Undergraduate and Graduate Student Coping with Stressful Experiences:

Transcription

1 Undergraduate and Graduate Student Coping with Stressful Experiences: A New Look at the Continuum of Distress, Suicidal Experiences and Campus Intervention Opportunities Elizabeth Wilson, Ashley Boynton, Stuart Irvin, & Andrea Saathoff 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 Penn State s CSCMH, 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 Suicidal ideation and behavior Qualities of self: Connectedness /belongingness and sense of coherence 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 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

7 Prevention Campaigns Goal to shift the well-being of the population 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.

8 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

9 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

10 The Jed Foundation and the Suicide Prevention Resource Center, 2006

11 Voice of the student What could your college or university have provided you or done differently to better help you manage during this stressful time? To be able to talk to a professional for more than an hour or more than once a week. Weekend and/or evening opportunities for counseling on campus.

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

13 Overview of 2011 Data Undergraduate and Graduate Student Coping with Stressful Experiences

14 Undergraduate and Graduate Student Coping with Stressful Experiences (2011) 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 Demographics fairly comparable to NCHA

15 Sample Demographics (N = 26,430) Age (mean): Undergraduates: 22 years Graduate Students: 30 years Gender: 63% Female Sexual Orientation: 92% Heterosexual Race/Ethnicity: African American, of African descent, African, of Caribbean descent, or Black 5.2% Asian or Asian American 11.6% Caucasian, White, of European descent, or European 74.2% Hispanic, Latino, or Latina 7.8% Middle Eastern or East Indian 2.9% Native American or Alaskan Native Native Hawaiian or other Pacific Islander 1.5% 0.5% Other 2.3% Multiracial 6%

16 Organization of Survey Demographics Preexisting vulnerabilities Baseline for Sense of Coherence and Belongingness (Qualities of Self) & Social Connectedness Mindfulness 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

17 Contributors to Stressful Period Select all the apply N = 26,430 Contributed to stressful time Academics 73% Financial problems 31% Friendship problems 18% Life transition 27% Family problems 20% Death of close family/friend 9% Emotional health problems 15% Physicalhealth problems 13% Problems experienced by others 9% Problems at work 13% Other 7.6% Drugs or alcohol 3.6% Other traumatic experience 2.4% Discrimination 2.7% Sexual orientation concerns 1.5% 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

18 Stressor Seriously considered suicide (N = 1167) Non-seriously considered suicide (N = 25,030) Difference score % of total endorsing this stressor What % of those who experience the stressor seriously considered suicide? Emotional health problems 50.7% 13.3% 37.4% 14.8% 15.1% Family problems 42.5% 19.5% 23.0% 20.4% 9.2% Romantic relationship problems 46.8% 26.5% 20.3% 27.3% 7.6% Friendship problems 34.6% 17.8% 16.8% 18.4% 8.3% Financial problems 41.1% 30.5% 10.6% 30.8% 5.9% Drugs/Alcohol 12.3% 3.2% 9.1% 3.6% 15.3% Physical health problems 20.9% 12.3% 8.6% 12.6% 7.3% Problems of a close person 16.0% 9.0% 7.0% 9.2% 7.7% Life transition 33.5% 27.0% 6.5% 27.2% 5.5% Sexual orientation concerns 5.9% 1.3% 4.6% 1.5% 17.4% Death of close person 12.9% 8.4% 4.5% 8.6% 6.7% Discrimination 6.8% 2.5% 4.3% 2.7% 11.3% Sexual assault 5.0% 0.7% 4.3% 0.9% 24.9% Relationship violence 5.1% 1.0% 4.1% 1.2% 19.1% Gender ID concerns 4.0% 0.4% 3.6% 0.6% 30.7% Legal problems 4.7% 1.8% 2.9% 1.9% 10.8% Other trauma 5.1% 2.3% 2.8% 2.4% 9.5% Problems at work 14.9% 12.7% 2.2% 12.7% 5.2% Suicide of close person 2.7% 1.0% 1.7% 1.1% 11.3% Other 7.6% 7.7% * -0.1% 7.6% 4.4% Academics 71.7% 72.9% * -1.2% 72.6% 4.4%

19 Discussion Are these the contributors to stress that you expected? How can these be addressed at the population level? How can these be addressed at the clinical level? More on this to come...

20 Voice of the student Let me know it existed! Let me know it was available in all 3 years as a student I did not know there was counseling services available. I wish I knew of counselors on campus sooner. Maybe letting it be known during orientation.

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

22 Suicidal Ideation and Behavior A look at 2011 student self reports

23 Self-Reports of Lifetime Suicidal Ideation and Attempts Suicidal Ideation Have you ever seriously considered attempting suicide at some point in your life? N = 26,430 20% Suicide Attempts How many times in your life have you attempted suicide? (% indicating 1 or more times) N = 26,430 6%

24 When First Considered Suicide When did you first seriously consider attempting suicide? Before or while in middle school N = 5,319 27% While in high school 41% After high school but before college 4% While in college 19% After college and before graduate school 4% While in graduate school 3% Other 3% * Of those who considered suicide at some point in their life 72%

25 Distress and Suicidality Continuum N = 26,430 This is all just too much 48% I wish this would all end 31% 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 19% I wish I was dead 8% I want to kill myself 5% I might kill myself 3% I will kill myself 1% I did not have any thoughts like these seriously consider attempting suicide? 40% 5% attempt suicide? 0.8%

26 Suicidal Behaviors & Preparations During Stressful Period For those seriously considering suicide during their most stressful period. Undergrad N = 781 Grad N = 379 Investigate ways to kill myself 37.6% 33.5% Formed a specific plan for attempting suicide 34.1% 33.2% Gathered the material for a suicide attempt 15.5% 10.8% During this stressful period, did you do any of the following? Wrote a suicide note but did not post it or leave it where others might read it 14.3% 8.2% Wrote a suicide note and shared it or posted it 1.8% 1.6% Wrote a will or otherwise put my affairs in order 5.1% 8.2% Formed a suicide pact with others.90%.8% Did a practice run of a suicide attempt 2.9% 1.8% Began a suicide attempt, then changed my mind 14.5% 8.2% None of the above 35.9% 39.6%

27 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 Sample N = % 23% 38% 12% I did not intend to die 6%

28 Role of Drugs & Alcohol 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 Sample 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 11% 13% 16% 5%

29 Voice of the student So many students live off campus and participate in on-line learning. I think the university counseling service should have on-line services to students. Being able to have a counseling session over the phone, maybe.

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

31 Qualities of Self Connectedness/Belongingness and Sense of Coherence

32 Sense of Coherence Model focusing, not on factors explaining disease, but on factors that promote health, conceptualizing maintenance or improvement of health on a continuum. Salutogenesis coined. (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)

33 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)

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

35 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

36 Belongingness: Baseline vs. During Stressor When approaching the challenges of daily life: Baseline Stressful period How understood by others do you feel? M = 3.20 M = 2.97 How cared for others do you feel? M = 3.94 M = 3.61 How much do you feel that you can count on others? How comfortable do you feel making new connections with others? M = 3.55 M = 3.33 M = 3.43 M = 2.76 Likert Scale 1 Not at all 5 Very

37 Connection with Friends, Family & School Do you consider your relationship with people you spend most of your time with to be: N = 26, (Not at all close) 4.7% 3 (Moderately close) 23.1% 4-5 (Very close) 72.1% On average, how close is your relationship with your family? 1 2 (Not at all close) 6.6% 3 (Moderately close) 18.8% 4-5 (Very close) 74.6% To what degree do you feel connected to your college or university? 1-2 (Not at all connected) 17.5% 3 (Moderately connected) 42.3% 4-5 (Very connected) 30.2%

38 Methods Used to Connect to Others: Baseline vs. During Stressor How important is the following? Baseline M During stressor M In person contact Phone Video chat Social networking (e.g., Facebook) Text message Gaming connections Blogging Other Likert Scale 1 Not at all important 5 Very important

39 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%

40 Discussion How might qualities of self be addressed at the population/clinical level to affect one s likelihood of experiencing stress/distress/suicidality? How can clinicians account for help-seeking patterns to prevent distress/suicidality on campus?

41 Voice of the student I dropped a class when my father died. When I called to get grief counseling they said I was ineligible because I wasn t full time. I explained the situation and they refused. If they had offered more than 6 sessions with a counselor.

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

43 2006 Data: Studies completed and in progress Wong, J. & Brownson, C. (in process). A mediation model of professional psychological help seeking for suicide ideation among Asian American and White American college students. Brownson, C., Becker, M. S., & Jaggars, S. (in press). Suicidal behavior and help seeking among diverse college students. Journal of College Counseling. Drum, D. J., & Burton Denmark, A. (2012). Campus suicide prevention: Bridging paradigms and forging partnerships. Harvard Review of Psychiatry, 20, Brownson, C., Drum, D., Smith, S., & Denmark, A. (2011). Differences in suicidal experiences of male and female undergraduate and graduate students. Journal of College Student Psychotherapy, 25, Drum D.J., & Burton Denmark A. (2011). College suicide prevention programs and interventions. In: Lamis DA, Lester D, eds. Understanding and Preventing College Student Suicide. Wong, Y. J., Brownson, C., & Schwing, A. E. (2011). Risk and protective factors associated with Asian American students suicidal ideation: A multi-campus, national study. Journal of College Student Development, 52, Drum, D., Brownson, C., Denmark, A., & Smith, S. (2009). New data on the nature of suicidal crises in college students: Shifting the paradigm. Professional Psychology: Research and Practice, 40,

44 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

45 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?

46 College Student Suicide Prevention Listserve To participate in an ongoing conversation Join a listserve about suicide in higher education by contacting Marian Trattner, Suicide Prevention Coordinator at UT Austin, at mtrattner@austin.utexas.edu

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

48 Questions?

49 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