Undergraduate and Graduate Student Coping with Stressful Experiences : The Continuum of Distress, Suicidal Experiences

1. Undergraduate and Graduate Student Coping with Stressful Experiences:The Continuum of Distress, Suicidal Experiences and Outcomes Chris Brownson, PhD cbrownson@austin.utexas.edu Elaine Hess, MA ehess@utexas.edu The University of Texas at Austin Jennifer Kyle, PhD jkyle3@gmail.com Queens College

2. Founded in 1991 at UT Austin • 6 completed studies to date • Will discuss data from our two most recent studies and campus-level data • Membership is determined study-by-study • Research is an essential ingredient for defining a subspecialty of college mental health (Penn State’s CSCMH, NCHA, Director’s Surveys, etc.)

3. National Suicide Statistics • 2nd leading cause of death on college campuses • National suicide rates for college students range from 6.5 to 7.5 per 100,000 • Compared to 16 per 100,000 in age-matched peers • Roughly 25% of campus suicides are counseling center clients, nationally • Suicides in CC clients are 3.3 times greater than non-clients • When taking into consideration the 4 most significant risk factors (previous attempts, psychiatric illness, gender, and firearms), you would expect clients of CCs to commit suicide 20 times more than non-clients. Schwartz, 2006, 2011

4. Overview of Presentation • Overview problem of college student suicide • Consortium 2006 & 2011 structure/demographics • Problem of college student suicide • Key findings from Consortium studies • College Student Coping • Distal and proximal risk factors • Presentation of study details • Proximal risk factors • Protective factor: Coping • Help-seeking • Help-seeking patterns • Help-avoidance patterns • Implications of help-seeking/avoidance data

5. Overview of Current Study Characteristics • Web-based survey, anonymous, intervention • Over 26,000 undergraduate and graduate student responses (~101,000 surveys sent) ~ 26% response rate • 74 colleges and universities participated • Random sample at each school • Goal: Useful info for IHEs/CCs; both research and “screening” Demographics comparable to most recent NCHA survey

6. Structure of Survey • Demographics • History of help-seeking, risk and protective factors • Focus in on recent stressful period • Characteristics of stressor • Level of distress during worst point • Coping approaches • Outcomes (e.g., suicidal ideation) • Resolution • Resilience and factors impacted ability to cope

7. Demographics • N = 26,430 • Mean Age of 25.5 years (Range: 18 – 95 years) • 63% Female • 92% Heterosexual

8. Race/Ethnicity

9. Mental Health History

10. Lifetime Suicidal Ideation for College Students • Approximately half endorsed some form of suicidal thoughts in lifetime (Drum, Brownson, Burton Denmark & Smith, 2009) • Approximately 20% endorsed seriously considering suicide in lifetime (Drum et al., 2009) • Female students more likely to report lifetime ideation and attempts (Brownson, Drum, Smith & Burton Denmark, 2011)

11. First Considered Suicide

12. Recent Suicidal Ideation • 5 to 6% seriously considered suicide in past 12 months (Drum et al., 2009; ACHA-NCHA II, 2011) • ~1% actually attempted in past year • Episodes of ideation in past year described as brief, recurrent and intense (Drum et al., 2009) • Female students appear to be at greater risk for recent suicidal ideation and attempts (Brownson et al., 2011)

13. Prevalence of Lifetime & Recent Suicide Attempts

14. Intentions at Time of Attempt

15. Role of Drugs & Alcohol in Attempt

16. Thoughts During Stressful Period

17. First experience STRESS Most students who experience DISTRESS Adapted from a presentation prepared by Arizona State University’s Wellness & Health Promotion Center

18. The idea is to reach students here… …so fewer end up here Adapted from a presentation prepared by Arizona State University’s Wellness & Health Promotion Center

19. Discussion Questions • What are your campuses doing to try to shift the curve (i.e., prevention & fostering well-being of entire population)? • What are some of the challenges with tying suicide prevention to broader prevention initiatives on campus? • Counseling Centers and Health Education Centers can’t be solely responsible for this • What successes and challenges have you had in collaborating with cross-campus partners?

20. Overview of Presentation • Overview problem of college student suicide • Consortium 2006 & 2011 structure/demographics • Problem of college student suicide • Key findings from Consortium studies • College Student Protective Factors and Coping • Distal and proximal risk factors • Presentation of study details • Proximal risk factors • Protective factor: Coping • Help-seeking • Help-seeking patterns • Help-avoidance patterns • Implications of help-seeking/avoidance data

21. Distal vs. Proximal Risk Factors • Suicide results from a complex interaction of distal and proximal risk factors • While having a lack of protective factors such as coping skills, family cohesion, adequate social support and access to mental health services • Proximal Risk factors: Stressful life events, Intoxication, Hopelessness Moscicki, 2001

22. Distal vs. Proximal Risk Protective Factors such as coping, spiritual faith influence the progression

23. Queens College Part of the City University of New York, the nation's largest urban public university. Established in 1937 to offer a liberal arts education. Enrollment of 20,000 students, including 16,000 undergraduate students. Students come from nearly 170 different countries and speak over 110 different languages. One of the “Best Public Universities-Master’s” institutions in U.S. News and World Report’s America’s Best Colleges. Historically, a commuter school, however, in 2011, Queens College opened the first residential facility.

24. National vs. Campus Level Data

25. Demographics: Race/Ethnicity

26. Religious Preference • Christian = 46.2% • Catholic = 29.5% • Jewish = 16.7% • Buddhist = 3.8% • Hindu = 3.8% • Agnostic = 10.3% • Atheist = 5.1% How important are your beliefs? • Very important = 37.2% • Moderately important = 35.9% • Not at all = 25.6%

27. Connection with Friends & Family

28. Past History of Suicide • Ever consider attempting suicide: • Yes = 19 (24%) • No = 59 (75.6%) • When did you first consider suicide? • Prior to college = 16 (20.5%) • While in College/Other = 3 (3.9%) • Therefore, 84% of those having ever thought about suicide had done so prior to attending college.

29. Proximal Risk: Stress

30. Comparison of Students with History of SI: Stress Management

31. Proximal Risk: Stress & Its Impact on Social Connectedness and Belongingness

32. Protective Factor: Coping

33. Coping: It’s Impact on Stress The strength of faith-based coping is its ability to find meaning that allows one to overcome adversity and maintain greater psychological and physical well being (Wachholtz & Sambamoorthi, 2011)

34. Protective Factor: Coping & Spiritual Faith • Faith-based coping 1) Helps develop personal meaning around a particular stressful event, and regulate the associated affective experience 2) facilitates the use of social support, e.g., faith- based gatherings. Youth with spiritual beliefs were more likely to use and favorably evaluate social support received from a variety of sources, e.g., parents, siblings, friends and church groups and were less at risk.

35. Proximal Risk: Stress to Distress And for some students, their distress manifested as overwhelming thoughts: • This is all just too much = 36 (46.2%) • I wish this all would end = 29 (37.2%) • I have to escape = 15 (19.2%) • I wish I was dead = 6 (7.7%) • I want to kill myself = 6 (7.7%) • I might kill myself = 2 (2.6%) • I will kill myself = 1 (1.3%)

36. Stress – Distress Continuum • Key finding on suicide crisis in college students reported that suicidal thoughts are common but most importantly that crises are often brief, intense and can be recurrent (Drum, Brownson, Burton Denmark & Smith, 2009). • Therefore understanding the role that individual and environmental protective factorsplay in the students progression from just being merely stressed to distressed and contemplating suicide becomes paramount.

37. Protective Factors Protective factors are varied and can include an individual's attitudinal and behavioral characteristics, as well as attributes of the environment and culture. Examples: • Strong connections to family and community support • Skills in problem solving and coping • Easy access to a variety of clinical interventions and support for help-seeking • Cultural and religious beliefs that discourage suicide

38. Protective Factors Study • Examining protective factors in a sample of diverse college youth as a means of predicting passive ideation • Instruments • Suicide (Outcome Variable): • HarkavyAsnis Suicide Scale (HASS) • Protective Factors (Predictor Variables) : • College Student-Reasons for Living Inventory (RFL-CS) • Young Adult Social Support Inventory (YA-SSI) • Spiritual Well- Being Scale (SWBS)

39. Dependent Variable: Suicide Data

40. Student Distress: Passive Ideation

41. Protective Factors as Predictors of Passive Ideation

42. Discussion Questions • Do we need to target students differently based on distal versus proximal risk factors? • How can we foster better coping skills among students, such as using freshman seminars? • How has your campus used existing programs or outreach efforts to foster better coping among students? • How can we increase social connectedness on college campuses? And would we need differential strategies for commuter versus residential universities? • As college counselors, how can we support students’ faith-based coping?

43. Overview of Presentation • Overview problem of college student suicide • Consortium 2006 & 2011 structure/demographics • Problem of college student suicide • Key findings from Consortium studies • College Student Coping • Distal and proximal risk factors • Presentation of study details • Proximal risk factors • Protective factor: Coping • Help-seeking • Help-seeking patterns • Help-avoidance patterns • Implications of help-seeking/avoidance data

44. Methods Used to Connect to Others

45. Disclosing Suicidal Thoughts2006 study: Asked of those who had seriously considered attempting suicide (N=1,321) • 54% told one or more people • 46% told no one

46. Racial / Ethnic Identity Help-Seeking

47. Help-Seeking Disparities for Racial and Ethnic Minority Students • Alaska Native / American Indian, Asian American, and Multiethnic students had more distressed thinking or suicidal ideation than others • Caucasian students more likely to be advised to seek professional help from confidant • Asian American students utilize professional help at lower rates than other students • Of those disclosing suicidal ideation, not frequently encouraged to seek help from confidants • In contrast, large proportion of those advised to seek help do follow through Brownson, Swanbrow Becker, Shadick, & Smith, in press

48. Help Seeking During a Stressful Period 2011 study: Comparison of sources of support sought by students who did and did not seriously consider suicide during the stressful period

49. Reasons for Choosing Help Sources2011 Study: Asked of those who turned to someone for help during stressful period

50. Reasons for Concealment2006 study: Asked of those who seriously considered suicide and did not tell anyone (N=769)