Reducing Emotional Problems in College by Increasing

Psychological Well-Being: A Shifting ParadigmMarty Swanbrow Becker, Ph.D.

Florida State University

History of the Paradigm Shift

Health Care in U.S. CollegesUniversal health coverage – sort ofModeled off of broader community norms“Pay for service” and individual focusShifting to true universal coverage?

History of our Paradigm Research

Curious about the experiences of suicidal students

National research consortium study – 2008Continuum of suicidal experiencesSuicidal crisis: brief, intense and recurringLack of help seeking

Continuum of DistressPrior research suggested 10% seriously consider

suicide

We found students endorsed:“I wish this would end” – 37%“I wish I was dead” – 11%“Have you seriously considered suicide” – 6%

Recurring ProblemsAmong all students

2% had them on a regular basis6% had repeated episodes23% few discrete episodes24% had one period in their life45% never had thoughts of suicide

Of those who thought about suicide in the past year69% thought about it more than once

Help-Seeking46% did not tell anyone about their thoughts of

suicide

Of those who told someone: 2/3 told a peer first 52% said the first person they confided in was helpful Those with stronger intent to die were less likely to be

advised to seek professional help by the first person they told

58% were referred to professional help by the first person they told

Less than ½ of students seriously considering suicide in the past year received professional help

Factors Preventing a Suicide Attempt

Factor % Factor %

Disappointing/hurting my family

77 Disappointing/hurting my partner

34

Disappointing/hurting my friends

56 Religious/moral beliefs 34

Hope/plans for the future 42 Support of my partner 26

Wanting to finish school 39 My pet 19

Support of my friends 38 Relationship with my mental health professional

10

Support of my family 35

Reasons Students Conceal Their Thoughts of Suicide

Reason %

Low risk (I knew I would never commit suicide) 18

Solicitude (I did not want to burden others) 16

Privacy (I choose to keep my feelings to myself / I deal with personal things privately)

15

Pointless (I didn’t think anyone could really help) 13

Stigma (I didn’t want to appear weak, crazy or out of control)

13

Shame (I was ashamed that I would take the easy way out)

7

Repercussions (I was afraid I would be pulled out of school)

7

Interference (I did not want someone to stop me) 7

Perceived lack of confidants (I didn’t trust anyone enough to tell them)

3

Campus CultureCampus-based living can be supportive but also

a damaging collectivesexual assault and drinking combine in negative

ways

Perceptions may not match realityACHA – NCHA study

What percentage of students used marijuana in the last 30 days?

How often did you use marijuana in the past 30 days?

Prior Experiences with Suicide

Students have considerable prior exposure to suicidal experiencesStudy of Resident Assistants (RAs)65% of RAs knew someone who had thoughts of

suicide (88% of those had a close friend or relative)

60% knew someone who attempted (54% of those close friend or relative)

34% knew someone who died by suicide (53% of those were close friend or relative)

Implications on Our Thinking about Campus

SuicideSuicidal experiences exist on a continuum of

distress

A recurrent problem and difficult to detect in the population

Peer support

Impact of campus culture

Prior experiences

Reasons for Population-Focused Intervention

Difficult to detect vulnerable individuals

Difficult to predict progression from thoughts to action

Difficult for people to act differently than peers

Differences in ability to cope

2011 Study on College Student Stress and CopingWhen did you first think about suicide?

68% before graduating from high schoolCollege student suicide prevention as relapse

prevention?

Over ½ of those attempting suicide used alcohol or drugs around time of attemptAlign suicide prevention with other programs

Ecological prevention

Proactive Prevention

Early Intervention

Treatment & Crisis Intervention

Lapse & Relapse Intervention

TYPE ECOLOGICAL PREVENTION

PROACTIVE PREVENTION

EARLYINTERVENTION

TREATMENT &CRISIS INTERVENTION

LAPSE & RELAPSE INTERVENTION

INTENDED BENEFICIARIES

Current and future populations

Current population with mixed levels of health and risk

Members of the population with identified warning signs

Persons meeting diagnostic criteria for condition or crisis

Population in recovery (asymptomatic for condition)

GOAL Improve ecological contributions to population health and decrease their role in pathogenic process

Reduce population prevalence of predisposing vulnerabilities and enhance personal assets

Disrupt pathogenic process at early stage of development Decrease/reverse physiological impact of chronic stress

Treat existing cases of the disorder and/or crisis

Improve safety

Stabilize and strengthen recovery and resilienceImprove ecological contributions to sustain recovery

INTERVEN-TION FOCUS

Problematic elements of the physical and constructed environment Precipitating events

Ranges from total population to selected sub-populations based on timing and convenience

Indicated population of individuals with identifiable signs of unfolding pathogenic process

Individuals in distress/crisis

Individuals in recovery & their constructed environment

METHODOLOGY Legislation, policy & procedure adjustmentsSystems interventionsEnvironmental modificationsContinuous Process Improvement

Psychoeducational interventions designed primarily to educate, raise consciousness and/or enhance motivation to changePostvention

Screening Programs Thematic groups Leaderless self-help programs; Individual counseling

Stress mgt techniques

Crisis counseling, triage Pharmacological intervention; Individual & group treatment Inpatient treatment

Peer support systems: Recovery community building;Access to individual and group sessions;Psychoeducational interventions

SCOPE Environment & Population level Symptomatic individuals Recovery Population

INTERVENTION CONTINUUM & TREATMENT OF SUICIDALITY

PREVENTION ZONE CLINICAL INTERVENTION ZONE RECOVERY ZONE

Role of the UniversityLead ecological prevention efforts to change

environment for all.The cost is that we impose interventions on those who

may not exhibit signs of distress, but as Geoffrey Rose noted…“a large number of people at a small risk may give rise to

more cases of disease than the small number who are at high risk”

Examples of population intervention:Canopies and treesLimiting access to guns / chemicalsCampaigns to reduce discrimination, change culture,

reduce barriers to help-seeking

Future Direction of our Research

How colleges can help students transform their lives and the impact of student’s sense of self on their growth

Improving suicide prevention programsWhat components lead to changes in behavior?

Implications for Campus Suicide Prevention

1. Develop a mental health alignment team

a. Shared responsibility on campus

b. Provide broad focus on improving health and resilience of students

c. Educate student affairs staff on how to intervene at a population level

d. Improve threat assessment

Implications for Campus Suicide Prevention

2. Create a vision for your campusa. Suicide prevention is easy

b. Joiner’s model

c. Change what is socially acceptable on campus

d. Develop a comprehensive plan

e. Help those in need reach out for help

Comprehensive Approach to Suicide Prevention

Implications for Campus Suicide Prevention

3. Focus on changing the ecology

Planting Trees

Firearms legislation

Reduce incidence of traumatic negative life events

Promote sources of resilience

Involve broader community High schools Department of Education

Change how we measure success

References American College Health Association. American College Health

Association-National College Health Assessment II: Reference Group Executive Summary Spring 2015. Hanover, MD: American College Health Association; 2015.

Burton Denmark, A., Hess, E., & Swanbrow Becker, M. (2012). College students' reasons for concealing suicidal ideation. Journal of College Student Psychotherapy,26(2), 83-98.

Drum, D. J., Brownson, C., Burton Denmark, A., & Smith, S. E. (2009). New data on the nature of suicidal crises in college students: Shifting the paradigm. Professional Psychology: Research and Practice, 40(3), 213-222.

Drum, D. J. & Burton Denmark, A. (2011) College suicide prevention programs and interventions. In Lamis & D. Lester (Eds.), Understanding and preventing college student suicide (pp. 255 - 277). Springfield, IL US: Charles C Thomas Publisher.

References Gallagher, R. P. (2004). National Survey of Counseling Center

Directors. Arlington, VA: International Association of Counseling Services.

Rose, G. (1985). Sick individuals and sick populations. International Journal of Epidemiology, 14, 32-38.

Swanbrow Becker, M., & Drum, D. (2015). The Influence of Suicide Prevention Gatekeeper Training on Resident Assistants’ Mental Health, Journal of Student Affairs Research and Practice, 52(1), 76-88.

Wyman, P. A., Brown, C. H., Inman, J., Cross, W., Schmeelk-Cone, K., Guo, J., et al. (2008). Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. Journal of Consulting and Clinical Psychology, 76(1), 104-115.

Questions?