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Running head: SUICIDE IDEATION IN COLLEGE POPULATIONS 1
Suicide Ideation in College Populations
Spring Hill College
I have written this review paper to satisfy the requirements of Dr. Royce Simpson’s Field
Experience course – PSY 446. If there are any questions regarding this review, I can be
contacted at email@example.com.
December 10, 2014
SUICIDE IDEATION IN COLLEGE POPULATIONS 2
Suicide Ideation in College Populations
Suicide rates among college students continue to be a growing concern on universities
across the country. As nationwide rates of suicide remain stable, those among adolescents and
young adults continue to rise (Barrios, Everett, Simon, & Brener, 2000). Although less than two
percent of college aged students successfully take their own lives each year, approximately 11%
of college aged students plan for or think about suicide (Gonzalez, 2012). Depression and
suicide ideation are strongly linked, with depression being further associated with increased risk
for self-injury, and academic impairment including dropping out of or failing out of college.
Additionally, suicide ideation is often considered the initial step in a continuum that ends with
suicide (Barrios, et al, 2000.). Recognizing ideation and those factors associated with ideation
could be the first step in university health centers minimizing these rates and promoting
psychological health and well-being on their campuses. Knowing the characteristics and
behaviors that students contemplating suicide are more likely to exhibit could also assist and
encourage the peers of suicidal students to reach out and seek help on behalf of their peers.
Characteristics Among Those That Exhibit Suicide Ideation
There are a number of traits that college aged individuals considering suicide exhibit with
more frequency than college aged individuals who are not considering suicide. Dixon, Heppner,
and Anderson (1991) studied the relationship between suicide ideation, stress, hopelessness, and
self-appraised problem solving ability in two studies of college students. Four self-report
questionnaires were used to determine the relationship between these variables. A Problem
Solving Inventory was used to measure each student’s self-appraisal of their problem solving
skill, but not their actual problem solving skills. A Life Experience Survey was given to each
participant to determine the number and severity of negative life events experienced. Beck,
SUICIDE IDEATION IN COLLEGE POPULATIONS 3
Kovacs, and Weissman’s Scale for Suicide Ideation was given to students in the first study to
measure the frequency and intensity of suicidal thoughts. A Hopelessness Scale was given to
students in the second study to measure the degree to which students’ negative outcomes for the
future. All participants were given the PSI and the LES (Dixon, et al., 1991).
In these two studies, researchers found that students under high levels of stress were more
likely to report hopelessness and suicidal thoughts than students under low levels of stress.
Additionally, students who characterized themselves as poor problem-solvers were more likely
to report hopelessness and suicidal thoughts than students who characterized themselves as
effective problem solvers. Together these findings suggest that high levels of stress and self-
appraised poor problem solving are associated with greater levels of hopelessness and suicide
ideation in students (Dixon, et al., 1991). As these studies are correlational, it cannot be
determined whether or not suicide ideation and hopelessness are a result of negative life events
and self-appraised poor problem solving. Dixon et al. (1991) attribute these associations to each
individual’s inability to adapt to life demands, but no clear cause can be determined due to the
nature of the studies.
Garlow, Rosenberg, Moore, Haas, Koestner, Hendin, and Nemeroff (2008) examined the
relationship between suicide ideation and depressive symptoms as well as the relationship
between suicide ideation and other intense emotional states in college undergraduates. Like
Dixon et al. (1991), Garlow et al. used questionnaires to determine the severity of depressive
symptoms, suicide ideation, and emotional states. The questionnaire used was the PHQ-9 along
with questions about frequency of suicidal thoughts and incidences of self-harm, the frequency
of anxiety, irritability, rage, desperation, and loss of control, the frequency of alcohol and drug
use, and finally a self-assessment of global impairment.
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The results of Garlow et al.’s (2008) study indicate a strong association exists between
depressive symptoms and suicide ideation in college students. Additionally, those students who
reported current suicidal thoughts also reported worse symptoms and depression while those
students with the severest symptoms of depression were more likely to report suicidal thoughts.
Suicide ideation was also associated with intense negative emotional states in the study. These
measures of internal distress – anxiety, irritability, rage, and feeling out of control – were more
common in students thinking about or planning for suicide (Dixon, et al., 1991). Of those
students with suicide ideation or major depression, 84% and 85% respectively were not receiving
treatment for their symptoms.
Related Injurious Behaviors
Suicide is the third leading cause of death in people aged 15 to 24. The first elading
cause is unintentional injury (Garlow, et al., 2008). It is possible that these causes of death are
related and that similar behaviors lead to one of these results. Some researchers have proposed
that students engaging in suicide ideation may also be engaging in injurious behaviors that could
lead to unintentional injury (Barrios et al., 2000). These researchers examined the relationship
between suicide ideation and risky behaviors in college students aged 18 to 24. Through
questionnaires, participating students reported whether or not they attempted suicide, planed for
suicide, or seriously considered committing suicide in the past year as well as how many times
they participated in the following behaviors: wore a seatbelt while riding in a car driven by
someone else, wore a seatbelt while driving a car, drank alcohol before going swimming or
boating, rode in a car driven by someone who had been drinking alcohol, drove car after
drinking alcohol, carried a weapon like a knife or club, carried a gun, and got into a physical
fight (Barrios et al.).
SUICIDE IDEATION IN COLLEGE POPULATIONS 5
The results of the Barrios et al. (2000) study suggest a relationship between suicide
ideation and other injurious behaviors. Students who report suicide ideation were more likely to
report neglecting to wear a seatbelt as both passenger and driver, to have carried a weapon, to
have been in a fight, to have ridden with a driver hat had been drinking, and to have driven after
drinking themselves than students who did not report suicide ideation (Barrios, et al.). Although
Barrios et al. cover many injurious behaviors in their study, there are limitations. For example,
the researchers did not control for depression which weakens the association between suicide
ideation and risky behaviors – both could be present as a result of depression. As a correlational
study, no causation can be determined so the exact nature of the relationship between ideation
and risky behaviors is unknown. Barrios et al. also used their own questionnaire to determine
past suicide attempts and ideation instead of a standardized questionnaire making comparisons of
their participants with the participants of other studies less exact.
Gonzalez (2012), in her research into the connection between suicide and solitary binge
drinking, did use standardized questionnaires. The NIAAA alcohol consumption question set
was used to determine episodes of solitary binge drinking within a typical month before the
study was conducted; solitary binge drinking is drinking four or more drinks in a sitting while
alone for women and drinking five or more drinks in a sitting while alone for men. Episodes of
social binge drinking were also determined. The Suicidal Behaviors Questionnaire – Revised
was used to determine each participant’s history of suicide attempts over their lifetimes, and the
Adult Suicidal Ideation Questionnaire was used to determine how frequently each participant
thought about suicide during the month before the study was conducted (Gonzalez).
Participants of the study were all binge-drinking college students aged 18 to 25.
Gonzalez (2012) found that approximately 94% of solitary binge drinkers were also social binge
SUICIDE IDEATION IN COLLEGE POPULATIONS 6
drinkers and that having attempted suicide in the past increased one’s likelihood of being a
solitary binge drinker. Furthermore, previous suicide attempts and suicide ideation were
associated with solitary binge drinking, but not social binge drinking. Gonzalez did not research
the participants’ reasons for solitary binge drinking in this study. She suggests that drinking to
excess while alone could be a coping behavior in the absence of social support, but the direction
of the relationship between suicidality and binge drinking cannot be determined. Another
limitation of Gonzalez’s study could be the setting of the university that the participants
attended. The study was conducted at a northwestern university in the United States from March
2009 to January 2010 meaning seasonal affective disorder could be a contributing cause of both
suicide ideation and binge drinking.
Potential Mediating Factors
Although the prevalence of suicide ideation on college campuses is relatively common
and growing each year, some potential mediating factors do exist. Dispositional optimism could
be a buffering personality trait that insulates college students from suicide ideation following
negative life events (Hirsch, Wolford, LaLonde, Brunk, & Morris, 2007). In their study of a
small eastern state college, Hirsch et al. found that students capable of maintaining a positive
outlook for the future after experiencing low to moderate negative life events were less likely to
engage in suicide ideation than students without optimism regarding the future. However,
dispositional optimism did not appear to have any buffering effect in the presence of extreme
stressors or traumatic negative life events.
Hirsch et al. (2007) used a number of questionnaires to compile their data. These
questionnaires include: The Life Orientation Test – Revised which assesses optimism and
pessimism, the Lifetime Incidence of Traumatic Events which assesses the frequency and
SUICIDE IDEATION IN COLLEGE POPULATIONS 7
severity of negative life events ranging from low to moderate to potentially traumatic, the Beck
Depression Inventory – II which measures the presence of depression symptoms, the Beck
Hopelessness Scale which predicts suicide ideation and suicide attempts, and finally the Beck
Scale for Suicide Ideation which measures thoughts and attitudes regarding suicide.
The results of the study provided further evidence that a relationship between negative
life events and suicide ideation exists (Hirsch, et al., 2007). The results also indicate that the
protective capabilities of dispositional optimism are limited. The benefits of dispositional
optimism for students that experience numerous negative life events or highly traumatic life
events are minimal. Indeed, students that are highly optimistic that have a traumatic experience
(such as forced sexual abuse) may be more at risk for suicide ideation than less optimistic
students (Hirsch et al.). One of the limitations of this study is the disagreement in the field
regarding the nature of optimism and pessimism. Some researchers believe that optimism and
pessimism are static traits. So for students that do not already have a stable and positive outlook
for the future, low to moderate negative life events could more easily lead to suicidal thoughts
and the likelihood that students have the knowledge or resources to increase their dispositional
optimism (if such a thing is possible) is small. Far more research in positive psychology is
needed to support Hirsch et al.’s claims.
Dispositional optimism is not the only potentially buffering factor in suicide and suicide
ideation. Self-esteem and perceived social support could also insulate students from the negative
psychological outcomes that follow traumatic events (Kleiman & Riskind, 2013). In their study,
Kleiman and Riskind used the Multidimensional Scale of Perceived Social Support to measure
students’ opinions on the availability of support from family and friends, the Coping Self-
SUICIDE IDEATION IN COLLEGE POPULATIONS 8
Efficacy Scale to measure students’ ability to use the social support available to them, the
Rosenberg Self-Esteem Inventory, and the Beck Suicide Scale to measure suicide ideation.
Kleiman and Riskind (2013) found that the perception of social support was not enough
to act as a buffer against suicide ideation. Students had to additionally utilize the social support
available to them in order to decrease their risk for suicidal thoughts. Furthermore, their findings
suggest that the utilization of social support may lead to increases in self-esteem which also
contribute to decreasing the risk for suicide ideation (Kleiman & Riskind). Unlike in Hirsch et
al.’s (2007) optimism study, Kleiman and Riskind did not control for depression as a mediator.
As in the other studies that do not control for depression, Kleiman and Riskind ignore the
possibility that the resultant relationships observed could each be the result of each factor’s
relationship to depression.
All of these studies share two common limitations of suicide ideation research: the results
are correlational, so no causal relationship can be determined, and they all rely on self-report
measures. Furthermore, despite the growth seen in this research area over the past two decades,
more research is still necessary to determine the validity and depth of the associations drawn by
the researchers in this literature review. The connection between deaths due to unintentional
injury and deaths due to suicide is a tenuous one at best. The data currently available are not
enough to suggest that suicidality could in some part be the cause of both. Similarly, few buffers
against suicide ideation have been studied and shown to be effective.
Although the exact nature of the relationships between suicide ideation and associated
characteristics and behaviors are not clear, the rates at which college students contemplate and
attempt suicide are startling. Many of the research articles presented here suggest the onus for
SUICIDE IDEATION IN COLLEGE POPULATIONS 9
action falls to university health centers to aid in reducing these numbers. Few college students
experiencing suicidal thoughts reach out to their on-campus resources so it falls to those
researches to reach out first. The role of social support systems being available and easily
utilized by these students cannot be stressed enough. Health centers should not only promote
themselves as resources, but should also educate students in the mediating role they can play for
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Barrios, L. C., Everett, S. A., Simon, T. R., & Brener, N. D. (2000). Suicide ideation among US
college students: Associations with other injury risk behaviors. Journal of American
College Health, 48(5), 229-233.
Dixon, W. A., Hepper, P. P., & Anderson, W. P. (1991). Problem-solving appraisal, stress,
hopelessness, and suicide ideation in college population. Journal of Counseling
Psychology, 38(1), 51-56.
Garlow, S. J., Rosenberg, J., Moore, J. D., Haas, A. P., Koestner, B., Hendin, H., & Nemeroff, C.
B. (2008). Depression, desperation, and suicidal ideation in college students: Results
from the American Foundation for Suicide Prevention-sponsored College Screening
Project at Emory University. Depression and Anxiety, 25(6), 482-488.
Gonzalez, V. M. (2012). Association of solitary binge drinking and suicidal behavior among
emerging adult college students. Psychology of Addictive Behaviors, 26(3), 609-614.
Hirsch, J. K., Wolford, K., LaLonde, S. M., Brunk, L., & Morris, A. P. (2007). Dispositional
optimism as a moderator of the relationship between negative life events and suicide
ideation and attempts. Cognitive Therapy and Research, 31, 533-546.
Kleiman, E. M., & Riskind, J. H. (2013). Utilized social support and self-esteem mediate the
relationship between perceived social support and suicide ideation: A test of a multiple
mediator model. The Journal of Crisis Intervention and Suicide Prevention, 34(1), 42-