A Risk Algorithm for the Persistence of Suicidal Thoughts and Behaviors During College

J Clin Psychiatry. 2017 Jul;78(7):e828-e836. doi: 10.4088/JCP.17m11485.

Abstract

Objective: The primary aims of this study are to (a) identify patterns of suicidal thoughts and behaviors (STB) during college among students with lifetime pre-matriculation STB and (b) develop a risk-screening algorithm for persistence of pre-matriculation STB during college.

Methods: Data come from the Leuven College Surveys, a series of prospective cohort studies of all incoming KU Leuven University freshmen. In the academic year 2012-2013, 4,889 incoming freshmen (73.2% response rate) provided baseline data on sociodemographic variables, childhood-adolescent traumatic experiences, 12-month stressful experiences, 12-month mental disorders, 12-month STB, and severity markers of pre-matriculation STB. A total of 2,566 students (69.3% conditional response rate) participated in 12- and 24-month follow-up surveys during the first 2 college years.

Results: Thirteen percent (weighted n = 535) of incoming freshmen reported lifetime pre-matriculation STB. Of those, 28.0% reported 12-month STB in 1 follow-up assessment, and another 27.7%, in both follow-up assessments. High persistence of STB (ie, 12-month STB in 2 follow-up assessments) was most strongly associated with severity markers of pre-matriculation STB, with odds ratios in the 2.4-10.3 range and population attributable risk proportions between 9.2% and 50.8%. When the aim was for less than 50% of false-positive cases (positive predictive value = 54.4%), a multivariate predictive risk algorithm (cross-validated area under the curve = 0.79) situated 59.9% of highly persistent cases among the 30% respondents with highest baseline predicted risk.

Conclusions: An individualized web-based screening approach is a promising strategy to identify students at the time of university entrance who may be at high risk for STB persistence during their academic career.

MeSH terms

  • Adolescent
  • Algorithms*
  • Child
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Health Surveys / statistics & numerical data
  • Humans
  • Life Change Events
  • Male
  • Mental Disorders / diagnosis
  • Mental Disorders / epidemiology
  • Mental Disorders / psychology
  • Netherlands
  • Risk Assessment / methods*
  • Risk Assessment / statistics & numerical data*
  • Students / psychology*
  • Students / statistics & numerical data*
  • Suicidal Ideation*
  • Suicide / prevention & control*
  • Suicide / psychology*
  • Suicide / statistics & numerical data
  • Suicide, Attempted / prevention & control*
  • Suicide, Attempted / psychology*
  • Suicide, Attempted / statistics & numerical data
  • Young Adult