Prevalence and correlates of 30-day suicidal ideation and intent: Results of the South African National Student Mental Health Survey
DOI:
https://doi.org/10.7196/SAMJ.2023.v113i4.16753Keywords:
Suicide, StudentsAbstract
Background. Although suicide prevention is recognised as a priority among university students in South Africa (SA), it is unclear what
proportion of students require urgent indicated interventions and what the characteristics are of these students.
Objective. To assess the prevalence and sociodemographic correlates of 30-day suicidal ideation, frequency of ideation and self-reported intention to act on ideation in the next year among a national sample of SA university students.
Methods. Self-report cross-sectional data were collected online from students (N=28 268) at 17 universities across SA as part of the national student mental health survey. Students reported suicidal ideation in the past 30 days, frequency of ideation and intention to act on ideation in the next year. Data were weighted within institutions by gender and population group, and across the four main types of universities (historically white, historically disadvantaged, technical and distance learning) to correct for response rate discrepancies. Prevalence was estimated with these weighted in the total sample and across types of universities. Poisson regression with robust error variances was used to investigate associations of sociodemographic characteristics with ideation and intention to act on suicidal ideation. Results are reported as relative risks (RRs) with design-based 95% confidence intervals (CIs).
Results. Thirty-day prevalence of suicidal ideation was 24.4% (standard error (SE) 0.3), with 2.1% (SE 0.1) and 4.1% (SE 0.1), respectively,
reporting suicidal ideation all/almost all the time, or most of the time. A total of 1.5% (SE 0.1) of respondents reported being very likely to act on their suicidal ideation, while 3.9% (SE 0.2) were somewhat likely, 8.7% (SE 0.2) were not very likely and 85.8 (SE 0.5) either reported no suicidal ideation or that they were not at all likely to act on this ideation. Risk of suicidal ideation with high intent in the total sample was elevated among females (RR 1.9, 95% CI 1.3 - 2.7) and gender non-conforming students (RR 4.3, 95% CI 1.4 - 13.0) relative to males, black African students compared with white students (RR 3.6, 95% CI 1.9 - 7.1), students whose parents did not progress to secondary school compared with students whose parents had a university education (RR 1.6, 95% CI 1.0 - 2.5) and sexual minority students compared with heterosexual students (RR 1.9, 95% CI 1.3 - 2.6). Among students with 30-day ideation (controlling for frequency of ideation), only two of these predictors of high intent remained significant: identifying as black African (RR 2.7, 95% CI 1.4 - 5.1), and having parents with less than secondary education (RR 1.5, 95% CI 1.0 - 2.1).
Conclusion. Scalable suicide prevention interventions are needed to reach the large number of SA students who report suicidal ideation with intent.
References
World Health Organization. Suicide worldwide in 2019: Global health estimates. Geneva: WHO, 2021.
World Health Organization. WHO-Western Pacific Region. Transforming mental health for all: World
Mental Health Report 2022. Geneva: WHO, 2022.
Mortier P, Auerbach RP, Alonso J, et al. Suicidal thoughts and behaviours among first-year college
students: Results from the WMH-ICS project. J Am Acad Child Adol Psychiatry 2018;57(4):263-273.
https://doi.org/10.1016/j.jaac.2018.01.018
MortierP,CuijpersP,KiekensG,etal.Theprevalenceofsuicidalthoughtsandbehavioursamongcollege students: A meta-analysis. Psychol Med 2018;48(4):554-565. https://doi.org/10.1017/S0033291717002215
Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behaviour. Epidemiol
Rev 2008;30(1):133-154. https://doi.org/10.1093/EPIREV/MXN002
Li W, Dorstyn DS, Jarmon E. Identifying suicide risk among college students: A systematic review.
Death Stud 2020;44(7):450-458. https://doi.org/10.1080/07481187.2019.1578305
Centers for Disease Control and Prevention. Self-directed violence surveillance; uniform definitions
and recommended data elements. Atlanta: CDC, 2011
Shneidman ES. Anodyne psychotherapy for suicide: A psychological view of suicide. In: Pompili M
(ed.). Phenomenology of Suicide. Berlin: Springer; 2018:209-217. https://doi.org/10.1007/978-3-319-
-7_13/COVER/
Jobes DA, Joiner TE. Reflections on suicidal ideation. Crisis 2019;40(4):227-230. https://doi.
org/10.1027/0227-5910/A000615
Nock MK, Borges G, Bromet EJ, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatr 2008;192(2):98-105. https://doi.org/10.1192/BJP.BP.107.040113
Fitzgerald B. An existential view of adolescent development. Adolescence 2005;40(160):793.
Klonsky ED, Qiu T, Saffer BY. Recent advances in differentiating suicide attempters from suicide
ideators. Curr Opin Psychiatr 2017;30(1):15-20. https://doi.org/10.1097/YCO.0000000000000294
Hodes R. Questioning ‘Fees Must Fall’. Afr Affairs 2017;116(462):140-150. https://doi.org/10.1093/
AFRAF/ADW072
Mavunga G. #FeesMustFall protests in South Africa: A critical realist analysis of selected newspaper articles. J Student Affairs Africa 2019;7(1):81-99. https://doi.org/10.4314/jssa.v7i1
Shepherd N. After the #fall: The shadow of Cecil Rhodes at the University of Cape Town. City 2020;24(3-4):565-579. https://doi.org/10.1080/13604813.2020.1784579
Ned LY, Chinyamurindi WT, Bantjes J. Content analysis of reports of student suicide deaths in South African print medium newspapers. J Public Mental Health 2022 (epub ahead of print). https://doi. org/10.1108/JPMH-10-2021-0129
MakhubelaM.SuicideandDepressioninUniversityStudents:APossibleEpidemic.SAGEPublications: London; 2021. https://doi.org/10.1177/0081246321992179
Bantjes J, Breet E, Lochner C, Roos J, Kessler RC, Stein DJ. Reducing nonfatal suicidal behaviour among university students: Actuarial analysis of potential effects of treating common mental disorders. S Afr J Psychol 2021;51(1):21-34. https://doi.org/10.1177/0081246320973838
Bantjes JR, Kagee A, McGowan T, Steel H. Symptoms of post-traumatic stress, depression, and anxiety as predictors of suicidal ideation among South African university students. J Am Coll Health 2016;64(6):429-437. https://doi.org/10.1080/07448481.2016.1178120
Nattrass N, Nattrass J. South Africa, the homelands and rural development. Dev South Afr 1990;7(Supp1):S517-S534. https://doi.org/10.1080/03768359008439560
Council on Higher Education. Universities of Technology – Deepening the Debate. Pretoria: CHE, 2010. 22. Chen J, Choi YJ, Mori K, Sawada Y, Sugano S. Socio‐economic studies on suicide: A survey. J Econ
Surv 2012;26(2):271-306. https://doi.org/10.1111/j.1467-6419.2010.00645.x
Bantjes J, Iemmi V, Coast E, et al. Poverty and suicide research in low- and middle-income countries: Systematic mapping of literature published in English and a proposed research agenda. Glob Mental
Health 2016;3(32). https://doi.org/10.1017/gmh.2016.27
Lewinsohn PM, Rohde P, Seeley JR. Psychosocial risk factors for future adolescent suicide attempts.
J Consul Clin Psychol 1994;62(2):297. https://doi.org/10.1037/0022-006X.62.2.297
Pfeffer CR, Klerman GL, Hurt SW, Kakuma T, Peskin JR, Siefker CA. Suicidal children grow up: Rates and psychosocial risk factors for suicide attempts during follow-up. J Am Acad Child Adoles Psychiatr
;32(1):106-113. https://doi.org/10.1097/00004583-199301000-00016
Cuijpers P, Auerbach RP, Benjet C, et al. Introduction to the special issue: The WHO world
mental health international college student (WMH‐ICS) initiative. Int J Methods Psychiatric Res
;28(2):e1762. https://doi.org/10.1002/mpr.1762
Posner K, Brown GK, Stanley B, et al. The Columbia Suicide Severity Rating Scale: Initial validity and
internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatr
;168(12):1266-1277. https://doi.org/10.1176/appi.ajp.2011.10111704
Groves RM, Couper MP. Nonresponse in Household Interview Surveys. New York: John Wiley &
Sons, 2012.
Chen W, Qian L, Shi J, Franklin M. Comparing performance between log-binomial and robust Poisson
regression models for estimating risk ratios under model misspecification. BMC Med Res Method
;18(1):1-12. https://doi.org/10.1186/s12874-018-0519-5
Auerbach RP, Mortier P, Bruffaerts R, et al. WHO World Mental Health Surveys International College
Student Project: Prevalence and distribution of mental disorders. J Abnormal Psychol 2018;127(7):623.
https://doi.org./10.1037/abn0000362
Joe S, Stein DJ, Seedat S, Herman A, Williams DR. Prevalence and correlates of non-fatal suicidal behaviour among South Africans. Br J Psychiatry 2008;192(4):310-311.
Joe S, Stein DJ, Seedat S, Herman A, Williams DR. Non-fatal suicidal behaviour among South Africans. Social Psychiatr Psychiatric Epidemiol 2008;43(6):454-461. https://doi.org/10.1192/bjp.bp.107.037697 33. Bantjes J, Saal W, Lochner C, et al. Inequality and mental healthcare utilisation among first-year university students in South Africa. Int J Mental Health Syst 2020;14(1):1-11. https://doi.org/10.1186/
s13033-020-0339-y
Peden AR, Rayens MK, Hall LA, Beebe LH. Preventing depression in high-risk college women: A report of an 18-month follow-up. J Am Coll Health 2001;49(6):299-306.
Peden AR, Hall LA, Rayens MK, Beebe LL. Reducing negative thinking and depressive symptoms in college women. J Nurs Scholarsh 2000;32(2):145-151. https://doi.org/10.1111/j.1547-5069.2000.00145.x 36. Vázquez FL, Torres A, Blanco V, Díaz O, Otero P, Hermida E. Comparison of relaxation training
with a cognitive-behavioural intervention for indicated prevention of depression in university students: A randomized controlled trial. J Psych Res 2012;46(11):1456-1463. https://doi.org/10.1016/j. jpsychires.2012.08.007
Breet E, Matooane M, Tomlinson M, Bantjes J. Systematic review and narrative synthesis of suicide prevention in high-schools and universities: A research agenda for evidence-based practice. BMC Pub Health 2021;21(1):1-21. https://doi.org/10.1186/s12889-021-11124-w
Bantjes J. Digital solutions to promote adolescent mental health: Opportunities and challenges for research and practice. PLoS Med 2022;19(5):e1004008. https://doi.org/10.1371/JOURNAL. PMED.1004008
Gericke F, Ebert DD, Breet E, Auerbach RP, Bantjes J. A qualitative study of university students’ experience of internet‐based CBT for depression. Counsel Psychother Res 2021;21(4):792-804. https:// doi.org/10.1002/capr.12465
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