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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

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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.

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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.

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Authors and Affiliations

  1. Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Herestraat 49, 3000, Leuven, Belgium

    Philippe Mortier

  2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    Randy P. Auerbach & Stephanie Pinder-Amaker

  3. Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA

    Randy P. Auerbach

  4. Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain

    Jordi Alonso

  5. Pompeu Fabra University (UPF), Barcelona, Spain

    Jordi Alonso

  6. CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

    Jordi Alonso

  7. Population Studies Center, Survey Research Center, Institute for Social Research and the Department of Sociology, University of Michigan, Ann Arbor, MI, USA

    William G. Axinn

  8. Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

    Pim Cuijpers

  9. EMGO Institute for Health and Care Research, Amsterdam, The Netherlands

    Pim Cuijpers

  10. Department of Psychology, Clinical Psychology and Psychotherapy, Friedrich-Alexander University Nuremberg-Erlangen, Erlangen, Germany

    David D. Ebert

  11. School of Education, Boston University, Boston, MA, USA

    Jennifer G. Green

  12. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    Irving Hwang, Ronald C. Kessler, Howard Liu, Nancy A. Sampson & Alan M. Zaslavsky

  13. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Howard Liu

  14. Department of Psychology, Harvard University, Cambridge, MA, USA

    Matthew K. Nock

  15. McLean Hospital, Belmont, MA, USA

    Stephanie Pinder-Amaker

  16. Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria

    Jibril Abdulmalik

  17. University of California Davis Center for Reducing Health Disparities, Sacramento, CA, USA

    Sergio Aguilar-Gaxiola

  18. College of Medicine, Al-Qadisiya University, Diwania Governorate, Iraq

    Ali Al-Hamzawi

  19. Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico

    Corina Benjet

  20. Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium

    Koen Demyttenaere

  21. National School of Public Health, Management and Professional Development, Bucharest, Romania

    Silvia Florescu

  22. Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Brescia, Italy

    Giovanni De Girolamo

  23. Department of Psychiatry, University College Hospital, Ibadan, Nigeria

    Oye Gureje

  24. Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain

    Josep Maria Haro

  25. Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen, China

    Chiyi Hu

  26. Institute of Mental Health, Peking University, Beijing, China

    Yueqin Huang

  27. Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, The Netherlands

    Peter De Jonge

  28. Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands

    Peter De Jonge

  29. Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon

    Elie G. Karam

  30. Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon

    Elie G. Karam

  31. Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon

    Elie G. Karam

  32. Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland

    Andrzej Kiejna

  33. Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University, Paris, France

    Viviane Kovess-Masfety

  34. Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong

    Sing Lee

  35. Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, 4072, Australia

    John J. Mcgrath

  36. Queensland Brain Institute, The University of Queensland, St Lucia, QLD, 4065, Australia

    John J. Mcgrath

  37. National Centre for Register-based Research, Aarhus University, Aarhus, V 8000, Denmark

    John J. Mcgrath

  38. School of Psychology, Ulster University, Londonderry, UK

    Siobhan O’neill

  39. Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria

    Vladimir Nakov

  40. Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA

    Beth-Ellen Pennell

  41. Universidad Cayetano Heredia, Lima, Peru

    Marina Piazza

  42. National Institute of Health, Lima, Peru

    Marina Piazza

  43. Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia

    José Posada-Villa

  44. Department of Psychological Medicine, University of Otago, Dunedin, New Zealand

    Charlene Rapsey

  45. Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil

    Maria Carmen Viana

  46. Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal

    Miguel Xavier

  47. Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium

    Ronny Bruffaerts

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  1. Philippe Mortier
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  2. Randy P. Auerbach
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  3. Jordi Alonso
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  4. William G. Axinn
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  5. Pim Cuijpers
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  6. David D. Ebert
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  7. Jennifer G. Green
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  8. Irving Hwang
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  9. Ronald C. Kessler
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  10. Howard Liu
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  11. Matthew K. Nock
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  12. Stephanie Pinder-Amaker
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  13. Nancy A. Sampson
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  14. Alan M. Zaslavsky
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  15. Jibril Abdulmalik
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  16. Sergio Aguilar-Gaxiola
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  17. Ali Al-Hamzawi
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  18. Corina Benjet
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  19. Koen Demyttenaere
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  20. Silvia Florescu
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  21. Giovanni De Girolamo
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  22. Oye Gureje
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  23. Josep Maria Haro
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  24. Chiyi Hu
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  25. Yueqin Huang
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  26. Peter De Jonge
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  27. Elie G. Karam
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  28. Andrzej Kiejna
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  29. Viviane Kovess-Masfety
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  30. Sing Lee
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  32. Siobhan O’neill
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  33. Vladimir Nakov
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  34. Beth-Ellen Pennell
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  35. Marina Piazza
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  36. José Posada-Villa
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  37. Charlene Rapsey
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  38. Maria Carmen Viana
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  39. Miguel Xavier
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  40. Ronny Bruffaerts
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Corresponding author

Correspondence to Philippe Mortier.

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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.

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Mortier, P., Auerbach, R.P., Alonso, J. et al. Suicidal thoughts and behaviors among college students and same-aged peers: results from the World Health Organization World Mental Health Surveys. Soc Psychiatry Psychiatr Epidemiol 53, 279–288 (2018). https://doi.org/10.1007/s00127-018-1481-6

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