Suicidal risk factors and interventions to reduce risk in the University student population

Abstract

The transition to university can pose a variety of challenges for students to navigate including academic, psychological, financial and social stressors. Such stressors can impact overall wellbeing, increase psychological distress and in some circumstances can result in suicidality and/or self-harm. Suicide and self-harm are major public health concerns worldwide and therefore risk reduction and prevention are key priorities within research. Despite increased awareness of risk factors for suicidality, there is a gap in the research literature relating to effective psychosocial interventions to reduce risk specifically in the student population. Increasing understanding of the multifaceted nature of suicidal risk in students warrants further exploration to ensure that interventions are tailored to meet their needs. The purpose of this thesis was to 1) evaluate the effectiveness of psychosocial interventions offered to university students with suicidality and/or self-harm and 2) explore factors predictive of increased suicidal risk in the student population. The work comprises two primary components: a systematic literature review and an empirical study. The systematic literature review in Section One was conducted to explore existing evidence relating to the nature, variety and effectiveness of psychosocial interventions offered to university students. The review synthesised evidence from 17 studies identified from four key databases. Methodological quality and intervention outcomes were critically appraised using established frameworks. Studies were categorised based on type of psychosocial intervention offered. The strongest evidence was in support of Cognitive Behavioural Therapy and Dialectal Behavioural Therapy, however delivery of treatment components varied across studies. Other categories of intervention identified were brief psychological interventions, group interventions and stepped-care models, although there was only a small number of studies with mixed-quality evidence in each category. The review highlighted that further research using higher quality research methodologies is needed to strengthen the evidence base for psychosocial interventions to support university students ii with suicidality and/or self-harm. The empirical study in Section Two explored suicidal risk and potential predictors. Longitudinal data from the Nurture-U student wellbeing survey was collated from five universities in the United Kingdom. Survey data from 6,543 student participants was collected including validated measures of suicidal risk, health, wellbeing lifestyle factors and access to support. Statistical analyses indicated that sociodemographic and wellbeing factors including mental health symptomology, ethnic group, sexual orientation, adverse childhood experiences, age and alcohol use were significant predictors of baseline suicidal risk at the start of the academic year. Follow-up data from 1,721 participants at the end of the academic year highlighted that relative changes in mental health and wellbeing symptoms including depression, anxiety, sleep quality, social resources, loneliness and alcohol use were dynamic predictors of changes to suicidal risk. Taken together, this thesis highlights the importance of understanding vulnerabilities unique to the student population and tailoring approaches to reduce suicidality and/or self harm that accounts for a diverse range of biopsychosocial risk factors. The thesis includes clinical implications for university services and recommendations for future research, including the provision of interventions that are attuned to the unique challenges faced by university students.Objective: Suicide is the third leading cause of death amongst young people aged 15-29 years. The evidence base for interventions to support individuals presenting with suicidality and/or-self harm is growing. Psychosocial interventions may offer benefits for risk reduction, yet little is known about utilising these interventions to target such difficulties in the university student population. Method: A systematic literature review searching four databases (Medline, Scopus, PsycInfo and Embase) was conducted. The search strategy incorporated terms relating to suicidality, self-harm and psychosocial interventions. Studies were from any country of origin, although inclusion in the review required participants to be university students. Results: 17 papers met the inclusion criteria. Several categories of intervention relating to evidence-based psychological treatments (Cognitive Behaviour Therapy and Dialectical Behaviour Therapy), brief psychological interventions, group interventions and stepped-care models were identified. Conclusions: Evidence-based psychological interventions may benefit the university student population presenting with suicidality and/or self-harm. Brief psychological interventions, group interventions and stepped-care models demonstrate some promise, although high quality evidence supporting their effectiveness is limited. Further studies using randomised controlled trial methodology to improve generalisability of the findings is needed to strengthen the research evidence for psychosocial interventions to support the university student population. Keywords: university; students; suicidality; self-harm; psychosocial interventions