Skip to main content
×
×
Home

The prevalence of suicidal thoughts and behaviours among college students: a meta-analysis

  • P. Mortier (a1), P. Cuijpers (a2), G. Kiekens (a1), R. P. Auerbach (a3) (a4), K. Demyttenaere (a1), J. G. Green (a5), R. C. Kessler (a6), M. K. Nock (a7) and R. Bruffaerts (a1)...
Abstract
Background

Adolescence and young adulthood carry risk for suicidal thoughts and behaviours (STB). An increasing subpopulation of young people consists of college students. STB prevalence estimates among college students vary widely, precluding a validated point of reference. In addition, little is known on predictors for between-study heterogeneity in STB prevalence.

Methods

A systematic literature search identified 36 college student samples that were assessed for STB outcomes, representing a total of 634 662 students [median sample size = 2082 (IQR 353–5200); median response rate = 74% (IQR 37–89%)]. We used random-effects meta-analyses to obtain pooled STB prevalence estimates, and multivariate meta-regression models to identify predictors of between-study heterogeneity.

Results

Pooled prevalence estimates of lifetime suicidal ideation, plans, and attempts were 22.3% [95% confidence interval (CI) 19.5–25.3%], 6.1% (95% CI 4.8–7.7%), and 3.2% (95% CI 2.2–4.5%), respectively. For 12-month prevalence, this was 10.6% (95% CI 9.1–12.3%), 3.0% (95% CI 2.1–4.0%), and 1.2% (95% CI 0.8–1.6%), respectively. Measures of heterogeneity were high for all outcomes (I 2 = 93.2–99.9%), indicating substantial between-study heterogeneity not due to sampling error. Pooled estimates were generally higher for females, as compared with males (risk ratios in the range 1.12–1.67). Higher STB estimates were also found in samples with lower response rates, when using broad definitions of suicidality, and in samples from Asia.

Conclusions

Based on the currently available evidence, STB seem to be common among college students. Future studies should: (1) incorporate refusal conversion strategies to obtain adequate response rates, and (2) use more fine-grained measures to assess suicidal ideation.

Copyright
Corresponding author
*Address for correspondence: P. Mortier, M.D., Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Herestraat 49, Leuven, Belgium. (Email: philippe.mortier@uzleuven.be)
References
Hide All
Allgulander, C (1989). Psychoactive drug use in a general population sample, Sweden: correlates with perceived health, psychiatric diagnoses, and mortality in an automated record-linkage study. American Journal of Public Health 79, 10061010.
American College Health Association (2000). American College Health Association-National College Health Assessment, 2000–2015. American College Health Association (producer and distributor): Hanover, MD, USA.
Appelbaum, PS (2006). Law & psychiatry: ‘depressed? Get out!’: dealing with suicidal students on college campuses. Psychiatric Services 57, 914916.
Arria, AM, Winick, ER, Garnier-Dykstra, LM, Vincent, KB, Caldeira, KM, Wilcox, HC, O'Grady, KE (2011). Help seeking and mental health service utilization among college students with a history of suicide ideation. Psychiatric Services 62, 15101513.
Auerbach, RP, Alonso, J, Axinn, WG, Cuijpers, P, Ebert, DD, Green, JG, Hwang, I, Kessler, RC, Liu, H, Mortier, P, Nock, MK, Pinder-Amaker, S, Sampson, NA, Aguilar-Gaxiola, S, Al-Hamzawi, A, Andrade, LH, Benjet, C, Caldas-De-Almeida, JM, Demyttenaere, K, Florescu, S, De Girolamo, G, Gureje, O, Haro, JM, Karam, EG, Kiejna, A, Kovess-Masfety, V, Lee, S, Mcgrath, JJ, O'neill, S, Pennell, BE, Scott, K, Ten Have, M, Torres, Y, Zaslavsky, AM, Zarkov, Z, Bruffaerts, R (2016). Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychological Medicine 46, 29552970.
Barendregt, JJ, Doi, SA, Lee, YY, Norman, RE, Vos, T (2013). Meta-analysis of prevalence. Journal of Epidemiology and Community Health 67, 974978.
Bartoli, F, Carra, G, Crocamo, C, Carretta, D, La Tegola, D, Tabacchi, T, Gamba, P, Clerici, M (2016). Association between depression and neuropathy in people with type 2 diabetes: a meta-analysis. International Journal of Geriatric Psychiatry 31, 829836.
Bauldry, S (2014). Conditional health-related benefits of higher education: an assessment of compensatory versus accumulative mechanisms. Social Science and Medicine 111, 94100.
Benatov, J, Nakash, O, Chen-Gal, S, Brunstein Klomek, A (2017). The association between gender, ethnicity, and suicidality Among vocational students in Israel. Suicide & Life-Threatening Behaviour [in press].
Bernal, M, Haro, JM, Bernert, S, Brugha, T, de Graaf, R, Bruffaerts, R, Lepine, JP, de Girolamo, G, Vilagut, G, Gasquet, I, Torres, JV, Kovess, V, Heider, D, Neeleman, J, Kessler, R, Alonso, J, Investigators, EM (2007). Risk factors for suicidality in Europe: results from the ESEMED study. Journal of Affective Disorders 101, 2734.
Breslau, J, Lane, M, Sampson, N, Kessler, RC (2008). Mental disorders and subsequent educational attainment in a US national sample. Journal of Psychiatric Research 42, 708716.
Bromet, EJ, Havenaar, JM, Tintle, N, Kostyuchenko, S, Kotov, R, Gluzman, S (2007). Suicide ideation, plans and attempts in Ukraine: findings from the Ukraine World Mental Health Survey. Psychological Medicine 37, 807819.
Brown, DR, Blanton, CJ (2002). Physical activity, sports participation, and suicidal behavior among college students. Medicine and Science in Sports and Exercise 34, 10871096.
Chan, S, Denny, S, Fleming, T, Fortune, S, Peiris-John, R, Dyson, B (2017). Exposure to suicide behaviour and individual risk of self-harm: findings from a nationally representative New Zealand high school survey. Australian & New Zealand Journal of Psychiatry, [in press].
Chevalier, A, Feinstein, L (2007). Sheepskin or Prozac: The Causal Effect of Education on Mental Health. Centre for the Economics of Education: London, UK.
Chou, CH, Ko, HC, Wu, JY, Cheng, CP (2013). The prevalence of and psychosocial risks for suicide attempts in male and female college students in Taiwan. Suicide & Life-Threatening Behavior 43, 185197.
Crawford, MJ, Nur, U, McKenzie, K, Tyrer, P (2005). Suicidal ideation and suicide attempts among ethnic minority groups in England: results of a national household survey. Psychological Medicine 35, 13691377.
Crespo, L, López-Noval, B, Mira, P (2013). Compulsory Schooling, Education and Mental Health: New Evidence from Sharelife (CEMFI Working Paper no. 1304). CEMFI: Madrid.
Cuijpers, P (2016). Meta-analyses in Mental Health Research – A Practical Guide. Vrije Universiteit Amsterdam: Amsterdam.
De Luca, SM, Franklin, C, Yueqi, Y, Johnson, S, Brownson, C (2016). The relationship between suicide ideation, behavioral health, and college academic performance. Community Mental Health Journal 52, 534540.
DerSimonian, R, Laird, N (1986). Meta-analysis in clinical trials. Controlled Clinical Trials 7, 177188.
Dervic, K, Akkaya-Kalayci, T, Kapusta, ND, Kaya, M, Merl, E, Vogel, E, Pellegrini, E, Friedrich, MH (2007). Suicidal ideation among Viennese high school students. Wiener Klinische Wochenschrift 119, 174180.
Drum, DJ, Brownson, C, Burton Denmark, A, Smith, SE (2009). New data on the nature of suicidal crises in college students: shifting the paradigm. Professional Psychology: Research and Practice 40, 213222.
Eisenberg, D, Gollust, SE, Golberstein, E, Hefner, JL (2007). Prevalence and correlates of depression, anxiety, and suicidality among university students. American Journal of Orthopsychiatry 77, 534542.
Eisenberg, D, Hunt, J, Speer, N (2013). Mental health in American colleges and universities: variation across student subgroups and across campuses. The Journal of Nervous and Mental Disease 201, 6067.
Engin, E, Gurkan, A, Dulgerler, S, Arabaci, LB (2009). University students’ suicidal thoughts and influencing factors. Journal of Psychiatric and Mental Health Nursing 16, 343354.
Evans, E, Hawton, K, Rodham, K, Deeks, J (2005). The prevalence of suicidal phenomena in adolescents: a systematic review of population-based studies. Suicide & Life-Threatening Behavior 35, 239250.
Fletcher, JM (2010). Adolescent depression and educational attainment: results using sibling fixed effects. Health Economics 19, 855871.
Garlow, SJ, Rosenberg, J, Moore, JD, Haas, AP, Koestner, B, Hendin, H, Nemeroff, CB (2008). Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention College Screening Project at Emory University. Depression and Anxiety 25, 482488.
Goldman-Mellor, SJ, Caspi, A, Harrington, H, Hogan, S, Nada-Raja, S, Poulton, R, Moffitt, TE (2014). Suicide attempt in young people: a signal for long-term health care and social needs. JAMA Psychiatry 71, 119127.
Gollust, SE, Eisenberg, D, Golberstein, E (2008). Prevalence and correlates of self-injury among university students. Journal of American College Health 56, 491498.
Groves, RM (2006). Nonresponse rates and nonresponse bias in household surveys. Public Opinion Quarterly 70, 646675.
Groves, RM, Fowler, FJ, Couper, MP, Lepkowski, JM, Singer, E, Tourangeau, R (2004a). Survey Methodology. Wiley: New York.
Groves, RM, Presser, R, Dipko, S (2004b). The role of topic interest in survey participation decisions. Public Opinion Quarterly 68, 231.
Gunnell, D, Harbord, R, Singleton, N, Jenkins, R, Lewis, G (2004). Factors influencing the development and amelioration of suicidal thoughts in the general population. Cohort study. British Journal of Psychiatry 185, 385393.
Haapea, M, Miettunen, J, Laara, E, Joukamaa, MI, Jarvelin, MR, Isohanni, MK, Veijola, JM (2008). Non-participation in a field survey with respect to psychiatric disorders. Scandinavian Journal of Public Health 36, 728736.
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. Journal of Clinical Psychiatry 77, 815824.
Hansen, V, Jacobsen, BK, Arnesen, E (2001). Prevalence of serious psychiatric morbidity in attenders and nonattenders to a health survey of a general population : the Tromso Health Study. American Journal of Epidemiology 154, 891894.
Harrod, CS, Goss, CW, Stallones, L, DiGuiseppi, C (2014). Interventions for primary prevention of suicide in university and other post-secondary educational settings. The Cochrane Database of Systematic Reviews 10, CD009439.
Henrich, J, Heine, SJ, Norenzayan, A (2010). The weirdest people in the world? Behavioral and Brain Sciences 33, 6183; discussion 83–135.
Hintikka, J, Viinamaki, H, Tanskanen, A, Kontula, O, Koskela, K (1998). Suicidal ideation and parasuicide in the Finnish general population. Acta Psychiatrica Scandinavica 98, 2327.
Hoffman, S, Marsiglia, FF (2014). The impact of religiosity on suicidal ideation among youth in central Mexico. Journal of Religion and Health 53, 255266.
Hom, MA, Stanley, IH, Joiner, TE Jr. (2015). Evaluating factors and interventions that influence help-seeking and mental health service utilization among suicidal individuals: a review of the literature. Clinical Psychology Review 40, 2839.
Hunt, J, Eisenberg, D (2010). Mental health problems and help-seeking behavior among college students. Journal of Adolescent Health 46, 310.
Juni, P, Holenstein, F, Sterne, J, Bartlett, C, Egger, M (2002). Direction and impact of language bias in meta-analyses of controlled trials: empirical study. International Journal of Epidemiology 31, 115123.
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, HU, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry 51, 819.
Kim, KH, Kong, JC, Choi, JY, Choi, TY, Shin, BC, McDonald, S, Lee, MS (2012). Impact of including Korean randomized controlled trials in Cochrane reviews of acupuncture. PLoS ONE 7, e47619.
Kjoller, M, Helweg-Larsen, M (2000). Suicidal ideation and suicide attempts among adult Danes. Scandinavian Journal of Public Health 28, 5461.
Kraemer, HC, Gardner, C, Brooks, JOI, Yesavage, JA (1998). Advantages of excluding underpowered studies in meta-analysis: inclusionist versus exclusionist viewpoints. Psychological Methods 3, 2331.
Kwak, YS, Jung, YE, Kim, MD (2015). Prevalence and correlates of attention-deficit hyperactivity disorder symptoms in Korean college students. Neuropsychiatric Disease and Treatment 11, 797802.
Lamis, DA, Lester, D (2011). Understanding and Preventing College Student Suicide. Charles C Thomas Pub Ltd: Springfield.
Lee, S, Shin, A (2017). Association of atopic dermatitis with depressive symptoms and suicidal behaviors among adolescents in Korea: the 2013 Korean Youth Risk Behavior Survey. BMC Psychiatry 17, 3.
Li, ZZ, Li, YM, Lei, XY, Zhang, D, Liu, L, Tang, SY, Chen, L (2014). Prevalence of suicidal ideation in Chinese college students: a meta-analysis. PLoS ONE 9, e104368.
Lowry, R, Crosby, AE, Brener, ND, Kann, L (2014). Suicidal thoughts and attempts among U.S. High school students: trends and associated health-risk behaviors, 1991–2011. Journal of Adolescent Health 54, 100108.
Marusic, A (2005). History and geography of suicide: could genetic risk factors account for the variation in suicide rates? American Journal of Medical Genetics Part C: Seminars in Medical Genetics 133C, 4347.
Mata, DA, Ramos, MA, Bansal, N, Khan, R, Guille, C, Di Angelantonio, E, Sen, S (2015). Prevalence of depression and depressive symptoms Among resident physicians: a systematic review and meta-analysis. JAMA 314, 23732383.
Meyer, WJ, Morrison, P, Lombardero, A, Swingle, K, Campbell, DG (2016). College students’ reasons for depression nondisclosure in primary care. Journal of College Student Psychotherapy 30, 197205.
Millner, AJ, Lee, MD, Nock, MK (2015). Single-Item measurement of suicidal behaviors: validity and consequences of misclassification. PLoS ONE 10, e0141606.
Moher, D, Pham, B, Klassen, TP, Schulz, KF, Berlin, JA, Jadad, AR, Liberati, A (2000). What contributions do languages other than English make on the results of meta-analyses? Journal of Clinical Epidemiology 53, 964972.
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. Social Psychiatry and Psychiatric Epidemiology 50, 15771591.
Mortier, P, Demyttenaere, K, Auerbach, RP, Cuijpers, P, Green, JG, Kiekens, G, Kessler, RC, Nock, MK, Zaslavsky, AM, Bruffaerts, R (2016). First onset of suicidal thoughts and behaviours in college. Journal of Affective Disorders 207, 291299.
Mortier, P, Demyttenaere, K, Auerbach, RP, Green, JG, Kessler, RC, Kiekens, G, Nock, MK, Bruffaerts, R (2015). The impact of lifetime suicidality on academic performance in college freshmen. Journal of Affective Disorders 186, 254260.
Nock, M, Borges, G, Ono, Y (2012). Suicide: Global Perspectives From the WHO World Mental Health Surveys. Cambridge University Press: Cambridge.
Nock, MK, Borges, G, Bromet, EJ, Alonso, J, Angermeyer, M, Beautrais, A, Bruffaerts, R, Chiu, WT, de Girolamo, G, Gluzman, S, de Graaf, R, Gureje, O, Haro, JM, Huang, Y, Karam, E, Kessler, RC, Lepine, JP, Levinson, D, Medina-Mora, ME, Ono, Y, Posada-Villa, J, Williams, D (2008a). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry 192, 98105.
Nock, MK, Borges, G, Bromet, EJ, Cha, CB, Kessler, RC, Lee, S (2008b). Suicide and suicidal behavior. Epidemiologic Reviews 30, 133154.
Nock, MK, Green, JG, Hwang, I, McLaughlin, KA, Sampson, NA, Zaslavsky, AM, Kessler, RC (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry 70, 300310.
Organisation for Economic Co-operation and Development (OECD) (2012). Education at a Glance 2012: OECD Indicators. (https://www.oecd.org/edu/EAG%202012_e-book_EN_200912.pdf). Accessed 31 July 2017.
Organisation for Economic Co-operation and Development (OECD) (2013). Education Indicators in Focus - What are the Social Benefits of Education? (https://www.oecd.org/edu/EAG%202012_e-book_EN_200912.pdf). Accessed 31 July 2017.
Paul, E, Tsypes, A, Eidlitz, L, Ernhout, C, Whitlock, J (2015). Frequency and functions of non-suicidal self-injury: associations with suicidal thoughts and behaviors. Psychiatry Research 225, 276282.
Ramberg, IL, Wasserman, D (2000). Prevalence of reported suicidal behaviour in the general population and mental health-care staff. Psychological Medicine 30, 11891196.
Renberg, ES (2001). Self-reported life-weariness, death-wishes, suicidal ideation, suicidal plans and suicide attempts in general population surveys in the north of Sweden 1986 and 1996. Social Psychiatry and Psychiatric Epidemiology 36, 429436.
Ribeiro, JD, Franklin, JC, Fox, KR, Bentley, KH, Kleiman, EM, Chang, BP, Nock, MK (2016). Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies. Psychological Medicine 46, 225236.
Saha, S, Chant, D, McGrath, J (2008). Meta-analyses of the incidence and prevalence of schizophrenia: conceptual and methodological issues. International Journal of Methods in Psychiatric Research 17, 5561.
Schafer, MH, Wilkinson, LR, Ferraro, KF (2013). Childhood (Mis)fortune, educational attainment, and adult health: contingent benefits of a college degree? Social Forces 91, 10071034.
Schwarzer, G (2016). Meta: General Package for Meta-Analysis (https://cran.r-project.org/web/packages/meta/index.html). Accessed 31 July 2017).
Scott, EM, Hermens, DF, Naismith, SL, White, D, Whitwell, B, Guastella, AJ, Glozier, N, Hickie, IB (2012). Thoughts of death or suicidal ideation are common in young people aged 12 to 30 years presenting for mental health care. BMC Psychiatry 12, 234.
Sidhartha, T, Jena, S (2006). Suicidal behaviors in adolescents. Indian Journal of Pediatrics 73, 783788.
Stang, A (2010). Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European Journal of Epidemiology 25, 603605.
Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, Moher, D, Becker, BJ, Sipe, TA, Thacker, SB (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283, 20082012.
Swannell, SV, Martin, GE, Page, A, Hasking, P, St John, NJ (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide & Life-Threatening Behavior 44, 273303.
Tang, F, Xue, F, Qin, P (2015). The interplay of stressful life events and coping skills on risk for suicidal behavior among youth students in contemporary China: a large scale cross-sectional study. BMC Psychiatry 15, 182.
The WHO World Mental Health Surveys International College Student Project (WMH-ICS) (2015). (https://www.hcp.med.harvard.edu/wmh/college_student_survey.php). Accessed 31 July 2017.
Trikalinos, TA, Trow, P, Schmid, CH (2013). Simulation-Based Comparison of Methods for Meta-Analysis of Proportions and Rates. Agency for Healthcare Research and Quality (US): Rockville, MD, USA.
Waldrop, AE, Hanson, RF, Resnick, HS, Kilpatrick, DG, Naugle, AE, Saunders, BE (2007). Risk factors for suicidal behavior among a national sample of adolescents: implications for prevention. Journal of Traumatic Stress 20, 869879.
Wang, L, He, CZ, Yu, YM, Qiu, XH, Yang, XX, Qiao, ZX, Sui, H, Zhu, XZ, Yang, YJ (2014). Associations between impulsivity, aggression, and suicide in Chinese college students. BMC Public Health 14, 551.
Whitlock, J, Knox, KL (2007). The relationship between self-injurious behavior and suicide in a young adult population. Archives of Pediatrics and Adolescent Medicine 161, 634640.
Wilcox, HC, Arria, AM, Caldeira, KM, Vincent, KB, Pinchevsky, GM, O'Grady, KE (2010). Prevalence and predictors of persistent suicide ideation, plans, and attempts during college. Journal of Affective Disorders 127, 287294.
World Health Organization (WHO) (2016). Suicide data. (http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/). Accessed 31 July 2017.
Yang, LS, Zhang, ZH, Sun, L, Sun, YH, Ye, DQ (2015). Prevalence of suicide attempts among college students in China: a meta-analysis. PLoS ONE 10, e0116303.
Zhao, J, Yang, X, Xiao, R, Zhang, X, Aguilera, D, Zhao, J (2012). Belief system, meaningfulness, and psychopathology associated with suicidality among Chinese college students: a cross-sectional survey. BMC Public Health 12, 668.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Type Description Title
UNKNOWN
Supplementary materials

Mortier supplementary material
Mortier supplementary material 1

 Unknown (1.5 MB)
1.5 MB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed