct support from the Iraqi IMHS team with funding from both the Japanese and European Funds through United Nations Development Group Iraq Trust Fund (UNDG ITF). The Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation (L.E.B.A.N.O.N.) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), National Institute of Health/Fogarty International Center (R03 TW006481-01), anonymous private donations to IDRAAC, Lebanon, and unrestricted grants from, Algorithm, AstraZeneca, Benta, Bella Pharma, Eli Lilly, Glaxo Smith Kline, Lundbeck, Novartis, Servier, Phenicia, UPO. The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544-H), with supplemental support from the PanAmerican Health Organization (PAHO). Corina Benjet has received funding from the (Mexican) National Council of Science and Technology (Grant CB-2010-01-155221). Te Rau Hinengaro: The New Zealand Mental Health Survey (NZMHS) is supported by the New Zealand Ministry of Health, Alcohol Advisory Council, and the Health Research Council. The Nigerian Survey of Mental Health and Wellbeing (NSMHW) is supported by the WHO (Geneva), the WHO (Nigeria), and the Federal Ministry of Health, Abuja, Nigeria. The Northern Ireland Study of Mental Health was funded by the Health & Social Care Research & Development Division of the Public Health Agency. The Peruvian World Mental Health Study was funded by the National Institute of Health of the Ministry of Health of Peru. The Polish project Epidemiology of Mental Health and Access to Care – EZOP Project (PL 0256) was supported by Iceland, Liechtenstein and Norway through funding from the EEA Financial Mechanism and the Norwegian Financial Mechanism. EZOP project was co-financed by the Polish Ministry of Health. The Portuguese Mental Health Study was carried out by the Department of Mental Health, Faculty of Medical Sciences, NOVA University of Lisbon, with collaboration of the Portuguese Catholic University, and was funded by Champalimaud Foundation, Gulbenkian Foundation, Foundation for Science and Technology (FCT) and Ministry of Health. The Romania WMH study projects “Policies in Mental Health Area” and “National Study regarding Mental Health and Services Use” were carried out by National School of Public Health & Health Services Management (former National Institute for Research & Development in Health), with technical support of Metro Media Transilvania, the National Institute of Statistics-National Centre for Training in Statistics, SC. Cheyenne Services SRL, Statistics Netherlands and were funded by Ministry of Public Health (former Ministry of Health) with supplemental support of Eli Lilly Romania SRL. The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708), and the John W. Alden Trust. Liu’s work was supported in part by a training grant from the National Institute of Mental Health (T32 MH017119). Mortier’s work was supported by the Belgian Federal Fund for Fundamental Scientific Research (FWO; 11N0514N/11N0516N). The funding sources had no role in the design and conduct of the study; collection, management, analysis, interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Compliance with ethical standards

Conflict of interest

In the past 3 years, Dr. Kessler received support for his epidemiological studies from Sanofi Aventis; was a consultant for Johnson & Johnson Wellness and Prevention, Shire, Takeda; and served on an advisory board for the Johnson & Johnson Services Inc. Lake Nona Life Project. Kessler is a co-owner of DataStat, Inc., a market research firm that carries out healthcare research. In the past 3 years, Dr. Demyttenaere has received personal fees from Lundbeck, Johnson & Johnson and Servier, as well as grant funding from Foundation ‘Ga voor Geluk’. In the past 3 years, Dr. Haro has received personal fees from Eli Lilly & Co., Lundbeck and Otsuka. The other authors report no biomedical financial interests or potential conflicts of interest.

Supplementary material

127_2018_1481_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 KB)

References

  1. 1.
    World Health Organization (WHO). Suicide data. Available from: http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/. Accessed June 7, 2017
  2. 2.
    Organisation for Economic Co-operation and Development (OECD). Education at a Glance 2012: OECD Indicators. Available from: http://www.oecd.org/edu/EAG%202012_e-book_EN_200912.pdf. Accessed June 7, 2017
  3. 3.
    Mortier P, Cuijpers P, Kiekens G et al. (2017) The prevalence of suicidal thoughts and behaviours among college students: a meta-analysis. Psychol Med 1–12Google Scholar
  4. 4.
    Han B, Compton WM, Eisenberg D, Milazzo-Sayre L, McKeon R, Hughes A (2016). Prevalence and mental health treatment of suicidal ideation and behavior among college students aged 18–25 years and their non-college-attending peers in the United States. J Clin Psychiatry 77(6):815–824CrossRefPubMedGoogle Scholar
  5. 5.
    Kessler RC, Üstün TB (2008). The WHO World Mental Health Surveys: global perspectives on the epidemiology of mental disorders. Cambridge University Press, CambridgeGoogle Scholar
  6. 6.
    Wolter K (1985). Introduction to Variance Estimation. SpringerGoogle Scholar
  7. 7.
    SAS Institute Inc. 2017. Base SAS® 9.4. SAS Institute Inc, CaryGoogle Scholar
  8. 8.
    Groves RM, Presser R, Dipko S (2004) The role of topic interest in survey participation decisions. Public Opin Q 68(1):2–31CrossRefGoogle Scholar
  9. 9.
    Millner AJ, Lee MD, Nock MK (2015) Single-item measurement of suicidal behaviors: validity and consequences of misclassification. PLoS ONE 10(10):e0141606CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Nock MK, Borges G, Bromet EJ et al (2008) Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry 192(2):98–105CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Nock MK, Green JG, Hwang I et al (2013) Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry 70(3):300–310CrossRefPubMedGoogle Scholar
  12. 12.
    Glenn CR, Lanzillo EC, Esposito EC, Santee AC, Nock MK, Auerbach RP (2016). Examining the course of suicidal and nonsuicidal self-injurious thoughts and behaviors in outpatient and inpatient adolescents. J Abnorm Child Psychol 45:971–983CrossRefGoogle Scholar
  13. 13.
    Borges G, Nock MK, Haro Abad JM et al (2010) Twelve-month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys. J Clin Psychiatry 71(12):1617–1628CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Mojtabai R, Stuart EA, Hwang I, Eaton WW, Sampson N, Kessler RC (2015) Long-term effects of mental disorders on educational attainment in the National Comorbidity Survey ten-year follow-up. Soc Psychiatry Psychiatr Epidemiol 50(10):1577–1591CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Auerbach RP, Alonso J, Axinn WG et al (2016) Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychol Med 3:1–16Google Scholar
  16. 16.
    Mortier P, Demyttenaere K, Auerbach RP et al (2015) The impact of lifetime suicidality on academic performance in college freshmen. J Affect Disord 186:254–260CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    De Luca SM, Franklin C, Yueqi Y, Johnson S, Brownson C (2016) The relationship between suicide ideation, behavioral health, and college academic performance. Commun Ment Health J 52(5):534–540CrossRefGoogle Scholar
  18. 18.
    Harrod CS, Goss CW, Stallones L, DiGuiseppi C (2014) Interventions for primary prevention of suicide in university and other post-secondary educational settings. Cochrane Database Syst Rev 10:Cd009439Google Scholar
  19. 19.
    De Silva S, Parker A, Purcell R, Callahan P, Liu P, Hetrick S (2013) Mapping the evidence of prevention and intervention studies for suicidal and self-harming behaviors in young people. Crisis 34(4):223–232CrossRefPubMedGoogle Scholar
  20. 20.
    Mortier P, Demyttenaere K, Auerbach RP et al (2016) First onset of suicidal thoughts and behaviours in college. J Affect Disord 207:291–299CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bruffaerts R, Demyttenaere K, Borges G et al (2012) Treatment of suicidal persons around the world. In: Nock MK, Borges G, Ono Y (eds) Suicide: global perspectives from the WHO World Mental Health Surveys. Cambridge University Press, New York, pp 199–212Google Scholar
  22. 22.
    van Spijker BA, van Straten A, Kerkhof AJ (2014) Effectiveness of online self-help for suicidal thoughts: results of a randomised controlled trial. PLoS ONE 9(2):e90118CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Eisenberg D, Gollust SE, Golberstein E, Hefner JL (2007) Prevalence and correlates of depression, anxiety, and suicidality among university students. Am J Orthopsychiat 77:534–542CrossRefPubMedGoogle Scholar
  24. 24.
    Brener ND, Hassan SS, Barrios LC (1999) Suicidal ideation among college students in the United States. J Consult Clin Psychol 67(6):1004–1008CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Philippe Mortier
    • 1
  • Randy P. Auerbach
    • 2
    • 3
  • Jordi Alonso
    • 4
    • 5
    • 6
  • William G. Axinn
    • 7
  • Pim Cuijpers
    • 8
    • 9
  • David D. Ebert
    • 10
  • Jennifer G. Green
    • 11
  • Irving Hwang
    • 12
  • Ronald C. Kessler
    • 12
  • Howard Liu
    • 12
    • 13
  • Matthew K. Nock
    • 14
  • Stephanie Pinder-Amaker
    • 2
    • 15
  • Nancy A. Sampson
    • 12
  • Alan M. Zaslavsky
    • 12
  • Jibril Abdulmalik
    • 16
  • Sergio Aguilar-Gaxiola
    • 17
  • Ali Al-Hamzawi
    • 18
  • Corina Benjet
    • 19
  • Koen Demyttenaere
    • 20
  • Silvia Florescu
    • 21
  • Giovanni De Girolamo
    • 22
  • Oye Gureje
    • 23
  • Josep Maria Haro
    • 24
  • Chiyi Hu
    • 25
  • Yueqin Huang
    • 26
  • Peter De Jonge
    • 27
    • 28
  • Elie G. Karam
    • 29
    • 30
    • 31
  • Andrzej Kiejna
    • 32
  • Viviane Kovess-Masfety
    • 33
  • Sing Lee
    • 34
  • John J. Mcgrath
    • 35
    • 36
    • 37
  • Siobhan O’neill
    • 38
  • Vladimir Nakov
    • 39
  • Beth-Ellen Pennell
    • 40
  • Marina Piazza
    • 41
    • 42
  • José Posada-Villa
    • 43
  • Charlene Rapsey
    • 44
  • Maria Carmen Viana
    • 45
  • Miguel Xavier
    • 46
  • Ronny Bruffaerts
    • 47
  1. 1.Research Group Psychiatry, Department of NeurosciencesKU Leuven UniversityLeuvenBelgium
  2. 2.Department of PsychiatryHarvard Medical SchoolBostonUSA
  3. 3.Center for Depression, Anxiety and Stress ResearchMcLean HospitalBelmontUSA
  4. 4.Health Services Research UnitIMIM-Hospital del Mar Medical Research InstituteBarcelonaSpain
  5. 5.Pompeu Fabra University (UPF)BarcelonaSpain
  6. 6.CIBER en Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
  7. 7.Population Studies Center, Survey Research Center, Institute for Social Research and the Department of SociologyUniversity of MichiganAnn ArborUSA
  8. 8.Department of Clinical, Neuro, and Developmental PsychologyVrije Universiteit AmsterdamAmsterdamThe Netherlands
  9. 9.EMGO Institute for Health and Care ResearchAmsterdamThe Netherlands
  10. 10.Department of Psychology, Clinical Psychology and PsychotherapyFriedrich-Alexander University Nuremberg-ErlangenErlangenGermany
  11. 11.School of EducationBoston UniversityBostonUSA
  12. 12.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  13. 13.Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonUSA
  14. 14.Department of PsychologyHarvard UniversityCambridgeUSA
  15. 15.McLean HospitalBelmontUSA
  16. 16.Department of PsychiatryCollege of Medicine, University of IbadanIbadanNigeria
  17. 17.University of California Davis Center for Reducing Health DisparitiesSacramentoUSA
  18. 18.College of MedicineAl-Qadisiya UniversityDiwania GovernorateIraq
  19. 19.Department of Epidemiologic and Psychosocial ResearchNational Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
  20. 20.Department of PsychiatryUniversity Hospital Gasthuisberg, Katholieke Universiteit LeuvenLeuvenBelgium
  21. 21.National School of Public HealthManagement and Professional DevelopmentBucharestRomania
  22. 22.Unit of Epidemiological and Evaluation PsychiatryIstituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research CentreBresciaItaly
  23. 23.Department of PsychiatryUniversity College HospitalIbadanNigeria
  24. 24.Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de BarcelonaBarcelonaSpain
  25. 25.Shenzhen Institute of Mental Health, Shenzhen Kangning HospitalShenzhenChina
  26. 26.Institute of Mental HealthPeking UniversityBeijingChina
  27. 27.Developmental Psychology, Department of PsychologyRijksuniversiteit GroningenGroningenThe Netherlands
  28. 28.Center Psychopathology and Emotion Regulation, Department of PsychiatryUniversity Medical Center GroningenGroningenThe Netherlands
  29. 29.Department of Psychiatry and Clinical Psychology, Faculty of MedicineBalamand UniversityBeirutLebanon
  30. 30.Department of Psychiatry and Clinical PsychologySt George Hospital University Medical CenterBeirutLebanon
  31. 31.Institute for Development Research Advocacy and Applied Care (IDRAAC)BeirutLebanon
  32. 32.Department of PsychiatryWroclaw Medical UniversityWroclawPoland
  33. 33.Ecole des Hautes Etudes en Santé Publique (EHESP)EA 4057 Paris Descartes UniversityParisFrance
  34. 34.Department of PsychiatryChinese University of Hong KongTai PoHong Kong
  35. 35.Queensland Centre for Mental Health ResearchThe Park Centre for Mental HealthWacolAustralia
  36. 36.Queensland Brain InstituteThe University of QueenslandSt LuciaAustralia
  37. 37.National Centre for Register-based ResearchAarhus UniversityAarhusDenmark
  38. 38.School of PsychologyUlster UniversityLondonderryUK
  39. 39.Department of Mental HealthNational Center of Public Health and AnalysesSofiaBulgaria
  40. 40.Survey Research Center, Institute for Social ResearchUniversity of MichiganAnn ArborUSA
  41. 41.Universidad Cayetano HerediaLimaPeru
  42. 42.National Institute of HealthLimaPeru
  43. 43.Colegio Mayor de Cundinamarca UniversityFaculty of Social SciencesBogotaColombia
  44. 44.Department of Psychological MedicineUniversity of OtagoDunedinNew Zealand
  45. 45.Department of Social MedicineFederal University of Espírito SantoVitoriaBrazil
  46. 46.Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências MédicasUniversidade Nova de LisboaLisbonPortugal
  47. 47.Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus GasthuisbergLeuvenBelgium

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