Background: Identifying signs for self-harm and suicidality (SHS) in college students remains challenging because many who engaged in SHS did not meet the criteria of any mental disorder (Britton et al., 2012). This study employed person-centered latent class analysis (LCA) (Muthén & Muthén, 2000) to offer insights on the heterogeneous risk factors for SHS in college students. Latent classes of students were identified based on their mental health (MH) symptoms, which were further examined in their relations to SHS by race/ethnicity.
Methods: 42,779 undergraduate degree-seeking students were drawn from the Spring 2017 American Health Association-National College Health Assessment (ACHA-NCHA IIB) Reference Group (N = 63,497). Eight MH and three SHS items (self-harm, suicidal intent, attempted suicide) were used for the prevalence within the past 12 months. LCA was conducted, followed by logistic regressions to compare racial/ethnic differences in SHS within each class.
Results: A two-class model of LCA was selected due to the best entropy (.87) and AIC (309857.90), BIC (310005.20), Chi-square (31472.66), parameters (17). Members from the Emotional Fatigue (EF) class endorsed high prevalence of emotional overwhelm and exhaustion but low prevalence of other MH symptoms. Members from the Multiple Psychiatric (MP) Symptoms class endorsed high prevalence of MH symptoms, including feeling not only emotionally fatigued but also sad, lonely, anxious, hopeless, depressed and angry. Across classes, the prevalence of SHS was 20%. The MP class showed significantly higher prevalence of SHS than the EF class. Within the MP class, multiracial students showed significantly elevated odds of SHS; within the EF class, Black students showed the greatest risk.
Conclusions: The results confirmed the associations of MH symptoms with SHS, particularly for racial/ethnic minority students. Considering that emotional fatigue is common to college students, it is noteworthy that Black students were at the greatest risk for SHS within this class. These findings hold implications for developing racial/ethnic-specific prevention and therapeutic programs for reducing SHS in college students.
Hello, my name is Hung-Chu Lin. I am speaking on behalf of my colleagues, Dr. Manyu Li, Dr. Courtney Stevens, Dr. Stephanie Pinder-Amaker, Dr. Justin A. Chen, and Dr. Cindy Liu.
The title of this study is: Self-Harm and Suicidality in US College Students: Associations with Emotional Exhaustion versus Multiple Psychiatric Symptoms
I wanted to mention that the findings of this study have been published in the Journal of Affective Disorders. The QR code in the slide provides the doi of this publication.
We started out with a question: Who are those students who engage in self-harm and suicidality without clear warning signs?
We know that self-harm and suicidality (SHS) pose grave concerns for health and well-being among college students. But identifying signs for self-harm and suicidality (SHS) in college students remains challenging because many who engaged in SHS did not necessarily meet the criteria of any mental disorder.
In order to identify the risk of SHS among college students, a person-centered analytical approach may offer better insights than those that are variable-centered, such as those conventional methods of factor analysis or structural equation modeling. Latent class analysis (or abbreviated as LCA) is one such person-centered technique that allows identification of unobserved classes of students based on their characteristics.
We used the participants (N = 42,779) drawn from the Spring 2017 American College Health Association-National College Health Assessment II (ACHA-NCHA II) Reference Group. Latent class analysis (LCA) was conducted based on participants’ reports of eight past-year psychiatric symptoms. Students were also asked whether they self-injured themselves, considered suicide, or attempted suicide during the last 12 months. And then SHS of the identified latent classes were examined by race/ethnicity to inform risk factors relevant to the subgroups of U.S. college population.
We have supplementary data available if you would like to see them. But let me quickly walk you through some of the most important findings from this study.
- First, LCA identified two unobserved classes as shown in Figure 1. The first class was labeled as Emotional Exhaustion class because members of this class endorsed high prevalence of emotional overwhelm and exhaustion but low prevalence of other psychiatric symptoms. The second class was labeled as Multiple Psychiatric Symptoms class because members not only endorsed high prevalence of emotional overwhelm and exhaustion but also sad, lonely, anxious, hopeless, depressed, and angry. Approximately 40% (n = 17,313) of students fell into the Emotional Exhaustion class and 60% (n = 25,466) fell into the Multiple Psychiatric Symptoms class.
- Figures 2 and 3 show the percentages of the two class members reporting self-harm, suicidal intent, and attempted suicide by race/ethnicity. Overall, the prevalence of SHS was much higher in the Multiple Psychiatric Symptoms Class (2.3% to 22.5%) than in the Emotional Exhaustion Class (0% to 1.4%).
- In Figures 4, you would see that, for the Emotional Exhaustion class, no significant differences in self-harm were observed across racial/ethnic groups. But racial/ethnic differences were observed for the suicidal intent and attempted suicide outcomes. Specifically, Black students showed significantly higher odds for suicidal intent and attempted suicide when compared to White students.
- In figure 5, for the Multiple Psychiatric Symptoms class, none of the minority groups showed higher odds of self-harm than White students. However, multiracial students showed higher odds of suicidal intent, and Black students showed higher odds of attempted suicide, when compared to White students, respectively.
Given the results, we have a couple of discussion points:
First, with close to 90% of students reporting psychiatric symptoms and 20% reporting SHS during the past 12 months, the rates mental health issues in the current sample were high and alarming.
By implementing LCA for the heterogeneity of the students in the sample, the findings revealed that Black students were at the greatest risk for showing SHS despite only reporting symptoms that predominantly involved no more than experiences of emotional overwhelm and exhaustion. A number of factors might contribute to the risk we observed in Black students.
- Black college students may face social pressures to succeed, and chronic perceived discrimination can worsen their academic strains (Stevens, Liu, & Chen, 2018), which have been found to be a precipitating factor for suicidality (De Luca, Yan, Lytle, & Brownson, 2014).
- Black students are less likely to endorse, seek help for psychiatric symptoms or disclose suicidality due to stigma of mental illness, intragroup pressure against psychological help-seeking (e.g., the thinking that Black people must be strong), and reported help-seeking barriers (e.g., cultural mistrust, microaggressions in therapy) (Chen et al., 2019; Taylor & Kuo, 2018). All these may perpetuate a disconnection between the reported psychiatric symptoms and their SHS.
As for multiracial students, the elevated odds of SHS may be due to persistent struggles with incoherent racial/ethnic identity and perceived racial discrimination (Harris, 2017).
In conclusions, the findings from this study have implications for developing preventative and intervention models that address unique risk factors and mental health needs for various subgroups of U.S. college population.
We would love to meet you in the live Zoom session on April 21.
Live Zoom Session – April 21st
Hung-Chu Lin, PhD, Manyu Li, PhD, Courtney Stevens, PhD, Stephanie Pinder-Amaker, PhD, Justin A. Chen, MD, MPH, Cindy H. Liu, PhD