Undergraduate and Graduate Student Coping with Stressful

Undergraduate and Graduate Student Coping with

Stressful Experiences: A New Look at the Continuum of Distress,

Suicidal Experiences and Campus Intervention Opportunities

Elizabeth Wilson, Ashley Boynton, Stuart Irvin, & Andrea Saathoff

The University of Texas at Austin

Introduction

Founded in 1991 at the University of Texas at Austin

6 completed studies to date

Membership in Consortium is determined study-by-study, and all are encouraged and welcome to participate

Research is an essential ingredient for defining a specialty of college mental health Penn State’s CSCMH, NCHA, Director’s Surveys, etc.

National Suicide Statistics 2nd leading cause of death on college campuses

National suicide rates for college students range from 6.5 to 7.5 per 100,000 Compared to 16 per 100,000 in age-matched peers

Roughly 25% of campus suicides are counseling center clients, nationally Suicides in CC clients are 3.3 times greater than non-clients When taking into consideration the 4 most significant risk

factors (previous attempts, psychiatric illness, gender, and firearms), you would expect clients of CCs to commit suicide 20 times more than non-clients.

(Schwartz, 2006, 2011)

Overview of Presentation Goals

Broaden the current clinical intervention treatment model to include a preventive, population-focused intervention approach

Explore college student self-report data on suicidal experiences and coping during recent stressors

Sections of presentation Expansion: Intervention approaches and distress/suicidality continuum

Overview of 2011 data Demographics

Nature of stressful period

Suicidal ideation and behavior

Qualities of self: Connectedness /belongingness and sense of coherence

Implications for population-focused prevention

Discussion

“The present era of epidemiology is coming to a close. The focus on risk factors at the individual level- the hallmark of this era- will no longer serve. We need to be concerned equally with causal pathways at the societal level and with pathogenesis and causality at the molecular level.” (Susser & Susser, 1996)

Prevention Campaigns At their core, population prevention programs are

organizational change efforts that often involve legislation and policy adjustments, environmental re-engineering and management, modification of processes/procedures, programmatic interventions, advocacy, and, at times, clinical interventions.

They require two types and waves of linked interventions: Ecological interventions

Psychoeducational proactive interventions

Prevention Campaigns Goal to shift the well-being of the population

Frolich and Potvin (1999) state that when many people lower their risk, even a little, the total benefit for the population is larger than if a few people at high risk experience a large reduction. This is consistent with the notion that groups of individuals function collectively, and as such, are affected by the average functioning of individuals around them.

0

5000

10000

15000

20000

25000

30000

Entire sample This is all just too much

I wish this would all end

I have to escape

I wish I was dead

I want to kill myself

I might kill myself

I will kill myself

During the stressful period, did you have any thoughts similar to the following?

Those endorsing "yes" to these thoughts

Most students who experience SUICIDALITY

First experience DISTRESS

Adapted from a presentation prepared by Arizona State University’s Wellness & Health Promotion

Center

0

5000

10000

15000

20000

25000

30000

Entire sample This is all just too much

I wish this would all end

I have to escape

I wish I was dead

I want to kill myself

I might kill myself

I will kill myself

During the stressful period, did you have any thoughts similar to the following?

Those endorsing "yes" to these thoughts

…so fewer end up here

The idea is to reach students

here…

Adapted from a presentation prepared by Arizona State University’s Wellness & Health Promotion

Center

The Jed Foundation and the Suicide Prevention Resource

Center, 2006

Voice of the student…What could your college or university have provided you or

done differently to better help you manage during this stressful time?”

“To be able to talk to a professional for more than an hour or more than once a week.”

“Weekend and/or evening opportunities for counseling on campus.”

Overview of Presentation Sections of presentation

Expansion: Intervention approaches and distress/suicidality continuum

Overview of 2011 data

Demographics



Qualities of self: Connectedness/belongingness and sense of coherence

Implications for Population-focused prevention

Discussion

Overview of 2011 Data“Undergraduate and Graduate Student Coping

with Stressful Experiences”

“Undergraduate and Graduate Student Coping with Stressful Experiences” (2011)

Brief overview of current study characteristics: Over 26,000 undergraduate and graduate student

responses (~101,000 surveys sent)

74 colleges and universities participated

Random sample at each school

Web-based survey, anonymous, intervention

26% response rate

Demographics fairly comparable to NCHA

Sample Demographics (N = 26,430) Age (mean):

Undergraduates: 22 years

Graduate Students: 30 years

Gender: 63% Female

Sexual Orientation: 92% Heterosexual

African American, of African descent, African, of Caribbean

descent, or Black5.2%

Asian or Asian American 11.6%Caucasian, White, of European

descent, or European 74.2%

Hispanic, Latino, or Latina 7.8%Middle Eastern or East Indian 2.9%Native American or Alaskan

Native 1.5%

Native Hawaiian or other Pacific Islander 0.5%

Other 2.3%Multiracial 6%

Race/Ethnicity:

Organization of Survey Demographics

Preexisting vulnerabilities

Baseline for Sense of Coherence and Belongingness (Qualities of Self) & Social Connectedness Mindfulness

Stressful period “Please reflect on the most stressful period of time that you have experienced

in the past 12 months…

“Now please focus on the "worst point….”

Coping during stressful period Experiences during the stressful period

What resources were helpful or could have been helpful

Contributors to Stressful PeriodSelect all the apply

N = 26,430

Contributed to stressful time

Academics 73%

Financial problems 31%

Friendship problems 18%

Life transition 27%

Family problems 20%

Death of close family/friend 9%

Emotional health problems 15%

Physical health problems 13%

Problems experienced by others 9%

Problems at work 13%

Other 7.6%

Drugs or alcohol 3.6%

Other traumatic experience 2.4%

Discrimination 2.7%

Sexual orientation concerns 1.5%

Relationship violence 1%

Suicide of close family member/friend 1%

Sexual assault 1%

Gender identity concerns 1%

15% Academic only

27% Non-academic only

58% Combined

Emotional health problems 50.7% 13.3% 37.4% 14.8% 15.1%

Family problems 42.5% 19.5% 23.0% 20.4% 9.2%

Romantic relationship problems 46.8% 26.5% 20.3% 27.3% 7.6%

Friendship problems 34.6% 17.8% 16.8% 18.4% 8.3%

Financial problems 41.1% 30.5% 10.6% 30.8% 5.9%

Drugs/Alcohol 12.3% 3.2% 9.1% 3.6% 15.3%

Physical health problems 20.9% 12.3% 8.6% 12.6% 7.3%

Problems of a close person 16.0% 9.0% 7.0% 9.2% 7.7%

Life transition 33.5% 27.0% 6.5% 27.2% 5.5%

Sexual orientation concerns 5.9% 1.3% 4.6% 1.5% 17.4%

Death of close person 12.9% 8.4% 4.5% 8.6% 6.7%

Discrimination 6.8% 2.5% 4.3% 2.7% 11.3%

Sexual assault 5.0% 0.7% 4.3% 0.9% 24.9%

Relationship violence 5.1% 1.0% 4.1% 1.2% 19.1%

Gender ID concerns 4.0% 0.4% 3.6% 0.6% 30.7%

Legal problems 4.7% 1.8% 2.9% 1.9% 10.8%

Other trauma 5.1% 2.3% 2.8% 2.4% 9.5%

Problems at work 14.9% 12.7% 2.2% 12.7% 5.2%

Suicide of close person 2.7% 1.0% 1.7% 1.1% 11.3%

Other 7.6% 7.7% * -0.1% 7.6% 4.4%

Academics 71.7% 72.9% * -1.2% 72.6% 4.4%

StressorSeriously

considered suicide (N = 1167)

Non-seriously considered suicide

(N = 25,030)Difference score % of total endorsing

this stressor

What % of those who experience the stressor seriously considered

suicide?

Discussion Are these the contributors to stress that you expected?

How can these be addressed at the population level?

How can these be addressed at the clinical level? More on this to come...

Voice of the student…“Let me know it existed! Let me know it was available – in

all 3 years as a student I did not know there was counseling services available.”

“I wish I knew of counselors on campus sooner. Maybe letting it be known during orientation.”




Demographics





Discussion

Suicidal Ideation and BehaviorA look at 2011 student self reports

Self-Reports of LifetimeSuicidal Ideation and Attempts

Suicidal Ideation

Have you ever seriously consideredattempting suicide at some point in

your life?

N = 26,430

20%

Suicide Attempts

How many times in your life have you attempted suicide?

(% indicating 1 or more times)

N = 26,430

6%

When First Considered Suicide

N = 5,319

When did you first seriously consider

attempting suicide?

Before or while in middle school 27%

While in high school 41%

After high school but before college 4%

While in college 19%

After college and before graduate school 4%

While in graduate school 3%

Other 3%

* Of those who considered suicide at some point in their life

72%

Distress and Suicidality Continuum

N = 26,430

During the stressful period, did you have any thoughts similar to the following? (Select all

that apply)

This is all just too much 48%

I wish this would all end 31%

I have to escape 19%

I wish I was dead 8%

I want to kill myself 5%

I might kill myself 3%

I will kill myself 1%

I did not have any thoughts like these 40%

During this stressful period, did you…

seriously consider attempting suicide? 5%

attempt suicide? 0.8%

Suicidal Behaviors & Preparations During Stressful Period

For those seriously considering suicide during their most stressful period.

UndergradN = 781

GradN = 379

During this stressful period, did you do

any of the following?

Investigate ways to kill myself 37.6% 33.5%

Formed a specific plan for attempting suicide 34.1% 33.2%

Gathered the material for a suicide attempt 15.5% 10.8%

Wrote a suicide note but did not post it or leave it where others might read it 14.3% 8.2%

Wrote a suicide note and shared it or posted it 1.8% 1.6%

Wrote a will or otherwise put my affairs in order 5.1% 8.2%

Formed a suicide pact with others .90% .8%

Did a practice run of a suicide attempt 2.9% 1.8%

Began a suicide attempt, then changed my mind 14.5% 8.2%

None of the above 35.9% 39.6%

Intentions at Time of AttemptFor those having attempted suicide during their most stressful period.

2011 SampleN = 200

Which of these statementsdescribe your intentions at the time of the attempt(s)?

I made a serious attempt to kill myself and intended to die 21%

I tried to kill myself but knew I might survive 23%

Was ambivalent and partly wanted to live 38%

Mostly wanted to live but small part wanted to die 12%

I did not intend to die 6%

Role of Drugs & AlcoholFor those having attempted suicide during their most stressful period.

2011 SampleN = 200

How would you describe the role of drugs or alcohol in your most

recent suicide attempt?

I was not using alcohol or drugs before or during my attempt 49%

I intended to overdose with alcohol or drugs 30%

I intended to use alcohol or drugs to reduce my inhibitions or fears about attempting suicide

11%

My attempt was not planned in advance and may have happened because I was using alcohol or drugs

13%

I was using alcohol or drugs but they were not related to my attempt 16%

Addiction to alcohol or drugs was a reason for my attempt 5%

Voice of the student…“So many students live off campus and participate in on-line

learning. I think the university counseling service should have on-line services to students.”

“Being able to have a counseling session over the phone, maybe.”




Demographics





Discussion

Qualities of SelfConnectedness/Belongingness

and Sense of Coherence

Sense of Coherence Model focusing, not on factors explaining disease, but on factors

that promote health, conceptualizing maintenance or improvement of health on a continuum. ‘Salutogenesis’ coined.

(Antonovsky, 1993)

3 components of SOC: Comprehensibility, manageability, meaningfulness

(Antonovsky, 1993)

Strongly related to perceived health, especially mental health

(Eriksson & Lindstrom, 2006)

Seemingly a health-promoting resource that bolsters resilience

(Eriksson & Lindstrom, 2006)

Social Connectedness & Belongingness

Linked to health and well-being (Armstrong & Oomen-Early, 2009; Baumeister & Leary, 1995;

Joiner et al, 2009)

Theorized to play important role in preventing desire for death (Joiner, 2005)

Increasing social connectedness on college campuses is a key strategy for suicide prevention (SPRC, 2004; CDC 2008)

Qualities of Self, Distress, and Suicidality: A Model

Peering into the Black Box

Coherence Belongingness

Suicidality DistressVulnerability

Sense of Coherence:Baseline vs. During Stressor

When approaching the challenges of daily life: Baseline Stressful period

How capable are you of managing your daily challenges? M = 4.14 M = 3.38

How motivated are you to manage your daily challenges? M = 3.90 M = 3.55

How meaningful do you view your life to be? M = 4.12 M = 3.62

To what extent are you able to understand what must be done to face the challenges

of daily life?M = 4.31 M = 3.76

Likert Scale1 Not at all – 5 Very

Belongingness:Baseline vs. During Stressor

When approaching the challenges of daily life: Baseline Stressful period

How understood by others do you feel? M = 3.20 M = 2.97

How cared for others do you feel? M = 3.94 M = 3.61

How much do you feel that you can count on others? M = 3.55 M = 3.33

How comfortable do you feel making new connections with others? M = 3.43 M = 2.76

Likert Scale1 Not at all – 5 Very

Connection with Friends, Family & School Do you consider your relationship

with people you spend most of your time with to be:

N = 26,430

1 - 2 (Not at all close) 4.7%3 (Moderately close) 23.1%

4 - 5 (Very close) 72.1%On average, how close is your relationship with your family?

1 – 2 (Not at all close) 6.6%3 (Moderately close) 18.8%

4 - 5 (Very close) 74.6%To what degree do you feel connected

to your college or university?1 - 2 (Not at all connected) 17.5%3 (Moderately connected) 42.3%

4 - 5 (Very connected) 30.2%

Methods Used to Connect to Others: Baseline vs. During Stressor

How important is the following? BaselineM

During stressorM

In person contact 4.41 4.20Phone 3.77 3.46Video chat 2.16 1.60Email 3.61 1.96Social networking (e.g., Facebook) 3.35 2.10Text message 3.71 2.70Gaming connections 1.48 1.19Blogging 1.40 1.17Other 1.39 1.20

Likert Scale1 Not at all important – 5 Very important

Help Seeking For Suicidal Thoughts(2006 Study)

Asked of those who had seriously considered attempting suicide (n=1321)

54% Told One or More People Romantic Partner: 34%

Peer: 33%

Family: 16%

Professional: 14%

Other (Clergy, Professor, RA): 3%

Discussion How might qualities of self be addressed at the

population/clinical level to affect one’s likelihood of experiencing stress/distress/suicidality?

How can clinicians account for help-seeking patterns to prevent distress/suicidality on campus?

Voice of the student… “I dropped a class when my father died. When I called to get

grief counseling they said I was ineligible because I wasn’t full time. I explained the situation and they refused.”

“If they had offered more than 6 sessions with a counselor.”




Demographics





Discussion

2006 Data: Studies completed and in progress Wong, J. & Brownson, C. (in process). A mediation model of professional psychological help

seeking for suicide ideation among Asian American and White American college students.

Brownson, C., Becker, M. S., & Jaggars, S. (in press). Suicidal behavior and help seeking among diverse college students. Journal of College Counseling.

Drum, D. J., & Burton Denmark, A. (2012). Campus suicide prevention: Bridging paradigms and forging partnerships. Harvard Review of Psychiatry, 20, 209-21.

Brownson, C., Drum, D., Smith, S., & Denmark, A. (2011). Differences in suicidal experiences of male and female undergraduate and graduate students. Journal of College Student Psychotherapy, 25, 277-94.

Drum D.J., & Burton Denmark A. (2011). College suicide prevention programs and interventions. In: Lamis DA, Lester D, eds. Understanding and Preventing College Student Suicide.

Wong, Y. J., Brownson, C., & Schwing, A. E. (2011). Risk and protective factors associated with Asian American students’ suicidal ideation: A multi-campus, national study. Journal of College Student Development, 52, 396-408.

Drum, D., Brownson, C., Denmark, A., & Smith, S. (2009). New data on the nature of suicidal crises in college students: Shifting the paradigm. Professional Psychology: Research and Practice, 40, 213-22.

Ecological prevention

Proactive Prevention

Early Intervention

Treatment & CrisisIntervention

Lapse & Relapse Intervention

TYPE ECOLOGICAL PREVENTION

PROACTIVE PREVENTION

EARLYINTERVENTION

TREATMENT &CRISIS INTERVENTION

LAPSE & RELAPSE INTERVENTION

INTENDED BENEFICIARIES

Current and future populations

Current population with mixed levels of health and risk

Members of the population with identified warning signs

Persons meeting diagnostic criteria for condition or crisis

Population in recovery (asymptomatic for condition)

GOAL Improve ecological contributions to population health and decrease their role in pathogenic process

Reduce population prevalence of predisposing vulnerabilities and enhance personal assets

Disrupt pathogenic process at early stage of development Decrease/reverse physiological impact of chronic stress

Treat existing cases of the disorder and/or crisis

Improve safety

Stabilize and strengthen recovery and resilienceImprove ecological contributions to sustain recovery

INTERVEN-TION FOCUS

Problematic elements of the physical and constructed environment Precipitating events

Ranges from total population to selected sub-populations based on timing and convenience

Indicated population of individuals with identifiable signs of unfolding pathogenic process

Individuals in distress/crisis

Individuals in recovery & their constructed environment

METHODOLOGY Legislation, policy & procedure adjustmentsSystems interventionsEnvironmental modificationsContinuous Process Improvement

Psychoeducational interventions designed primarily to educate, raise consciousness and/or enhance motivation to changePostvention

Screening Programs Thematic groups Leaderless self-help programs;Individual counseling

Stress mgt techniques

Crisis counseling, triage Pharmacological intervention;Individual & group treatmentInpatient treatment

Peer support systems: Recovery community building;Access to individual and group sessions;Psychoeducational interventions

SCOPE Environment & Population level Symptomatic individuals Recovery Population

INTERVENTION CONTINUUM & TREATMENT OF SUICIDALITY

PREVENTION ZONE RECOVERY ZONE

What can we do? Effectively target our limited resources

Utilize clinical resources to address needs of those who are highly distressed or at high risk

Expand population-based approaches to fit nature of population

Enhance capacity of existing support networks

Bolster students’ ability to preserve self during stressful times

Develop a climate that reduces barriers to help

Your ideas?

College Student Suicide Prevention Listserve

To participate in an ongoing conversation – Join a listserve about suicide in higher education by

contacting Marian Trattner, Suicide Prevention Coordinator at UT Austin, at [email protected]

Sections of presentation



Demographics





Discussion

Overview of Presentation

Questions?

Special Thanks To The 26,000 Student Research Participants

The 74 Research Consortium Participating Institutions and Counseling Center Directors

The Research Consortium team

http://cmhc.utexas.edu/researchconsortium.htmlConsortium Director: Chris Brownson, PhD

Email: [email protected]

http://cmhc.utexas.edu/researchconsortium.html�

Documents

Undergraduate and Graduate Student Coping with Stressful