undergraduate and graduate student coping with stressful experiences: the continuum of distress,...
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Undergraduate and Graduate Student Undergraduate and Graduate Student Coping with Stressful ExperiencesCoping with Stressful Experiences::
The Continuum of Distress, The Continuum of Distress, Suicidal Experiences and OutcomesSuicidal Experiences and Outcomes
Chris Brownson, PhDcbrownson@austin.utexas.edu
Elaine Hess, MAehess@utexas.edu
The University of Texas at Austin
Jennifer Kyle, PhD jkyle3@gmail.com
Queens College 1
Founded in 1991 at UT Austin6 completed studies to date
◦Will discuss data from our two most recent studies and campus-level data
Membership is determined study-by-studyResearch is an essential ingredient for
defining a subspecialty of college mental health (Penn State’s CSCMH, NCHA, Director’s Surveys, etc.)
2
National Suicide StatisticsNational 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.
3Schwartz, 2006, 2011
Overview of PresentationOverview of Presentation1. Overview problem of college student suicide
◦ Consortium 2006 & 2011 structure/demographics◦ Problem of college student suicide◦ Key findings from Consortium studies
2. College Student Coping◦ Distal and proximal risk factors◦ Presentation of study details◦ Proximal risk factors◦ Protective factor: Coping
1. Help-seeking◦ Help-seeking patterns◦ Help-avoidance patterns◦ Implications of help-seeking/avoidance data
4
Overview of Current Overview of Current Study CharacteristicsStudy CharacteristicsWeb-based survey, anonymous, interventionOver 26,000 undergraduate and graduate
student responses (~101,000 surveys sent)~ 26% response rate
74 colleges and universities participatedRandom sample at each schoolGoal: Useful info for IHEs/CCs; both research
and “screening”
Demographics comparable to most recent NCHA survey
5
Structure of SurveyStructure of SurveyDemographicsHistory of help-seeking, risk and
protective factorsFocus in on recent stressful period
◦Characteristics of stressor◦Level of distress during worst point◦Coping approaches◦Outcomes (e.g., suicidal ideation)
Resolution◦Resilience and factors impacted ability
to cope
6
DemographicsDemographics
◦N = 26,430
◦Mean Age of 25.5 years(Range: 18 – 95 years)
◦63% Female
◦92% Heterosexual
7
Race/EthnicityRace/Ethnicity2011
Undergrad
N = 14,080
2011GradN =
12,094
African American, of African descent, African, of Caribbean descent, or
Black4.1% 4.5%
Asian or Asian American 8.1% 12.6%
Caucasian, White, of European descent, or European
71.4% 67.9%
Hispanic, Latino, or Latina 6.5% 4.9%
Middle Eastern or East Indian 1.5% 3.0%
Native American or Alaskan Native 0.3% 0.3%
Native Hawaiian or other Pacific Islander
0.2% 0.2%
Other 1.4% 2.0%
Multiracial 6.3% 4.4%8
Mental Health HistoryMental Health History
Ever received MH services from:
UndergradN=14,113
GradN=12,131
Counselor 37.4% 44.4%
Psychiatrist 12.0% 14.1%
Clergy 6.1% 10.4%
Other medical provider 10.2% 10.2%
Alternative medical provider 4.2% 4.9%
Other 1.4% 1.7%
Never 53.7% 46.8%
Ever received counseling from college counseling center:
17.1% 22.6%
Taken medication for mental health concern:
16.1% 22.8%
Been hospitalized for mental health concern:
3.2% 3.0%
9
Lifetime Suicidal Ideation Lifetime Suicidal Ideation for College Studentsfor College StudentsApproximately half endorsed some
form of suicidal thoughts in lifetime (Drum, Brownson, Burton Denmark & Smith, 2009)
Approximately 20% endorsed seriously considering suicide in lifetime (Drum et al., 2009)
Female students more likely to report lifetime ideation and attempts (Brownson, Drum, Smith & Burton Denmark, 2011)
10
First Considered SuicideFirst Considered SuicideUndergradN = 3,088
GradN = 2,182
When did you first seriously
consider attempting
suicide?
Before or while in middle
school28.7% 23.2%
While in high school
46.1% 33.9%
After high school but
before college3.9% 3.9%
While in college
18.3% 18.7%
After college but before graduate
school
.30% 8.4%
While in graduate
school.10% 7.9%
Other 2.6% 4.4%* Of those who have considered suicide at some point in their life
11
Recent Suicidal Ideation Recent Suicidal Ideation 5 to 6% seriously considered suicide
in past 12 months (Drum et al., 2009; ACHA-NCHA II, 2011)◦~1% actually attempted in past year
Episodes of ideation in past year described as brief, recurrent and intense (Drum et al., 2009)
Female students appear to be at greater risk for recent suicidal ideation and attempts (Brownson et al., 2011)
12
Prevalence of Lifetime & Prevalence of Lifetime & Recent Suicide AttemptsRecent Suicide Attempts
2006Undergra
dN =
15,010
2006GradN =
11,441
2011Undergra
dN =
14,080
2011GradN =
12,094
Lifetime 7.6% 5.4% 7.2% 5.2%
Past 12 Months
0.85% 0.30% 0.81%* 0.22%*
During Stressful
Time Period
1.1% .40%
13
*NOTE: 2011 Past 12 Months item asked of those who endorsed one or more lifetime attempts; rates adjusted to
reflect entire sample
Intentions at Time of AttemptIntentions at Time of Attempt
For those who said “Yes” to having attempted suicide during their most stressful period.
Undergrad
N = 152
GradN = 43
Which of these statements
describe your intentions at the
time of the attempt(s)?
I made a serious attempt to kill myself and intended to die
24.3% 11.6%
I tried to kill myself but knew I might survive
25.0% 20.9%
Was ambivalent and partly wanted to live
35.5% 46.5%
Mostly wanted to live but small part wanted to die
11.2% 11.6%
I did not intend to die 3.9% 9.3%
14
Role of Drugs & Alcohol in Role of Drugs & Alcohol in AttemptAttemptFor those who said “Yes” to having attempted suicide during their most
stressful period.
UndergradN = 155
GradN = 43
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
44.5% 53.5%
I intended to overdose with alcohol or drugs 30.3% 27.9%
I intended to use alcohol or drugs to reduce my inhibitions or fears about attempting suicide
11.6% 9.3%
My attempt was not planned in advance and may have happened because I was using alcohol or drugs
12.9% 14.0%
I was using alcohol or drugs but they were not related to my attempt
16.1% 11.6%
Addiction to alcohol or drugs was a reason for my attempt
5.8% 2.3%
15
Thoughts During Stressful Thoughts During Stressful PeriodPeriod
Undergrad
N = 14,080
GradN =
12,094
During the stressful
period, did you have any
thoughts similar to the
following? (Select all that apply)
This is all just to much 51.2% 44.5%
I wish this would all end 33.3% 27.5%
I have to escape 20.1% 17.1%
I wish I was dead 9.4% 7.3%
I want to kill myself 5.7% 3.6%
I might kill myself 3.1% 1.9%
I will kill myself 1.0% .50%
I did not have any thoughts like these
37.5% 42.8%16
Most students who experience
DISTRESS
First experience STRESS
Adapted from a presentation prepared by Arizona State University’s
Wellness & Health Promotion Center17
…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 Center18
Discussion QuestionsDiscussion QuestionsWhat are your campuses doing to try to
shift the curve (i.e., prevention & fostering well-being of entire population)?
What are some of the challenges with tying suicide prevention to broader prevention initiatives on campus?
Counseling Centers and Health Education Centers can’t be solely responsible for this ◦ What successes and challenges have you had in
collaborating with cross-campus partners?
19
Overview of PresentationOverview of Presentation1. Overview problem of college student suicide
◦ Consortium 2006 & 2011 structure/demographics◦ Problem of college student suicide◦ Key findings from Consortium studies
2. College Student Protective Factors and Coping◦ Distal and proximal risk factors◦ Presentation of study details◦ Proximal risk factors◦ Protective factor: Coping
1. Help-seeking◦ Help-seeking patterns◦ Help-avoidance patterns◦ Implications of help-seeking/avoidance data
20
Distal vs. Proximal Risk Factors
◦Suicide results from a complex interaction of distal and proximal risk factors While having a lack of protective factors such
as coping skills, family cohesion, adequate social support and access to mental health services
Proximal Risk factors: Stressful life events, Intoxication, Hopelessness
21
Moscicki, 2001
Distal vs. Proximal RiskDistal vs. Proximal Risk
22
Protective Factors such as coping, spiritual faith influence the progression
Queens College
23
• Part of the City University of New York, the nation's largest urban public university.
Established in 1937 to offer a liberal arts education.
Enrollment of 20,000 students, including 16,000 undergraduate students.
Students come from nearly 170 different countries and speak over 110 different languages.
One of the “Best Public Universities-Master’s” institutions in U.S. News and World Report’s America’s Best Colleges.
Historically, a commuter school, however, in 2011, Queens College opened the first residential facility.
National vs. Campus Level DataNational vs. Campus Level DataNational Queens College
Sample Size 26,430 78
Age M = 25.5Range: 18 - 95
M = 29.82Range: 18 - 64
Gender Female = 63% Female = 70.5%
Sexual Orientation Heterosexual = 92%
Heterosexual = 87.2%
Housing Parents or family = 51.3%Partner or spouse = 16.7%Alone = 15.4%
24
Demographics: Race/EthnicityDemographics: Race/Ethnicity
25
African American, of African descent, African, of Caribbean
descent, or Black5.2% 14%
Asian or Asian American 11.6% 10.3%
Caucasian, White, of European descent, or European
74.2% 41%
Hispanic, Latino, or Latina 7.8% 20.5%
Middle Eastern or East Indian 2.9% 2.6%
Native American or Alaskan Native 1.5% --
Native Hawaiian or other Pacific Islander
.5% --
Other 2.3% 5.1%
Religious PreferenceReligious PreferenceChristian =
46.2%Catholic = 29.5%Jewish = 16.7%Buddhist = 3.8%Hindu = 3.8%Agnostic =
10.3%Atheist = 5.1%
How important are your beliefs?
• Very important = 37.2%
• Moderately important = 35.9%
• Not at all = 25.6%
26
Connection with Friends & FamilyConnection with Friends & Family
27
Do you consider your relationship with people you spend most of your
time with to be:
Overall Sample
N = 26,297M = 4.09
Queens CollegeN = 78
M = 4.00
1 - 2 (Not at all close) 4.7% 7.7%
3 (Moderately close) 23% 47.4%
4 - 5 (Very close) 71.8% 44.9%
On average, how close is your relationship with
your family?
N = 26,304M = 4.16
N = 78M = 3.96
1 – 2 (Not at all close) 6.5% 3.8%
3 (Moderately close) 18.7% 30.8%
4 - 5 (Very close) 74.3% 65.4%
Past History of SuicidePast History of SuicideEver consider attempting suicide:
◦Yes = 19 (24%) ◦No = 59 (75.6%)
When did you first consider suicide? ◦Prior to college = 16 (20.5%)◦While in College/Other = 3 (3.9%)
Therefore, 84% of those having ever thought about suicide had done so prior to attending college.
28
Proximal Risk: StressProximal Risk: StressWhat sources of stress did students report?
And during that time, what was their level of distress?
Academics 64.1%
moderately to very much (56.4%)
Financial problems 35.9%
moderately to very much (33.3%)
Family problems 32.1%
moderately to very much (26.9%)
Emotional health problems
23.1%moderately to very much (21.8%)
Problems at work 21.8%
moderately to very much (20.5%)
Friendship problems
16.7%moderately to very much (12.8%) 29
Comparison of Students with History Comparison of Students with History of SI: Stress Managementof SI: Stress Management
When approaching the challenges of daily life:
History of Suicide Ideation Yes (n =
19)
History of Suicide Ideation No (n =
59)
..how critical are you of yourself?
M = 3.58 M = 3.46 NS
…how capable are you of managing
your daily challenges?
M = 3.89 M = 4.08 NS
…how motivated are you to manage
your daily challenges?
M = 3.11 M = 4.02
t (23.506) = -2.630, p < .05
…how meaningful do you view your
life to be? M = 3.00 M = 4.10
t (24.382) = -2.984, p < .01
30
Proximal Risk: Stress & Its Impact on Proximal Risk: Stress & Its Impact on Social Connectedness and BelongingnessSocial Connectedness and Belongingness
Baseline
Stressful Period
How much do you feel you are a burden on others?
M = 2.24
M = 2.59
t (73) = -2.680, p < .01
Increase in feeling a burden
How understood by others do you feel?
M = 3.03
M = 2.94 NS
How cared for by others do you feel?
M = 3.77
M = 3.31t (73) = 3.676, p < .01
Decrease in feeling cared for
How much do you feel that you can count on others?
M = 3.01
M = 3.01 NS
How comfortable do you feel making new connections with others?
M = 3.33
M = 2.71t (72) = 4.275, p < .01
Decrease in feeling
comfortable in making new connections
31
Protective Factor: CopingProtective Factor: Coping
During the stressful period…
Methods of
Student Coping
How helpful was this
method of coping?
Type of Coping
Acknowledging emotions
44.9%moderately to very much (34.6 %)
Emotion-focused Coping
Creating a plan
41.0%moderately to very much (32%)
Problem-focused Coping
Distracting myself
38.5%moderately to very much (32%)
Avoidance Coping
Prayer 21.8%moderately to very much (19.3%)
Faith-based Coping
32
Coping: It’s Impact on StressCoping: It’s Impact on Stress
How the following impacted your ability to cope?
Improvedmy ability to
cope
Connection with your friends 59.0%
Connection with your family 51.3%
Having experienced a similar situation before
47.4%
Connection to religion, spirituality or a higher power
32.0%
Connection with a mental health professional
14.1%
33
The strength of faith-based coping is its ability to find meaning that allows one to overcome adversity and maintain greater psychological and physical well being (Wachholtz & Sambamoorthi, 2011)
Protective Factor: Protective Factor: Coping & Spiritual FaithCoping & Spiritual Faith
Faith-based coping 1) Helps develop personal meaning around a particular stressful event, and regulate the associated affective experience 2) facilitates the use of social support, e.g., faith-based gatherings.
Youth with spiritual beliefs were more likely to use and favorably evaluate social
support received from a variety of sources, e.g., parents, siblings, friends and church groups and were less at risk.
34
Proximal Risk: Stress to DistressProximal Risk: Stress to Distress
And for some students, their distress manifested as overwhelming thoughts:
This is all just too much = 36 (46.2%) I wish this all would end = 29 (37.2%) I have to escape = 15 (19.2%) I wish I was dead = 6 (7.7%) I want to kill myself = 6 (7.7%) I might kill myself = 2 (2.6%) I will kill myself = 1 (1.3%)
35
Stress – Distress ContinuumStress – Distress ContinuumKey finding on suicide crisis in
college students reported that suicidal thoughts are common but most importantly that crises are often brief, intense and can be recurrent (Drum, Brownson, Burton Denmark & Smith, 2009).
◦ Therefore understanding the role that individual and environmental protective factors play in the students progression from just being merely stressed to distressed and contemplating suicide becomes paramount.
36
Protective FactorsProtective Factors
Protective factors are varied and can include an individual's attitudinal and behavioral characteristics, as well as attributes of the environment and culture.
Examples: Strong connections to family and community
support Skills in problem solving and coping Easy access to a variety of clinical interventions and
support for help-seeking Cultural and religious beliefs that discourage suicide
37
Protective Factors StudyProtective Factors Study
Examining protective factors in a sample of diverse college youth as a means of predicting passive ideation
Instruments◦ Suicide (Outcome Variable):
1. Harkavy Asnis Suicide Scale (HASS)◦ Protective Factors (Predictor Variables) :
1. College Student-Reasons for Living Inventory (RFL-CS)
2. Young Adult Social Support Inventory (YA-SSI)
3. Spiritual Well- Being Scale (SWBS)
38
Dependent Variable: Suicide Dependent Variable: Suicide DataData
Harkavy Asnis Suicide Scale (HASS Demo)
N (%)
History of Suicide Ideation
78 (32.1%)
Beginning at age 8Mode: 14 years old16 (21%) reported having a plan
History of Suicide Attempts
6(3%)
Most reporting only one attempt; 2 subjects reported 5 or moreBeginning at age 8Mode: 13 years old
Current Suicide Ideation(Past 2 weeks)
1.6%(4)
3 subjects denied plan or intent1 was brought to Counseling Center
Better off dead (Within Past 2 weeks)
95 (39%)
Once: 82 (33.7%)2 – 4 times/week: 13 (5.3%)
39
Protective Factors as Predictors of Passive Ideation Protective Factors as Predictors of Passive Ideation
Summary of Hierarchical Regression Analysis Predicting Passive Ideation Using Social Support, Spiritual Well-Being, Reasons For Living, Gender And Religious Affiliation Variables (N = 243)
41
Variable B SE B β
Step 1
Gender .470 .438 .085
Religious Affiliation
.144 .083 .137
Step 2
Gender .686 .423 .123
Religious Affiliation
.109 .079 .104
YA-SSI -.935 .243 -.326***
CS-RFLI -.265 .241 -.091
SWBS -.617 .260 -.192*
Note: * p < .05; ** p < .01; ***p < .000 R2 = .137, F (5,163) = 5.034, p <.000, R squared change = .115, F change (3, 158) = 7.013, p <.000
Discussion QuestionsDiscussion QuestionsDo we need to target students differently
based on distal versus proximal risk factors?How can we foster better coping skills among
students, such as using freshman seminars?How has your campus used existing
programs or outreach efforts to foster better coping among students?
How can we increase social connectedness on college campuses? And would we need differential strategies for commuter versus residential universities?
As college counselors, how can we support students’ faith-based coping?
42
Overview of PresentationOverview of Presentation1. Overview problem of college student suicide
◦ Consortium 2006 & 2011 structure/demographics◦ Problem of college student suicide◦ Key findings from Consortium studies
2. College Student Coping◦ Distal and proximal risk factors◦ Presentation of study details◦ Proximal risk factors◦ Protective factor: Coping
1. Help-seeking◦ Help-seeking patterns◦ Help-avoidance patterns◦ Implications of help-seeking/avoidance data
43
Methods Used to Connect to OthersMethods Used to Connect to Others
44
How important is the following?
Likert Scale1 Not at all important – 5 Very
important
Baseline (Mean)
During Stressful
Period(Mean)
Attempters
(Mean)
In person contact 4.41 4.20 3.71
Phone 3.77 3.46 2.91
Video chat 2.16 1.60 1.53
Email 3.61 1.96 1.68
Social networking (e.g., Facebook) 3.35 2.10 2.04
Text message 3.71 2.70 2.79
Gaming connections 1.48 1.19 1.31
Blogging 1.40 1.17 1.33
Other 1.39 1.20 1.22
Disclosing Suicidal ThoughtsDisclosing Suicidal Thoughts2006 study: Asked of those who had seriously considered attempting suicide 2006 study: Asked of those who had seriously considered attempting suicide (N=1,321)(N=1,321)
54% told one or more people
46% told no one45
Racial/Ethnic Identity
Students Advised Seek Professional Help
N = 596
Students Advised Seek Help Who Did
N = 331
Caucasian 61% 72%
Multi-Ethnic 52% 36%
Latino/a 45% 50%
Asian American 40% 80%
Alaska Native / American Indian 40% 50%
International Student 29% 50%
African American 27% 43%
Average 56% 69%
Racial / Ethnic Identity Help-Seeking
Help-Seeking Disparities for Racial and Help-Seeking Disparities for Racial and Ethnic Minority StudentsEthnic Minority Students
Alaska Native / American Indian, Asian American, and Multiethnic students had more distressed thinking or suicidal ideation than others
Caucasian students more likely to be advised to seek professional help from confidant
Asian American students utilize professional help at lower rates than other students◦Of those disclosing suicidal ideation, not
frequently encouraged to seek help from confidants
◦ In contrast, large proportion of those advised to seek help do follow through
47Brownson, Swanbrow Becker, Shadick, & Smith, in press
Help Seeking During a Stressful PeriodHelp Seeking During a Stressful Period
48
2011 study: Comparison of sources of support sought by students who did and did not seriously consider suicide during the stressful period
Reasons for Choosing Help SourcesReasons for Choosing Help Sources2011 Study: Asked of those who turned to someone for help during stressful period2011 Study: Asked of those who turned to someone for help during stressful period
49
Concealment Category
Percentage
Example of Category
Low Risk 18% “The chances of me going through with it wasn’t extremely unlikely…even though I wanted to”
Solicitude 16% “I didn’t want to bother anyone with my problems”
Privacy 15% “Because it’s something I don’t feel comfortable sharing with others”
Pointless 13% “Didn’t think anyone would care, or that they wouldn’t take me seriously”
Stigma 13% “Didn’t want to appear weak, out of control, crazy”
Shame 7% “I was ashamed to admit that I had these thoughts”
Repercussions 7% “Because they would make me go to the doctor or tell on me”
Interference 7% “I didn’t want anyone to talk me out of doing it”
Perceived Lack of Confidants
3% “There wasn’t anyone I felt I could turn to”
Reasons for ConcealmentReasons for Concealment2006 study: Asked of those who seriously considered suicide and did not tell anyone 2006 study: Asked of those who seriously considered suicide and did not tell anyone (N=769)(N=769)
50
Reasons For Not Seeking HelpReasons For Not Seeking Help2011 Study: Asked of those who indicated seeking help from no one during stressful 2011 Study: Asked of those who indicated seeking help from no one during stressful period period
51
Future Help-Seeking & Referral of Others Future Help-Seeking & Referral of Others to Counseling Center Servicesto Counseling Center ServicesUndergraduate sample, Undergraduate sample, N = 13,960, M = 2.54N = 13,960, M = 2.54
52
Discussion QuestionsDiscussion QuestionsKnowing that students are the most
important gatekeepers but the hardest to train, what can we do?
What are ways that IHEs can create a greater sense of connectedness and belongingness among students?
Knowing how students connect to others generally and when in stress, how do we best use social media for creating meaningful connections?
53
Special Thanks ToSpecial Thanks To The 26,000 Student Research Participants The 74 Research Consortium Participating Institutions and
Counseling Center Directors David Drum, Ph.D. Adryon Burton Denmark, Ph.D. The entire Research Consortium Team!!
54
http://cmhc.utexas.edu/researchconsortium.html
National Director: Chris Brownson, PhDEmail: cbrownson@austin.utexas.edu
ReferencesReferences
55
American College Health Association-National College Health Assessment II [ACHA-NCHA II]:
Reference Group Data Report Spring 2011. Baltimore: American College Health
Association; 2011. Brownson, C., Drum, D. J., Smith, S. E., & Denmark, A. B. (2011). Differences in suicidal experiences
of male and female undergraduate and graduate students. Journal of College Student
Psychotherapy, 25(4), 277–294.
Brownson, C., Swanbrow Becker, M., Shadick, R., & Smith, S. (in press). Suicidal behavior and help seeking among diverse clients. Journal of College Counseling. Drum, D. J., Brownson, C., Burton Denmark, A., & Smith, S. E. (2009). New data on the nature of
suicidal crises in college students: Shifting the paradigm. Professional Psychology: Research and
Practice, 40(3), 213-222. Mościcki, E. K. (2001). Epidemiology of completed and attempted suicide: toward a framework for
prevention. Clinical Neuroscience Research, 1(5), 310–323. Schwartz, A. J. (2006). College Student Suicide in the United States: 1990-1991 Through 2003-2004. Journal of American College Health, 54(6), 341-352. Schwartz, A. J. (2011). Rate, relative risk, and method of suicide by students at 4-year colleges and universities in the United States, 2004-2005 through 2008-2009. Suicide and Life-Threatening Behavior, 41(4), 353-371.
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