Undergraduate and Graduate Student Coping with Stressful Experiences: The Continuum of Distress, Suicidal Experiences and Outcomes

Transcription

1 Undergraduate and Graduate Student Coping with Stressful Experiences: The Continuum of Distress, Suicidal Experiences and Outcomes Chris Brownson, Ph.D. & David Drum, Ph.D. The National Research Consortium of Counseling Centers in Higher Education The University of Texas at Austin

2 Introduction Founded in 1991 at the University of Texas at Austin 6 completed studies to date Membership in Consortium is determined study-bystudy, and all are encouraged and welcome to participate Research is an essential ingredient for defining a specialty of college mental health CCMH, NCHA, Director s Surveys, etc.

3 National Suicide Statistics 2 nd leading cause of death on college campuses National suicide rates for college students range from 6.5 to 7.5 per 100,000 Compared to 16 per 100,000 in age-matched peers Roughly 25% of campus suicides are counseling center clients, nationally Suicides in CC clients are 3.3 times greater than non-clients When taking into consideration the 4 most significant risk factors (previous attempts, psychiatric illness, gender, and firearms), you would expect clients of CCs to commit suicide 20 times more than non-clients. (Schwartz, 2006, 2011)

4 Overview of Presentation Goals Broaden the current clinical intervention treatment model to include a preventive, population-focused intervention approach Explore college student self-report data on suicidal experiences and coping during recent stressors Sections of presentation Expansion: Intervention approaches and distress/suicidality continuum Overview of 2011 data Demographics Nature of stressful period Qualities of self: Connectedness /belongingness and sense of coherence Suicidal behavior and help-seeking Implications for Population-focused prevention Discussion

5 The present era of epidemiology is coming to a close. The focus on risk factors at the individual level- the hallmark of this era- will no longer serve. We need to be concerned equally with causal pathways at the societal level and with pathogenesis and causality at the molecular level. (Susser & Susser, 1996)

6 Population-Based Intervention: Our New Frontier Population- vs. clinical-based interventions Clinical approach: Target known risk and protective factors HOW DO WE ENHANCE? Population approach: Target known risk and protective qualities/processes to bolster resilience and prevent deterioration A university/college campus is a membership organization with many stakeholders and levers of change HOW DO WE EXPAND? Changing the language Risk and protective factors Qualities/processes of self

7 Population-Based Intervention: Our New Frontier Population- vs. clinical-based interventions Clinical approach: Target known risk and protective factors at the level of the individual Concerned with shifting the decisional balance in favor of living vs. dying Population approach: Target known risk and protective qualities/processes to bolster resilience and prevent deterioration of population wellbeing Concerned with shifting qualities of the campus ecology such that they tilt the decisional balance of the the population in favor of health by proactively enhancing as well as preventing decline in properties/qualities of the self. Treat both as a singular entity Individual- establish a treatment program (micro) Population- determine a core curriculum (macro)

8 WHO Definition of Health Health is a state of optimal physical, mental and social well-being, and not merely the absence of disease and infirmity

9 Goal is to Shift Population Well-being Frolich and Potvin (1999) state that when many people lower their risk, even a little, the total benefit for the population is larger than if a few people at high risk experience a large reduction. This is consistent with the notion that groups of individuals function collectively, and as such, are affected by the average functioning of individuals around them

10 INTERVENTION CONTINUUM & TREATMENT OF SUICIDALITY PREVENTION ZONE RECOVERY ZONE TYPE ECOLOGICAL PREVENTION PROACTIVE PREVENTION EARLY INTERVENTION 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 INTERVEN- Ecological TION FOCUS prevention METHODOLOGY Improve ecological contributions to population health and decrease their role in pathogenic process Proactive Prevention Problematic elements of the physical and constructed environment Precipitating events Legislation, policy & procedure adjustments Systems interventions Environmental modifications Continuous Process Improvement Reduce population prevalence of predisposing vulnerabilities and enhance personal assets Early Intervention Ranges from total population to selected sub-populations based on timing and convenience Psychoeducational interventions designed primarily to educate, raise consciousness and/or enhance motivation to change Postvention Disrupt pathogenic process at early stage of development Decrease/reverse physiological impact of chronic stress Treatment & Crisis Intervention Indicated population of individuals with identifiable signs of unfolding pathogenic process Screening Programs Thematic groups Leaderless self-help programs; Individual counseling Stress mgt techniques Treat existing cases of the disorder and/or crisis Improve safety Individuals in distress/crisis Lapse & Relapse Intervention Crisis counseling, triage Pharmacological intervention; Individual & group treatment Inpatient treatment Stabilize and strengthen recovery and resilience Improve ecological contributions to sustain recovery Individuals in recovery & their constructed environment Peer support systems: Recovery community building; Access to individual and group sessions; Psychoeducational interventions SCOPE Environment & Population level Symptomatic individuals Recovery Population

11 30000 During the stressful period, did you have any thoughts similar to the following? First experience DISTRESS Those endorsing "yes" to these thoughts Most students who experience SUICIDALITY Entire sample This is all just too much I wish this would all end I have to escape I wish I was dead I want to kill myself I might kill myself I will kill myself Adapted from a presentation prepared by Arizona State University s Wellness & Health Promotion Center

12 30000 During the stressful period, did you have any thoughts similar to the following? The idea is to reach students here Those endorsing "yes" to these thoughts so fewer end up here Entire sample This is all just too much I wish this would all end I have to escape I wish I was dead I want to kill myself I might kill myself I will kill myself Adapted from a presentation prepared by Arizona State University s Wellness & Health Promotion Center

13 Questions, Reactions, Discussion?

14 Overview of Presentation Sections of presentation Expansion: Intervention approaches and distress/suicidality continuum Overview of 2011 data Demographics Nature of stressful period Qualities of self: Connectedness/belongingness and sense of coherence Suicidal behavior and help-seeking Implications for Population-focused prevention Discussion

15 Undergraduate and Graduate Student Coping with Stressful Experiences Brief overview of current study characteristics: Over 26,000 undergraduate and graduate student responses (~101,000 surveys sent) 74 colleges and universities participated Random sample at each school Web-based survey, anonymous, intervention 26% response rate

16 Age, Gender, & Sexual Orientation Undergraduate Demographics: N = 14,080 Mean Age = 22 years 64% Female 92% Heterosexual

17 Race/Ethnicity African American, of African descent, African, of Caribbean descent, or Black 2011 Undergrad N = 14,080 4% Asian or Asian American 8% Caucasian, White, of European descent, or European 71% Hispanic, Latino, or Latina 7% Middle Eastern or East Indian 2% Native American or Alaskan Native.3% Native Hawaiian or other Pacific Islander.2% Other 1% Multiracial/Multiethnic 6%

18 Organization of Survey Demographics Preexisting vulnerabilities Baseline for Sense of Coherence (Qualities of Self )and Belongingness/Social Connectedness Stressful period Please reflect on the most stressful period of time that you have experienced in the past 12 months Now please focus on the "worst point. Coping during stressful period experiences during the stressful period what resources were helpful or could have been helpful

19 Contributors to Stressful Period Select all the apply Undergrad N = 14,080 Contributed to stressful time Academics 74% Financial problems 32% Friendship problems 25% Life transition 24% Family problems 23% Death of close family/friend 9% Emotional health problems 17% Physical health problems 13% Problems experienced by others 10% Problems at work 8% Other 7% Drugs or alcohol 5% Other traumatic experience 3% Discrimination 2% Sexual orientation concerns 2% Relationship violence 1% Suicide of close family member/friend 1% Sexual assault 1% Gender identity concerns 1% 15% Academic only 27% Non-academic only 58% Combined

20 Distress and Suicidality Continuum 2011 Undergrad N = 14,080 This is all just too much 51% I wish this would all end 33% During the stressful period, did you have any thoughts similar to the following? (Select all that apply) During this stressful period, did you I have to escape 20% I wish I was dead 9% I want to kill myself 6% I might kill myself 3% I will kill myself 1% I did not have any thoughts like these 38% seriously consider attempting suicide? 6% attempt suicide? 1%

21 Coping Strategies During Stressful Period Undergrad Perceived helpfulness N = 14,080 Select all that apply Behaviors used to manage 4 or 5 on Likert scale* stressful time Acknowledging emotions 48% 36% Distracting myself 43% 38% Creating a plan 41% 57% Sleeping 38% 39% Exercising 33% 60% Focusing on positive 31% 54% Prayer/meditation/spirituality 27% 69% Suppressing or avoiding 26% 20% Eating healthy 14% 46% Other 7% *Likert Scale 1 Not at all 3 Moderately 5 Very much

22 Behaviors Engaged in During Stressful Period During the stressful period, did you engage in any of the following behaviors? Undergrad N = 14,080 Increased internet use or gaming 24% Severely restricted or excessive eating 23% Significant drop in academic performance 19% Increased use of drugs or alcohol 18% Getting into fights 8% Risky sexual behavior 7% Risk-taking behavior (e.g., drunk driving, speeding) 6% Self-injury (e.g., intentional cutting, burning) 4% Violating the law or violating school policies 2% Increased gambling 1% None of the above 46%

23 Overview of Presentation Sections of presentation Expansion: Intervention approaches and distress/suicidality continuum Overview of 2011 data Demographics Nature of stressful period Qualities of self: Connectedness/belongingness and sense of coherence Suicidal behavior and help-seeking Implications for Population-focused prevention Discussion

24 Sense of Coherence Salutogenic model explaining maintenance or improvement of health on a continuum (Antonovsky, 1993) 3 components of SOC: Comprehensibility, manageability, meaningfulness (Antonovsky, 1993) Strongly related to perceived health, especially mental health (Eriksson & Lindstrom, 2006) Seemingly a health-promoting resource that bolsters resilience (Eriksson & Lindstrom, 2006)

25 Sense of Coherence: Baseline vs. During Stressor When approaching the challenges of daily life: Baseline Stressful period How capable are you of managing your daily challenges? How motivated are you to manage your daily challenges? How meaningful do you view your life to be? To what extent are you able to understand what must be done to face the challenges of daily life? M = 4.14 M = 3.38 M = 3.90 M = 3.55 M = 4.12 M = 3.62 M = 4.31 M = 3.76 Likert Scale 1 Not at all 5 Very

26 Social Connectedness & Belongingness Linked to health and well-being (Armstrong & Oomen-Early, 2009; Baumeister & Leary, 1995; Joiner et al, 2009) Theorized to play important role in preventing desire for death (Joiner, 2005) Increasing social connectedness on college campuses is a key strategy for suicide prevention (SPRC, 2004; CDC 2008)

27 Belongingness: Baseline vs. During Stressor When approaching the challenges of daily life: Baseline Stressful period How understood by others did you feel? M = 3.12 M = 2.86 How cared for by others did you feel? M = 3.90 M = 3.52 How much did you feel that you counted on others? How comfortable did you feel making new connections with others? M = 3.47 M = 3.24 M = 3.41 M = 2.75 Likert Scale 1 Not at all 5 Very

28 Qualities of Self, Distress, and Suicidality: A Model Peering into the Black Box Coherence Belongingness Vulnerability Suicidality Distress

29 Questions, Comments, Discussion?

30 Overview of Presentation Sections of presentation Expansion: Intervention approaches and distress/suicidality continuum Overview of 2011 data Demographics Nature of stressful period Qualities of self: Connectedness/belongingness and sense of coherence Suicidal behavior and help-seeking Implications for Population-focused prevention Discussion

31 First Considered Suicide When did you first seriously consider attempting suicide? 2011 Undergrad N = 3,088 Before or while in middle school 29% While in high school 46% After high school but before college 4% While in college 18% Other 3% * Of those who considered suicide at some point in their life 79%

32 Suicidal Behaviors & Preparations During Stressful Period For those seriously considering suicide during their most stressful period Undergrad N = 781 Investigate ways to kill myself 38% Formed a specific plan for attempting suicide 34% Gathered the material for a suicide attempt 16% During this stressful period, did you do any of the following? Began a suicide attempt, then changed my mind 15% Wrote a suicide note but did not post it or leave it where others might read it 14% Wrote a will or otherwise put my affairs in order 5% Did a practice run of a suicide attempt 3% Wrote a suicide note and shared it or posted it 2% Formed a suicide pact with others 1% None of the above 36%

33 Intentions at Time of Attempt For those having attempted suicide during their most stressful period. Which of these statements describe your intentions at the time of the attempt(s)? I made a serious attempt to kill myself and intended to die I tried to kill myself but knew I might survive Was ambivalent and partly wanted to live Mostly wanted to live but small part wanted to die 2011 Undergrad N = % 25% 36% 11% I did not intend to die 4%

34 Role of Drugs & Alcohol in Attempt For those having attempted suicide during their most stressful period. How would you describe the role of drugs or alcohol in your most recent suicide attempt? I was not using alcohol or drugs before or during my attempt 2011 Undergrad N = % I intended to overdose with alcohol or drugs 30% I intended to use alcohol or drugs to reduce my inhibitions or fears about attempting suicide My attempt was not planned in advance and may have happened because I was using alcohol or drugs I was using alcohol or drugs but they were not related to my attempt Addiction to alcohol or drugs was a reason for my attempt 12% 13% 16% 6%

35 Reasons for Attempt For those having attempted suicide during their most stressful period. Which of the following best describe your reasons for attempting suicide? 2011 Undergrad N = 155 My emotional pain became unbearable 59% I did not know what else to do 43% I felt like I was a burden on others 38% I had nothing else to live for 34% It was impulsive and not really a choice 28% I wanted to show others the extent of my pain or unhappiness 25% I wanted to get help 17% I wanted others to pay attention and take me seriously 16% I wanted to make others feel guilty or sorry 13% Other 5%

36 Help-seeking and Help-avoidance Why do some students reach out while others do not?

37 Help Seeking For Suicidal Thoughts (2006 Study) Asked of those who had seriously considered attempting suicide (n=1321) 54% Told One or More People Romantic Partner: 34% Peer: 33% Family: 16% Professional: 14% Other (Clergy, Professor, RA): 3%

38 Reasons for Choosing Help Sources 2011 Study: Asked of those who indicated turning to someone for help during stressful period

39 Reasons For Not Seeking Help 2011 Study: Asked of those who indicated seeking help from no one during stressful period

40 Overview of Presentation Sections of presentation Expansion: Intervention approaches and distress/suicidality continuum Overview of 2011 data Demographics Nature of stressful period Qualities of self: Connectedness/belongingness and sense of coherence Suicidal ideation and behavior Implications for Population-focused prevention Discussion

41 Prevention Campaigns At their core, population prevention programs are organizational change efforts that often involve legislation and policy adjustments, environmental reengineering and management, modification of processes/procedures, programmatic interventions, advocacy, and, at times, clinical interventions They require two types and waves of linked interventions: Ecological interventions Psychoeducational proactive interventions

42 Important Considerations in Prevention Campaigns Understanding the dynamics of the type of population with which you are intervening Being aware of the characteristics of the problem, condition or disease that impact the prevention effort Building stakeholder partnerships and reliable political will at multiple levels Matching the scope of intervention to the above

43 INTERVENTION CONTINUUM & TREATMENT OF SUICIDALITY PREVENTION ZONE RECOVERY ZONE TYPE ECOLOGICAL PREVENTION PROACTIVE PREVENTION EARLY INTERVENTION 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 INTERVEN- Ecological TION FOCUS prevention METHODOLOGY Improve ecological contributions to population health and decrease their role in pathogenic process Proactive Prevention Problematic elements of the physical and constructed environment Precipitating events Legislation, policy & procedure adjustments Systems interventions Environmental modifications Continuous Process Improvement Reduce population prevalence of predisposing vulnerabilities and enhance personal assets Early Intervention Ranges from total population to selected sub-populations based on timing and convenience Psychoeducational interventions designed primarily to educate, raise consciousness and/or enhance motivation to change Postvention Disrupt pathogenic process at early stage of development Decrease/reverse physiological impact of chronic stress Treatment & Crisis Intervention Indicated population of individuals with identifiable signs of unfolding pathogenic process Screening Programs Thematic groups Leaderless self-help programs; Individual counseling Stress mgt techniques Treat existing cases of the disorder and/or crisis Improve safety Individuals in distress/crisis Lapse & Relapse Intervention Crisis counseling, triage Pharmacological intervention; Individual & group treatment Inpatient treatment Stabilize and strengthen recovery and resilience Improve ecological contributions to sustain recovery Individuals in recovery & their constructed environment Peer support systems: Recovery community building; Access to individual and group sessions; Psychoeducational interventions SCOPE Environment & Population level Symptomatic individuals Recovery Population

44 What can we do? Effectively target our limited resources Utilize clinical resources to address needs of those who are highly distressed or at high risk Expand population-based approaches to fit nature of population Enhance capacity of existing support networks Bolster students ability to preserve self during stressful times Develop a climate that reduces barriers to help Your ideas?

45 Special Thanks To The 26,000 Student Research Participants The 74 Research Consortium Participating Institutions and Counseling Center Directors The Research Consortium team Consortium Director: Chris Brownson, PhD

46 Questions and Discussion

47 END OF SLIDES