Suicidal thoughts and behaviors among college students and same-aged peers: results from the World Health Organization World Mental Health Surveys

Philippe Mortier*, Randy P. Auerbach, Jordi Alonso, William G. Axinn, Pim Cuijpers, David D. Ebert, Jennifer G. Green, Irving Hwang, Ronald C. Kessler, Howard Liu, Matthew K. Nock, Stephanie Pinder-Amaker, Nancy A. Sampson, Alan M. Zaslavsky, Jibril Abdulmalik, Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Corina Benjet, Koen Demyttenaere, Silvia FlorescuGiovanni De Girolamo, Oye Gureje, Josep Maria Haro, Chiyi Hu, Yueqin Huang, Peter De Jonge, Elie G. Karam, Andrzej Kiejna, Viviane Kovess-Masfety, Sing Lee, John J. Mcgrath, Siobhan O’neill, Vladimir Nakov, Beth Ellen Pennell, Marina Piazza, José Posada-Villa, Charlene Rapsey, Maria Carmen Viana, Miguel Xavier, Ronny Bruffaerts

*Corresponding author for this work

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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 OpenSPiltSPi 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 OpenSPiltSPi 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.

Original languageEnglish
Pages (from-to)279-288
Number of pages10
JournalSocial Psychiatry and Psychiatric Epidemiology
Volume53
Issue number3
Early online date16 Jan 2018
DOIs
Publication statusPublished - Mar 2018

Funding

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 Foga-rty 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 Shenz-hen 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 GlaxoS-mithKline. 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 Tran-silvania, 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. 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.

FundersFunder number
Alcohol Advisory Council
Belgian Federal Fund for Fundamental Scientific Research
CONACyT-G30544-H
EEA Financial Mechanism
Eli Lilly Romania SRL
Federal Ministry of Health, Abuja, Nigeria
Gulbenkian Foundation
INPRFMDIES4280
Iceland
Iraq Mental Health Survey
Johnson & Johnson and Servier
Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation
Liechtenstein and Norway
Mexican National Comorbidity Survey
Nova University of Lisbon
New Zealand Mental Health Survey
Nigerian Survey of Mental Health and Wellbeing
Norwegian Financial Mechanism
PanAmerican Health Organization
Portuguese Catholic University
UNDG
United Nations Development Group Iraq Trust Fund
National Institutes of Health
National Institute of Mental HealthR13MH066849, U01-MH60220
National Institute on Drug Abuse
Substance Abuse and Mental Health Services Administration
Fogarty International CenterR03 TW006481-01
Robert Wood Johnson Foundation044708
John W. Alden TrustT32 MH017119
GlaxoSmithKline
World Health Organization
Ministry of Health
Ministry of Health, New Zealand
Health Research Council of New Zealand
Public Health Agency
Fundação para a Ciência e a Tecnologia
Fonds Wetenschappelijk Onderzoek11N0514N/11N0516N
Consejo Nacional de Ciencia y TecnologíaCB-2010-01-155221
Ministry of Public Health
Instituto de Salud Carlos IIIFIS 00/0028
Ministerio de Ciencia y TecnologíaSAF 2000-158-CE
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
Regione Piemonte
Departament de Salut, Generalitat de CatalunyaRETICS RD06/0011 REM-TAP, CB06/02/0046
H. Lundbeck A/S
Fundação Champalimaud
Ministerio de SaludPL 0256

    Keywords

    • Academic performance
    • College student
    • Epidemiology
    • Suicidal thoughts and behaviors
    • Young adult

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