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Childhood adversities and suicidal thoughts and behaviors among first-year college students: results from the WMH-ICS initiative

Abstract

Purpose

To investigate the associations of childhood adversities (CAs) with lifetime onset and transitions across suicidal thoughts and behaviors (STB) among incoming college students.

Methods

Web-based self-report surveys administered to 20,842 incoming college students from nine countries (response rate 45.6%) assessed lifetime suicidal ideation, plans and attempts along with seven CAs: parental psychopathology, three types of abuse (emotional, physical, sexual), neglect, bully victimization, and dating violence. Logistic regression estimated individual- and population-level associations using CA operationalizations for type, number, severity, and frequency.

Results

Associations of CAs with lifetime ideation and the transition from ideation to plan were best explained by the exact number of CA types (OR range 1.32–52.30 for exactly two to seven CAs). Associations of CAs with a transition to attempts were best explained by the frequency of specific CA types (scaled 0–4). Attempts among ideators with a plan were significantly associated with all seven CAs (OR range 1.16–1.59) and associations remained significant in adjusted analyses with the frequency of sexual abuse (OR = 1.42), dating violence (OR = 1.29), physical abuse (OR = 1.17) and bully victimization (OR = 1.17). Attempts among ideators without plan were significantly associated with frequency of emotional abuse (OR = 1.29) and bully victimization (OR = 1.36), in both unadjusted and adjusted analyses. Population attributable risk simulations found 63% of ideation and 30–47% of STB transitions associated with CAs.

Conclusion

Early-life adversities represent a potentially important driver in explaining lifetime STB among incoming college students. Comprehensive intervention strategies that prevent or reduce the negative effects of CAs may reduce subsequent onset of STB.

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Funding

Funding to support this project was received from the National Institute of Mental Health (NIMH) R56MH109566 (RPA), and the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or NIMH; the Belgian Fund for Scientific Research (11N0514N/11N0516N/1114717N) (PM), the King Baudouin Foundation (2014-J2140150-102905) (RB), and Eli Lilly (IIT-H6U-BX-I002) (RB, PM); BARMER, a health care insurance company, for project StudiCare (DDE); ZonMw (Netherlands Organisation for Health Research and Development; grant number 636110005) and the PFGV (PFGV; Protestants Fonds voor de Geestelijke Volksgezondheid) in support of the student survey project (PC); South African Medical Research Council (Mid-Career Scientist Programme awarded to Jason Bantjes); Consejo Nacional de Ciencia y Tecnología (CONACyT: CB-2016–01-28554) (BC); Fondo de Investigación Sanitaria, Instituto de Salud Carlos III—FEDER (PI13/00343), ISCIII (Río Hortega, CM14/00125), ISCIII (Sara Borrell, CD12/00440); European Union Regional Development Fund (ERDF) EU Sustainable Competitiveness Programme for Northern Ireland, Northern Ireland Public Health Agency (HSC R&D), and Ulster University (TB); Ministerio de Sanidad, Servicios Sociales e Igualdad, PNSD (Exp. 2015I015); DIUE Generalitat de Catalunya (2014 SGR 748), FPU (FPU15/05728) (JA). In Australia, the World Mental Health International College Student project is supported by Suicide Prevention Australia. Philippe Mortier has a Sara Borrell research contract awarded by the Instituto de Salud Carlos IIII (SCIII—CD18/00049). The World Mental Health International College Student project is carried out as part of the WHO World Mental Health (WMH) Survey Initiative. The WMH survey is supported by the National Institute of Mental Health NIMH R01MH070884, 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.

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All authors made substantial contributions to the conception or design of the manuscript, or the acquisition, analysis, or interpretation of data; drafted the work or revised it critically for important intellectual content; approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Data analysis was performed by PM, AMZ, and RCK. The first draft of the manuscript was written by PM and all authors commented on previous versions of the manuscript.

WHO WMH-ICS Collaborators. Australia: Mark Boyes, David Preece, (School of Population Health, Curtin University); Belgium: Erik Bootsma, Koen Demyttenaere (KU Leuven); Germany: Matthias Berking, Marvin Franke, Fanny Kählke (Friedrich-Alexander University Erlangen Nuremberg); Harald Baumeister, Ann-Marie Küchler (University of Ulm); Hong Kong: Siu Oi-ling, Lingnan University; Mexico: Yesica Albor, Guilherme Borges, Maria Elena Medina-Mora (Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz); Raúl Alejandro Gutierrez-García (Universidad la Salle Bajío); Ma. Socorro Durán, Gustavo Pérez Tarango, María Alicia Zavala Berbena (Universidad la Salle Bajío); Rogaciano González González, Maria Abigail Paz-Peréz (Universidad la Salle Salamanca); Alicia Edith Hermosillo de la Torre, Kalina Isela Martínez Martínez (Universidad Autonoma de Aguascalientes); Anabell Covarrubias Díaz (Universidad La Salle Noroeste); Sinead Martínez Ruiz (Universidad la Salle Pachuca); Ana María Martínez Jérez (Universidad Autonoma de Tamaulipas); Rebeca Guzmán (Universidad Autonoma del Estado de Hidalgo); Adrián Abrego Ramírez (Universidad Cuauhtémoc); Northern Ireland: Tony Bjourson, Margaret McLafferty, Elaine Murray, (Ulster University); South Africa: Christine Lochner, Janine Roos, Lian Taljaard, (MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University); Wylene Saal, (Department of Psychology, Stellenbosch University); Spain: The UNIVERSAL study Group (Universidad y Salud Mental) includes: Itxaso Alayo, Laura Ballester, Gabriela Barbaglia, Maria Jesús Blasco, Pere Castellví, Ana Isabel Cebrià, Carlos García-Forero, Andrea Miranda-Mendizábal, Oleguer Parès-Badell (Pompeu Fabra University); José Almenara, Carolina Lagares (Cadiz University), Enrique Echeburúa, Andrea Gabilondo, Álvaro Iruin (Basque Country University); María Teresa Pérez-Vázquez, José Antonio Piqueras, Victoria Soto-Sanz, Jesús Rodríguez-Marín (Miguel Hernández University); and Miquel Roca, Margarida Gili, Margarida Vives (Illes Balears University).

Corresponding author

Correspondence to Philippe Mortier.

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Conflict of interest

Dr. Auerbach serves on the scientific advisory board for Ksana Health. Dr. Ebert reports to have received consultancy fees/served on the scientific advisory board for Sanofi, Novartis, Minddistrict, Lantern, Schoen Kliniken, and two German health insurance companies (BARMER, Techniker Krankenkasse). He is also a stakeholder in the Institute for health training online (GET.ON), which aims to implement scientific findings related to digital health interventions into routine care. Dr. Wilks receives consultation fees from Mindstrong Health and Click Therapeutics. In the past 3 years, Dr. Kessler was a consultant for Datastat, Inc., Holmusk, RallyPoint Networks, Inc., and Sage Pharmaceuticals. He has stock options in Mirah, PYM, and Roga Sciences.

Ethics approval

Details about ethics approval for the WHO WMH‐ICS Initiative countries is available online [29].

Consent to participate

Informed consent was obtained before administering the web-based self-report questionnaires and after explaining study procedures in all countries.

Consent for publication

Not applicable.

Availability of data and material

The participant data and statistical analysis plan used for this study are available upon reasonable request from the corresponding author (PM) as long as the main objective of the data sharing request is replicating the analysis and findings as reported in this paper.

Code availability

The statistical code (SAS) used for this study are available upon reasonable request from the corresponding author (PM) as long as the main objective of the statistical code sharing request is replicating the analysis and findings as reported in this paper.

Additional information

The members of the group "WHO WMH-ICS Collaborators" are listed in Acknowledgements section.

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Mortier, P., Alonso, J., Auerbach, R.P. et al. Childhood adversities and suicidal thoughts and behaviors among first-year college students: results from the WMH-ICS initiative. Soc Psychiatry Psychiatr Epidemiol (2021). https://doi.org/10.1007/s00127-021-02151-4

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Keywords

  • Childhood adversity
  • Suicidal ideation
  • Suicide attempt
  • College students
  • Multivariate models
  • Population-attributable risk