Abstract
To investigate the associations of demographic variables, childhood adversities (CAs), and mental disorders (MDx) with onset, transition, and persistence of suicidal thoughts and behaviors (STB) among first-year university students.
Method
Poisson regression models within a discrete-time survival framework were constructed using web-based self-report survey data from 72,288 incoming university students across 18 countries (response rate=20.9%; median age=19 years, 57.9% female, 1.4% transgender, 21.0% non-heterosexual). These models examined the associations of four demographic variables, five CAs, and eight MDx with STB outcomes.
Results
Lifetime prevalence of suicidal ideation, plans, and attempts was 47.0%, 26.0%, and 9.6%, respectively; 12-month estimates were 30.6%, 14.0%, and 2.3%. In unadjusted analyses, associations were strongest between lifetime onset of suicidal ideation and CAs (RR range 4.4–7.0), particularly parental psychopathology (relative risk [RR]=7.0 [95% CI 6.5–7.7]), followed by MDx (RR range 1.3–3.0). Of the demographic subgroups, transgender students had highest risk of STB (lifetime ideation onset RR=2.4 [2.3–2.6]; ideation-to-attempt transition RR=1.5 [1.3–1.8]). In fully adjusted models, strongest predictors of lifetime ideation onset were emotional abuse (RR=2.1 [1.9–2.2]), major depressive disorder (RR=2.0 [1.9–2.1]), and bipolar disorder (RR=1.8 [1.6–2.0]). Ideation-to-attempt transition remained most strongly associated with panic disorder (RR=1.5 [1.3–1.7]), bipolar disorder (RR=1.4 [1.2–1.7]), and sexual abuse (RR=1.4 [1.2–1.7]). Most predictors were significantly but weakly associated with persistence of ideation and plan, while only physical abuse remained associated with repeated suicide attempts (RR=1.3 [1.0–1.8]).
Conclusion
CAs and MDx are strong predictors of both onset of and transition within the STB spectrum, underscoring the importance of implementing early-life prevention interventions.
| Original language | English |
|---|---|
| Article number | 116555 |
| Pages (from-to) | 1-13 |
| Number of pages | 13 |
| Journal | Psychiatry research |
| Volume | 350 |
| Early online date | 22 May 2025 |
| DOIs | |
| Publication status | Published (in print/issue) - 1 Aug 2025 |
Bibliographical note
Publisher Copyright:© 2025 The Author(s)
Data Availability Statement
The data analyzed in this study is subject to the following licenses/restrictions: The WMH-ICS data sharing agreement limits access of this data to members of the consortium. The participant data and statistical analysis plan used for this study are available upon reasonable request from the corresponding author (Jordi Alonso) as long as the main objective of the data sharing request is replicating the analysis and findings as reported in this paper.Funding
South Africa: The work reported herein was made possible through funding by the South African Medical Research Council (SAMRC) through its Division of Research Capacity Development under the MCSP (awarded to JB and XH). The World Mental Health International College Student (WMH-ICS) initiative is carried out as part of the World Mental Health (WMH) Survey Initiative. The WMH survey is supported by the National Institute of Mental Health NIMH R01MH070884 , the John D. and Catherine T. MacArthur Foundation , the Pfizer Foundation , the US Public Health Service ( R13-MH066849 , R01-MH069864 , and R01 DA016558 ), the Fogarty International Center (FIRCA R03-TW006481 ), the Pan American Health Organization , Eli Lilly and Company , Ortho-McNeil Pharmaceutical , GlaxoSmithKline , and Bristol-Myers Squibb (RCK). Philippe Mortier received funding from grant Miguel Servet CP21/00078 funded by the Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union ; project grant AC22/00006 , supported by Instituto de Salud Carlos III (ISCIII), and by the European Union NextGenerationEU , Mecanismo para la Recuperaci\u00F3n y la Resiliencia (MRR), under the frame of ERA PerMed ; project grant PI22/00107 , funded by Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union ; and project grant 202220\u201330 from the Fundaci\u00F3 la Marat\u00F3 de TV3 . Saudi Arabia: The Saudi University Mental Health Survey is conducted by the King Salman Center for Disability Research; funded by Saudi Basic Industries Corporation , King Abdulaziz City for Science and Technology , Ministry of Health (Saudi Arabia) and King Saud University . Funding in-kind was provided by King Faisal Specialist Hospital & Research Center , and Ministry of Economy & Planning , General Authority for Statistics , Riyadh. The Netherlands: ZonMw (Netherlands Organisation for Health Research and Development ; grant number 636110005 ) and the PFGV ( PFGV; Protestants Fonds voor de Geestelijke Volksgezondheid ) in support of the student survey project. Spain: The PROMES-U study is supported by Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union , grant number PI20/00006 ; the Departament de Recerca i Universitats of the Generalitat de Catalunya (AGAUR 2021 SGR 00624 ); and CIBER -Consorcio Centro de Investigaci\u00F3n Biom\u00E9dica en Red - ( CB06/02/0046 ), Instituto de Salud Carlos III , Ministerio de Ciencia e Innovaci\u00F3n and Uni\u00F3n Europea . For surveys directed by Parc Sanitari Sant Joan de D\u00E9u, funding was provided by Fundaci\u00F3 Sant Joan de D\u00E9u . AMM received funding from Sara Borrell grant ( CD23/00010 ) ISC-III . Northern Ireland: The Student Psychological Intervention Trial (SPIT) was supported by Clinical Healthcare Intervention Trials in Ireland Network (CHITIN) . CHITIN has received \u20AC10.6 million funding from the European Union\u2019s INTERREG VA programme managed by the Special EU Programmes Body (SEUPB) with match funding from the Departments of Health in NI and ROI ( CHI/5433/18 ) Australia: pH has received funding for this work from Suicide Prevention Australia , the Feilman Foundation , and the National Health and Medical Research Council (ID 2032058 ). New Zealand: The WMH-ICS NZ surveys were supported by a Rutherford Discovery Fellowship and a James Hume Bequest Grant. Romania: This work was supported by a grant of the Ministry of Research, Innovation and Digitization , CNCS - UEFISCDI , project number PN-IV-P1-PCE-2023\u20131854 , within PNCDI IV. SM-G received funding from ANID/Millennium Science Initiative Program - NCS2021_081 and ANID/PFCHA/DOCTORADO EN EL EXTRANJERO BECAS CHILE/2019 \u2013 72200092 . Sweden: CA, MB and AHB received funding for this work from the Swedish Research Council ( ID 2019\u201301127 ) as well as from a Public Health Agency in Sweden ( ID 04252\u20132021\u20132.3.2 ). Both grants were awarded to AHB. Belgium: The Belgian Fund for Scientific Research ( 11N0514N/11N0516N / 1114717N ), the King Baudouin Foundation ( 2014-J2140150\u2013102905 ; RB), the Ministry of Education, Flanders - Grant# EDC-E3738 , institutional payment, awarded to RB. Chile: MAC, VM, JG, and \u00C1IL received funding from ANID/Millennium Science Initiative Program - NCS2021_081 and ANID/FONDECYT REGULAR - N\u00B01221230 .
| Funders | Funder number |
|---|---|
| South African Medical Research Council | |
| Eli Lilly and Company | |
| Instituto de Salud Carlos III | |
| King Saud University | |
| Generalitat de Catalunya | |
| GlaxoSmithKline | |
| Ortho-McNeil Pharmaceutical | |
| SEUPB | |
| 636110005 | |
| 2021 SGR 00624 | |
| CD23/00010 | |
| 04252–2021–2.3.2 | |
| CHI/5433/18 | |
| European Commission | PI20/00006, AC22/00006 |
| European Commission | |
| 2014-J2140150–102905 | |
| FIRCA R03-TW006481 | |
| 11N0514N/11N0516N / 1114717N | |
| R01 DA016558, R13-MH066849, R01-MH069864 | |
| Swedish Research Council | 2019–01127 |
| 1221230 | |
| NCS2021_081 | |
| CHILE/2019 – 72200092 | |
| R01MH070884 | |
| PI22/00107, 202220–30 | |
| PN-IV-P1-PCE-2023–1854 | |
| CB06/02/0046 | |
| EDC-E3738 | |
| National Health and Medical Research Council | 2032058 |
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
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SDG 3 Good Health and Well-being
Keywords
- Suicide
- self-injurious behavior
- students
- Mental health
- Adverse childhood experiences
- Prevalence
- Risk factors
- Students
- Self-injurious behavior
- Global Health
- Suicide, Attempted - statistics & numerical data
- Humans
- Suicidal Ideation
- Mental Disorders - epidemiology - psychology
- Male
- Universities
- Young Adult
- Adolescent
- Adverse Childhood Experiences - statistics & numerical data
- Female
- Adult
- Students - statistics & numerical data - psychology
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