| Suicide is a public health problem of global importance,with 804,000 people dying from suicide worldwide each year.It is the second cause of death among 15–29 year olds,suggesting that more attention should be paid to this population.WHO has published a report titled “Preventing Suicide: A Global Imperative”,which declared that reducing suicide-related mortality is a global imperative,a welcome contrast to the traditional taboo that has surrounded suicidal behaviors.This report emphasized that preventing suicide required understanding of the method preferences of different groups in society.And developing a national suicide prevention strategy is to make multi-sectoral prevention priority that involves not only the health sector but also education,employment,social welfare,the judiciary and so on.Recently,the frequent suicides of college students in China have aroused great concern from all circles.Ministry of Education of the Communist Party of China issued the "Guidelines for Mental Health Education for Students in Colleges and Universities".It was pointed out that the main tasks of mental health education for students in higher education institutions include strengthening the prevention and intervention of psychological crisis.Suicide is a complicated issue.It is often regarded as a taboo topic,which make hindered efferts to relevant researches.Although there were more than 23 million college students in China and a considerable number of suicide cases among this population had been reported,little was known about the characteristics of youth’s suicide risk and its cause.This study had three objectives.First,the study aimed to investigate the characteristics of suicidal ideation and behaviors of college students though a large sample survey.In addition,the study also explored the predictive factors of suicide attempt and the relationship between suicidal ideation/behavior and depression and anxiety symptoms.Second,the study aimed to figure out the relationship between suicide,stress and sleep by establishing structural equation modelling.Stress and sleep are risk factors for suicide.However they are easier to change and there are abundant intervention and empirical research conclusions for stress and sleep in clinical practice.So we planed to prevent suicide indirectly using the alterability of stress and sleep.Third,brief mindfulness meditation was used to decrease suicide ideation of college students.The study aimed to prove that the brief mindfulness meditation was a safe,economical and efficient way to prevent suicide for college students.The methods and results of the three parts were showed below.1.Suicidal ideation and behaviors of college students though a large sample surveyCluster sampling was used in the survey.6836 first-year college undergraduate and postgraduate students who were aged 18-30 years and from a comprehensive university in Shanghai completed the questionnaires.The questionnaires included Scale for Suicide Ideation(SSI),the Suicidal Behaviors Questionnaire-Revised(SBQ-R),the Patient Health Questionnaire(PHQ-9),and Generalized Anxiety Disorder(GAD-7).The results were:(1)The proportions of college students at high suicide risk were as follows: 18% of the students scored with high suicidal ideation.14.5% of the students scored with high suicidal behavior.Using SSI and SBQ-R as criteria,the proportion of students at high suicide risk was 21.9%.In addition,1% of the students had the experience of suicide attempt.18.8% of students have thought about specific plans or have specific plans for suicide;0.4% of the students prepared a suicide note for their own suicide plan;0.7% of the students made aftercare arrangements for their suicide.(2)Suicide ideation varied in gender,academic level and subject.The incidence of high suicidal ideation of male students was significantly lower than that of female students(7.0% vs.15.0%),OR [95% CI]=0.88 [0.77,1.10],P=0.045;that of undergraduate students was significantly higher than that of graduate students(13.9% vs.8.0%),OR [95% CI]= 2.05 [1.57,2.68],P<0.001;and the incidence of high suicidal ideation of liberal arts students was significantly lower than that of science students(10.1% vs.11.8%),OR [95% CI]=1.21 [1.07,1.36],P=0.002.Age did not predict the incidence of high suicidal ideation significantly.(3)College students in China had high acceptance of suicide and lack of value for life.For example,18.2% of the students expressed a weak to strong desire to die,14.7% of the students thought that suicide was acceptable,and 61.4% of the students believed that suicide could help people solve or escape realistic problems.(4)The Predictors of college students’ suicide attempts included: specificity of suicide plan(OR[95%CI]= 2.91 [1.71,4.93],P<0.001),attitude toward suicide(OR[95%CI]= 1.80 [1.20,2.71],P=0.005),threatened others to commit suicide(OR[95%CI]=1.82 [1.13,2.93],P=0.013)and the likelihood of future suicide(OR[95%CI]= 1.31 [1.03,1.67],P=0.028).So following situations would increase the possibility of attempt suicide of college students: specific suicide plans had been prepared,taking suicide into a way to solve/escape problems or threatening others and believing in the possibility of suicide in the future.(5)The high scores of suicide ideation/behavior of college students was related to depression and anxiety symptoms.The scores of suicidal ideation,suicidal behavior,depressive symptoms and anxiety symptoms were positively correlated,but the relationship was weak.The scores of depression/anxiety symptoms and the proportion of students who scored above the threshold were significantly higher in college students with high suicide ideation scores.However,87.6% of college students with high suicidal ideation had no significant depression and anxiety symptoms.2.The relationship between suicide,stress and sleep780 undergraduate and graduate students aged 18-30 years were surveyed by convenient sampling.Students were invited to fill in the Questionnaires on the internet included: SSI,SBQ-R,The Perceived Stress Scale(PSS),the Short Form of the Childhood Trauma Questionnaire(CTQ-SF),and the Pittsburgh Sleep Index Questionnaire(PSQI).The results were:(1)Suicidal ideation and behavior of College students: 33.6% of college students have high suicidal ideation and 26.4% of college students have suicidal behaviors.2.7% of the students had experience of suicide attempt.29% of the students reported that they had thoughts about detailed suicide plan or had a detailed suicide plan.0.8% of the students said they had prepared for their suicide,and 1% had made aftercare arrangements for suicide.The proportion of the above results were all higher than that of the first survey.(2)Childhood trauma and stress of college students: Among college students,the incidence and frequency of emotional neglect-related events were relatively high.Traumatic experiences with high incidence and high frequency included: lack of family care and protection,feeling unimportant at home,feeling family members do not care about each other,feeling that family relationship is not intimate,without the love feelings from family members.The total scores of CTQ in boys were significantly higher than that of girls,and the scores of physical neglect in boys were significantly higher than that in girls.The physical neglect scores of students from key universities and ordinary universities were lower than that of students from colleges.There was no significant difference in PSS stress scores between male and female students,while the total PSS scores of students from key universities,ordinary universities,and colleges decreased significantly.(3)Sleep patterns and sleep quality of College students: The average bedtime of college students was 22:50±1:49,the average wake time was 7:13±0:53,the average daily sleep duration was 6.89±1.26 hours/day,and 34.2% of the students had insufficient sleep.The average sleep latency of college students was 31.15±34.64 minutes,and 45.4% of them had more than 30 minutes sleep latency.The average sleep efficiency of the students was 83.50%±11.54%.49% of the students had sleep efficiency lower than 85%.The average PSQI score of college students was 6.64±3.00,and 36% of college students had PSQI scores more than 7.The bedtime of boys was significantly later than that of girls,but the sleep efficiency of boys was significantly higher than that of girls.The students from key universities had sleep problems of late sleep,short sleep duration and poor sleep quality,which were more prominent than that of the other students.(4)The relationship between suicide,stress and sleep of college students.Suicide ideation and suicide behavior were positively correlated with childhood trauma,stress and sleep.A well-fitted structural equation model(χ2 =1.52,df =1,χ2/df =1.52,RMSEA =0.03,CFI =1.00,NFI =1.00)was constructed in this study.The hierarchical regression test showed that all the path coefficients in the model were significant.Mediating effect test found that childhood emotional neglect could play a role in suicide behavior through a number of mediating effect pathways,including emotional abuse-stress feeling-sleep-suicide ideation-suicide behavior,emotional abuse-stress feeling-sleep-suicide behavior,emotional abuse-stress feeling-suicide behavior,emotional abuse-sleep-Suicide There are six paths of suicide: ideation-suicide behavior,emotional abuse-sleep-suicide behavior,emotional abuse-suicide idea-suicide behavior.Among them,emotional abuse-suicide idea-suicide behavior path accounted for 82.2% of the total mediating effects.The effects of the six mediating paths accounted for 73.7% of the total effects.3.The effects of brief mindfulness meditation on suicide ideation of college studentsExperiment 1: The effects of brief mindfulness meditation on emotion processing and its safety test.In experiment 1,42 healthy college students were randomly divided into BMM group and emotional regulation education(ERE)group.They were trained for 7 consecutive days(15 minutes a day).Before and after training,trainers were tested for mood state and emotion processing function.Mood state measured by Center for Epidemiologic Studies Depression Scale(CES-D)and(State Anxiety Inventory)SAI;emotion processing functions were tested by 3 cognitive experimental tasks including emotional intensity evaluation task,emotional memory task and emotional attention bias task.The results showed that:After intervention,the emotion intensity,the response time of emotional memory task and the attention bias toward negative emotional stimuli of the treatment group decreased significantly compared with the emotional regulation education(ERE)group.This study demonstrated that BMM is an economical,convenience and safe way that could help the practitioners to improve emotion processing and remain concentrated and peaceful.Experiment 2: The effects of brief mindfulness meditation on high suicide ideation for college students.In experiment 2,60 college students with high suicidal ideation(SSI < 6)were randomly divided into BMM group(15 min every day for one month)and waiting list group(WL).The BMM group completed intensive training once a week and self-help training four times a week.The suicidal ideation,suicide behavior,stress,immunity and sleep were measured before and after training.The suicide ideation and suicide behavior measured by Scale for Suicide Ideation(SSI)and The Suicidal Behaviors Questionnaire-Revised(SBQ-R)respectively;Stress measured by morning salivary cortisol concentration,and The Perceived Stress Scale(PSS);immune measurement is salivary interleukin-1beta(IL-1β);sleep measurement included Pittsburgh Sleep Index Questionnaire(PSQI),7-day sleep diary recording,and 7-day Actiwatch sleep recording.The results showed that:In terms of suicide,the suicide ideation scores of the BMM group and the WL group were significantly decreased.The salivary cortisol concentration of BMM group decreased after training.There was no significant change in PSS and IL-1β concentration.There was no significant change in stress and immunity in WL group.After training,sleep quality of BMM group improved,as evidenced by decreased sleep latency time and increased sleep efficiency.Sleep of WL group did not change significantly.This study draws the following conclusions.(1)In this study,the proportion of college students with high suicide risk was about 21.9%.The proportion of college students who had attempted suicide was about 1%.A large proportion of students indicated that they accepted suicide or took suicide as a way to solve problems.Among all kinds of suicide ideation,the concreteness of suicide plan,the attitude towards suicide,the possibility of threatening suicide and the likelihood of future suicide could significantly predict suicide attempt of college students.Although the high suicide risk of college students was related to depression and anxiety symptoms,the relationship is weak.87.6% of college students with high suicide risk did not have depression and anxiety symptoms.Their suicide risk might be related to their attitude towards suicide.On the one hand,this study suggested that colleges and universities should pay attention to students’ depression and anxiety symptoms,assess students’ suicide risk,and encourage students to actively find help when necessary;on the other hand,they should pay attention to life education for college students,help them establish correct view of life and improve their problem-solving ability.(2)College students had prominent sleep problems,and there might be more sleep problems such as shorter sleep duration,longer sleep latency,lower sleep efficiency,and poor sleep quality.There was no significant difference in sleep quality between male and female students.Sleep quality in key university might be more serious than that of ordinary university and colleges.In terms of childhood trauma,the incidence and frequency of emotional neglect experiences were relatively high in college students.The total score of CTQ-SF of male students was significantly higher than that of female students.There was no significant gender difference in PSS scores,while the scores of PSS of key university,ordinary university and colleges were significantly decreased.The results suggested that sleep of college students need more attention and targeted guidance.(3)Suicide ideation and suicide behaviors were significantly positively correlated with the total scores and dimensions of childhood trauma,the perceived stress and sleep quality.In the well-fitting structural equation model,childhood emotional abuse could play a role in suicide behaviors through six mediating effects pathways consisting of stress,sleep and suicide ideation.Sleep and perceived stress had predictive effects on suicidal behaviors,but the effect was only 17.8%,and suicide ideation had a very important predictive effect on suicidal behavior in individuals with emotional abuse experience.In the framework of suicide,stress,and sleep,only childhood emotional abuse entered the model.Childhood emotional abuse might be more likely to play a role in suicide through stress and sleep than other childhood traumatic experiences.(4)The study verified that brief mindfulness meditation(JW2016)could improve suicide risk,stress response,sleep latency and sleep quality.However,it did not show significant effect on immunity.Therefore,15 minutes of brief mindfulness meditation training was safe enough to help reduce the risk of suicide,and improve stress and sleep among college students.In addition,it was an economical and efficient method of physical and mental training suitable for suicide prevention for college students. |
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