Connecting Suicidal College Students to Care

Transcription

1 Connecting Suicidal College Students to Care Cheryl A. King, Ph.D. Department of Psychiatry University of Michigan Funding National Institute of Mental Health, R34 MH A1; K24 MH07705 R01 MH Financial Disclosure No financial holdings or other conflicts of interest with this presentation

2 5000 US Suicide Deaths and Rates-2015 Number of Deaths Crude Rate Number of Deaths Suicide Rate Per 100, Age Group Centers for Disease Control and Prevention. (2016). Web-based Injury Statistics Query and Reporting System (WISQARS) Retrieved April 7, 2017, from

3 BACKGROUND Depression, Alcohol, Suicidal Ideation, and Suicide Risk among College Students Depression is leading predictor of suicide proneness and suicide attempts among college students (Dvorak et al., 2013; Garlow et al., 2008) Depressed college students are more likely to consume alcohol, which exacerbates suicide risk. Alcohol misuse and depression represent an especially high-risk profile for suicidal behavior, repeated suicidal behavior and suicide (Lamis et al., 2010; Sher et al., 2007) Approximately 6% of undergraduates report having seriously considered attempting suicide in the past year (Drum et al., 2009; Downs & Eisenberg, 2012) The most common suicide method considered by college student ideators is drug or alcohol overdose (Drum et al., 2009).

4 BACKGROUND Mental Health Service Utilization Among College Students Of 32% undergraduates with a mental health problem, only 36% received treatment during previous year (Eisenberg et al., 2011; 2013). Among college students reporting suicidal ideation, 51.5% received some type of treatment during previous year (Downs & Eisenberg, 2012). 46% of undergraduate students with suicidal thoughts chose not to tell anyone (Drum et al., 2009) Correlates of treatment use include perceived need, beliefs that treatment effective, lower personal stigma, contact with service users, among others (Downs & Eisenberg, 2012)

5 BACKGROUND Why use the Internet? 37.5% of college students have searched Internet for health information 3+ times over the past year (Percheski & Hargittai, 2011) 30.8% of college students have searched for mental health information online; Among these, 8.2% once a week, 36.7% a few times/year (Horgan & Sweeney, 2009) Web-based screening can identify college students at risk for suicide (Haas et al., 2008; King et al., 2015) 24% of college student participants engaged in 1 or more anonymous online dialogues with a counselor (Haas et al., 2008)

6 e-bridge INTERVENTION DEVELOPMENT PLAN Explore Concept Develop e-bridge Website Develop Intervention Manual Obtain Advisory Members Input Feasibility Pilot Pilot Randomized Controlled Trial Report Findings

7 Theoretical Model Motivational Interviewing Theory Theory of Health Behavior Adapted Motivational Interviewing Theory of Planned Behavior Self Determination Theory

8

9

10 All Student Participants Screen plus Personalized Feedback Students privately complete screen/baseline 7-15 question screen Patient Health Questionnaire: PHQ- 3 items Alcohol Use Disorders Identification Disorders Test (AUDIT-C) In your lifetime have you ever attempted suicide? Current suicidal thoughts If screen is positive, 22 additional questions Students see information online about availability of services Students who screen positive receive personalized feedback report

11 Screening Constructs Depression PHQ-2 Suicidal ideation PHQ-9 item History of Suicide Attempts National Comorbidity Study question Alcohol Abuse AUDIT

12 PERSONALIZED FEEDBACK Details scores on screening measures Provides normative or severity data Identifies problem areas Summary of goals and values

13

14 Pilot RCT All 1 st year Students: Freshmen, Transfer, Graduate Total invited by = 7,000 Survey started = 1,744 (25.0%) Survey completed = 1,488 (21.26%) Eligible for full survey (elevated risk) = 116 (7.8%) Eligible for intervention (not in tx) = 76 (65.5%) Randomized to intervention group = 35

15 Participants 116 students positive for suicide risk Depression (Dep) + Suicidal Ideation and/or Hx Suicide Attempt (SI/SA) (n = 57) Dep + Alcohol Abuse (n = 23) Dep + Alcohol Abuse + SI/SA (n = 19) Alcohol Abuse + SI/SA (n = 15) SI + SA (n = 2) 40 excluded for current mental health treatment

16 Participants 76 students randomized 59.2% female M = 22.9 years old (SD = 5.02) Race/Ethnicity Caucasian (n = 54, 71%), Asian American (n = 21, 28%), and American Indian/Alaskan Native (n = 1, 1%). Hispanic (n = 4; 5%) No demographic difference between groups

17 Baseline and Follow-Up Measures Suicide Risk Factors PHQ-9 remaining 6 questions AUDIT remaining 7 questions Primary Outcome Measures Readiness to Access Help 11 questions- readiness to access help seeking behaviors seeking help from a mental health professional accessing self-help or support group Professional help-seeking Perceived public stigma and personal stigma

18 Engagement with Survey Completed Survey Did not Complete Survey Males 823 (16.3%) 4211 Females 1287 (25.9%) 3679 p <.001 Freshmen 1182 (23.6%) 3818 Sophomores 928 (18.6%) 4072 p <.001 Females and freshmen were significantly more likely to complete the initial survey

19 Student Engagement* by Demographics Female (n = 46) Male (n = 24) Freshman (n = 39) Sophomore (n = 31) Did Not Post 30 (65%) 18(75%) 22 (56%) 26 (84%) Did Post at Least One Message 16 (35%) 6 (25%) 17 (44%) 5 (16%) * Student postings (prompted or unprompted by Counselor)

20 Results e-bridge Intervention Effects Unadjusted means Control Intervention Difference p (N = 29) (N = 31) Outcomes on Likert/rating scales Readiness: seek information * Readiness: talk to family <.01 Readiness: talk to friend <.01 Readiness: see MH professional <.001 Readiness: self-help or support group Readiness: academic support services Readiness: AVERAGE <.01 Note: All measures range from a Linear regressions estimated for Likert/rating scale outcomes, logistic regressions for binary outcomes. *Becomes insignificant when regression is adjusted.

21 Results e-bridge Intervention Effects Unadjusted means Control Intervention Difference p (N = 29) (N = 31) Outcomes on Likert/rating scales Perceived public stigma score (0-4) * Personal stigma score (0-4) <.01 PHQ-9 score (0-27) AUDIT score (0-40) Binary outcomes Met w/ MH professional (2 mo) <.01 Therapy/counseling (current) Psychiatric medication (current) a Linear regressions estimated for rating scale outcomes, logistic regressions for binary outcomes. *Becomes significant when regression is adjusted.

22 SUMMARY Students in ebridge group reported significantly higher readiness scores and were more likely to have received mental health treatment.

23 Next Steps Multi-University R01 In Progress (Year 3) University of Michigan Stanford University University of Iowa University of Nevada-Reno Similar Participation Rates/Rates of Treatment across Sites Plan to Examine Effectiveness for Key Subgroups, including sexual minorities, gender minorities, racial/ethnic minorities, males/females

24 Co-Investigators Kai Zheng, Ph.D. Daniel Eisenberg, PhD Stephen Chermack, PhD Brenda Gillespie, PhD Acknowledgments Project Coordinator Anne Kramer, LMSW Online MI Counselors Anne Kramer, LMSW Ewa Czyz, MA Consultant Ann Haas, Ph.D. Research Assistants Adam Horwitz Ryan Hill Campus Advisors Robert Winfield, MD Todd Sevig, PhD Students from Campus Groups: Finding Voice, PULSE

25 Thank you For additional information: