UC Berkeley

College suicide rates are stable, but up to 10% of students experience suicidal ideation each year, and most do not access mental health services. Little is known about campus mental health service structure and delivery. In a mixed model, quantitative-to-qualitative design, this study examined the link between suicidal ideation, mental health service use, and suicide attempt using archival survey data of over 25,000 college students from 70 campuses, collected in 2006 by the UT Austin-based National Research Consortium of Counseling Centers in Higher Education. Survey respondents had lower levels of 12-month suicidal ideation (6%) than typical national rates, and almost half of those with ideation had accessed mental health services. The quantitative analysis included multiple psychosocial and demographic variables known to affect suicide risk – an extension of prior college suicide research. Bivariate and regression tests of association found that several health service variables, for example seeing a counselor, were significantly associated with higher rates of suicide attempt. This seemingly counter-intuitive finding was mostly driven by a group of “high reactors” - students with both significant distress and a higher tendency to access services. The qualitative analysis sought to expand knowledge of what resources students use to cope with ideation, including formal healthcare or informal sources of support, and how this differed on two variables: whether students had accessed services and whether they had made a suicide attempt. Survey respondents’ open-ended descriptions of what they found helpful or unhelpful during their suicidal crises were analyzed for common themes. Social support from friends and loved ones was more often reported by service users than non-service users, and was associated with lower attempt rates. Social interaction increased attempt rates if students described receiving unhelpful feedback, such as shaming or minimization of their emotional state, and this risk was greater for those students who also did not see any mental health provider. Another common theme that was associated with lower suicide attempt rates, regardless of service use, was the use of coping behaviors and skills, such as talking problems through with a friend. These findings suggest areas of focus for future research and intervention; for example, mental health providers can guide students in recruiting appropriate social support. This study contributes to the understanding of how and whether suicidal students utilize campus mental health services and other sources of support, which is needed for guiding policy on suicide prevention efforts and directing future research on service effectiveness. Campus-level variables were also examined for differences in suicidal behaviors and service use, with few differences found across the 70 campuses.