DOI QR코드

DOI QR Code

Predicting Suicidal Ideation in College Students with Mental Health Screening Questionnaires

  • Received : 2018.03.28
  • Accepted : 2018.08.21
  • Published : 2018.11.30

Abstract

Objective The present study aimed to identify risk factors for future SI and to predict individual-level risk for future or persistent SI among college students. Methods Mental health check-up data collected over 3 years were retrospectively analyzed. Students were categorized as suicidal ideators and non-ideators at baseline. Logistic regression analyses were performed separately for each group, and the predicted probability for each student was calculated. Results Students likely to exhibit future SI had higher levels of mental health problems, including depression and anxiety, and significant risk factors for future SI included depression, current SI, social phobia, alcohol problems, being female, low self-esteem, and number of close relationships and concerns. Logistic regression models that included current suicide ideators revealed acceptable area under the curve (AUC) values (0.7-0.8) in both the receiver operating characteristic (ROC) and precision recall (PR) curves for predicting future SI. Predictive models with current suicide non-ideators revealed an acceptable level of AUCs only for ROC curves. Conclusion Several factors such as low self-esteem and a focus on short-term rather than long-term outcomes may enhance the prediction of future SI. Because a certain range of SI clearly necessitates clinical attention, further studies differentiating significant from other types of SI are necessary.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea (NRF)

References

  1. Arnett JJ. Emerging adulthood. A theory of development from the late teens through the twenties. Am Psychol 2000;55:469-480. https://doi.org/10.1037/0003-066X.55.5.469
  2. Eskin M, Sun JM, Abuidhail J, Yoshimasu K, Kujan O, Janghorbani M, et al. Suicidal behavior and psychological distress in university students: a 12-nation study. Arch Suicide Res 2016;20:369-388. https://doi.org/10.1080/13811118.2015.1054055
  3. Mortier P, Cuijpers P, Kiekens G, Auerbach RP, Demyttenaere K, Green JG, et al. The prevalence of suicidal thoughts and behaviours among college students: a meta-analysis. Psychol Med 2018;48:554-565. https://doi.org/10.1017/S0033291717002215
  4. Roh MS, Jeon HJ, Lee HW, Lee HJ, Han SK, Hahm BJ. Suicide-related behaviors among the college students. J Korean Neuropsychiatr Assoc 2007;46:35-40.
  5. Mann JJ. A current perspective of suicide and attempted suicide. Ann Intern Med 2002;136:302-311. https://doi.org/10.7326/0003-4819-136-4-200202190-00010
  6. Park EH, Hong N, Jon DI, Hong HJ, Jung MH. Past suicidal ideation as an independent risk factor for suicide behaviours in patients with depression. Int J Psychiatry Clin Pract 2017;21:24-28. https://doi.org/10.1080/13651501.2016.1249489
  7. Garlow SJ, Rosenberg J, Moore JD, Haas AP, Koestner B, Hendin H, et al. Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention College Screening Project at Emory University. Depress Anxiety 2008;25:482-488. https://doi.org/10.1002/da.20321
  8. Goldman-Mellor SJ, Caspi A, Harrington H, Hogan S, Nada-Raja S, Poulton R, et al. Suicide attempt in young people: a signal for long-term health care and social needs. JAMA Psychiatry 2014;71:119-127. https://doi.org/10.1001/jamapsychiatry.2013.2803
  9. Reinherz HZ, Tanner JL, Berger SR, Beardslee WR, Fitzmaurice GM. Adolescent suicidal ideation as predictive of psychopathology, suicidal behavior, and compromised functioning at age 30. Am J Psychiatry 2006;163:1226-1232. https://doi.org/10.1176/ajp.2006.163.7.1226
  10. Konick LC, Gutierrez PM. Testing a model of suicide ideation in college students. Suicide Life Threat Behav 2005;35:181-192. https://doi.org/10.1521/suli.35.2.181.62875
  11. Van Orden KA, Witte TK, James LM, Castro Y, Gordon KH, Braithwaite SR, et al. Suicidal ideation in college students varies across semesters: the mediating role of belongingness. Suicide Life Threat Behav 2008;38:427-435. https://doi.org/10.1521/suli.2008.38.4.427
  12. Toprak S, Cetin I, Guven T, Can G, Demircan C. Self-harm, suicidal ideation and suicide attempts among college students. Psychiatry Res 2011;187:140-144. https://doi.org/10.1016/j.psychres.2010.09.009
  13. Zhai H, Bai B, Chen L, Han D, Wang L, Qiao Z, et al. Correlation between family environment and suicidal ideation in university students in China. Int J Environ Res Public Health 2015;12:1412-1424. https://doi.org/10.3390/ijerph120201412
  14. Kraemer HC, Kazdin AE, Offord DR, Kessler RC, Jensen PS, Kupfer DJ. Coming to terms with the terms of risk. Arch Gen Psychiatry 1997;54:337-343. https://doi.org/10.1001/archpsyc.1997.01830160065009
  15. Franklin JC, Ribeiro JD, Fox KR, Bentley KH, Kleiman EM, Huang X, et al. Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research. Psychol Bull 2017;143:187-232. https://doi.org/10.1037/bul0000084
  16. Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA 1984;252:1905-1907. https://doi.org/10.1001/jama.1984.03350140051025
  17. Kwon M, Kim DJ, Cho H, Yang S. The smartphone addiction scale: development and validation of a short version for adolescents. PLoS One 2013;8:e83558. https://doi.org/10.1371/journal.pone.0083558
  18. Sohn SI, Kim DH, Lee MY, Cho YW. The reliability and validity of the Korean version of the Pittsburgh Sleep Quality Index. Sleep Breath 2012;16:803-812. https://doi.org/10.1007/s11325-011-0579-9
  19. An JY, Seo ER, Lim KH, Shin JH, Kim JB. Standardization of the Korean version of Screening Tool for Depression (Patient Health Questionnaire-9, PHQ-9). J Korean Soc Biol Ther Psychiatry 2013;19:47-56.
  20. Seo JG, Park SP. Validation of the Generalized Anxiety Disorder-7 (GAD-7) and GAD-2 in patients with migraine. J Headache Pain 2015;16:97. https://doi.org/10.1186/s10194-015-0583-8
  21. Yu ES, Ahn CI, Park KH. Factor structure and diagnostic efficiency of A Korean version of the Liebowitz Social Anxiety Scale. Kor J Clin Psychol 2007;26:251-270. https://doi.org/10.15842/kjcp.2007.26.1.015
  22. Jeong B, Lee SW, Lee JS, Yoo JH, Kim KW, Cho S, et al. The psychometric properties of the Korean version of the verbal abuse questionnaire in university students. Psychiatry Investig 2015;12:190-196. https://doi.org/10.4306/pi.2015.12.2.190
  23. Lim HK, Woo JM, Kim TS, Kim TH, Choi KS, Chung SK, et al. Reliability and validity of the Korean version of the Impact of Event Scale-Revised. Compr Psychiatry 2009;50:385-390. https://doi.org/10.1016/j.comppsych.2008.09.011
  24. Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med 2005;35:245-256. https://doi.org/10.1017/S0033291704002892
  25. Shin MS, Park KB, Oh KJ, Kim ZS. A study of suicidal ideation among high school students: the structural relation among depression, hopelessness , and suicidal ideation. Kor J Clin Psychol 1990;9:1-19.
  26. Lee JY, Nam SK, Lee MK, Lee JH, Lee SM. Rosenberg' self-esteem scale: analysis of item-level validity. Korean J Couns Psychother 2009;21:173-189.
  27. Johnson J, Gooding PA, Wood AM, Tarrier N. Resilience as positive coping appraisals: testing the schematic appraisals model of suicide (SAMS). Behav Res Ther 2010;48:179-186. https://doi.org/10.1016/j.brat.2009.10.007
  28. R Core Team. A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2017.
  29. Wuensch KL. Independent Samples T Tests versus Binary Logistic Regression. In: Karl Wuensch's Statistics Lessons. Available at: http://core.ecu.edu/psyc/wuenschk/StatsLessons.htm. Accessed September 11, 2017.
  30. Wuensch KL. Binary Logistic Regression with SPSS. In: Karl Wuensch's Statistics Lessons. Available at: http://core.ecu.edu/psyc/wuenschk/StatsLessons.htm. Accessed February 17, 2017.
  31. Field A. Discovering Statistics Using SPSS. London, UK: Sage; 2009.
  32. Grau J, Keilwagen J. Package 'PRROC'. April 21, 2017. Available at: https: //CRAN.R-project.org/package=PRROC. Accessed October 19, 2017.
  33. Grau J, Grosse I, Keilwagen J. PRROC: computing and visualizing precision-recall and receiver operating characteristic curves in R. Bioinformatics 2015;31:2595-2597. https://doi.org/10.1093/bioinformatics/btv153
  34. Davis J, Goadrich M. The Relationship between Precision-Recall and ROC Curves. In: Cohen WW, Moore A, Editors. Proceedings of the 23rd International Conference on Machine Learning. Pittsburgh, Pennsylvania, USA: ACM, 2006, p.233-240.
  35. Kumar R, Indrayan A. Receiver operating characteristic (ROC) curve for medical researchers. Indian Pediatr 2011;48:277-287. https://doi.org/10.1007/s13312-011-0055-4
  36. Arria AM, O'Grady KE, Caldeira KM, Vincent KB, Wilcox HC, Wish ED. Suicide ideation among college students: a multivariate analysis. Arch Suicide Res 2009;13:230-246. https://doi.org/10.1080/13811110903044351
  37. Isometsa ET, Heikkinen ME, Marttunen MJ, Henriksson MM, Aro HM, Lonnqvist JK. The last appointment before suicide: is suicide intent communicated? Am J Psychiatry 1995;152:919-922. https://doi.org/10.1176/ajp.152.6.919
  38. Walsh CG, Ribeiro JD, Franklin JC. Predicting risk of suicide attempts over time through machine learning. Clin Psychol Sci 2017;5:457-469. https://doi.org/10.1177/2167702617691560
  39. Barak-Corren Y, Castro VM, Javitt S, Hoffnagle AG, Dai Y, Perlis RH, et al. Predicting suicidal behavior from longitudinal electronic health records. Am J Psychiatry 2017;174:154-162. https://doi.org/10.1176/appi.ajp.2016.16010077
  40. Hack L, Jovanovic T, Carter S, Ressler K, Smith A. Suicide prediction using machine learning techniques in screening and clinician-derived data. Biol Psychiatry 2017;81:S361.
  41. Oh J, Yun K, Hwang JH, Chae JH. Classification of suicide attempts through a machine learning algorithm based on multiple systemic psychiatric scales. Front Psychiatry 2017;8:192. https://doi.org/10.3389/fpsyt.2017.00192
  42. Gibb BE, Alloy LB, Abramson LY, Rose DT, Whitehouse WG, Hogan ME. Childhood maltreatment and college students' current suicidal ideation: a test of the hopelessness theory. Suicide Life Threat Behav 2001;31:405-415. https://doi.org/10.1521/suli.31.4.405.22042
  43. Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 1999;156:181-189.
  44. Joiner TE. Why People Die by Suicide. Cambridge, MA: Harvard University Press; 2005.
  45. Cukrowicz KC, Schlegel EF, Smith PN, Jacobs MP, Van Orden KA, Paukert AL, et al. Suicide ideation among college students evidencing subclinical depression. J Am Coll Health 2011;59:575-581. https://doi.org/10.1080/07448481.2010.483710
  46. Hom MA, Stanley IH, Joiner TE. Evaluating factors and interventions that influence help-seeking and mental health service utilization among suicidal individuals: a review of the literature. Clin Psychol Rev 2015;40:28-39. https://doi.org/10.1016/j.cpr.2015.05.006
  47. Biddle L, Gunnell D, Sharp D, Donovan JL. Factors influencing help seeking in mentally distressed young adults: a cross-sectional survey. Br J Gen Pract 2004;54:248-253.
  48. Borges G, Benjet C, Medina-Mora ME, Orozco R, Familiar I, Nock MK, et al. Service use among Mexico City adolescents with suicidality. J Affect Disord 2010;120:32-39. https://doi.org/10.1016/j.jad.2009.04.008
  49. Cheung AH, Dewa CS. Mental health service use among adolescents and young adults with major depressive disorder and suicidality. Can J Psychiatry 2007;52:228-232. https://doi.org/10.1177/070674370705200404
  50. Rudd MD, Joiner TE Jr, Rajab MH. Help negation after acute suicidal crisis. J Consult Clin Psychol 1995;63:499-503. https://doi.org/10.1037/0022-006X.63.3.499
  51. McCall WV, Black CG. The link between suicide and insomnia: theoretical mechanisms. Curr Psychiatry Rep 2013;15:389. https://doi.org/10.1007/s11920-013-0389-9
  52. Kim JH, Park EC, Cho WH, Park CY, Choi WJ, Chang HS. Association between total sleep duration and suicidal ideation among the Korean general adult population. Sleep 2013;36:1563-1572. https://doi.org/10.5665/sleep.3058
  53. Sanchez-Teruel D, Robles-Bello MA. Protective factors promoting resilience to suicide in young people and adolescents. Papeles del Psicologo 2014;35:181-192.
  54. Min JA, Lee CU, Chae JH. Resilience moderates the risk of depression and anxiety symptoms on suicidal ideation in patients with depression and/or anxiety disorders. Compr Psychiatry 2015;56:103-111. https://doi.org/10.1016/j.comppsych.2014.07.022
  55. Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry 2011;168:1266-1277. https://doi.org/10.1176/appi.ajp.2011.10111704
  56. Large MM, Nielssen O. Suicidal ideation and later suicide. Am J Psychiatry 2012;169:662; author reply 663.
  57. Large M, Smith G, Sharma S, Nielssen O, Singh SP. Systematic review and meta-analysis of the clinical factors associated with the suicide of psychiatric in-patients. Acta Psychiatr Scand 2011;124:18-29. https://doi.org/10.1111/j.1600-0447.2010.01672.x
  58. Large M, Sharma S, Cannon E, Ryan C, Nielssen O. Risk factors for suicide within a year of discharge from psychiatric hospital: a systematic meta-analysis. Aust N Z J Psychiatry 2011;45:619-628. https://doi.org/10.3109/00048674.2011.590465
  59. Pokorny AD. Prediction of suicide in psychiatric patients: report of a prospective study. Arch Gen Psychiatry 1983;40:249-257. https://doi.org/10.1001/archpsyc.1983.01790030019002
  60. Goldstein RB, Black DW, Nasrallah A, Winokur G. The prediction of suicide: sensitivity, specificity, and predictive value of a multivariate model applied to suicide among 1906 patients with affective disorders. Arch Gen Psychiatry 1991;48:418-422. https://doi.org/10.1001/archpsyc.1991.01810290030004

Cited by

  1. Data-driven analysis using multiple self-report questionnaires to identify college students at high risk of depressive disorder vol.10, pp.None, 2018, https://doi.org/10.1038/s41598-020-64709-7
  2. The relationship between left-behind experience and obsessive-compulsive symptoms in college students in China: the mediation effect of self-esteem vol.26, pp.5, 2021, https://doi.org/10.1080/13548506.2020.1748667
  3. Sex Difference in Peripheral Inflammatory Biomarkers in Drug-Naïve Patients with Major Depression in Young Adulthood vol.9, pp.7, 2018, https://doi.org/10.3390/biomedicines9070708