| Objectives This study aims to:(1) estimate prevalence of suicidal ideation, suicide attempts among college students in one-year follow-up period.(2) describe the characteristics of suicidal ideation and suicide attempts, including the reasons for suicide, suicide plan, suicide methods, help-seeking behaviors before suicide crisis.(3) identify independent predictors for suicidal ideation and suicide attempts from demographic variables, adverse childhood experiences, and family history of suicidal behaviors, recent life events, impulsive/aggressive personality, depression/anxiety symptoms, and baseline suicidal behavior variables.(4) construct risk indexes for suicidal behaviors in the future year. Methods A total of 11,541 enrolled college students in grades 1 through 2 from three medical college schools in Anhui province(including Anhui Medical University, Wannan Medical College, and Bengbu Medical College) were invited to participate in this longitudinal study for one year, with an interval of 6 months. Data were collected by using “Mental Health and Related Life Experiences Questionnaires”, which included suicidal behaviors, adverse childhood experiences, family histories of suicide behaviors, recent negative life events, the Beck Depression Inventory, Beck Anxiety Inventory, Barratt Impulsiveness Scale, Aggressiveness Questionnaire, Social Support Rating Scale, Life Events Scale, and Family APGAR Index. The final analysis was based on 7298 students that participated in the whole three surveys, gave written informed consent and provided qualified questionnaires, with a response rate for 63.2%. We used Epi Data3.1 for data entry and SPSS15.0 for statistical analyses. Cross-tabulations were used to estimate one-year prevalence of suicidal ideation and attempts during the follow-up period. Non-conditional logistic regression equations were used for identifying independent predictors for suicidal ideation and attempts from the potential risk factors in the baseline survey. Every value of the most important predictor in logistic regression equation was cross-classified with the count of the other predictors to form some combinations, and then we calculated a predicted probability of outcome from each combination. This distribution of predicted probabilities was then inspected and divided into stratus using the logic of stratum-specific likelihood ratios(SSLRs) to construct a risk index for suicidal ideation or attempt during 1-year follow-up. Results(1) The prevalence of suicidal ideation and attempts during 1-year follow-up were 8.4%(n=613) and 0.8%(n=58), respectively. 10.6% of suicidal ideators and 32.5% of attempters had two or more suicidal behaviors(2) The Characteristics of Suicidal Ideation and Attempts: 38.8% of suicidal ideators and 32.8% of attempters had help-seeking behaviors. Both suicidal ideators and attempters were more likely to seek help from family members and friends, accounting for 83.0% and 89.5%, respectively. The common causes of suicidal behaviors were, in rank order: learning problems, family disputes, physical illness, mental illness, and love affairs. 78.5% of suicidal ideators did not develop a suicide plan, and 93.0% of suicide attempters were unplanned attempters. The most frequent method used by attempters was cutting(59.6%). 57.9% of suicide attempters used tools readily available in their homes. Nearly 20% of subject received any kind of treatment after attempts.(4) The Independent Predictors for Suicidal Ideation and Attempts: Eight independent predictors for suicidal ideation were identified in the final multivariate logistic regression model. The history of suicidal ideation(OR=7.67-12.4), especially the history of suicide plan was the most important predictor. Other predictors included negative life events in the year before baseline survey, the number of adverse childhood experiences, religious beliefs, female, high self-attack scores, higher depression scores, and family dysfunction(OR=1.24-2.03). Five independent predictors for suicide attempts were identified. The history of suicide attempts(OR=16.07-36.12) and the history of suicidal ideation(OR=3.66-6.96) were the main predictors for attempts. Other three predictors were the number of adverse childhood experiences, high self-attack scores and women(OR =1.43-3.35).(4) Risk Index for Suicidal Ideation and Attempts: A summary risk index, which was constructed by cross-classifying the tracheotomy for history of prior suicidal ideation with a 0-7 count of the other predictors, could predict suicidal ideation in the future year with a good accuracy(AUC=0.813). The index could be collapsed to five categories: 66.4% of respondents were classified as the first category(very low risk, PPV=2.4%). 17.6% of respondents were classified as the second category(low risk, PPV=7.9%). 5.2%、7.4% and 2.4% of respondents were classified as the third, fourth and fifth category(high risk, PPV=24.6%, 35.3%, and 48.3%), respectively. Another summary risk index, which was constructed by cross-classifying the Quintiles for history of prior suicide attempts with a 0-3 count of the other predictors, could predict suicide attempts in the future year with a good accuracy(AUC=0.865). The index could be collapsed to four categories: 84.0% of respondents were classified as the first category(very low risk, PPV=0.2%). 12.0% of respondents were classified as the second category(low risk, PPV=0.7%). 2.8% of respondents were classified as the third category(high risk, PPV=4.9%). 1.2% of respondents were classified as the fourth category(very high risk, PPV=33.0%), accounting for 51.7% of attempters. Conclusions Suicidal ideation and attempts are two common behavioral events among college students. Individual aggregation, the causes of suicide being mostly common exposures, suicide tools being available, being mostly impulsive, and low rate of help-seeking are main characteristics of suicidal behaviors. The history of suicidal ideation and suicide attempts are the most important predictors for suicidal ideation and attempts, respectively. However, the unique effect of a single factor does not significantly increase the risk of future suicidal behaviors. The indexes constructed by multiple factors can predict suicidal behaviors during 1-year follow-up with high accuracy. Some characteristics of suicidal ideation and attempts(e.g., unplanned, low-assistance rate) suggest that the increase of coverage of mental-health services in campus can not effectively increase the recognition rate of suicidal crisis. So, how to timely and effectively identify or predict suicide crisis is critical for suicide prevention among college students. The risk index combined by independent predictors can help screening individuals at high risk of suicide and assessing the risk for suicide. |
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