Colleges and universities can support students with previous history of suicidal ideation or self-harm with long-term counseling or mental health support.
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Over the past two decades, suicide rates in the U.S. have increased 37 percent, according to data from the Centers for Disease Control. Fifteen percent of all deaths by suicide are among individuals ages 10 to 24 years old, making it the second leading cause of death for this age group.
This heightened risk has pushed colleges and universities to invest in preventative measures to address the complex issues that impact student well-being.
A January report from Pennsylvania State University’s Center for Collegiate Mental Health (CCMH) finds that students with a history of suicidal or self-injurious behaviors report lower levels of distress after engaging with counseling center services, but they remain at higher levels of distress over all compared to their peers.
Methodology
The report includes data from the 2023–24 academic year, beginning July 2023 and closing June 2024. Data was collected from 213 college and university counseling centers, including 173,536 unique students seeking care, 4,954 clinicians and over 1.2 million appointments. The data is not representative of the general student population, only those accessing mental health services.
By the numbers: The number of students reporting previous suicidal or self-injurious behavior (S/SIB) histories jumped four percentage points from 2010–11 to 2023–24, according to CCMH data.
“While counseling centers have historically treated a considerable segment of students with heightened suicide risk, ongoing questions remain about the complexity of co-occurring problems experienced, the scope of services they utilize, and whether gaps in care exist,” according to the report.
Compared to their peers without a history of S/SIB, these learners had higher levels of self-reported distress, particularly in symptoms of generalized anxiety, general distress and depression. They were also more likely to report a history of trauma or past hospitalization.
Students had a higher likelihood of continuing to demonstrate self-injurious thoughts or behaviors, compared to other students, but the overall rates remained low, with only 3.3 percent of students with past S/SIB reporting it during college counseling.
They were 14.3 times more likely to engage in self-injury and 11.6 times more likely to attempt suicide during treatment, and more than five times more likely to be admitted or referred to a hospital for a mental health concern. This, again, constituted a small number of students (around one in 180) but researchers noted the disproportionate likelihood of these critical case events.
Ultimately, students with suicidal or self-injurious behavior history saw similar benefits from accessing services compared to their peers, with data showing less generalized distress or suicidal ideation among all learners between their first and final assessments. However, they still had greater levels of distress, even if slightly lower than initial intake, showing a need for additional resources, according to researchers.
“The data show that students with a history of suicidal or self-injurious behaviors could benefit from access to longer-term and comprehensive care, including psychological treatment, psychiatric services and case management at counseling centers, as well as adjunctive support that contributes to an overall sense of well-being, such as access to disability services and financial aid programs,” said Brett Scofield, executive director for the CCMH, in a Jan. 28 press release.
Future considerations: Researchers made note that while prior history of suicidal behaviors or self-harm are some of the risk factors for suicide, they are not the only ones, and counseling centers should note other behaviors that could point to suicidal ideation, such as substance use or social isolation.
Additionally, some centers had higher rates of students at risk for suicide, ranging from 20 to 50 percent of clients, so examining local data to understand the need and application of data is critical, researchers wrote.
The data also showed a gap in capacity to facilitate longer-term care, such as case management or psychiatric services available, which can place an additional burden on clinicians or require outsourcing for support, diluting overall quality of care at the center. “Therefore, it is imperative that colleges and universities invest in under-resourced counseling centers to ease the burden on counseling center staff and optimize treatment for students with heightened suicide risk,” according to the report.
Investing in on-site psychological treatment or psychiatric care and finding creative solutions to work alongside outside partners can help deliver more holistic care.
Other trends: In addition to exploring how college counseling centers can address suicidality in young people, CCMH researchers built on past data to illustrate some of the growing concerns for on-campus mental health service providers.
- Rates of prior counseling and psychotropic medication usage grew year over year and are at the highest level since data was first collected in 2012. A 2023 TimelyCare survey found six in 10 college students had accessed mental health services prior to entering college, and CCMH data echoed this trend, with 63 percent of students entering with prior counseling history.
- The number of clients reporting a history of trauma remains elevated, up eight percentage points compared to 2012, though down slightly year over year, at 45.5 percent, compared to last year’s 46.8 percent.
- Anxiety is the most common presenting concern, with 64.4 percent of clients having anxiety, as assessed by clinicians.
- In-person counseling services have rebounded since the start of the COVID-19 pandemic in 2020, with 63.7 percent of clients receiving exclusively in-person counseling and 13.5 percent receiving only video care.
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If you or someone you know are in crisis or considering suicide and need help, call the 988 Suicide & Crisis Lifeline by dialing 9-8-8, or contact the Crisis Text Line by texting HOME to 741741.
