The influence of diagnosed mental health conditions and symptoms of depression and/or anxiety on suicide ideation, plan, and attempt among college students: Findings from the Healthy Minds Study, 2018-2019

Abstract

Background: Approximately 11% of 18-25 year-olds report thoughts of suicide. Additionally, suicide is the second leading cause of death in college student populations. We sought to evaluate the relationship between diagnosed mental health conditions and current symptoms of depression and/or anxiety and suicidality in the past year.

Methods: Healthy Minds Study (HMS) 2018-2019 data from 38,757 college students were analyzed. The PHQ-9, GAD-7, and prior mental health condition diagnoses were used to create a suicidality severity index and we determined how these associations varied by race/ethnicity, gender, and sexual orientation. We also assessed non-suicidal self-injury (NSSI) outcomes in the past year.

Results: Students with both a mental health condition diagnosis and current moderate/severe symptoms of depression and/or anxiety had a higher prevalence of NSSI, 10 times the odds (95% CI 9.4-11.5) of suicide ideation, 28 times the odds (95% CI 23.8-33.1) of suicide ideation, with planning or attempt, and 47 times the odds (95% CI 31.1-71.4) of suicide ideation, with planning and attempt, compared to students with none/minimal depression and/or anxiety symptoms and no mental health condition diagnosis.

Limitations: We could not clinically confirm depression or anxiety diagnoses nor infer causality of associations in this cross-sectional study. Future longitudinal studies are needed to establish temporality.

Conclusions: Mental health condition diagnoses and moderate/severe symptoms of depression and/or anxiety were strongly associated with suicidality among college students. These findings identify potential opportunities to further understand and address the mental health needs of college students.

Keywords: Abbreviations; Anxiety; College students; Depression; GAD-7 = General Anxiety Disorder-7; HMS = Healthy Minds Study; Mental health; NSSI = Non-suicidal self-injury; PHQ-9 = Patient Health Questionnaire-9; Suicide attempted; Suicide ideation; U.S = United States.