Final Field Experience Paper

Final Field Experience Paper

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  Running head: SUICIDEIDEATION IN COLLEGE POPULATIONS 1 Suicide Ideation in College Populations Tiffany Thomas Spring Hill College Author’s Note 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 protected]. December 10, 2014
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  SUICIDE IDEATION INCOLLEGE 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,
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  SUICIDE IDEATION INCOLLEGE 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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  SUICIDE IDEATION INCOLLEGE POPULATIONS 4 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.).
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  SUICIDE IDEATION INCOLLEGE 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
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  SUICIDE IDEATION INCOLLEGE 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
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  SUICIDE IDEATION INCOLLEGE 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-
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  SUICIDE IDEATION INCOLLEGE 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. Conclusion 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
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  SUICIDE IDEATION INCOLLEGE 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 their peers.
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  SUICIDE IDEATION INCOLLEGE POPULATIONS 10 References 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- 49.